A Narrative Review of the Association between Obstructive Sleep Apnea and Glaucoma in Adults.

BACKGROUND: Obstructive sleep apnea (OSA) is a sleep disorder, primarily of the upper airway, which not only has a significant impact on quality of life but is also associated with various systemic diseases. Several ophthalmological diseases are also associated with OSA, especially glaucoma. The purpose of this review is to take a closer look at the causality and mutual influence. METHODS: A systematic literature search was conducted using PubMed. A total of 19 studies with 316,178 adult participants were included. RESULTS: Eleven of the sixteen studies concentrating on the prevalence of glaucoma in patients with OSA showed an association of both entities. One paper found a higher risk for progression of glaucoma in OSA patients. Five of the sixteen included studies failed to show a correlation between OSA and glaucoma. One study out of three surveying specific ophthalmological parameters showed an influence of OSA therapy on retinal nerve fiber layer (RNFL) thinning and vision. One study showed a rise in intraocular pressure (IOP), while two other studies showed no increase under continuous positive airway pressure (CPAP). CONCLUSIONS: Our findings suggest an association between OSA and glaucoma and, especially, between OSA and thinning of RNFL. CPAP therapy appears to be also suitable for patients with comorbid glaucoma.

Sensorimotor Cortical Activity during Respiratory Arousals in Obstructive Sleep Apnea.

Intensity of respiratory cortical arousals (RCA) is a pathophysiologic trait in obstructive sleep apnea (OSA) patients. We investigated the brain oscillatory features related to respiratory arousals in moderate and severe OSA. Raw electroencephalography (EEG) data recorded during polysomnography (PSG) of 102 OSA patients (32 females, mean age 51.6 ± 12 years) were retrospectively analyzed. Among all patients, 47 had moderate (respiratory distress index, RDI = 15−30/h) and 55 had severe (RDI > 30/h) OSA. Twenty RCA per sleep stage in each patient were randomly selected and a total of 10131 RCAs were analyzed. EEG signals obtained during, five seconds before and after the occurrence of each arousal were analyzed. The entropy (approximate (ApEn) and spectral (SpEn)) during each sleep stage (N1, N2 and REM) and area under the curve (AUC) of the EEG signal during the RCA was computed. Severe OSA compared to moderate OSA patients showed a significant decrease (p < 0.0001) in the AUC of the EEG signal during the RCA. Similarly, a significant decrease in spectral entropy, both before and after the RCA was observed, was observed in severe OSA patients when compared to moderate OSA patients. Contrarily, the approximate entropy showed an inverse pattern. The highest increase in approximate entropy was found in sleep stage N1. In conclusion, the dynamic range of sensorimotor cortical activity during respiratory arousals is sleep-stage specific, dependent on the frequency of respiratory events and uncoupled from autonomic activation. These findings could be useful for differential diagnosis of severe OSA from moderate OSA.

[Functional and morphological disorders of taste and olfaction in COVID-19 patients]. / Funktionelle und morphologische Geschmacks- und Geruchsstörungen bei COVID-19-Patienten.

OBJECTIVE: This study aimed to test the prevalence and evolution of acute olfactory and gustatory functional impairment and their morphologic correlates in COVID-19 patients who require hospitalization due to COVID-19-related respiratory conditions. METHODS: Included were 53 consecutive hospitalized patients (23 males, 30 females; age 42.54 ± 10.95 years) with an RT-PCR-confirmed COVID-19 diagnosis. Patients were examined twice: just after hospital discharge and 4-6 weeks later. Electrogustometric (EGM) thresholds at the tongue area supplied by the chorda tympani, at the soft palate, and in the region of the vallate papillae were recorded bilaterally. Olfaction was examined by Sniffin' sticks (Burghardt GmbH, Wedel, Germany). The patients' nasal and oral mucosa (fungiform papillae, fpap) were examined by contact endoscopy. Findings were compared to those of 53 healthy individuals matched for sex and age (23 males, 30 females; age 42.90 ± 10.64 years). RESULTS: EGM thresholds in patients were significantly higher than those of healthy subjects at both timepoints. EGM thresholds at the second measurement were significantly lower than those at the first measurement. Accordingly, patient-reported gustatory outcomes were improved at the second measurement. The same pattern was found using Sniffin' sticks. Significant alterations in form and vascularization of fPap were detected in patients, especially at the first instance. Interestingly we did not observe any significant changes in the morphology and vascularization of nasal mucosa. CONCLUSION: COVID-19 affects both gustatory and olfactory functions. In parallel, it also affects the structure and vascularization of both nasal and oral mucosa, albeit the nasal mucosa to a much lesser, non-significant extent. Our findings suggest that COVID-19 may cause a mild to profound neuropathy of multiple cranial nerves.

