Obstructive Sleep Apnea and Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

OBJECTIVES: To evaluate the associations between obstructive sleep apnea (OSA) and sensorineural hearing loss (SNHL) and the effects of continuous positive airway pressure (CPAP) therapy on SNHL. DATA SOURCES: Ovid Medline, Embase, and Scopus databases. REVIEW METHODS: A systematic search was done for studies investigating relationships between OSA and SNHL in adults, with manual searches for additional references. The final update was done on December 22, 2021. The Risk of Bias Assessment Tool for Nonrandomized Studies was applied for quality assessments. RESULTS: The 20 included studies had a total of 34,442 participants (66% male; mean age, 46.6 years). The OSA group had a significantly worse mean hearing threshold level (HTL) than the control group for midfrequency ranges (500, 1000, 2000 Hz; mean difference, 4.00 dB; 95% CI, 2.40-5.61) and high-frequency ranges (4000, 8000 Hz; mean difference, 6.24 dB; 95% CI, 2.99-9.49). An association between OSA and SNHL was found. When compared with controls, patients with OSA had an odds ratio of 1.52 (95% CI, 1.12-2.06) for midfrequency hearing impairment and 1.19 (95% CI, 1.05-1.34) for high-frequency hearing impairment. However, we did not find significant improvements in midfrequency HTL after CPAP therapy. CONCLUSIONS: HTL was significantly poorer among participants with OSA (especially in severe cases) than non-OSA controls. Studies on patients with OSA with SNHL treated with CPAP did not show significant improvements in midfrequency HTL. Further studies are warranted on these issues.

Validity and reliability of the Thai version of the pediatric obstructive sleep apnea screening tool.

OBJECTIVE: Obstructive sleep apnea (OSA) is highly prevalent in children and requires an expensive and relatively unavailable sleep study for diagnosis. This study was undertaken to translate the previously validated pediatric OSA screening tool (POSAST) to the Thai language and assess its accuracy and test-retest reliability in at-risk symptomatic children. STUDY DESIGN: Prospective cross-sectional cohort study. METHODS: Pediatric patients clinically referred for suspected OSA who underwent overnight polysomnography (PSG) were recruited, and caregivers completed the Thai version of the POSAST. The same questionnaire was completed again after 2-4 weeks. The reliability of the questionnaire was determined by internal consistency and test-retest reliability. The validity of the questionnaire was assessed by constructing receiver operating characteristic (ROC) curves to identify the equation-derived score and total additive score cutoff points that identify high risk for moderate and severe OSA (AHI of ≥ 5 events/h). RESULTS: One hundred and ten subjects completed the study. The mean age was 8.4 ± 2.9 years. The mean apnea-hypopnea index (AHI) was 10.9 ± 11.9 events/h. Test-retest reliability (Pearson correlation coefficient = 0.96, p < .001) and internal consistency between each question (Cronbach's alpha coefficient = 0.82, p < .001) were excellent. An equation-derived score cut-off of 1.9 yielded 78.4% sensitivity, 50.0% specificity, 76.3% positive predictive value (PPV), and 52.9% negative predictive value (NPV), while a total additive score cut-off of 8 corresponded to 81.1% sensitivity, 52.8% specificity, 77.9% PPV, and 57.6% NPV for diagnosing moderate and severe OSA (AHI ≥ 5 events/h). CONCLUSION: The internal consistency and reproducibility of the Thai version of the POSAST are satisfactory, display acceptable validity, and the instrument can be used for screening symptomatic Thai children for OSA.

Watch Peripheral Arterial Tonometry in the Diagnosis of Pediatric Obstructive Sleep Apnea.

