Gender differences in the upper airway, craniofacial morphological and polysomnographic parameters in patients with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) is a common sleep disorder characterized by repetitive episodes of upper airway collapse during sleep associated with arousals with or without oxygen desaturation. OBJECTIVE: This study aims to assess and analyse the morphological and neurological factors associated with obstructive sleep apnoea using polysomnography study data and two-dimensional cephalometric analysis of airway and skeletal parameters and their correlation in the patients with varying severities of obstructive sleep apnoea. METHODS: This study included 892 patients who underwent a complete work up, including a thorough history, clinical examination, standard polysomnography study and 2D cephalometric analysis to diagnose obstructive sleep apnoea. This study divided the participants into two groups based on the AHI score from the PSG study: AHI < 15 and AHI > 15 groups. The groups were further divided into male and female groups to study the prevalence of OSA. The analysis involved 13 cephalometric parameters: Seven linear and six angular measurements. The airway parameters measured in this study were minimum posterior airway space (PAS_min), hyoid bone to the mandibular plane (H_MNP) and soft palate length (SPL). All the subjects in this study underwent a standard overnight polysomnography study at the sleep centre in Samsung Medical Center. RESULTS: A total of 892 adult participants (M: F = 727:165, mean age: 50.6 ± 13.2 years and age range: 18-85 years). AHI >15 group was significantly older with higher BMI, NC and WC compared to the AHI < 15 groups in both male and female groups. There was statistical significance observed in N1, N3, AI, ODI, lowest saturation (%) and apnoea max length between the groups (p < .001). The arousal index (AI), especially the respiratory arousal index was considerably higher in the male group. There were significantly higher values in all the PSG parameters in the male group. In the airway parameters, hyoid bone position and soft palate length showed significant differences (p < .001), whereas the PAS did not show any differences (p = .225) between the AHI <15 and AHI >15 groups. The overall skeletal cephalometric parameters showed no significant differences between the groups, whereas the gonial angle and AB to mandibular plane angle showed significant differences in the female group (p = .028, p = .041 respectively). CONCLUSION: The partial correlation of cephalometric parameters with AHI showed a stronger correlation between the H_MNP and AHI in both men and women. The position of the hyoid bone and the soft palate length influences the progression of OSA, especially in male patients. This study found no direct association between the minimum PAS and varying severities of OSA in men and women. We speculate that more than the craniofacial morphological factors such as the sagittal and vertical position of the maxilla and the mandible, the position of the hyoid bone might be more responsible for the severity of OSA.

Obstructive Sleep Apnea Is Associated With Late-Onset Preeclampsia in Overweight Pregnant Women in Korea.

BACKGROUND: Obstructive sleep apnea (OSA) is closely related to maternal obesity in pregnant women, and the association increases with later pregnancy. Obesity and OSA are risk factors of pregnancy-related complications, including gestational hypertension, gestational diabetes mellitus (GDM), and fetal morbidities. We aimed to determine the prevalence of OSA and to assess the impact of OSA on pregnancy-related disorders in overweight pregnant women. METHODS: Eligible participants who were overweight [body mass index (BMI) ≥ 23 kg/m²] in gestational age 30 weeks or more, assessed OSA using a portable polysomnography at home. Clinical data were collected from pregnant women and their babies. RESULTS: The average age of 51 participants was 34.5 years (27-44 years). The number of primipara was 25 (49%) and that of multipara was 26 (51%). Eight cases of GDM (15.7%) and five cases of preeclampsia (9.8%) were reported, and six patients (11.8%) experienced preterm delivery. In results of polysomnography, 14 patients (27.5%) were diagnosed as OSA. Apnea-hypopnea index moderately correlated with BMI (r = 0.515, P < 0.001). The BMI (P < 0.005) and preeclampsia rate (P < 0.017) were higher in the OSA group compared to the control group. Odds ratios (ORs) adjusting age, BMI, parity, and abortion history were calculated. The presence of OSA increased OR of preeclampsia (OR, 13.1; 95% confidence interval, 1.1-171.3). The majority of preeclampsia patients (4/5, 80%) underwent preterm delivery. CONCLUSION: OSA is an important risk factor for preeclampsia, resulting in preterm delivery. For overweight pregnant women, an OSA evaluation should be mandatory.

