Dysphagia is a common symptom in various neurological disorders affecting pharyngeal functions. Cricopharyngeal dysfunction is one of the major findings in these patients. The most effective treatment for restoring normal swallowing function in persistent cricopharyngeal dysfunction is cricopharyngeal myotomy, especially when mechanical obstruction or a well-localized neuromuscular dysfunction, such as a cricopharyngeal muscle spasm, is present. However, when there is a more diffuse neurological disorder present the results of surgery are more disappointing. In unclear cases, or in patients with temporary problems, no good method other than swallowing training, bougienage, and tube feeding are available. During the past decade, botulinum toxin has been found to be of therapeutic value in the treatment of a variety of neurological disorders associated with inappropriate muscular contractions such as torticollis and spasmodic dysphonia. Recently, injections of botulinum toxin in patients with cricopharyngeal muscle dysfunction have been reported to result in marked relief of dysphagia. In this article we describe our experiences with botulinum toxin injections to treat four patients suffering from deglutition problems and cricopharyngeal dysphagia of different origins. Botulinum toxin was injected into the cricopharyngeus muscle that was identified by endoscopy under general anesthesia. In this study, no major side effects were observed. Three patients obtained a significant improvement of esophageal symptoms after the first injection. The treatment had limited effect in one patient who had reflux disease and only slight cricopharyngeus dysfunction.

A total of 687 school children, aged six to 15 years, were examined clinically, radiologically and audiometrically. Lateral radiological examination of paranasal sinuses was carried out in 663 (96.5 per cent) children for evaluation of the size of adenoids. The size of the soft tissue shadow (adenoids) was assessed as normal or large. It was large in 133 (25 per cent) children, three times more frequently in seven-year-old than in 14-year-old children. The occurrence of adenoidal symptoms (blocked nose, mouth breathing, snoring, snuffling or rhinitis) varied from 14.3 to 30.1 per cent in children with large adenoids compared to 7 to 9.8 per cent in children with normal adenoids. Logistic regression analysis revealed that only recurrent snoring and the child's age were significantly associated with radiologically large adenoids. The hearing thresholds were 1.1 to 4.2 dB poorer and mean middle ear pressure values were 60 to 70 mmH2O lower in children with large adenoids compared to those with normal size adenoids. Large adenoids have an influence on the hearing level of a child, but probably via the negative middle ear pressure.

Severe obstructive sleep apnea (OSAS) is most often accompanied by metabolic syndrome, obesity, diabetes and coronary disease. In its most severe form, it is a life-threatening condition, requiring active and immediate help. Nasal continuous positive airway pressure (CPAP) is the most efficient nonsurgical treatment for patients with OSAS. However, for anatomical, disease-related and subjective reasons, many patients cannot accept this treatment. A permanent tracheostomy may be one alternative in such patients who, in addition, often suffer from extreme obesity and severe heart disease. In this paper, we describe the long-term follow-up results of 7 patients suffering from OSAS and treated with permanent tracheostomy. All the patients (5 men, 2 women) were diagnosed using the static charge sensitive bed method and night-time oximetry for sleep analysis. The mean body mass index (BMI) of the patients ranged from 34 to 60 and the age from 41 to 64 years. All the patients had severe OSAS and long periods of low oxygen saturation (SaO₂) levels. Six patients had a CPAP trial before tracheostomy. Only 2 patients tolerated the trial but, despite the continuous use of CPAP, they were nonresponders. Permanent tracheostomy was done according to normal routine in each patient. After primary healing of 2 days, they used silver cannulae, which also allowed them to speak. The patients were evaluated every year after the tracheostomy. After some practical difficulties including proper maintenance of the cannula, all the patients quickly learned the correct management. In postoperative sleep studies, nadir SaO₂ levels had improved significantly, obstructive apneas had disappeared and the subjective quality of life had improved. No marked changes in BMI were found.

The present study provides new data on the hearing sensitivity among unselected 7-, 10-, and 14-yr-old school children. Furthermore, it provides normative values on the hearing thresholds of otologically normal children in these three age groups.

A total of 687 school children between the ages of 6 and 15 years were examined for nasal septal deformities as part of a comprehensive epidemiological ENT study. Stepwise logistic regression analysis showed that the occurrence of clinically significant septum deviation was associated with age, sex, and dental malocclusion. The authors could not demonstrate any unambiguous correlation between respiratory symptoms or infections and nasal septal deformities, although there was a tendency for an increased frequency of infections in children with clinically significant septum deformity.