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Results of voice analysis in 96 elderly patients are presented. The objective of the study was to evaluate dysphonia and its morphologic conditions. Videolaryngostroboscopic (VLSS) examination distinguished between oedematic and atrophic form of senile dysphonia. Morphologic evaluation of the vocal fold mucosa with the use of light microscopy (LM) and transmission electron microscopy (TEM) confirmed the clinical diagnosis. Evaluation of aerodynamic factors of the larynx function, particularly MPT and VVI, suggested hyperfunctional and hypofunctional modes of the voice formation in patients with the larynx oedema and in patients with atrophic changes, respectively.

Objectives: To evaluate the relationship between airbag-induced noise and individual metabolic risk factors in determining persistent hypoacusia in drivers after road accidents.

Methodology: We selected 22 patients previously involved in a car accident with deployment of airbags. Patients underwent general and audiological clinical history, tonal audiometric examination, vocal audiometric examination, impedance meter examination and blood tests.

Results: We divided patients, according to audiometric data, into 2 groups: group A with no residual otological disturbances (6 subjects) and group B with persistent hypoacusia (16 subjects). Blood parameters were into physiological levels in all group A patients; on the contrary 12 (subgroup B1) out of 16 group B patients had altered blood levels of glucose, urea and cholesterol, with mean values of 155.8 +/- 38.6 mg/dl, 48.2 +/- 8.3 mg/dl and 250.8 +/- 28.1 mg/dl, respectively, revealing statistically significant differences in these parameters when compared with the other 4 hypoacusic cases (Sub-group B2) and with the normal subjects (Group A) (p < 0.01 for glucose, p < 0.05 for urea and p < 0.001 for cholesterol).

Conclusions: Our findings confirm the transitory otological damage due to airbag deployment: the intensity of the acoustic wave hitting the ear after airbag deployment is responsible for a temporary rise in the acoustic threshold but the persistence of an auditory deficit can be due to co-factors able to interfere with the acute acoustic trauma recovery processes through a metabolic, angiopathic, neuropathic or unknown mechanism. Moreover, also the age of the patients could affect in a significant way the recovery from the acoustic trauma.

The case of a 5 year old boy who had a right petrous bone fracture with right CSF otorrhea and deafness is reported. This child presented, three years after the trauma, a right side otitis media, complicated by meningitis and pneumococcal sepsis, which might have as consequence a left side deafness. The bilateral deafness and the early possibility for cochlear ossification made us decide rapidly on a cochlear implant. Benjamin was then operated for a left side cochlear implant 40 days after contracting meningitis. Two months later, this boy was able to understand a speech without lip reading. Current concepts in the management of petrous bone fractures with CSF otorrhea are reviewed in this report. We also discussed prophylactic attitudes to adopt to reduce the risk of post temporal bone fracture meningitis.

For the initial management of auditory processing disorders, it is essential to refer to a theoretical model which conceptualizes the functioning of these processes in their interaction with the higher cognitive functions of language and its representations stored in LTM, attention and memory. Such a conceptualization highlights, therefore, the need for a multidisciplinary approach to this type of disorder. On this theoretical basis, this article proposes, firstly, to describe for each of the central auditory processes (ASHA) certain clinical signs of a disorder at this level together with the central auditory assessment tests which allow more specific targeting of these manifestations. This article then aims to group, non-exhaustively, different types of therapeutic approach proposed in the literature, according to whether they concentrate on "Bottom-Up" processing concerned in the transduction of the acoustic message and/or rather on "Top-Down" processing, activated in the interpretation of the auditory information.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma of late adult life, but is relatively uncommon in the head and neck region. That region has been reported to be the origin of malignant fibrous histiocytoma in 3-10% of cases. Only one case of the tumor occurring in the pharynx has been reported. Histologically it is sometimes hard to distinguish this tumor from some sarcomas and pleomorphic carcinomas. The treatment of choice is a large surgical resection, while radiotherapy and chemotherapy are reserved for recurrences. The authors present a case of oropharyngeal malignant fibrous histiocytoma. The patient complained dysphagia and dyslalia progressively worsening in six months. Pharyngo-laryngoscopy revealed a mass of the left lateral wall of oro and hypopharynx. CT scan examination showed a capsuled mass which displaced but not involved the neck neurovascular structures; there was no evidence of linphonodal involvement. Transoral surgical excision of the mass was performed with the preservation of speech and swallowing. For more than 1 year postoperatively, there has been no evidence of the disease or metastasis.

Unlabelled: Computer aided surgery (CAS) is now routinely introduced in the ENT surgical field especially in endoscopic endonasal surgery.

Objective: Using a frameless computer aided surgery for endoscopic endonasal approach (SurgiGATE ORL TM), we tried to evaluate the practical use of such a system, to calculate supplementary installation time of the procedure, to determine the number of matching attempt (referencing) before starting optonavigation and to determine its clinical accuracy.

Patients and methods: Thirty two patients underwent endoscopic endonasal surgery with the help of CAS; 13 revision cases (2 nasal polyposis, 7 paranasal sinus mucoceles, 4 frontal recess stenosis) and 19 primary cases (16 inflammatory diseases, 3 benign tumor removal). Paired points matching was used as referencing before optonavigation. Clinical accuracy of CAS was calculated at two confidence points during optonavigation and measured in multiples of the pixel size on CT Scan.

Results: Number of matching attempts before starting optonavigation was; mean 1.8 (1-4). Supplementary installation time of the system was; mean 15 minutes (10-40). Clinical accuracy at two confidence points was always between 0.5 mm and 2 mm. (6 < 0.5 mm, 16 < 1 mm, 10 < 2 mm). There was no major complication during surgery neither no side effect due to the use of the CAS except for one case who presented a slight tongue edema due to a wrong position of the dynamic reference base (maxillary splint) during the procedure.