The Mechanism of Action and Clinical Efficacy of Low-Dose Long-Term Macrolide Therapy in Chronic Rhinosinusitis.

Various chronic inflammatory airway diseases can be treated with low-dose, long-term (LDLT) macrolide therapy. LDLT macrolides can be one of the therapeutic options for chronic rhinosinusitis (CRS) due to their immunomodulatory and anti-inflammatory actions. Currently, various immunomodulatory mechanisms of the LDLT macrolide treatment have been reported, as well as their antimicrobial properties. Several mechanisms have already been identified in CRS, including reduced cytokines such as interleukin (IL)-8, IL-6, IL-1ß, tumor necrosis factor-α, transforming growth factor-ß, inhibition of neutrophil recruitment, decreased mucus secretion, and increased mucociliary transport. Although some evidence of effectiveness for CRS has been published, the efficacy of this therapy has been inconsistent across clinical studies. LDLT macrolides are generally believed to act on the non-type 2 inflammatory endotype of CRS. However, the effectiveness of LDLT macrolide treatment in CRS is still controversial. Here, we reviewed the immunological mechanisms related to CRS in LDLT macrolide therapy and the treatment effects according to the clinical situation of CRS.

Learning curve and technical nuances of endoscopic skull base reconstruction with nasoseptal flap to control high-flow cerebrospinal fluid leakage: reconstruction after endoscopic skull base surgery other than pituitary surgery.

PURPOSE: Although reconstruction techniques after endoscopic skull base surgery have been improved, there are difficulties in reconstructing the skull base with a nasoseptal flap (NSF), especially in the case of high-flow cerebrospinal fluid (CSF) leak. The aim of this study was to analyze risk factors for the development of postoperative CSF leaks in terms of less experienced surgeon practices. METHODS: Retrospective review of medical records was performed for 125 patients who underwent endoscopic skull base surgery for intradural pathology with intraoperative high-flow CSF leakage between Oct 2012 and Apr 2017. Basic demographic data were collected, including body mass index (BMI), tumor pathology, comorbidities, and outcomes. To assess the learning curve effect, patients were divided into early cohort (n = 30) and late cohort (n = 95) groups. RESULTS: Overall postoperative CSF leakage was 10.4% (13/125) in this series. There were no significant risk factors for postoperative CSF leakage among the demographic data including BMI, comorbidities, or radiation history. Postoperative CSF leakage was most prevalent in the transclival approach than in other approaches, but the difference was not statistically significant (20.8%, p = 0.351). When dividing the results by timetable, the patients who underwent skull base reconstruction in the early cohort experienced more postoperative CSF leakage (23.3%, 7 cases out of 30) than in the late cohort (6.3%, 6 cases out of 95, p = 0.014). The learning curve was steeper in the early cohort (30 early cases 23.3%, 31-60 10%, 61-90 6.7%, 91-125 2.9%). CONCLUSIONS: To improve the success rate of endoscopic skull base reconstruction, surgeons have to keep the basic technical details in mind to reduce the learning curve.

Efficacy and safety of rupatadine fumarate in the treatment of perennial allergic rhinitis: A multicenter, double-blinded, randomized, placebo-controlled, bridging study in Koreans.