Obstructive Sleep Apnea Disrupts Glycemic Control in Obese Individuals.

The link between obstructive sleep apnea (OSA) and obesity, and their common comorbidities such as diabetes mellitus (DM) or cardiovascular diseases, is not fully understood. The aim of this study was to investigate the possible association of OSA severity in obese individuals with polysomnography-based sleep parameters, as well as C-reactive protein (CRP) and glycated hemoglobin (HbA1c) serum levels. Polysomnographic recordings and blood samples were retrospectively compared between a group of 23 adult obese individuals with mild OSA (apnea-hypopnea index (AHI) = 7.5 (5.5-12.5)/h, age = 42.57 ± 11.44 years, 16 male, 7 female, body mass index (BMI) = 37.35 ± 3.88 kg/m²) and an age-, sex-, and BMI-matched group of individuals with moderate or severe OSA (AHI 41.5 (25.7-71.8)/h, age = 43.43 ± 11.96 years, 16 male, 7 female, BMI = 37.87 ± 4.74 kg/m²). All respiratory sleep-associated parameters were significantly higher in individuals with moderate and severe OSA compared to those with mild OSA. CRP levels did not differ between the two OSA severity groups. However, serum levels of HbA1c were significantly higher in the moderate/severe OSA group. Therefore, OSA severity may have a significant impact on glycemic control in obese individuals. Additionally, OSA severity did not appear to be further associated with systemic inflammation in obese individuals. Obese individuals may benefit not only from lifestyle modification, but also from OSA screening and treatment, particularly to prevent DM-associated disorders and conditions.

Quality of Life Assessment for Tonsillar Infections and Their Treatment.

Background and Objectives: Tonsillar infections are a common reason to see a physician and lead to a reduction in the patients' health-related quality of life (HRQoL). HRQoL may be an important criterion in decision science and should be taken into account when deciding when to perform tonsillectomy, especially for chronic tonsillitis. The aim of this study was to determine the health utility for different states of tonsillar infections. Materials and Methods: Hospitalized patients with acute tonsillitis or a peritonsillar abscess were asked about their HRQoL with the 15D questionnaire. Patients who had undergone tonsillectomy were reassessed six months postoperatively. Results: In total, 65 patients participated in the study. The health states of acute tonsillitis and peritonsillar abscess had both a utility of 0.72. Six months after tonsillectomy, the mean health utility was 0.95. Conclusions: Our study confirms a substantial reduction in utility due to tonsillar infections. Tonsillectomy significantly improves the utility and therefore HRQoL six months after surgery.

OSA in patients with head and neck cancer is associated with cancer size and oncologic outcome.

PURPOSE: Obstructive sleep apnea (OSA) is associated with severe daytime sleepiness and reduced quality of life. These symptoms are also present in patients with squamous cell carcinoma of the head and neck (SCCHN) before, during and after treatment, so that comorbidity cannot be excluded. The aim was to evaluate the prevalence of OSA and its impact on the quality of life in patients with oropharyngeal, hypopharyngeal and lateral tongue SCCHN in a prospective study. METHODS: We performed cardiorespiratory home sleep apnea testing and recorded sleep-related patient-reported outcomes in 33 patients with confirmed oropharyngeal, hypopharyngeal and lateral tongue SCCHN. We correlated the sleep-related variables to oncologic variables and endpoints. RESULTS: Five female and 28 male patients with SCCHN (aged 46-77 years) were recruited. Thirty patients (90%) had OSA as defined by an Apnea/Hypopnea Index (AHI) > 5 /h before treatment. Evaluation after treatment, which was possible in 17 patients, showed OSA in 16 patients (94%). Radiologic primary tumor size showed significant positive correlation with AHI and apnea-index. Tumor recurrence and tumor-related mortality showed significant positive association with AHI. PSQI of these patients showed at least a moderate sleep disturbance. EORTC QLQ c30 questionnaire showed reduced values for all tested qualities, in particular for fatigue, insomnia, pain and financial distress. CONCLUSION: Obstructive sleep apnea is a significant comorbidity in patients with SCCHN. Pre-interventional AHI may be correlated with the oncologic outcome. Further research is needed to further describe the course of OSA and its treatment before, during and after therapy.

