Angelo Salami

Piezoelectric bone surgery in otologic surgery

he aim of this work has been to evaluate the use ofPiezosurgery in the different otological surgical tech-niques. Piezoelectric bone surgery, also known simply asPiezosurgery, is a new technique for osteotomy and osteo-plasty. The equipment consists of two piezoelectric hand-pieces and two inserts that are connected to a main unit.This unit supplies power and has holders for the handpieceand irrigation fluids. It contains two peristaltic pumps forcooling during surgery with a jet of physiological solutionthat discharges from the 1,2inserts (Fig 1).The piezoelectric device uses low-frequency ultrasonicwaves (25-30 kHz) that are created by the piezoelectriceffect. (certain ceramics and crystals are modified when anelectric current is passed across them, which causes anoscillation that has an ultrasonic frequency). The instru-ment’s power can be modulated between 2.8 and 16 W, inaccordance to the density of the bone. The microvibrationsthat are created in the piezoelectric handpiece cause theinserts to vibrate linearly between 60 and 210 m.Appropriate handpieces and inserts (Fig 2) have beencreated for platinotomy, antroatticotomy, mastoidectomy,and endoauricular osteotomy, with the width, thickness, andangle of the inserts depending on the applied power, bonedensity, and surgical technique.

Piezoelectric bone surgery in otosclerosis

Conclusion. This test of the Piezosurgery® medical device for osteoplasty of the external auditory duct posterior wall and stapedotomy highlighted the advantages of this device. The devices accuracy and selectivity render it superior to conventionally rotating instruments in otologic surgery. The precise nature of the instrument allows exact, clean, and smooth cut geometries during surgery, without any visible injury to the adjacent soft tissue. Objective. The aim of this work was to test the Piezosurgery® device as a new and alternative method to conventional bone tissue management in otologic surgery and in particular in stapedotomy and the external auditory duct posterior wall. Materials and methods. The Piezosurgery® medical device is a piezoelectric ultrasonic bone-cutting surgical instrument designed to perform sharp cutting actions. The equipment consists of two piezoelectric hand-pieces and two insets that are connected to a main unit, which supplies power and has holders for the hand-piece and irrigation fluids. Piezosurgery uses low frequency ultrasonic waves (24.7–29.5 kHz), the applied power can be modulated between 2.8 and 16 W, and the machine is programmed in accordance with the density of the bone cut. The micro-vibrations that are created in the piezoelectric hand-piece cause the inserts to vibrate linearly between 60 and 210 µm and allow a selective cut of mineralized tissues without trauma to soft tissues. The interoperative irrigation cools down the bone surface and make the operating site blood-free. Twenty patients affected by otosclerosis underwent treatment utilizing the device. Results. In all the patients treated, the characteristics of the ultrasonic frequencies allowed rapid and easy intraoperative management, without any visible injury to the adjacent soft tissue. No side effects were detected.

Effects of Tonsillectomy on Speech and Voice

The aim of this study was to evaluate changes in acoustic features of speech after tonsillectomy and to establish concepts of patient management and rational therapeutic approach. Before and 1 month after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) in all the patients, as an evaluation of nasal resonance, speech articulation, and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter percent, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks, and peak amplitude variation. Our data showed that 1 month after tonsillectomy, improvements in all the acoustic parameters, a subjective decrease of hypernasality, and an improvement of speech articulation and VHI were achieved. These data suggest the reduction of the nasal resonance and highlight the role of tonsillectomy in the improvement of voice and speech quality. Furthermore, tonsillectomy should be performed before consideration of pharyngeal flap surgery. Our results highlight that objective evaluation of speech and voice helps the specialist to improve patient management and avoid unnecessary and dangerous surgical procedures.

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, while 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<0.05) lower (75.13+/-27.1mg/dl vs 96.87+/-41.3mg/dl; 74.23+/-26.2mg/dl vs 98.24+/-42.7 mg/dl), IgA titers were higher (238.14+/-122.1mg/dl vs 218.62+/-115.8 mg/dl; 239.72+/-119.7 mg/dl vs 210.46+/-107.3mg/dl), serum concentrations of IgG and IgM unchanged, VAS scores presented a significant (p<0.05) improvement (1.8+/-0.19 vs 6.8+/-0.54; 1.9+/-0.21 vs 6.9+/-0.61), NMTT was normal (11.15+/-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<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.

A prognostic multigene classifier for squamous cell carcinomas of the larynx.

Survival after diagnosis of laryngeal cancer has not improved over the last 20 years. Selection of patients for radio- and chemotherapy or surgery or follow-up strategies based on a prognostic classifier could improve survival without unduly extending radical surgery. We performed microarray gene expression analysis and developed a four-gene classifier for laryngeal cancer using Prediction Analysis of Microarray and leave-one-out cross validation. A four-gene classifier containing the non-coding gene H19, the histone HIST1H3F and the two small nucleolar RNAs, SNORA16A and SNORD14C was developed that assigns cases to low and high risk classes. The high risk class has a relative risk of 6.5 (CI=1.817-23.258, Fisher exact test p<0.0001). The maternally imprinted gene H19 is the top classifier gene.

