Confident texture-based laryngeal tissue classification for early stage diagnosis support

none8siopenMoccia, Sara; De Momi, Elena; Guarnaschelli, Marco; Savazzi, Matteo; Laborai, Andrea; Guastini, Luca; Peretti, Giorgio; Mattos, Leonardo S.Moccia, Sara; De Momi, Elena; Guarnaschelli, Marco; Savazzi, Matteo; Laborai, Andrea; Guastini, Luca; Peretti, Giorgio; Mattos, Leonardo S

Transnasal approach to the orbital apex and cavernous sinus

OBJECTIVES: The aim of this study was to provide the anatomic rationale for a transnasal approach to the orbital apex and cavernous sinus, and to evaluate its applicability and efficiency. METHODS: One hundred patients with lesions of the orbital apex, cavernous sinus, optic nerve, clivus, parapharyngeal space, infratemporal fossa, or pterygopalatine fossa were reviewed over a 10-year period. All patients underwent an endoscopic transnasal approach to the orbital apex and cavernous sinus. The surgical technique required a standard endoscopic sinus surgery set. The possible complications were recorded and classified as intraoperative or postoperative. RESULTS: There were complications in 8 cases: 4 intraoperative and 4 postoperative. The intraoperative complications included rupture of the internal carotid artery in 1 patient and cerebrospinal fluid leak in 3 patients. All intraoperative complications were resolved during surgery. The postoperative complications were transitory eyelid ptosis in 2 patients (resolved in 6 months) and transitory diplopia with immediate deficit of the medial rectus muscle in 2 patients (completely resolved in 1 month). CONCLUSIONS: With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her way, thereby significantly reducing the rate of complications

The new bony scalpel: Piezosurgery\uae

Innovative advances have recently occurred regarding instrumentations, energy sources, and devices aimed at facilitating surgical procedures in terms of efficient hemostasis, dissection, safety, and reduction in surgical time. In the present chapter, we introduce to the practice of otologic surgery a new ultrasound instrument: the Piezosurgery\uae device (Mectron Medical Technology, Genoa, Italy). The piezoelectric device is an ultrasound bone scalpel, it uses low-frequency ultrasonic waves (24.7-29.5 kHz), the applied power can be modulated between 2.8 and 16W, and the machine is programmed in accordance to the density of the bone cut. The main advantage of the piezoelectric device is its selective cut that recognizes tissue hardness and works only on mineralized structures without soft-tissue damage. In our experience, the piezoelectric device has been used successfully in otologic surgery, nasal surgery and maxillofacial surgery. \ua9 2012 by Nova Science Publishers, Inc. All rights reserved

Deleterious sucking habits and atypical swallowing in children with otitis media with effusion

Objective: The aim of this study was to investigate the possible correlation between otitis media with effusion, bad sucking habits and atypical swallowing in children affected by otitis media with effusion. Methods: 65 children, aged from 7 to 12 years, observed in the ENT Department of the "La Sapienza" University of Rome, were enrolled in the study group (group A). All children were affected by otitis media with effusion for more than 3 months. As control group, 60 healthy children, aged from 7 to 12 years were identified (group B). All the children underwent medical history, with evaluation of the sucking habits, ENT examination, tympanometry, orthodontic examination and evaluation of swallowing. In the orthodontic examination the variables analyzed were: maximum mouth opening, right and left mandibular lateral movements and mandibular protrusion. Atypical swallowing was considered to occur when lip activity produced strong tension in the perioral musculature, and/or the tip of the tongue was placed or pushed against the anterior teeth during swallowing. Results: In the group A, atypical swallowing was found in 33/65 subjects out of the 65 children (50.7%). In the control group (group B) 16/60 children (26.6%) showed atypical swallowing. Compared with group B. deleterious sucking habits were significantly higher (p < 0.05) in the study group (28/65 vs. 12/60). In both the study and control group, deleterious sucking habits were present in almost all children with atypical swallowing (28/33 in group A and 12/16 in group B). Conclusions: Our data suggest a correlation between otitis media with effusion, deleterious sucking habits and prevalence of atypical swallowing. (C) 2011 Elsevier Ireland Ltd. All rights reserved

Acoustic features of voice in patients with severe hearing loss

Objective: The aim of this study was to evaluate changes in the acoustic features of voice in patients with sensorineural hearing loss. Design: Thirty male patients, between 35 and 53 years of age with postlingual bilateral symmetric severe sensorineural hearing loss, were included (group A). As a control group (group B), 30 normal-hearing male adults, aged 38 to 51 years, were identified. Setting: ENT Department, University of Genoa (Italy). Methods: Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all subjects. Main Outcome Measures: The parameters estimated were the average of fundamental frequency (F0), jitter percent (jitter), shimmer, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voicelessness (DUV), degree of voice breaks (DVB), and peak amplitude variation (vAm). Results: Compared to the control group, in group A, the following acoustic parameters presented a statistically significantly higher value (p < .05) of F0 (137.2 Hz vs 120.0 Hz), jitter (1.93% vs 0.67%), shimmer (6.67% vs 3.81%), NHR (0.19 vs 0.10), SPI (12.9 vs 8.76), DVB (2.12% vs 0.01%), DUV (9.53% vs 0.51%), and vAm (23.12% vs 12.06%). In group A, F0 was also significantly higher in the balanced sentences (126 Hz vs 111 Hz). Conclusions: This study demonstrates that hearing loss affects voice production by changing its parameters, especially in subjects with marked hearing loss

Sodium enoxiparin in the treatment of idiopathic sudden sensorineural hearing loss