Objective To assess the accuracy and clinical reliability of watch peripheral arterial tonometry (PAT) compared with polysomnography (PSG) for the diagnosis of pediatric obstructive sleep apnea (OSA). Study Design Prospective, diagnostic test study. Setting National tertiary referral hospital. Subjects and Methods Patients aged 8 to 15 years with clinically suspected OSA were recruited. All participants underwent PSG and PAT simultaneously in the sleep laboratory. Results Thirty-six patients were included, with a mean age of 10.2 ± 1.8 years. Median (interquartile range) of the apnea hypopnea index (AHI) was 8.0 (5.5-12) and 2.9 (0.5-7.5) events/h, median oxygen desaturation index (ODI) was 2.5 (1.4-8.3) and 1.3 (0.2-3.8) events/h, mean ± standard deviation total sleep time was 398.4 ± 38.3 and 401.9 ± 36.1 minutes, and mean minimum oxygen saturation was 87.1% ± 8.1% and 89.4% ± 7.1% for PSG and PAT sleep parameter results, respectively. Agreement between methods was excellent for the AHI (intraclass correlation coefficient [ICC]: 0.89; 95% CI, 0.40-0.96; P < .001) and ODI (ICC: 0.87; 95% CI, 0.69-0.94; P < .001). Correlation between methods was very good for the ODI ( r = 0.83; 95% CI, 0.67-0.90; P < .001) and moderate for the AHI ( r = 0.64; 95% CI, 0.30-0.85; P < .001). From the receiver operating characteristic curve constructed to assess PAT diagnostic capability, AHI of PAT (W-AHI) at a cutoff of 3.5 events/h provided the highest accuracy (76.9% sensitivity, 78.3% specificity), while W-AHI at 10 events/h yielded 91.3% specificity for diagnosing severe OSA. Conclusion PAT correlated well and had good agreement with PSG. Children with W-AHI ≥10 had high specificity for the diagnosis of severe OSA. Larger studies with PAT designed for children across all age ranges and with a normal control group are still needed.

A randomized study of temperature-controlled versus bipolar radiofrequency for inferior turbinate reduction.

UNLABELLED: The objective of this study is to compare outcomes of temperature-controlled radiofrequency (TCRF) and bipolar radiofrequency (BRF) for inferior turbinate reduction in patients with chronic rhinitis (CR). This was a prospective, randomized non-inferiority trial. Eighty-four adult patients with CR refractory to medication were randomized into two intervention groups: TCRF(42) or BRF(42). Primary outcomes consisted of patient-orientated visual analog scale (VAS; 0-10) of nasal obstruction at 4th postoperative week. Secondary subjective outcomes included VAS of nasal discharge, sneezing, hyposmia, and postnasal drip. Objective outcomes included crusting, mucociliary transportation time, minimal cross-sectional area, total nasal volume, and nasal airway resistance performed by blind assessors before and at 4th postoperative week and 1-year follow-up. Baseline and perioperative data showed no statistically significant difference between both groups, except for longer operative time in TCRF (481.5 ± 36.2 vs. 37.1 ± 3.0 s, p < 0.001) and slightly more crusts in BRF group (p = 0.04). Both intention-to-treat and per-protocol analyses, TCRF(39) versus BRF(41), revealed no significant difference among subjective and objective outcomes between two groups at 4th postoperative week. The 95% confidence intervals of mean differences of VAS scores of all subjective symptoms were within defined margin (-1.5 to 1.5), except for nasal discharge. At 1-year follow-up, there was still no significant difference in the outcomes. Minimal pain and minor bleeding without serious adverse effects from both interventions were reported. Both BRF and TCRF resulted in similar short-term outcomes, while less operative time was found in BRF group. Further studies, particularly, on cost-effectiveness should be conducted for better treatment selection. LEVEL OF EVIDENCE: 1b.

Radiofrequency inferior turbinate reduction improves smell ability of patients with chronic rhinitis and inferior turbinate hypertrophy.

Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18-60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6-10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> -6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (-7.25 to -5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (-3.65 to -10; -3.73 to -10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened.

Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: outcomes and practicability.

OBJECTIVES/HYPOTHESIS: To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. STUDY DESIGN: Prospective, nonrandomized, before-after study. METHODS: Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. RESULTS: Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. CONCLUSIONS: This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.

Epworth sleepiness scale in obstructive sleep disordered breathing: the reliability and validity of the Thai version.