Electrogustometry: Normative data for stimulus duration, tongue site and age decline.

OBJECTIVES: Our primary goal was to evaluate the effect of stimulus duration on electrogustometry (EGM) thresholds. Additionally, we sought to evaluate any sex-related influences and compare the above results to those of taste strips. DESIGN: Electrogustometry thresholds of various stimulus durations (0.5, 1.0, 1.5 and 2.0 seconds) were measured in 212 non-smokers (age range: 10-80 years, divided into eight age-groups) without self-reported gustatory impairment. Furthermore, taste strips chemogustometry measurements in 132 participants were performed. SETTING: Tertiary referral medical centre. PARTICIPANTS: 212 non-smokers, divided into eight age-groups participated in the study. MAIN OUTCOME MEASURES: Electrogustometry thresholds and taste strips, duration of EGM stimuli. RESULTS: Electrogustometry thresholds increased progressively with age and with stimulus duration from 0.5 to 2 seconds. This pattern was consistent in all six anatomic areas, irrespective of sex. In contrast, when using chemogustometry, no age- or sex-related differences were observed. CONCLUSIONS: Electrogustometry-threshold values increase progressively with age and with stimulus duration. Therefore, we recommend documenting stimulus duration in the future EGM recordings as it may significantly affect EGM amplitude threshold values.

Obstructive Sleep Apnea in Patients with Head and Neck Cancer-More than Just a Comorbidity?

Obstructive sleep apnea is the most common type of sleep-disordered breathing with growing prevalence. Its presence has been associated with poor quality of life and serious comorbidities. There is increasing evidence for coexisting obstructive sleep apnea in patients suffering from head and neck cancer, a condition that ranks among the top ten most common types of cancer worldwide. Routinely, patients with head and neck cancer are treated with surgery, radiation therapy, chemotherapy, immunotherapy or a combination of these, all possibly interfering with the anatomy of the oral cavity, pharynx or larynx. Thus, cancer treatment might worsen already existing obstructive sleep apnea or trigger its occurrence. Hypoxia, the hallmark feature of obstructive sleep apnea, has an impact on cancer biology and its cure. Early diagnosis and sufficient treatment of coexisting obstructive sleep apnea in patients with head and neck cancer may improve quality of life and could also potentially improve oncological outcomes.

Obstructive sleep apnea as a risk factor for primary open angle glaucoma and ocular hypertension in a monocentric pilot study.