The audiovestibular system can be affected by an immunological etiology; the presence of immune mediated sensorineural hearing loss (IMSNHL) as part of or in combination with other autoimmune diseases is well documented in the literature. Hearing loss can be caused by autoimmune disorders localized to the inner ear or secondary to systemic immune diseases (Cogan's syndrome, juvenile chronic arthritis, ulcerative colitis, Wegener's granulomatosis, scleroderma, pulseless disease, and SLE). A systemic autoimmune disorder can be present in fewer than one-third of cases The clinical presentation of immune inner-ear disease is extremely variable and depends on the type of immune reaction and on the site of injury within the inner ear. IMSNHL typically presents with an idiopathic, progressive unilateral and successive bilateral rapidly progressive sensorineural hearing loss; the course of the hearing loss occurs over weeks to months and is most common in middle-aged women; it may be accompanied by tinnitus and vertigo and is almost always unilateral. IMSNHL is still a diagnostic and therapeutic dilemma, and predicting recovery from it is very difficult. Different factors may influence a prognosis: e.g., severity of hearing loss, duration of symptoms before treatment, presence of vertigo, type of audiogram, and age of patients. The therapeutic approaches normally used for this pathological condition include the systemic and local administration of cortisone, vasoactive agents, anticoagulants, vitamin complexes, a cytotoxic agent and plasmapheresis. These drugs can be effective in reversing such hearing loss, although at the cost of occasionally severe side effects. Currently, evaluating the importance of an autoimmune phenomenon in the genesis of inner-ear disease is difficult because the clinical and biological criteria of autoimmune deafness have not yet been well defined. A positive response to treatment is a criterion for the diagnosis of immune inner-ear disease. This chapter aims to assess the effect of sodium enoxaparin on the recovery of hearing in patients affected by ISSNHL. Sodium enoxaparin was administered subcutaneously at a dose of 4,000 IU once a day for 10 days. Sodium enoxaparin is a particular kind of heparin with a low molecular weight (LMWH) and is endowed with a high antithrombotic activity. The literature does not report any therapeutic protocols for autoimmune IMSNHL treatment with sodium enoxaparin or other kinds of unfractionated heparin. Our decision to use enoxaparin was based both on the pathogenesis of this condition and on evaluation of the other classes of drugs currently used

Robot-assisted system for free-beam transoral laser microsurgery

This paper describes an innovative robot-assisted system for transoral laser microsurgery (TLM) of the larynx. It transforms and greatly advances the state of the art of TLM equipment, offering a more ergonomic, intuitive, and programmable laser control system based on a tablet interface with dynamic intraoperative planning capabilities. The system couples such interface to a motorized and fully programmable free-beam laser micromanipulator, which offers wide range covering the entire surgical field. The system allows path recording, which enables fast and accurate repetitions of surgeon- defined laser trajectories. This feature enhances the laser incision quality and also provides the means for previewing the surgical action before its actual execution, leading to unmatched precision and control during delicate microsurgeries. Laser trajectories of any shape and length can be dynamically planned using the tablet interface. Evaluation experiments performed with experienced surgeons demonstrated the robotic system provides great improvements in terms of system usability and laser aiming accuracy. Trajectory tracing trials recorded a drop of 92% in maximum absolute error and about 86% in RMS error when comparing the robotic system with a modern TLM surgical system. Therefore, the robot-assisted system offers potential for significant improvements in surgical precision, quality, and safety while also minimizing the need for extensive surgeon training by providing a more intuitive laser control interface

Sulphurous water inhalations in the prophylaxis of recurrent upper respiratory tract infections

Objective: The aim of this study was to evaluate the efficacy and the effect of sulphurous thermal water inhalations in the treatment of the recurrent upper respiratory tract (RURT) infections in children. Methods: A total of 100 children with RURT infections were included. All children underwent a 12-day course warm vapour inhalations. For the inhalations, we used sulphurous thermal water in the group A, white physiological solution in the group B. At the beginning, at the end and 3 months after start, all children underwent medical history, ENT examination, plasma levels of immunoglobulins class E, G, A, M (IgE, IgG, IgA, IgM), subjective assessment of symptoms (VAS), nasal mucociliar transport time (NMTT) determination, and evaluation of frequency, duration, severity and social impact of RURT episodes. Results: Compared with group B, after the treatment and at the end of the study, in children treated with sulphurous thermal water, the serum concentration of IgE was significantly (p &lt; 0.05) tower (75.13 +/- 27.1 mg/dl vs 96.87 +/- 41.3 mg/dl; 74.23 +/- 26.2 mg/dl vs 98.24 +/- 42.7 mg/dl), IgA titers were higher (238.14 +/- 122.1 mg/dl vs 218.62 +/- 115.8 mg/dl; 239.72 +/- 119.7 mg/dl vs 210.46 +/- 107.3 mg/dl), serum concentrations of IgG and IgM unchanged, VAS scores presented a significant (p &lt; 0.05) improvement (1.8 +/- 0.19 vs 6.8 +/- 0.54; 1.9 +/- 0.21 vs 6.9 +/- 0.61), NMTT was normal (111.15 +/- 1.59 min vs 17.63 +/- 2.17; 11.25 +/- 2.10 min vs 17.77 +/- 2.19 min) and frequency, duration, severity and social impact of RURT episodes were significantly (p &lt; 0.05) lower. Conclusions: Our findings indicate that, in addition to their known effects, the sulphurous water also have an immunomodulant activity that contributes to their therapeutic effects. (C) 2008 Elsevier Ireland Ltd. All rights reserved