BACKGROUND: The efficacy of rupatadine for the treatment of AR has been confirmed in numerous clinical studies, however there are very few studies on asian patients. OBJECTIVE: To assess the safety and efficacy of rupatadine fumarate in the treatment of Korean perennial allergic rhinitis (PAR) patients. METHODS: A multicenter, double-blind, randomized, placebo-controlled, comparative study of rupatadine fumarate and bepotastine besilate was conducted. Each group was administered rupatadine, bepotastine or placebo for 4 weeks. Primary parameters for efficacy included morning and evening symptom reduction from baseline at 4 weeks. Treatment safety and tolerability were evaluated according to a self-reported incidence and type of adverse events at each follow up visit. RESULTS: Rupatadine showed a significant reduction in symptoms at morning and evening evaluations, in both 5TSS (-5.69, P < 0.0006) and 4NTSS (-4.74, P < 0.0015) compared to placebo. There was a significant reduction from baseline for 5TSS (-65.4%, P = 0.002) and 4NTSS (-63.7%, P = 0.003) with rupatadine compared with placebo. At evening evaluations, there were significant reductions of 5TSS (-63.2%, P = 0.009) and 4NTSS (-61.6%, P = 0.013) for the rupatadine group. Compared with bepotastine, rupatadine showed greater reduction in the morning symptoms at 4 weeks. When individual symptoms were assessed with 12-hour reflective mean daily symptom score, rupatadine showed better efficacy than placebo in sneezing (P = 0.016) and rhinorrhea (P = 0.097). The rate of adverse events showed no statistical significance. CONCLUSIONS: Rupatadine is a safe and effective treatment option for Korean PAR patients and possibly a better choice over bepotastine for controlling morning symptom.

Age-associated changes in chronic rhinosinusitis endotypes.

BACKGROUND: Immunologic function in innate and adaptive immunity changes with the ageing process. Thus, age-related cytokine profiles in chronic rhinosinusitis (CRS) need to be investigated for precision medicine. OBJECTIVE: The objective of this study was to characterize age-related changes in immunologic profiles according to CRS subtypes. METHODS: Subjects in control (n = 29), CRS without nasal polyps (CRSsNP, n = 86), and CRS with nasal polyps (eosinophilic NP: ENP, n = 81; non-eosinophilic NP: NENP, n = 113) were enrolled in this study. Twenty markers for type 1/2/3 inflammation and other inflammatory processes were measured in homogenates of sinonasal tissues and statistically analysed. RESULTS: In control tissues, type 2/3 and proinflammatory mediators showed an inverse correlation with age. CRSsNP and NENP showed an age-related increase in type 2 cytokines and a decline in type 3 cytokines. Interestingly, the age-related decrease in type 3 mediators was associated with those of CT scores in NENP. ENP showed an age-related increase in type 3 cytokines with type 2 mediators sustained at high levels. Smokers with ENP demonstrated age-associated increases in type 1/2/3 mediators as well as CT scores. These age-related patterns in each CRS were confirmed by statistically adjusting atopy status, smoking history, and disease duration. CONCLUSION: Age-associated cytokine changes differed among CRS subtypes and control tissues. CRSsNP and NENP demonstrated a decline in type 3 mediators and increase in type 2 mediators, whereas type 3 mediators increased with age in ENP.

Development and evaluation of myofunctional therapy support program (MTSP) based on self-efficacy theory for patients with obstructive sleep apnea.

PURPOSE: The aim of this study is to determine the impact of myofunctional therapy support program (MTSP) based on self-efficacy theory compared to no support during myofunctional therapy (MT) in patients with obstructive sleep apnea (OSA). METHODS: Thirty-one patients with OSA were randomized into two groups: 12 weeks of treatment with the MTSP developed in this study (experimental group) and one education session of MT (control group). Patients were evaluated at the beginning and the end of the study using questionnaires (self-efficacy scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, snoring intensity and frequency, dry mouth) and polysomnography. RESULTS: The control (n = 15) and experimental (n = 16) groups had similar results for all variables at study entry. The control group showed no significant change in any variables during the study period. In contrast, the experimental group showed a significant increase in self-efficacy 61.38 ± 9.50 to 65.56 ± 10.89 (p = 0.020) and a significant decrease in apnea-hypopnea index (AHI) 19.51 ± 11.41 to 14.11 ± 9.13 (p = 0.039), daytime sleepiness 9.88 ± 3.84 to 7.56 ± 3.42 (p = 0.028), snoring intensity 5.57 ± 3.13 to 4.44 ± 2.68 (p = 0.008), and dry mouth 6.44 ± 3.14 to 3.63 ± 2.33 (p = 0.005), compared to the baseline. No significant change in lowest SaO2 (p = 0.969), sleep quality (p = 0.307), and snoring frequency (p = 0.321) during the study period. CONCLUSIONS: The intensive and interactive intervention of MTSP improved the self-efficacy of OSA patients, and consequently, resulted in sign and symptom relief, such as AHI, daytime sleepiness, snoring and dry mouth. The MTSP was dedicated to the nurse practitioner to improve the way to dispense the MT. This research has implications for the successful treatment of OSA.