Conclusions: CAS and optonavigation using the surgiGATE ORL TM is safe and efficient in endoscopic endonasal surgery. The accuracy of the system is sufficient and its use appropriate for primary either revision rhinologic procedures.

Between 1991 and 2000, 154 cerebello-pontine angle (CPA) tumors were seen at the University ENT-department of the Sint-Augustinus Hospital, Antwerp. Amongst these, 127 were vestibular schwannomas detected by MR-imaging. Noteworthy is that in 5% of these, the ABR latencies were within normal limits. One hundred patients underwent tumor removal either by the translabyrinthine (66) or by the retrosigmoid (34) approach and all had a follow-up of at least two years. For large tumors (> 2 cm extension in the CPA) or in the case of poor hearing the translabyrinthine approach was used. For patients with tumor extension in the CPA ofless than 2 cm and with serviceable residual hearing on the affected side, (at least < 50 dB PTA, > 50% SSD) the retrosigmoid approach with endoscopic control was used. Most patients (96%) had a House-Brackmann grade 1 or 2 facial function before surgery. Although this group dropped to 76% 6 months after surgery it increased again to reach 84% within 2 years. Thus, 88% percent of patients with normal preoperative facial function achieved a Grade I or II after two years. The facial outcome is very much dependent on the size of the tumor. A good result (House-Brackmann Grade 1 or 2) is the rule (92%) for small tumors (< 10 mm extension in the CPA), still attainable (82%) for medium tumors (11-25 mm), but less apparent (56%) for large tumors (> 26 mm). It was possible to preserve hearing in 38% of the retrosigmoid interventions. Although unbalance and headache are rather frequent early postoperative symptoms (respectively 52% and 31%), these complaints decrease with time and are infrequent after two years (unbalance = 7%, headache = 4%). Our results were compared with three large multicentric studies. They are in line with data from the literature and compare favorably with the better results. Although good grading systems exist for facial nerve and hearing outcomes, the authors regret that a general consensus on tumor size measurement is still not yet available. It would facilitate data comparison between different centers and the choice between the therapeutical modalities.

Cartilage has been used successfully as a graft in middle ear surgery. It used to be reserved for advanced pathology because of its possible detrimental effect on postoperative hearing. Recent papers however failed to prove this effect. The present study describes the authors' experience in 161 cases of conchal cartilage tympanoplasty. In tympanoplasty type I postoperative pure tone average air-bone gap was within 20 dB in 88.4% of the cases. If combined with ossiculoplasty when the stapes was intact, 72% was within 20 dB and when the stapes was absent, 54.5% was within 20 dB. Taking rate of the graft was 95.6% (154/161) with 22% (36/161) representing revision surgery. At present the author uses cartilage graft as a first choice in tympanoplastic procedures.

Introduction: Radiosurgery is an alternative to the microsurgical resection of vestibular schwannoma (VS). Since its introduction, radiosurgery has been used in more than 8000 patients with VS worldwide and the long term tumor control rates are reported to be 86 to 100%. The aim of this study is to report our experience with Leksell Gamma Knife (LGK) radiosurgery in the management of VS and to evaluate the serviceable hearing preservation rate after one-year follow-up.

Material and methods: Between January 2000 and October 2002, 95 patients with unilateral VS underwent LGK radiosurgery at the University Erasmus Hospital of Brussels with the first worldwide installed LGK C. All patients in our series underwent evaluation with high resolution neurodiagnostic imaging including computed tomography and MRI, and clinical evaluation as well as audiological tests that included tonal and vocal audiometries. The Gardner Robertson (GR) classification is used to report the results of this study. We identified 48 patients treated for VS with LGK, tested and retested with vocal and tonal audiometries by the same team, and followed for a minimum of one year. There were 38 patients with previously untreated VS (9 grade I, 9 grade II, 20 grade III according to Koos) and 10 patients with postoperative evolutive residual tumor.

Results: Before LGK, 24 patients had serviceable (17 GR class I and 7 GR class II) hearing; 16 (67%) of these patients had preservation of serviceable hearing (Pure tone average < 50 db and Speech discrimination > 50%) at the one-year audiological follow-up. It was observed that 9 of the 17 GR class I patients (52.9%) maintained their level of audition and 14 of these (82.3%) preserved serviceable hearing. No deterioration of hearing occurred in the 7 patients with preradiosurgery radiosurgery nonserviceable hearing (GR class III) at the one-year follow-up. One patient improved from GR class V to III after LGK. No patient developed trigeminal neuropathy and only one patient who had preradiosurgery facial nerve dysfunction experienced deterioration at one-year follow-up.

Conclusions: In view of the high tumor control rate and excellent long-term cranial nerve preservation rates, LGK radiosurgery should now be considered as an excellent alternative strategy to microsurgery for the management of VS grade I to III as well as in cases of residual tumor after microsurgery. Compared to results obtained in centers with long-term experience, our data suggest that LGK radiosurgery is an efficient reproducible therapeutic approach that offers high rate of hearing preservation. This justifies the choice of radiosurgery as the first treatment option in VS.

The aim of the present research was to assess articulation and myofunction in patients wearing fixed or removable prostheses supported by oral implants. 164 edentulous patients with implant supported prostheses were divided in four subgroups, dependent on their dental status, and compared to control groups of forty five subjects having a natural dentition. More than fifteen articulatory and myofunctional parameters were evaluated. The results showed that subjects with prostheses on implants tend to have more articulation problems than controls. Especially patients with a complete fixed prosthesis on implants in the upper jaw seemed to experience problems pronouncing /s/ and /z/. There also seemed to be influences of age and hearing factors.