Fiatalkori hallásrehabilitáció Baha® Attract implantátumrendszerrel | Pediatric hearing rehabilitation with the Baha ® Attract implant system

Absztrakt: Bevezetés: A Baha® Attract egy új, implantálható transcutan csontvezetéses hallásjavító rendszer, amely fiatalkorban is előnyösebb lehet a klasszikus percutan eszközökkel szemben. Célkitűzés: Az eszköz alkalmazási lehetőségeinek bemutatása a fiatalkori hallásrehabilitációs műtéteknél. Módszer: Klinikánkon ez idáig nyolc esetben végeztünk fiatalkorban implantációt (átlag 13,2 ± 3,2 év) az általunk módosított „posterosuperior” feltárásos technikával, 5 mm-es implantátummal. Az életkori sajátságok indokolták, hogy kiegészítő tanulmányként 72 fő, 1–8 éves gyermek koponya-CT-felvételét elemezve megmérjük a koponyacsont vastagságát az implantátum beültetésének ideális lokalizációjában. Eredmények: Az implantációk átlag 30 perces műtéti idővel történtek. Intra- és posztoperatív szövődményt nem észleltünk. A beszédprocesszorokat a negyedik héten illesztettük. Audiológiai eredményekben 51,58 ± 11,22 SD dBHL hallásteljesítmény, valamint 43,3 ± 16,02 SD dB beszédhallásküszöb-javulást értünk el. A koponyacsont-vastagság átlagosan 3,39 ± 1,05 SDmm-nek adódott. Következtetés: A Baha® Attract új lehetőség a fiatalkori hallásrehabilitációban. Az implantációt megelőzően javasolt a koponyáról CT-vizsgálatot végezni, amellyel megállapítható a csont vastagsága és megtervezhető az implantátum beültetésének optimális helye. Orv. Hetil., 2017, 158(8), 304–310. | Abstract: Introduction: Baha® Attract is a new transcutaneous bone-conduction hearing aid, which is more preferable in childhood than the conventional percutaneous systems. Aim: Our aim was to demonstrate the possibilities of application in childhood. Method: Eight children have undergone surgeries (mean age of 13.2 ± 3.2 years; “posterosuperior” incision technique, 5 mm implants). The thickness of the skull bone was determined in 72 children (1-8 years old) at the recommended implant site, based on CT scans. Results: The average duration of surgeries was 30 minutes. There were no intra- and postoperative complications observed. Sound processors were fitted at the postoperative 4th week. Hearing measurements proved 51.58±11.22SD dBHL gain in warble tone thresholds, and 43.3 ± 16.02 SD dB in speech discrimination thresholds. The skull bone thickness was measured as 3.39 ± 1.05 SD mm. Conclusion: The Baha Attract system is a new tool for hearing rehabilitation in pediatric population. Preoperative CT provides valuable knowledge about skull bone thickness. Orv. Hetil., 2017, 158(8), 304–310

Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea

Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients

Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review

Introductions: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. Relevant Sections: By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Discussions: The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions: The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. Future directions: Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy

Multidisciplinarity and Transdisciplinarity as Current Trends in Otorhinolaryngology and Head and Neck Pathology

The specialty of otorhinolaryngology and cervicofacial surgery has experienced accelerated development in recent decades through the development of the techniques and technologies involved [...

Súlyos krónikus obstruktív tüdőbetegségben szenvedő betegek tüdőfunkciója és társbetegségei a marosvásárhelyi Tüdőgyógyászati Klinikán

Bevezetés: A krónikus obstruktív tüdőbetegség (COPD) gyakori krónikus gyulladásos betegség, nagy mortalitással. Célkitűzés: A vizsgálat célja a COPD-ben szenvedő betegek paraméterei – életkor, nemi megoszlás, kockázati ténye- zők (dohányzás, foglalkozási expozíció), a COPD súlyossága, testtömegindex, tüdőfunkció, társbetegségek és szö- vődmények – közötti összefüggések feltárása volt dohányzó és foglalkozási ártalomnak kitett betegeknél. Módszer: 209 beteg adatait elemeztük, akiket 2019-ben a marosvásárhelyi Tüdőgyógyászati Klinikára COPD-exacer- batio miatt vettek fel. Eredmények: A tápláltsági állapot alapján 4 csoportba soroltuk a betegeket: 50 alultáplált, 53 normál testsúlyú, 53 túlsúlyos, valamint 53 elhízott páciens. A férfi : nő arány 2,48 volt. Az esetek 67%-a aktív, keresőkorban levő páciens, 55,98%-a 55–65 év közötti volt. A betegek 10,5%-a volt 75 év feletti. A páciensek jelentős része (76,55%) dohányzott, a férfiak 91,9%-a és a nők 33,8%-a. A foglalkozási ártalom az esetek 30,62%-ában a dohányzással társult. A nem dohányzóknál a foglalkozási expozíció volt a fő tényező a COPD patogenezisében (81,6%). A „biomassza-tüzelőanyagoknak” vagy a passzív dohányzásnak való expozíció is főleg a nem dohányzó nőknél volt megfigyelhető (78,9%). A FEV1 átlagértékei alacsonyabbak voltak a túlsúlyos, elhízott és alultáplált betegekben, mint a normál testsúlyúaknál. Az elhízott és túlsúlyos COPD-s betegek körében gyakrabban fordult elő ischaemiás szívbetegség (41,5%, illetve 43,4%), mint a normál súlyú, illetve sovány betegeknél (24%, illetve 20%). Megbeszélés: Adataink rávilágítanak a károsodott tüdőfunkció súlyosságára mind a cachexiás, mind az elhízott bete- geknél, és alátámasztják a testmozgás, a táplálkozás-ellenőrzés, a légzőfunkciók szűrése és az általános rehabilitáció szükségességét a COPD-s betegek tüdőkapacitásának javítása érdekében. Következtetés: A COPD multidiszciplináris megközelítése mind diagnosztikai módszerként, mind a COPD-társbetegségek helyes kezeléséhez szükséges

Early experience on a modern, thin cochlear implant family. A retrospective, international multicenter study

Cochlear implantation is the most effective method of rehabilitation for patients with severe to profound sensorineural hearing loss. Binaural hearing forms the basis of the development of hearing-associated cortical networks in infants and toddlers, but simultaneous bilateral implantation is often postponed due to the demands of classical surgical methods, which are associated with large incisions and a deep bony well.The authors report on the use of a modern, thin implant type and the possibilities it provided to simplify the surgical technique.Recent models of the Cochlear™ Nucleus® implant family were studied in an international retrospective multi-center study: 6 otolaryngologists in 5 centers shared their experiences on 73 consecutively implanted, thin implants. The surgical incision could be made shorter than before and only shallow bony wells or none at all were created in 4 out of 5 centers. No complications occurred.This study underlines that implants with thin electronics capsules enable a simplified, fast and safe implantation procedure that allows simultaneous bilateral cochlear implantation

Obstructing Sleep Apnea in Children with Genetic Disorders—A Special Need for Early Multidisciplinary Diagnosis and Treatment

Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life