PURPOSES: The objectives of this study are to test the reliability and validity of the Thai version of the Epworth sleepiness scale (ESS) and to assess the relationship between the ESS score and the severity of obstructive sleep disordered breathing. METHODS: A total of 228 subjects (149 males and 79 females) were recruited. In order to check the discriminant validity of the ESS, we included 32 healthy volunteers and 39 patients with primary snoring to be the control groups and 126 patients with obstructive sleep apnea (OSA) confirmed by full polysomnography to be the disease groups. The test-retest reliability was investigated in 71 subjects. To check the responsiveness properties of the questionnaire, we asked a separate group of 31 patients who were successfully treated with either continuous positive airway pressure (CPAP) or upper airway surgery to complete the ESS before and after treatment at 3-6 months. RESULTS: The internal consistency demonstrated by Cronbach's alpha coefficients for standardized item was 0.87 and a range from 0.84 to 0.86 if some items were deleted. The test-retest reliability was shown by intra-class correlation coefficients of 0.79. There was a statistically significant difference between the mean of the ESS scores of the control groups (6.1 ± 3.0) and the OSA patients (9.9 ± 5.3) (p < 0.001). The ESS scores decreased significantly after a successful treatment with both CPAP and surgery (p < 0.001); however, there was no statistically significant difference among different severities of OSA. CONCLUSIONS: Our Thai version of the ESS showed an excellent internal consistency and test-retest reliability. It is able to discriminate between control subjects and OSA patients and to assess the response of treatment; however, it has a weak relationship with the apnea-hypopnea index. Therefore, we recommend use it to combine with more comprehensive clinical evaluation in obstructive sleep disordered breathing patients.

Long-term effect of stenting after an endoscopic modified Lothrop procedure.

BACKGROUND: The aim of this study was to study the effect of stenting with a silastic sheet on the long-term patency of the common frontal ostium after an endoscopic modified Lothrop procedure (EMLP). METHODS: A retrospective analysis was performed of prospectively collected data at an academic tertiary referral center, where 72 patients underwent an EMLP between 1996 and 2003. Patency of the common frontal ostium was studied as an ordinal variable with three classes (patent, stenotic, and closed). RESULTS: A common ostium was endoscopically visualized in 94% of the patients (61.1% patent and 33.3% stenotic). Symptoms improved in 75% of the patients. A significant positive correlation was found between ostium patency and symptom improvement. Twenty-five patients were stented postoperatively. There was no statistical difference between the stented and the nonstented groups with regards to ostium patency and symptoms improvement. CONCLUSION: Short-term stenting does not appear to reduce the rate of postoperative stenosis of the common frontal ostium after an EMLP.

Endoscopic sinus surgery for benign and malignant nasal and sinus neoplasm.

PURPOSE OF REVIEW: Endoscopic sinus surgery has become widely accepted as the standard of treatment for chronic inflammatory diseases of the paranasal sinuses unresponsive to medical treatment. With increased skill with endoscopic surgical technique, advanced technologies such as intraoperative imaging systems, and a better understanding of the complex anatomy of the paranasal sinuses and surrounding vital structures, many otolaryngologists have increasingly applied their expertise in endoscopic sinus surgery to the resection of nasal and sinus neoplasms. The following represents a review of the recent literature on the latest trends regarding endoscopic resection of nasal and paranasal sinus neoplasms. RECENT FINDINGS: There has been an increasing popularity in the removal of nasal and paranasal sinus neoplasms through an endoscopic approach. In the recent literature, emphasis has been on the endoscopic surgery of benign tumors, especially inverted papilloma and nasopharyngeal angiofibroma. Other benign neoplasms have also been reported, but only in small case reports. There have been a few recent reports supporting endoscopic removal of malignant neoplasms as well. However, the follow-up is too short and study groups too small to make definitive conclusions. SUMMARY: In the hand of experienced and skilled surgeons, complete endoscopic removal is attainable in most cases. Especially for the more common benign neoplasms, such as inverted papilloma and early stage angiofibroma. En bloc resection is not necessary to achieve oncologic cure. However, several factors have to be considered before selection of this surgical approach. Large tumor size, intracranial or orbital extension, and extensive frontal or infratemporal fossa involvement are relative, but not absolute limitations.