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\s=b\ Laryngomalacia has been described in the medical literature for over 100 years. During this time many different names have been used for the same condition. There have been numerous discussions of symptoms, cause, pathogenesis, relationships to other conditions, hereditary factors, and treatment. The purpose of this study is to historically review the literature, clarify terminology, and describe the clinical aspects of the disease.We also summarize and make conclusions regarding cause, pathogenesis, genetic and disease relationships, prognosis, and treatment. Finally, we present a case report of severe laryngomalacia and describe a surgical technique used to treat it. (Arch Otolaryngol 1984;110:546-551) Iaryngomal aci a is described as an infantile inspiratory stridor, present at birth or within the perina¬ tal period. The stridor increases in

Intractable, unexplained deep-ear pain presents a rare, albeit significant problem in otolaryngological and neurosurgical practice. The authors review their experience with 18 cases of primary otalgia during the past 15 years. A total of 31 surgical procedures were performed. Seventeen patients had sequential rhizotomies and one patient had microvascular decompression alone. Based on the clinical diagnosis, the nerves sectioned were singly or in combination: the nervus intermedius (14 patients), geniculate ganglion (10 patients), ninth nerve (14 patients), 10th nerve (11 patients), tympanic nerve (four patients), and chorda tympani nerve (one patient). Microvascular decompression of the involved nerves was undertaken in nine patients, in whom vascular loops were discovered. Adhesions (six patients), thickened arachnoid (three patients), and benign osteoma (one patient) were other intraoperative abnormalities noted. The overall success of these procedures in providing pain relief was 72.2%, and the mean follow-up period was 3.3 years (range 1 month to 14.5 years). There was no surgical mortality. Expected side effects were: decreased lacrimation, salivation, and taste related to nervus intermedius nerve section, and transient hoarseness and diminished gag related to ninth and 10th nerve section. Four patients developed sequelae consisting of sensorineural hearing loss, vertigo, and transient facial nerve paresis. One patient had a cerebrospinal fluid leak and another developed aseptic meningitis as postoperative complications. Except when primary glossopharyngeal neuralgia is the working diagnosis, a combined posterior cranial fossa-middle cranial fossa approach is recommended for adequate exploration and/or section of the fifth, ninth, and 10th cranial nerves as well as the geniculate ganglion and nervus intermedius.

This study presents the results of our experience with 115 children between the ages of 3 and 19 years who have had symptoms of upper airway obstruction and nocturnal enuresis. Twelve children had secondary enuresis, and 103 children had primary enuresis. Surgical removal of upper airway obstruction led to a significant decrease in or complete cure of nocturnal enuresis in 87 (76%) of the children studied. Eleven children were also studied with polysomnographic tracings in an attempt to determine a relationship between their sleep patterns and nocturnal enuresis.

For many years (auditory) middle latency response (MLR) reportedly has been an excellent electrophysiological procedure for estimating frequency specific auditory thresholds. Currently the 40 Hz potential, a derivative of the MLR, holds even greater promise for threshold testing. MLR also appears to have potentially valuable applications in the evaluation of functional hearing loss and assessment of higher auditory function. However, MLR is not without controversy. Questions of origin, filtering effects, and its use in pediatric assessment are current issues surrounding applications of MLR. The following article analyzes the values and limitations of MLR within the framework of past, present, and future research and clinical uses.

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Bariatric surgery as a means of treating SAS in the morbidly obese provides effective long-term reduction in RDI. Bariatric surgery also significantly improves minimum oxygen saturation in morbidly obese patients with SAS. Biliopancreatic bypass is more effective in reducing RDI to normal values than vertical banded gastroplasty.

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