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The incidence reported for carcinomas of the head and neck currently peaks between the sixth and seventh decades of life. In this retrospective study we were interested in learning whether age is a potentially significant prognostic factor for survival. We considered a set of variables in a series of 134 patients, divided into two groups; between 65 and 70 years of age, and older than 70. Stage I–II tumors were present in 44 patients, while locally advanced lesions (stages III–IV) were present in 90. Statistical analysis of survival was performed using the actuarial survival rates according to Kaplan-Meier; significance was evaluated using the log-rank test. Multivariate analysis was performed according to the Cox logistic regression model to determine the prognostic significance of any of the variables. Univariate analysis was performed on a series of variables regarding the patient, tumor and treatment. In the younger group, age appeared to be a favorable prognostic factor. Tumor size had a significant effect on disease-free survival, both globally and between the two groups (p<0.05). Lymph node status substantially influenced the five-year survival rate (p=0.001). Tumor invasion of the lymph nodes led to a difference between the two groups. Survival was lower in the younger than in the older group. There was a significant difference (p<0.01) in survival between patients who had undergone surgery (75%) and those who received radiotherapy alone (33%). Multivariate analysis of these variables showed that disease stage, and treatment of lymph nodes were both significant (p=0.0016 and p=0.0002, respectively). Survival rates for the so-called “young elderly” (65–70 years) are generally higher than that for those aged 70 and over. Following accurate and comprehensive assessment by the anesthesiologist and the internist, and appropriate adjustment of the patient’s nutritional and metabolic status, combined radical surgery and radiotherapy can and must be performed. Minimal palliative interventions, in the belief that tumor growth is biologically less aggressive in the elderly patient, should be avoided.

The modifications of stapedial reflex have been studied in 30 subjects affected by myasthenia gravis. The test was performed in basal conditions (i.e. at least 6 h after the last administration of an anticholinesterase drug), after the injection of Tensilon and again in basal conditions, 1 week after thymectomy. The reflex was elicited in 27 patients but in 1 case it appeared only after therapy. Among the various parameters analyzed, only rise velocity, decay velocity and amplitude have shown lower values in patients than in the normal group. These parameters increased significantly after the pharmacological test and 1 week after thymectomy in 60% of the cases. The data suggest that patients with more evident muscular damage are more likely to present a rise of stapedial strength after therapy. The efficiency of thymectomy has also been demonstrated.Le sujet de notre recherche a été l'étude des variations des paramètres dynamiques du réflexe stapédien produites par la myasthénie grave dans 30 cas. L'analyse a été effectuée en conditions standard, c'est-à-dire plus de 6 h après la dernière administration d'un médicament anticholinestérasique, après perfusion de Tensilon et, de nouveau en conditions standard, 1 semaine après thymectomie. Le réflexe stapédien a été mis en évidence chez 27 sujets, mais dans un cas il est apparu seulement après thérapie. Parmi les paramètres analysés, seules la vitesse de contraction, la vitesse de décontraction et l'amplitude présentaient, pour les sujets atteints de myasthénie grave, des valeurs inférieures à celles obtenues dans le groupe de contro˘le. Ces paramètres présentaient, dans 60% des cas, un accroissement significatif après perfusion de Tensilon et 1 semaine après thymectomie. Les résultats obtenus démontrent, en outre, que plus le déficit de contraction du muscle stapédien est grand, meilleures sont les perspectives d'amélioration après thérapie, soit médicale, soit chirurgicale.

Retraction-convergence nystagmus is a classic finding in extensive and bilateral lesions of the dorsal midbrain, usually neoplastic and, as such, considered to signal a poor prognosis.

The authors present the results obtained during an audiometric screening of 153 children aged 5-18 years, affected by beta-thalassemia and treated with regular blood transfusions and iron overload chelation by means of desferrioxamine. Thirty-eight percent of the patients showed a significant sensorineural hearing loss at high frequencies with recruitment. Younger patients had a greater hearing loss, indicating that cochlear damage was not due to the disease itself. Furthermore, hearing loss appeared to be correlated with the mean and peak desferrioxamine doses administered and was higher in subjects with lower iron load. Thus, the ototoxic effect seems to have been higher when a good iron chelation had been obtained. Among our patients, conductive hearing loss was not more frequent than in patients without beta thalassemia.

Auditory results following stapes surgery in 26 patients with otosclerosis >60 years of age at the time of surgery were compared with those obtained in 140 patients <60 years undergoing stapes surgery during the same time period. Stapedotomy was performed in all cases. The mean follow-up period was 29 months. Hearing results as judged by postoperative air-bone gaps were as good in the older age group as in the younger patients. Moreover, complications of surgery, such as postoperative formation of perilymphatic fistula, did not occur more frequently in elderly vs younger patients. On the basis of the results obtained, it is concluded that stapes surgery should be offered to elderly patients with the same indications as younger patients with otosclerosis.