Beneficial effect of nasal saline irrigation in children with allergic rhinitis and asthma: A randomized clinical trial.

BACKGROUND: Asthma and allergic rhinitis (AR) are chronic inflammatory diseases of airway and affect the disease severity each other. OBJECTIVE: We performed this study to examine whether nasal saline irrigation (NSI) improves bronchial hyperresponsiveness and clinical parameters in children with asthma and allergic rhinitis (AR). METHODS: We enrolled 20 children with AR and asthma aged between 6-18 years. Patients were randomized into two groups: irrigation group (8 boys and 2 girls) and control group (8 boys and 2 girls). The irrigation group performed daily NSI. All patients received 12-week treatment with montelukast, levocetirizine, and inhaled glucocorticoids. Provocative concentrations of methacholine causing a 20% decrease in FEV1 (PC20), Asthma Control Test (ACT), the Questionnaire for Quality-of-Life Specific to Allergic Rhinitis in Korean Children (QQOL-ARK) and exhaled nitric oxide (FENO) were compared before and after the study. RESULTS: The PC20 at week 12 was higher than baseline measurements in the irrigation group (P = 0.017), while there was no difference in PC20 before and after treatment in the control group (P = 0.333). ACT score increased after 12 weeks of NSI (P = 0.007), while QQOL-ARK score decreased compared to baseline scores (P = 0.028) in the irrigation group. No differences in ACT and QQOL-ARK were found between weeks 0 and 12 in the control group. No differences were found in the median value of changes in PC20, ACT, QQOL-ARK and FENO between the irrigation and control groups. CONCLUSIONS: Our results suggest that NSI is beneficial for treatment of asthma and AR in children.

Risk factors for intraoperative saddle nose deformity in septoplasty patients.

INTRODUCTION: Septoplasty is one of the most common otolaryngologic procedures. Previous studies have reported that the overall rate of significant change in cosmetic appearance of the nose after septoplasty ranged from 0.4 to 3.4%, and saddle nose was the most commonly cited deformity. In this study, we evaluated the risk factors for intraoperative saddle nose in a group of septoplasty patients. METHODS: This case-control study (1:2 case:control) was conducted based on retrospective chart review. Intraoperative saddle nose was observed in 108 (5.1%) of 2106 patients who underwent septoplasty in our center between January 2008 and December 2017. The control group consisted of 216 randomly selected, hospital-matched septoplasty patients who had no intraoperative saddle nose deformity in the same period. The demographic data, preoperative endoscopic findings, and surgical procedures of the two groups were analyzed to identify possible risk factors of intraoperative saddle nose deformity. RESULTS: The mean ages of the two groups were 34.8 years (saddle group) and 33.2 years (control group). In multivariate logistic regression analysis, clinical risk factors associated with intraoperative saddle nose were female gender (OR 3.39; 95% CI 1.76-6.54; p < 0.01), severe caudal septal deviation (OR 2.22; 95% CI 1.30-3.79; p = 0.003), and intraoperative finding of septal cartilage fracture (OR 3.96; 95% CI 1.92-8.19; p < 0.01). CONCLUSIONS: Severe caudal septal deviation, intraoperative fracture of septal cartilage, and female gender were risk factors for intraoperative saddle nose deformity in our study population.

Clinical pattern of fungal balls in the paranasal sinuses: our experience with 70 patients.