BACKGROUND: Both glaucoma and obstructive sleep apnea (OSA) are widespread diseases. OSA may presumably partly cause or worsen glaucoma, although the etiopathogenesis is unclear. Here we analyze for the first time the possible association between different glaucoma phenotypes and OSA. METHODS: 110 patients (47 females, 63 males; median age 64.3 years, median BMI 26.62 kg/m2) with suspected glaucoma and without any prior diagnosis of OSA were prospectively studied by one-night home sleep apnea testing (HSAT), 101 of the patients were analyzed. HSAT parameters, like apnea hypopnea index (AHI) and oxygen desaturation index as well as opthalmological parameters like intraocular pressure (IOP) and mean defect depth (MD) were collected. Moreover, HSAT results were compared across four phenotypic groups: primary open angle glaucoma (POAG), low-tension-glaucoma (LTG), ocular hypertension (OH), and controls. RESULTS: There was no strong correlation between IOP or MD and AHI. BMI, age and gender did not differ between groups. Significant differences between POAG and LTG were found for all HSAT parameters. The AHI showed the most prominent group difference (Wilcoxon-Kruskal-Wallis rank sum test was highly significant with chi2 = 22, df = 3 p < 0.0001) with severely lower event rates in the LTG (9.45/h) compared to POAG (22.7/h) and controls (21.9/h; p < 0.0001 and 0.02, respectively). Highly significant differences were found between the four groups regarding AHI (Chi2 = 22, df = 3, p < 0.0001) with significantly lower events per hour in the LTG compared to POAG (Hodges-Lehmann = - 13.8, 95% CI (- 18.6 - - 8.8; p < 0.0001) and to controls (Hodges-Lehmann = 12.1, 95% CI -19.9 - - 2.4; p < 0.02). Severe and moderate OSA was more prevalent in POAG (69.8%) and OH (33.3%) than in LTG (9%). The effect of the glaucoma phenotype on the AHI was more prominent in females (p = 0.0006) than in males (p = 0.011). CONCLUSION: Although physical endpoints, such as MD and IOP, do not correlate with AHI, there was a strong correlation between the POAG and OH clinical glaucoma phenotypes and the AHI. Further studies should investigate the necessity to test routine screening for OSA by HSAT in patients with diagnosed POAG and OH. Besides, some characteristics of LTG differed widely from other glaucoma types and controls. LTG patients had a significantly lower rate of OSA compared to other glaucoma types and even controls. This might be due to a different pathogenesis of LTG. TRIAL REGISTRATION: Retrospectively registered at DRKS ( nr. S00021201 ) on April 9th 2020.

Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.

OBJECTIVE: Ramsay Hunt syndrome (RHS) and Bell palsy (BP) are typically known as facial nerve motor syndromes and are primarily unilateral. The aim of this study was to challenge this assertion, because both conditions are also known to be associated with viruses that typically affect several nerves. METHODS: Ten participants with RHS, 12 with BP, all clinically unilateral, and 12 healthy controls were prospectively enrolled. Electrogustometric thresholds were measured bilaterally in the areas of the chorda tympani, the glossopharyngeal, and the major petrosal nerve. Also bilaterally, the taste function was tested using chemogustometry with different tastant concentrations. Again bilaterally, the morphology of the mucosa and the vessels of the anterior fungiform papillae were examined by contact endoscopy. Statistically, RHS and BP participants were compared with the healthy controls, and the paretic sides of RHS and BP were compared pairwise with their mobile sides. RESULTS: Electrogustometrically, perception was reduced bilaterally in RHS (10-19dB, p < 0.001) and BP (3-5dB, p = 0.011-0.030) in all 3 innervation areas. Chemogustometrically, it was also reduced bilaterally in RHS (20-70%) and BP (8-50%). Papillary atrophies were increased 100% in RHS (p = 0.001) and BP (p < 0.001). They were more increased on the paretic side in RHS (30%, p = 0.078) and BP (83%, p < 0.001). INTERPRETATION: In these 2 clinically unilateral conditions, the gustatory perception and morphology are bilaterally affected, more in RHS and more on the paretic side. BP, known as an isolated motor condition, appears to be a cranial polyneuritis. A bilateral examination and therapeutic gustatory monitoring might follow these observations in evidence-based practice. Ann Neurol 2018;83:807-815.

Electrogustometry Thresholds, Tongue Tip Vascularization, Density, and Form of the Fungiform Papillae Following Smoking Cessation.

