Should lateral wall collapse be a contraindication for hypoglossal nerve stimulation?

OBJECTIVE: The purpose of this study is to examine how lateral wall collapse affects treatment outcomes for hypoglossal nerve stimulation (HNS) patients. METHODS: Patients (n = 111) queried from a single surgeon's database of HNS cases were divided into groups based on their degree of oropharyngeal lateral wall collapse noted on drug-induced sleep endoscopy (DISE): Complete, Partial, None. For each group, apnea hypopnea index (AHI) reduction, Epworth Sleepiness Scale (ESS) score, stimulation voltage, average nightly usage, need for alternate device configuration/awake sleep endoscopy, and rate of surgical success were collected. Patients with Complete collapse were compared to those with Partial/None via Student's t-tests and Pearson's Chi-square test. RESULTS: Of the 111 eligible patients, 45 had complete, 30 partial, and 36 had no lateral oropharyngeal wall collapse. There were no statistically significant differences found between the Complete and Partial/None groups in terms of age, BMI, sex, AHI (pre and post-op), ESS (pre and post-op), voltage, alternate device configuration, or nightly adherence. Notably, a significantly greater number of the Partial/None group had surgical success (84.84 % vs 66.67 %, p = 0.024). CONCLUSIONS: Patients with Partial/None oropharyngeal collapse were significantly more likely than patients with Complete lateral wall collapse to see surgical success. There are many factors to weigh when assessing a patient's surgical candidacy, it is clear that complete lateral wall collapse at the level of the oropharynx is a negative predictor for success in HNS.

Respiratory Sensing Lead Malfunction in Upper Airway Stimulation: A Single Institution Report.

OBJECTIVES: Upper airway stimulation (UAS) is an effective treatment for patients with obstructive sleep apnea. The device consists of a stimulating electrode, an internal pulse generator, and a respiratory sensing lead. The purpose of this study is to characterize the incidence of sensing lead malfunction necessitating revision surgery in a high-volume center in conjunction with a review of the FDA Manufacturer and User Facility Device Experience (MAUDE) database reports on adverse events associated with the sensing lead component. METHODS: Patients age ≥18 implanted with the device were reviewed between July 2017 and June 2022. Those determined to have sensing lead malfunction were analyzed. The FDA MAUDE database was reviewed for reports associated with "Inspire Model 4323 Respiratory" and "Inspire Model 4340 Respiratory" between January 2014 and September 2022. RESULTS: One hundred ninety patients underwent UAS at our institution during the study period and four (2.1%) patients were found to have sensing lead malfunction. Analysis of the MAUDE database revealed 122 reports of adverse events associated with the sensing lead component, with 72% (88/122) of these requiring revision surgery. The most frequently reported adverse event was sensing lead tip separation from lead body, noted in 46% of these reports (56/122). CONCLUSION: The functionality of the sensing lead component is vital to the integrity of the UAS device and is measurable through waveform analysis. To provide optimal care after device implantation, it is essential to have a comprehensive understanding of the scenarios in which this component fails, the incidence of such events, and appropriate management. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1479-1484, 2024.

Early effects of very early cochlear implant activation on tinnitus.

BACKGROUND: Cochlear implantation (CI) has long been the standard of care for patients with severe-to-profound hearing impairment. Yet the benefits of CI extend far beyond speech understanding, with mounting recent literature supporting its role in tinnitus abatement. However, those studies have uniformly analyzed the effects of tinnitus after the traditional 3-4 weeks waiting period between CI surgery and device activation. As many clinics are shifting these waiting intervals to become shorter (in some cases within 24 hours, little is known about tinnitus abatement very early in the postoperative period. The aim of this study was to compare preoperative and postoperative tinnitus handicaps in this unique but growing population of very early-activated patients. METHODS: Twenty-seven adults with severe-to-profound hearing impairment with chronic tinnitus (>6 months) were included. Patients with concomitant psychiatric disorders were excluded. All patients were implanted with the same array and were switched on within 24 hours after the surgery. Tinnitus Handicap Inventory (THI) was recorded preoperatively, immediately after activation at 24 hours postoperatively, at 1 week, 2 weeks, and I month after activation. Wilcoxon signed-rank test was used to compare values between preoperative assessment and respective fitting sessions. RESULTS: Mean THI 24 hours after implantation increased in comparison to that assessed preoperatively (77.6 vs 72.5, p = 0.001). By 1 week after surgery, the THI had decreased to 54.9 ( p < 0.001). This trend continued and was statistically significant at 2 weeks (36.0, p < 0.001) and 1 month (28.5, p < 0.001). CONCLUSION: On average, most patients with tinnitus will note a significant improvement in their tinnitus handicap when activated within 24 hours of CI. However, tinnitus does increase between surgery and 24 hours, most likely reflecting not only intracochlear changes, but modulation of the entire auditory pathway. Following this early rise, the tinnitus continues to abate over the following month. Patients with tinnitus may benefit from early activation, although should be counseled that they may experience an exacerbation during the very early postoperative period.