PURPOSE: Many physicians recommend endoscopic sinus surgery (ESS) even when an asymptomatic paranasal sinus (PNS) fungal ball is detected incidentally. The aim of this study was to investigate the natural behavior of PNS fungal balls via sinus imaging techniques. METHODS: A follow-up study of 74 pathologically confirmed fungus balls was conducted in 70 patients who underwent multiple head and neck computed tomography (CT) scans or magnetic resonance imaging (MRI). We investigated the changes in symptoms and lesion size, as well as any new occurrences. RESULTS: Of the 74 fungus balls detected in 70 patients, we observed the renewed formation of a fungal ball in 21 patients, which was not present on initial imaging conducted over a period of 2-162 months. The fungal ball was already present in 53 patients on the initial screening, and the longest follow-up was 197 months (range 1-197 months). Of these 53 lesions, 29 lesions showed an increase in size (29/53, 54.7%), whereas 12 lesions were not associated with any clinical symptoms (12/53, 22.6%). In the 21 newly formed fungal balls, further development was observed in 10 lesions, with 4 lesions showing an increase in size. Thus, size increment occurred in 33 of the 57 fungus balls. CONCLUSIONS: The fungal balls can exist without local tissue invasion for up to 17 years and new formation of the fungal balls was observed even within 2 months, especially when accompanied by initial clinical symptoms of sinusitis.

Clinical significance of IgG4 in sinonasal and skull base inflammatory pseudotumor.

INTRODUCTION: Inflammatory pseudotumor (IPT) in the sinonasal cavity and skull base region is benign non-neoplastic inflammatory process. However, IPT can mimic malignant tumor or infectious disease and there are difficulties in confirmation of diagnosis. The aim of study is to evaluate the clinical significance of immunoglobulin G4 (IgG4) in IPT in terms of steroid response and differential diagnosis with other skull base infiltrative lesions. METHODS: Medical records were reviewed retrospectively from 1998 to 2016. Subjects diagnosed with IPT by surgical biopsy were enrolled. IgG4 positivity was defined as IgG4/IgG ratio > 0.4. Additionally, IgG4/IgG ratio was calculated in eight skull base osteomyelitis (SBO) patients. RESULTS: Twenty-six IPT patients were included and the average age was 52.3 years, and 57.7% were male and 42.3% were female. Most lesions were involved in the sinuses (88.5%) and the incidence of extension beyond the sinuses itself was as follows: the cheek/hard palate/parapharynx (15.4%), orbit (61.5%), skull base (57.7%), and dura or brain (23.1%). All IPT cases revealed IgG4 + plasma cells and IgG4/IgG ratio over 0.4 was detected in 42.3% (11/26) of cases. In case of SBO, no patients had IgG4/IgG ratio exceed 0.4. Main treatment modality was systemic steroids (61.5%) and other modalities were used: surgery (3.8%), immunosuppressant (7.7%), radiotherapy (30.8%), or a combination of these modalities (15.4%). Steroid responses were not significantly different, but IgG4-positive group tended to have better response to steroid therapy. CONCLUSIONS: IgG4-positive and IgG4-negative IPT patients revealed no differences in involvement sites, clinical course, and steroid responses. However, IgG4/IgG ratio and IgG4 + plasma cell count can provide a diagnostic clue for infiltrative skull base lesions such as IPT and a differential diagnosis of SBO.

Clinical course of rhinosinusitis and efficacy of sinonasal evaluation in kidney transplant recipients: review of 1589 patients.

INTRODUCTION: Rhinosinusitis in patients who undergo kidney transplantation (KT) might have specific clinical characteristics due to immune status of recipients. The aim of this study was to identify the clinical course of rhinosinusitis after KT and to evaluate the efficacy of routine sinonasal evaluation before KT. METHODS: The study included 1589 kidney transplant adult patients who underwent preoperative sinonasal evaluation including sinonasal symptoms, nasal endoscopy, and plain X-ray between November 1994 and December 2013 (19 years). Demographic data and clinical course of rhinosinusitis were evaluated retrospectively. RESULTS: The study population consisted of 897 men (56.5%) and 692 women (43.5%) with a mean age of 42.5 years (range 18-75 years). The prevalence of pre-KT rhinosinusitis was 4.2% (66/1589), and that of post-KT rhinosinusitis was 0.9% (13/1503). The prevalence of acute rhinosinusitis and chronic rhinosinusitis (CRS) was 0.13 and 2.33% in pre-KT patients and 0.2 and 0.6% in post-KT patients, respectively. The recurrence rate of CRS in pre-KT patients was 37.8%. Of the 27 asymptomatic patients, the recurrence rate was 11.1%. Symptomatic patients had more severe endoscopic findings and higher Lund-Mackay CT scores than asymptomatic patients. The prevalence of fungal ball (0.8% in pre-KT and 0.3% in post-KT patients) was similar to that in the general population, and only one patient experienced invasive fungal rhinosinusitis after KT. No patient with pre-KT rhinosinusitis experienced severe complications. CONCLUSIONS: The prevalence and recurrence rate of rhinosinusitis in KT patients was not increased after KT. Symptomatic patients needed surgical or medical treatment before KT, but asymptomatic patients showed no deterioration of clinical course after KT. Routine sinonasal evaluation for asymptomatic patients is not recommended before KT.

