1,721,021 research outputs found
Dynamic intraoperative planning in robotic laser phonomicrosurgery
No full textIntroduction: One persistent drawback in surgical systems for laser phonomicrosurgery impacting even modern "robotic" devices is the mechanical joystick for laser control. This interface is currently the major limiting factor for improved surgical precision, quality and safety, requiring extensive practice and dexterity from the surgeon. Another limiting drawback is the lack of programming capabilities.
Material and methods: A new robotic system was developed to overcome these drawbacks by offering a more ergonomic, intuitive and programmable interface for surgical laser control: A touch interface with dynamic intraoperative planning capabilities. The system is based on a large-range laser scanner that is fully controlled using a stylus over a tactile sensor. It is able to control the laser in real-time over the entire surgical field and features path memorization allowing for accurate repetitions of surgeon-defined laser paths. This feature enables surgical action visualization before execution and unmatched control over long cuts. Laser paths of any shape and length are dynamically planned also using the intuitive stylus interface.
Results: Preliminary trials on ex-vivo swine larynxes and artificial targets have demonstrated the new system is highly intuitive, effective and safe: Reductions of 80% in maximum absolute error and nearly 50% in RMS error were recorded when using the stylus interface in path-following trials. The dynamic planning feature has also demonstrated its benefits: Practically no error was observed in trials, which recorded only 0.03mm average RMS error under a 40x microscope magnification. The research leading to these results has received funding from the μRALP European project
Binocular flash-induced nystagmus in humans
No full textObjective: The aim of this study was to demonstrate that binocular flash-induced nystagmus (B-FIN) can be evoked in humans. Design: The study evaluated the presence of B-FIN by stimulation with a stroboscopic flash. Setting: The study was conducted with 12 healthy patients in the Otorhinolaryngology Department of the University of Genoa (Italy), between April 2008 and January 2009. Methods: Patients underwent binocular flashing light stimulation, in the dark, by stroboscopic flash presented through a photostimulator at frequencies of 4.7 and 7.69 cycles/second for 120 seconds, with their eyes covered by a homogeneous field hollow opal hemisphere. The photostimulator was placed in three different positions with respect to the anterior-posterior axis: 0u, 45u to the right, and 45u to the left. Main Outcome Measures: Eyemovementswere recorded by electronystagmography (ENG). ENGrecording started 30 seconds before the stimulation and stopped 60 seconds after the end of the luminance stimuli to test the presence of flash induced after nystagmus (FIAN). Results: B-FIN was clearly evoked from 10 of the 12 healthy adults, whereas FIAN was evoked from 4 of the 12 subjects. The best stimulation of B-FIN was obtained through an intermittent luminance stimulus presented at a frequency of 4.7 cycles/second and the photostimulator placed at 0u to the optic axis. Conclusions: Our investigation demonstrates that B-FIN can be evoked in humans and its possible value in the differential diagnosis between central and peripheral vertigo
Deleterious sucking habits and atypical swallowing in children with otitis media with effusion
No full textOBJECTIVE:
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
Acoustic features of voice in patients with severe hearing loss
No full textObjective: 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
Results of revision mastoidectomy with Piezosurgery®
No full textObjectives: The aim of this study was to determine the efficiency of the piezoelectric device in revision surgery for chronic otitis media. Methods: A total of 30 patients had revision mastoidectomy with previous canal wall up mastoidectomy. The piezoelectric device was used in all intraoperative steps. Before surgery and 1 month and 1 year after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. Results: The piezoelectric device provided effective cutting, with excellent control and without side effects on the adjacent structures of the middle and inner ear (lateral sinus, facial nerve, and/or dura mater). Postoperatively, all patients had an uneventful recovery with no evidence of audiovestibular deficit or side effects. Among 30 cases followed for 1 year, 29 (97%) maintained a dry and safe ear. Intermittent otorrhea with perforation of the tympanic membrane occurred in one patient (3%). Conclusion: For otologic revision surgery, the advantage of the piezoelectric device appears real because it is possible to perform a 'blind' cutting of bone with fewer precautions necessary for soft tissues such as the facial nerve, lateral sinus, and dura mater
Outcomes of uvulopalatopharyngoplasty with harmonic scalpel after failure of continuous positive airway pressure in sleep apnea syndrome.
