BackgroundEvaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy.Material and MethodsA randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient’s own home.ResultsForty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements.ConclusionsThe use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy. Key words:Obstructive sleep apnea (OSA), mandibular advance device, treatment, efficacy, clinical assay.

Our data support the hypothesis that there is a slight osteopenia of the roof of the superior semicircular canal associated with aging, and this effect seems to be more pronounced in menopausal women.

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We describe five patterns of superior semicircular canal roofs: normal, thick, papyraceous, pneumatised and dehiscent. The papyraceous type and the dehiscent type would be subject to producing pathology, and in some cases the latter could be a consequence of the former.

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TO THE EDITOR:Hearing loss has been classically classified as conductive, when the defect is located in the outer and/or middle ear, sensorineural, when the defect is located in the inner ear, or mixed when a combination of both conductive and sensorineural defects occurs. It has been shown, however, that conductive or mixed hearing loss may also result from the alteration of fluid mechanics in the inner ear, as it occurs in labyrinthine fistulae [Minor, 2003], in X-linked deafness Type III/DFNX2 caused by mutations in the POU class 3 homeobox 4 (POU3F4) gene [Phelps et al., 1991;Vore et al., 2005], in a small percentage of cases of Pendred syndrome/DFNB4 caused by solute carrier family 26, member 4 (SLC26A4) gene mutation [Campbell et al., 2001;Santos et al., 2010], and in superior semicircular canal dehiscence (SSCD) [Minor et al., 1998;Minor, 2003]. SSCD is a rare disorder originally described by Minor et al. in 1998. In SSCD, the absence of bone overlying the superior semicircular canal creates a third labyrinthine window, leading to loss of acoustic energy and abnormal stimulation of the vestibular system. Besides variable conductive or mixed hearing loss [Chi et al., 2010], the clinical manifestations of SSCD include vertigo induced by loud sounds (Tullio phenomenon), by Valsalva maneuvers, and by exercise. It is important to note that, if detected, SSCD can be partially or fully corrected with surgery [Minor et al., 1998;Crovetto et al., 2008].The incidence of SSCD is 0.5% [Crovetto et al., 2010]. Given this low incidence, it is not surprising that the etiology of SSCD remains poorly characterized. Interestingly, several studies have recently provided evidence for a possible contribution of genetic alterations to SSCD. Thus, targeted disruption of the Brn4/POU3F4 gene in mice causes abnormal development of the superior semicircular canal, suggesting that mutations in human POU3F4, which cause DFNX2, might be related to SSCD [Sobol and Teng, 2005]. Moreover, in humans, SSCD is sometimes associated to Pendred syndrome [Brandolini and Modugno, 2011]. A possible role for genetic factors in SSCD has been further reinforced by the recent finding of a patient with SSCD in a family with autosomal dominant nonsyndromic hearing loss caused by mutation in the cochlin (COCH) gene [Hildebrand et al., 2009].In order to evaluate the possibility that mutations in loci responsible for different types of genetic hearing loss are commonly associated with SSCD, we carried out a detailed mutational analysis of the COCH, POU3F4, and SLC26A4 genes in three patients with proven SSCD.Patient 1 is a 43-year-old male reporting a 2-year history of Tullio phenomenon in his right ear, pressure-induced vertigo, oscillopsia, and autophony. Besides this audiovestibular problem, the patient was a healthy man with neither a family history of deafness or vertigo nor any signs suggesting a syndromic deafness. Highresolution temporal bone CT scan showed a dehiscence of the right superior semicircular canal. The patient was operated by transmas...