Impact of gender and sleep position on relationships between anthropometric parameters and obstructive sleep apnea syndrome.

OBJECTIVE: Considering the mechanisms by which obesity affects obstructive sleep apnea syndrome (OSAS) and the differences of fat distribution depending on gender, associations between anthropometric parameters, and OSAS may differ depending on gender or sleep position. We analyzed the impact of gender and sleep position on the relationship between fat distribution and development of OSAS. METHODS: One thousand thirty-two consecutive subjects were analyzed. Recorded anthropometric measurements and overnight polysomnographic data of the subjects were reviewed retrospectively. The presence of OSAS was defined by the respiratory disturbance index (RDI) ≥5 with documented symptoms of excessive daytime sleepiness. RESULTS: Eight hundred fifty-eight males and 174 females were included. Male subjects had significantly higher body mass index (BMI), larger waist circumference (WC), and lower percent of overall body fat (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). The severity of OSAS was significantly higher in male subjects (RDI 26.9 ± 22.4 in males vs. 10.2 ± 13.8 in females, P < 0.0001). In male subjects, BMI, WC, and overall body fat were significantly associated with severity of OSAS and had larger impacts on supine RDI than lateral RDI. Overall body fat was not associated with severity of OSAS in female subjects, and there were no significant differences of the associations between all anthropometric parameters and RDIs depending on sleep position. CONCLUSIONS: Evaluation of the correlation of anthropometric data with severity of OSAS should consider sleep position as well as gender.

Effect of uvulopalatopharyngoplasty on CPAP compliance.

In this retrospective cohort study, we tried to evaluate the compliance of continuous positive airway treatment (CPAP) in the patients with or without previous surgical treatment to OSAS. Retrospective study with prospectively collected data was performed. Eighty-six consecutive OSAS patients who decided to try CPAP were enrolled, and data regarding polysomnography, history of previous surgical treatment and CPAP usage were collected. Among them, nine patients who had history of uvulopalatopharyngoplasty for OSAS were included in the surgery group and another 77 non-surgical patients were assigned to the untreated group. There was no statistical difference for demographics or polysomnographic parameters. They showed similar CPAP acceptance and air leak after the first trial. However, the surgery group (6.39 ± 1.49 h/day) used CPAP significantly longer than the untreated group (4.73 ± 1.64 h/day; p = 0.007) and less troubled with 'waking up during night'. The present study showed that the prior surgery for OSAS doesn't preclude the subsequent CPAP therapy.

Sinonasal evaluation and treatment before liver transplantation: a retrospective review of 982 patients.