No full textConclusions: Our data highlight that uvulopalatopharyngoplasty (UPPP) with harmonic scalpel (HS) is a reliable treatment in selected patients affected by obstructive sleep apnea (OSA) and users of continuous positive airway pressure (CPAP). Objectives: The aim of this paper was to verify the efficacy and applicability of UPPP with HS in the treatment of patients affected by OSA and users of CPAP. Methods: A total of 21 patients with a retropalatal obstruction and users of CPAP underwent UPPP with HS and were evaluated (before and 6 months after surgery) using the apnea/hypopnea index (AHI); oxygen desaturation index >= 4% (ODI4); Epworth Sleepiness Scale (ESS); snoring level (SL); subjective assessment of the postoperative pain on postoperative days 1, 3, and 10; and number of days until return to solid food. Results: Six months after surgery: AHI decreased significantly (p < 0.05) from 31.8 +/- 2.83 to 9.0 +/- 0.68; ODI4 was 2.1 +/- 0.4 vs a preoperative value of 24.0 +/- 1.9; ESS scores were also significantly decreased (p < 0.05) from 14.0 +/- 3.7 to 4.7 +/- 2.2; SL was significantly lower (p < 0.05) 1.6 +/- 0.3 vs 7.9 +/- 0.8. Postoperatively, patients experienced lower levels of pain and the median of time to return to normal diet was 3 days
Sulphurous thermal water inhalations in the treatment of chronic rhinosinusitis
No full textThe aim of this study was to evaluate the efficiency of sulphurous thermal water in the treatment of chronic rhinosinusitis (CRS). Eighty patients with CRS were included and randomly assigned into two groups. Patients underwent a 12-day course of warm vapour inhalations and nasal irrigations with sulphurous thermal water in group A, and a physiological solution in group B. Compared with group B, in group A the results were as follows: serum concentration of IgE was significantly lower (p < 0.05) 12 days (76.27 ± 26.3 mg/dl vs. 97.44 ± 45.4) and 3 months after the beginning of the treatment (75.48 ± 26.1 mg/dl vs. 98.37 ± 41.4); IgA titers were not significantly higher 12 days (231.09 ± 120.3 mg/dl vs. 220.44 ± 114.4 mg/dl) and 3 months after the beginning of the treatment (235.44 ± 118.5 mg/dl vs. 214.51 ± 111.8 mg/dl); VAS scores were significantly (p < 0.05) improved at 12 days (1.7 ± 0.18 vs. 6.9 ± 0.51) and 3 months after the start (1.8 ± 0.22 vs. 7.1 ± 0.59); NMTT was normal at 12 days (11.54 ± 1.59 min vs. 17.38 ± 1.83 min) and 3 months after the beginning of the treatment (11.46 ± 2.07 min vs. 17.43 ± 2.01 min); total nasal resistances were significantly (p < 0.05) decreased at 12 days and 3 months. Our results indicate the efficiency and applicability of sulphurous thermal water in the treatment of CRS
Transnasal approach to the orbital apex and cavernous sinus
No full textOBJECTIVES: 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
Day-case stapedotomy: is it a viable option?
No full textConclusions: Stapedotomy is, in our opinion, the technique of choice in stapes surgery. The precision of this technique allows clinicians to perform the surgical procedure in day surgery under local anesthesia. Objectives: There is a strong emphasis on increasing the number of elective day surgery cases, especially in the patients' best interest, as it decreases the likelihood of late cancellation and hospital-acquired morbidity. A prospective study was performed to determine whether stapes surgery for otosclerosis could be performed safely in an outpatient setting. Methods: We present a series of stapes surgery cases for otosclerosis performed on a day-case basis. We performed a classic stapedotomy in 9 patients, a reverse classic step stapedotomy in 2 patients, a partial reverse classic step stapedotomy in 11 patients, and a hemi-stapedectomy in two patients. Results: Three of 24 patients (12.5%) treated with classic stapedotomy, 1 patient with partial reverse classic step stapedotomy, and 1 patient with hemi-stapedectomy were formally admitted to the hospital after surgery (length of stay, 23 h). The indications were vertigo (two patients) and asthenia (one patient). These patients were treated under general anesthesia. Two of these patients resided more than 250 km away from the hospital
Piezosurgery® for removal of symptomatic ear osteoma
No full textPiezosurgery® is an ultrasound instrument (24.7-29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissue damage. The aim of this work has been to determine the applicability and efficiency of the piezoelectric device in the excision of symptomatic ear osteomas. 10 patients affected by osteoma of the external auditory canal (EAC) (6 right, 4 left) were enrolled. Patients underwent excision of the EAC osteoma through a transcanal approach, with the piezoelectric device. Before and 6 months after surgery, all the patients underwent pure-tone audiometry, tympanometry, transient-evoked otoacoustic emissions, distortion product otoacoustic emissions, auditory brainstem response, and electronystamographic recording. The piezoelectric device provided excellent control without side effects on the adjacent structures of the external, middle and inner ear. The piezoelectric device is a new bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue (nerve, vessel, dura mater, skin, etc.) will not be damaged even on accidental contact with the cutting tip. A feature of the piezoelectric device is its good manageability, which makes it easy for a well-trained otologic surgeon to create a straight osteotomy line: this renders the piezoelectric device suitable for bone surgery and for removal osteomas of the EAC
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