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Contains fulltext : 305161.pdf (Publisher’s version ) (Open Access), Hearing impairment constitutes a significant health problem in developed countries. If hearing loss is slowly progressive, the first signs may not be noticed in time, or remain untreated until the moment the auditory dysfunction becomes more apparent. The present study will focus on DFNA9, an autosomal dominant disorder caused by pathogenic variants in the COCH gene. Although several cross-sectional studies on this topic have been conducted, a crucial need for longitudinal research has been reported by many authors. Longitudinal trajectories of individual hearing thresholds were established as function of age and superimposed lowess curves were generated for 101 female and male carriers of the p.Pro51Ser variant. The average number of times patients have been tested was 2.49 years with a minimum of 1 year and a maximum of 4 years. In addition, interaural and sex differences were studied, as they could modify the natural evolution of the hearing function. The current study demonstrates that, both in female carriers and male carriers, the first signs of hearing decline, i.e. hearing thresholds of 20 dB HL, become apparent as early as the 3rd decade in the highest frequencies. In addition, a rapid progression of SNHL occurs between 40 and 50 years of age. Differences between male and female carriers in the progression of hearing loss are most obvious between the age of 50 and 65 years. Furthermore, interaural discrepancies also manifest from the age of 50 years onwards. High-quality prospective data on the long-term natural evolution of hearing levels offer the opportunity to identify different disease stages in each cochlea and different types of evolution. This will provide more insights in the window of opportunity for future therapeutic intervention trials.

Introduction: Efficacy of oral appliance therapy is variable, limiting its potential as first-line therapy. Site and severity of pharyngeal collapse are known determinants of success/failure with oral appliance therapy. Specifically, risk factors for an incomplete response to oral appliances include a more collapsible upper-airway, complete concentric collapse of the palate (CCCp), and collapse at oropharyngeal lateral walls. Collapsibility can be estimated from clinical polysomnography, but site of collapse detection remains limited. We recently developed a method for differentiating patients with CCCp and lateral wall collapse from those with tongue-base or epiglottic collapse using airflow from polysomnography (Op de Beeck et al World Sleep 2022). In the current study, we applied this method to investigate the utility of including polysomnographic site of collapse with collapsibility for predicting oral appliance treatment responses. Method(s): Eighty-one patients with OSA (median[IQR] apnea-hypopnea index, AHI: 34[22,54]events/h, age: 50[45,56]years, 20 women, BMI: 30[27,34]kg/m2) were assessed via polysomnography at baseline and on oral appliance treatment. From the baseline study, collapsibility was estimated using the average reduction in ventilation per respiratory event ("event depth"). For site of collapse, a continuous variable describing the probability of CCCp and lateral walls versus tongue base and epiglottis was estimated; briefly, six recognizable flow-shape characteristics (including greater inspiratory scoopiness, skewness, earlier peak flow) calculated from breaths within scored hypopneas were combined using linear regression (trained to predict results of drug-induced sleep endoscopy: cross-validated OR=4.3[1.6-11.8], pseudo-R2=0.33). We tested the hypothesis that a complete response to oral appliance therapy (>50% reduction in AHI and treatment AHI<10 events/h) is associated with absence of predicted CCCp or lateral wall collapse, adjusting for

Objective/Background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Patients/Methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, ‘normal, not ill’ 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = −0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and −0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. Conclusions: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.

A decade after its first introduction into the clinic, little is known about the clinical impact of helical tomotherapy (HT) on head and neck cancer (HNC) treatment. Therefore, we analyzed the basics of this technique and reviewed the literature regarding HT's potential benefit in HNC. The past two decades have been characterized by a huge technological evolution in photonbeamradiotherapy (RT). InHNC,staticbeamintensitymodulated radiotherapy (IMRT) has shown superiority over three-dimensional conformal RT in terms of xerostomia and is considered the standard of care. However, the next-generation IMRT, the rotational IMRT, has been introduced into the clinic without any evidence of superiority over static beam IMRTother than being substantially faster. Of these rotational techniques, HT is the first system especially developed for IMRT in combination with image-guided RT. HT is particularly promising for the treatment of HNC because its sharp dose gradients maximally spare the many radiosensitive organs at risk nearby. In addition, HT's integrated computed tomography scan assures a very precise dose administration and allows for some adaptive RT. Because HT is specifically developed for IMRT in combination with (integrated) imageguidance, it allows for precise dose distribution ("dose painting"), patient setup, and dose delivery. As such, it is an excellent tool for difficult HNC irradiation. The literature on the clinical results of HT in HNC all show excellent short-term (≤2 years) results with acceptable toxicity profiles. However, properly designed trials are still warranted to further substantiate these results. ©AlphaMed Press 2013.

Obstructive Sleep Apnea (OSA) is a condition in which the patient repeatedly stops breathing during sleep due to the collapse of the upper airway. The upper airway collapse is caused by a relaxation of the upper airway muscles, combined with a decrease in intraluminal pressure and hence an increase in external pressure from the surrounding tissue. A possible treatment that is becoming more and more popular, due to its reversibility, is the oral intervention like a Mandibular Advancement Device. This device brings the mandibula forward in order to increase the upper airway volume and prevent total upper airway collapse during sleep. The patient only uses the device during the night. However the efficiency of the MAD can vary significantly from patient to patient. The use of Computational Fluid Dynamics allows for a prediction of the outcome of a treatment with an MAD. This makes it possible to compare upper airway volume and to determine the upper airway resistance (UAR) through finite volume flow simulations for both cases. Boundary conditions for the model are obtained from the patient during a sleep study. Therefore the flow modelling is based on patient specific geometry and patient specific boundary conditions. A mesh dependency and turbulence dependency study was performed. Whenever the simulations showed a decrease in upper airway resistance, also a clinical improvement was observed. Clinical improvements are measured by looking at the apnea-hypopnea index (AHI) which indicates the number of events (upper airway closures or near closures) per hour and the snoring index quantifying the degree of snoring. In conclusion, one can say that the combination of advanced imaging and functional analysis shows a large potential for future medical treatments.