Study Objectives: Different therapeutic strategies have been investigated for the treatment of positional obstructive sleep apnea, but more evidence is needed about efficacy and compliance. The objective of this study was to describe the efficacy of vibrotactile neck-based treatment in patients with positional obstructive sleep apnea with different degrees of obstructive sleep apnea severity who were followed for 6 months. Methods: This is a retrospective study including 162 patients with positional obstructive sleep apnea undergoing vibrotactile neck-based positional therapy. We compared polysomnographic data obtained at baseline and during positional therapy after 1 month. We performed a subgroup analysis based on obstructive sleep apnea severity. Furthermore, we analyzed follow-up data in 84/162 (51.8%) patients with particular focus on discontinuation and complications related to the device. Results: We observed a significant difference between mean baseline obstructive apnea-hypopnea index (OAHI; 21.9 ± 9.9 events/h) and during positional therapy (12 ± 9.2 events/h; P < .01). Moreover, 87/162 (54.9%) patients showed a reduced baseline OAHI of at least 50% and 38/162 (23.4%) achieved complete disease control (OAHI < 5 events/h). At subgroup analysis, at least 50% reduction from baseline OAHI was observed in 56.8% of patients with mild, 55% with moderate, and 47.4% with severe OAHI, whereas complete control of disease was achieved in 50% of patients with mild, 22.5% with moderate, and 7.9% with severe OAHI. At a 6-month follow-up, only 35/84 patients (41.6%) were regularly using the device, with a mean of 5.9 ± 1.2 days per week. Conclusions: Our results on the efficacy and long-term adherence to vibrotactile neck-based positional therapy showed that positional therapy can be an efficient first-line treatment option for mild positional obstructive sleep apnea and in selected cases of moderate disease. Long-term compliance is limited because of complications and low satisfaction in some patients.
Quantitative analysis of signal intensity variations during dynamic contrast-enhanced MR imaging with fat suppression can be useful in the characterization of small renal lesions.
The aim of the present study was to obtain data from a large community sample of patients with Ménière’s disease (MD) in Italy through a web-based nationwide survey. Demographic, clinical, and epidemiological features of MD among members of the Italian Association of Ménière’s Disease (AMMI) were collected through a web-based survey. The questionnaire was posted on the AMMI website between 01/SEP/2021 and 31/OCT/2021. A total of 520 patients (374 F, 146 M) with MD were included. The age at interview (average ± standard deviation, SD) was 51.4 ± 10.9 years, with a disease duration of 9.9 ± 9.8 years. Eighty percent of cases were unilateral. No patients reported neurocognitive disorders or Parkinson’s disease. A positive family history of MD was reported in 13% of participants, while a history of allergic diseases was reported in 33%. Comorbid thyroid disorders were present in 25% of participants, and 28% used betahistine as the main treatment. To our knowledge, this is the first study that has investigated the epidemiology and current patterns of care of MD in Italy, using an anonymous survey directly sent to patients, thus implying their active participation. We hope that future studies will support the utilization of web-based surveys to address the unmet needs in the management of patients with MD.
Background and Objectives: Clinical management of vagal schwannoma is a real diagnostic and therapeutic challenge because the medical history and clinical examination are often non-specific and vagal nerve injury following surgical resection still represents an unsolved problem. The aim of this paper is to provide a case series along with a diagnostic and therapeutic algorithm for vagal schwannoma of the head and neck, combining our experience with clinical evidence available in the literature. Materials and Methods: We retrospectively analyzed a series of patients affected by vagal schwannoma who were treated between 2000 and 2020. In addition, a review of the literature on vagal schwannoma management was conducted. Based on the cases described and the literature review, we made a diagnostic and therapeutic algorithm for the management of vagal schwannoma. Results: We were able to identify 10 patients affected by vagal schwannoma and treated between 2000 and 2020. All patients presented with a painless, mobile, slow-growing lateral neck mass with onset varying from a few months to years. The preoperative diagnostic workup included ultrasound (US) in nine cases, computed tomography (CT) with contrast in six patients and magnetic resonance imaging (MRI) of the neck in seven cases. All patients included in this study were surgically treated. Conclusions: Vagal schwannoma management represents a true challenge for clinicians and surgery is currently the most effective therapeutic strategy. A multidisciplinary approach through the collaboration of otolaryngologist with other specialists is desirable to develop a tailored treatment plan for the patient.
Background. Pregnancy is a specific female physiological period characterized by significant changes, included otological and neurotological manifestations. Vestibular disorders like vertigo and dizziness, are common complaints from pregnant women to primary care. Objectives. The aim of this paper is to describe clinical pictures, evaluation methods and therapeutic options of acute vertigo in pregnancy with the related pathogenetic hypotheses. Method. We describe 11 cases of vertigo in pregnancy. All patients underwent audio-vestibular evaluation, consisting of pure-tone audiometry, impedance and clinical testing of the vestibular function, the "bed side examination". Results. Audiological evaluation showed normal puretone audiometry and impedance in 10 patients. Only in one case a sudden right total deafness was highlighted with vestibular areflexia, showing a secondary positional vertigo. Seven patients presented a benign paroxysmal positional vertigo (BPPV) effectively treated by liberatory maneuvers. Three patients had a diagnosis of vestibular neuritis and they were treated with corticosteroids therapy with a complete resolution of dizziness and vertigo in one month. Conclusions. Our results point out the importance of multidisciplinarity between otolaryngologist, neurologist and gynecologist. From a pathogenic point of view, the vascular etiology, strictly related to the gravidic hormonal variations, is often hypothesized. SOMMARIORazionale. La gravidanza costituisce un periodo di vita per la donna, caratterizzato da significativi cambiamenti di tipo fisiologico e adattativo, incluse possibili manifestazioni otoneurologiche. Disturbi vestibolari quali vertigini e instabilità, costituiscono una sintomatologia frequente nelle donne in gravidanza. Obiettivo. Scopo dell'articolo consiste nel descrivere specifici quadri clinici, metodi diagnostici e opzioni terapeutiche di vertigine acuta in gravidanza con relative ipotesi patogenetiche. Materiali e metodi. Descriviamo 11 casi di vertigine in gravidanza. Tutte le pazienti sono state sottoposte ad esame cocleovestibolare, ossia ad esame audiometrico tonale, esame impedenzometrico e esame vestibolare, clinico, la cosiddetta "bed side examination". Risultati. All'esame audiompedenzometrico, 10 pazienti risultavano normoacusiche. Solo in un caso è stata riscontrata un'anacusia destra improvvisa associata ad areflessia vestibolare e successiva vertigine posizionale. Sette pazienti hanno presentato una vertigine parossistica posizionale benigna (BPPV) trattata con le manovre liberatorie. A tre pazienti è stata diagnosticata una neurite vestibolare, trattata con terapia corticosteroidea e conseguente completa risoluzione della sintomatologia in un mese. Conclusioni. Alla luce dei risultati ottenuti, si dimostra fondamentale la multidisciplinarietà tra otorinolaringoiatra, neurologo e ginecologo. Da un punto di vista patogenetico, l'eziologia vascolare, strettamente correlata alle variazioni ormonali durante la gravidanza, è spesso ipotizzata.
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