Immunosuppression after liver transplantation (LT) increases complications from infection. The usefulness of sinonasal evaluation before LT has not been fully evaluated. The aim of this study was to determine the usefulness of routine sinonasal evaluation before LT and pre-transplant treatment of sinusitis. The clinical records of 982 adult patients (age ≥18 years) who underwent LT between January 1997 and June 2011 were retrospectively reviewed and analyzed. A total of 920 patients (93.7 %) underwent pre-LT sinonasal evaluation, including a sinonasal symptom questionnaire, nasal endoscopy and plain X-ray. Of these patients, 269 (29.2 %) had abnormal findings and underwent paranasal CT scans. Based on CT, 102 patients, including 21 with fungal ball, were diagnosed with sinusitis and 62 (60.8 %) underwent LT after medical or surgical treatment for sinusitis. Another 40 patients (33 with sinusitis and 7 with fungal ball) underwent LT without treatment for sinusitis. No difference in infectious complications was observed according to sinusitis treatment type. Among chronic rhinosinusitis patients, those who underwent LT (n = 48) after adequate treatment had a lower mortality rate than those who did not receive treatment (n = 33) (12.5 vs. 33.3 %; p = 0.024). Sinonasal evaluation preceding LT did not prevent infectious complications but untreated sinusitis might be correlated with increased mortality after LT. Routine pre-LT sinonasal evaluation would be considered for safer transplantation.

Differences in Nasal Shapes and the Degree of Changes Over a Decade or More: A Paired Analysis.

OBJECTIVES: This study investigated age-related differences in nasal morphometry and the degree of changes within an individual over at least a 10-year period by pairing previous and recent three-dimensional reconstructed computed tomography (CT) images. METHODS: Forty-eight adult Korean patients who underwent at least two CT scans of the nasal region with an interval of at least 10 years were selected. Patients were categorized into six subgroups according to sex and age (20-39 years, 40-49 years, and ≥50 years) at the time of initial imaging. Eight nasal parameters were measured on the initial and recent images, and paired comparisons between the two images were performed based on the data. The differences in the degree of change by age were also analyzed. RESULTS: Over an average image interval of 12 years, men exhibited an increase in the nasofrontal angle (3.2°±5.4°, P=0.041), profile nasal length (1.7±1.7 mm, P=0.002), and nasal bridge height (1.2±1.6 mm, P=0.002). Conversely, they showed a decrease in the nasofacial angle (-2.3°±2.9°, P=0.010). Women also demonstrated an increase in the nasofrontal angle (2.5°±5.2°, P=0.010), profile nasal length (1.4±1.9 mm, P<0.001), and nasal bridge height (1.3±1.6 mm, P<0.001). However, they exhibited a decrease in the nasofacial angle (-2.0°±2.1°, P<0.001), glabella angle (-9.1°±9.8°, P<0.001), and pyriform angle (-8.5°±10.1°, P<0.001). With the exception of the nasal bridge height (P=0.036) and pyriform angle (P=0.022), the degree of changes in most parameters did not show significant differences across age groups. CONCLUSION: Our findings indicate that the aging nose exhibits a greater nasal length with inferior angulation of the nasal tip, with an increase in the nasofrontal angle, profile nasal length, and nasal bridge height, along with a decrease in the nasofacial angle. The degree of most nasal morphologic changes demonstrated no significant differences by specific age group.

The functional and biological effects of systemic dexamethasone on mice with facial nerve crushing injury.

BACKGROUND: Corticosteroid therapy is commonly recommended for acute facial nerve weakness; however, its effectiveness in treating traumatic nerve injuries remains controversial. This study investigated the functional recovery and cellular effects of systemic dexamethasone administration after facial nerve injury. METHODS: C57BL/6 mice were assigned to two groups by intraperitoneal injection: the phosphate-buffered saline group and the dexamethasone group. Facial nerve crush injury was induced, followed by the functional grading of recovery. Cellular effects were investigated using transmission electron microscopy, flow cytometry, immunofluorescence, and intravital imaging. RESULTS: Macrophage infiltration into the facial nerves was significantly inhibited by systemic dexamethasone administration. However, dexamethasone group slightly delayed the functional recovery of the facial nerve compared to the PBS group. In addition, the morphological changes in the nerve were not significantly different between the two groups at 14 days post-injury. Macrophage migration analysis in the intravital imaging also showed no difference between groups. CONCLUSIONS: In summary, systemic dexamethasone successfully inhibited leukocyte infiltration; however, functional recovery was delayed compared to the PBS control group. Clinically, these findings indicate that more evidence and research are required to use steroid pulse therapy for the treatment of traumatic facial nerve injuries.

Obstructive sleep apnea and its association with coronary artery calcium volume in asymptomatic male subjects.