Evaluation of an automated auditory brainstem response in a multi-stage infant hearing screening

An automated auditory brainstem response (AABR) method, the Maico MB-11 with BERAphone®, has been developed for hearing screening in newborns. The aim of this study was to test the validity of this automated ABR screening method in a multistage newborn hearing screening (NHS). We applied a “five level” protocol using transient evoked otoacoustic emission (TEOAE), AABR-MB-11 with BERAphone® and conventional auditory brainstem response (ABR). TEOAE, AABR, and conventional ABR testing were performed by ENT specialists experienced in neonatal screening techniques. Among the 8,671 newborns tested (males 3,889; females 4,782), only 42 newborns were lost to follow-up and the final false-positive rate was of 0.03%. Our experience highlights that for the neonatal period, conventional auditory brainstem response is the most reliable method for assessing the hearing level and minimizing the false-positive rate. Although AABR (performed by ENT specialists experienced in neonatal screening techniques) is easy to use, fast and with a good compliance, the device is unable to provide accurate and certain diagnosis on the degree of hearing loss to allow a proper treatment.

Piezosurgery in otologic surgery : Four years of experience

Objectives: Piezosurgery (Mectron Medical Technology, Genoa, Italy) is a new ultrasound instrument (24.7-29.5 kHz) that is able to cut the bone without necrosis and nonmineralized tissues damage. The aim of this work has been to report our experience with the piezoelectric device in otologic surgery. Study Design: We have used the piezoelectric device in 50 patients affected by otosclerosis, 50 by chronic otitis media, 20 by posttraumatic facial nerve palsy, 10 by type A glomus tympanicum tumor, and in three patients with a B-cell non-Hodgkin lymphoma. Subjects and Methods: Patients underwent platinotomy, mastoidectomy, antroatticotomy, posterior tympanotomy, facial nerve decompression, and excision of middle ear tumors. Before and 6 months 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: In each surgical technique, the piezoelectric device provided excellent control without side effects on the adjacent structures of the middle and inner ear. Conclusions: The piezoelectric device is a new and revolutionary bony scalpel using the microvibrations at ultrasonic frequency so that soft tissue will not be damaged even on accidental contact with the cutting tip; this renders the piezoelectric device ideal for otologic bone surgery.

The impact of tonsillectomy with or without adenoidectomy on speech and voice

OBJECTIVES The aim of this study was to evaluate changes in acoustic features of speech and voice after tonsillectomy with or without adenoidectomy. METHODS Before and 1 month after surgery the following parameters were estimated: average of fundamental frequency (Fo), Jitter percent (Jitt), Shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV), degree of voice breaks (DVB) and peak amplitude variation (vAm); as an evaluation of nasal resonance, speech articulation and voice handicap index (VHI). RESULTS The results were statistically evaluated using the unpaired t-test. Probability values below 0.05 were regarded as significant. One month after surgery, our data showed significant (P<0.05) improvements of the acoustic and other parameters in the children submitted to adenotonsillectomy: Fo (176Hz vs. 206Hz, after sustained vowels: 206Hz vs. 192Hz; 148Hz vs. 168Hz; 171Hz vs. 161Hz after balanced sentences), Jitt (0.85% vs. 1.81% to 0.82% vs. 1.81%), Shimmer (3.41% vs. 5.81% to 4.89% vs. 5.73%), NHR (0.16 vs. 0.42 to 0.29 vs. 0.39), VTI (0.05 vs. 0.38 to 0.28 vs. 0.37), SPI (14.78 vs. 21.14-19.89 vs. 21.89), DUV (0% vs. 0.44% to 0% vs. 0.48%), DVB (0% vs. 0.42% to 0% vs. 0.42%) and vAm (8.93% vs. 23.89% to 8.89% vs. 24.25%). CONCLUSIONS The results suggest the role of adenotonsillectomy in the improvement of voice and speech quality and of objective evaluation of speech and voice in the correct management of these children.

A novel approach to facial nerve decompression: use of Piezosurgery®

Conclusions. The safety of Piezosurgery® as regards soft tissues in facial nerve decompression was confirmed. No side effects were detected during unintentional contact with the nerve. Objectives. The aim of this work was to test Piezosurgery® as a new and alternative method to conventional bone tissue management in facial nerve decompression by posterior tympanotomy. Patients and methods. We used Piezosurgery under general anaesthesia on 10 patients affected by facial paralysis following temporal bone fractures. The equipment consists of two hand-pieces, two inserts and two peristaltic pumps connected to the control unit. The device uses low frequency ultrasonic waves (24.7–29.5 kHz), the applied power can be modulated between 2.8 and 16 W, and the machine is programmed in accordance with the density of the bone. The micro-vibrations that are created in the piezoelectric hand-piece cause the inserts to vibrate linearly between 60 and 210 µm. Results. Piezosurgery® proved effective in sclerotic and pneumatic mastoid. This approach results in significantly less operative blood loss and better visibility in the surgical field compared with conventional methods. Its safety as regards soft tissues was confirmed: no side effects were detected during unintentional contact with the nerve. All patients presented a complete recovery from facial paralysis at the last follow-up.

Piezosurgery in endoscopic dacryocystorhinostomy

Piezosurgery is a recently developed system for cutting bone with microvibrations. The equipment consists of two hand pieces, two inserts, and two peristaltic pumps connected to the control unit. The device is endowed with an irrigation system of high-flow saline solution that breaks up into very small particles, with a “bloodless” effect on the surgical site and a low indirect thermal damage to the bone surfaces and adjacent structures. 4,5 The touch screen of the main unit permits selection of the specific insert, and modulation of the irrigation and the power according to the bone density. The device uses low-frequency ultrasonic waves (24.7-29.5 kHz), the applied power can be modulated between 2.8 and 16 W, and the machine is pro