The aim of this study was to analyze the association between various parameters related to obstructive sleep apnea (OSA) and coronary artery calcium (CAC) volume. We retrospectively reviewed the medical records of 315 male subjects who underwent standard polysomnography (PSG) and coronary artery computed tomography. In this study, we found that only the apnea index (AI) and minimal oxygen saturation (minimal SaO2) were independently associated with CAC volume after adjustment for confounders; for a 1/h increase in the AI, the CAC volume increased by 1.311 mm3, and for a 1% increase in the minimal SaO2, the CAC volume decreased by 2.187 mm3. We also found that the CAC volume was significantly different between the habitual snorer and the severe OSA group (21.27 ± 40.79 vs 71.33 ± 175.00, p = 0.042). Moreover, the CAC volume was significantly different between the first and fourth quartile groups of the AI (32.42 ± 59.54% vs. 78.74 ± 198.50, p = 0.048), but not among groups according to the hypopnea index quartile. Therefore, we concluded that among various OSA-related PSG parameters, the AI and minimal SaO2 was independently associated with the CAC volume and significantly related to upcoming cardiovascular events in middle-aged men.

White matter microstructure and connectivity changes after surgery in male adults with obstructive sleep apnea: recovery or reorganization?

Study objectives: Obstructive sleep apnea (OSA) is a prevalent clinical problem significantly affecting cognitive functions. Surgical treatment is recommended for those unable to use continuous positive airway pressure. We aimed to investigate the therapeutic effect of upper airway surgery on the white matter (WM) microstructure and brain connectivity in patients with OSA. Methods: Twenty-one male patients with moderate-to-severe OSA were recruited for multi-level upper airway surgery. Overnight polysomnography (PSG), neuropsychiatric tests, and brain MRI scans were acquired before and 6.1 ± 0.8 months after surgery. Nineteen male patients with untreated OSA were also included as a reference group. We calculated the longitudinal changes of diffusion tensor imaging (DTI) parameters, including fractional anisotropy (ΔFA) and mean/axial/radial diffusivity (ΔMD/AD/RD). We also assessed changes in network properties based on graph theory. Results: Surgically treated patients showed improvement in PSG parameters and verbal memory after surgery. Globally, ΔFA was significantly higher and ΔRD was lower in the surgery group than in the untreated group. Especially ΔFA of the tracts involved in the limbic system was higher after surgery. In network analysis, higher Δbetweenness and lower Δclustering coefficients were observed in the surgical group than in the untreated group. Finally, the improvement of verbal memory after surgery positively correlated with ΔFA in superior thalamic radiation (p = 0.021), fronto aslant tracts (p = 0.027), and forceps minor tracts (p = 0.032). Conclusion: Surgical treatment of OSA can alleviate alterations in WM integrity and disruptions in local networks, particularly for the tracts involved in the limbic system. These findings may further explain the cognitive improvement observed after the treatment of OSA.

One-Unit Osteotomy to Correct Deviated Bony Dorsum.

OBJECTIVES: A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vault is an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial and lateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfaction with deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure that combines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of both nasal bones. METHODS: Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy were enrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnaire was used to evaluate each patient's functional outcome. The angle of bony vault deviation before and after one-unit osteotomy was measured using a protractor and compared with the. RESULTS: of 14 patients who had undergone conventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and 3 months postoperatively. RESULTS: NOSE values improved from 8.4±6.4 to 4.1±4.2 (P =0.021). The angle of bony vault deviation improved from 6.9°±2.2° to 2.1°±1.2° (P <0.001) in one-unit osteotomy and from 7.3°±4.0° to 2.7°±1.2° (P =0.001) in conventional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6% in conventional osteotomy, which was a significant difference (P =0.033). The mean grade of the postoperative esthetic outcomes for the remaining deviation was 1.6±0.5, which was similar to that in the conventional osteotomy group. CONCLUSION: One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removing excessive bony fragments from the wider bony wall and providing better structural integrity. This technique improves functional outcomes and has equivalent esthetic. RESULTS: to those of the traditional procedure.