The objective of this study was to evaluate differences in gustatory function and in shape, density, and vascularization of the fungiform papillae (fPap) of smokers' tongue before and after smoking cessation. In 24 smokers (19 males, 5 females; median age: 54.6 ± 2.9 years) electrogustometry (EGM) thresholds at the chorda tympani area, at the soft palate area and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fungiform papillae (fPap) and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). Follow-up exams (EGM and CE) were performed on average 3.2 months after smoking cessation. Findings were compared between the 2 conditions as well as to those of a group of 24 non-smokers (median age: 55.2 ± 3.4 years; 19 males, 5 females). After smoking cessation, EGM thresholds decreased significantly (P = 0.02 or P = 0.03 depending on the tested area) but nonetheless still were quite different from those of non-smokers (P = 0.05 or 0.04 depending on the site of EGM measurement). Under CE the fPap density was higher after quitting smoking (P = 0.05) and the shape and vascularization of fPap also exhibited a trend to improvement (P = 0.05) after smoking cessation. Chronic exposure to cigarette smoke infers long lasting, although to a large extent reversible, alterations in morphology of taste buds in fungiform papillae, but rather irreversible EGM-related functional gustatory compromise, suggesting a profound physiologic effect on human peripheral taste organs.

Systemic inflammation in patients with compromised upper airway anatomy and primary snoring or mild obstructive sleep apnea.

Our aim was to study associations between serum fibrinogen and C-reactive protein (CRP) levels and respiratory parameters on polysomnography (PSG) in patients with snoring as their main complaint and compromised upper airway anatomy. In this retrospective study, consecutive patients (43 female and 132 male; age range 11-82 years, respiratory distress index-RDI range 0.1-94.4/h) with snoring as their main complaint and compromised upper airway anatomy who underwent PSG were assessed. Spearman's Rho coefficients between RDI, AI (apnea index), hypopnea index (HI), average and lowest SpO2 (in %) and CRP- and fibrinogen serum levels were calculated. Comparisons between groups were made using Wilcoxon-W test. Patients with CRP > 5 mg/dl (22 % of the cohort) had significantly increased RDI, AI, average and lowest SpO2 than patients with CRP < 5 mg/dl. Increased correlation coefficients were observed for average SpO2 (-0.386), RDI (0.355), lowest SpO2 (-0.323) and AI (0.309). Patients with fibrinogen >350 mg/dl (in 33 %) had significantly increased RDI, HI, AI, average and lowest SpO2 than patients with fibrinogen <350 mg/dl. Increased correlation coefficients were found for average (-0.340) and lowest (-0.268) SpO2, RDI (0.236) and AI (0.229). Even patients with RDI < 15/h had increased serum CRP-(in 11 %) and/or fibrinogen-(in 19 %) levels. Simultaneous elevation of both CRP and fibrinogen levels occurred only in patients with RDI > 5/h. Systemic inflammation is strongly associated with average and lowest SpO2, RDI and AI (and with HI) in snorers with compromised upper airway anatomy and is present even in patients with primary snoring and mild obstructive sleep apnea.

Electrogustometry and contact endoscopy findings in patients with head and neck malignancies treated with chemotherapy, radiotherapy, or radiochemotherapy.

This study aimed to investigate in parallel changes in gustatory function, changes in morphology of the fungiform papillae, as well as changes in the shape and density of the vessels of the tip of the tongue in patients treated with chemotherapy, radiotherapy, or radiochemotherapy. Twenty patients (7 females and 13 males; age range: 42-78 years) with head and neck malignancies (hypopharynx, larynx, oropharynx, and parotid) treated with radiochemotherapy (n = 8), chemotherapy (n = 8), or radiotherapy (n = 4) were prospectively studied. In all patients, electrogustometry and contact endoscopy were performed. Radiotherapy-treated patients exhibited higher electrogustometry thresholds and greater alterations in the morphology and vascularization of the fungiform papillae than the other two groups. Radiochemotherapy patients had less pronounced changes of the electrogustometry threshold and fungiform papillae structure compared with radiotherapy patients. Chemotherapy alone caused less severe change in both electrogustometry threshold and fungiform papillae structure than radiotherapy or radiochemotherapy. Radiotherapy alone caused greater disorders of taste-related anatomic parameters and electrogustometry thresholds compared with chemotherapy and combined radiochemotherapy.

Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: long-term results in 91 procedures.

BACKGROUND: The purpose of the present study was to evaluate long-term outcomes of endoscopic dacryocystorhinostomy (DCR) using a drill without the use of mucosal flaps. Ninety one procedures in eighty seven patients were reviewed. All patients showed epiphora, caused by primary or secondary nasolacrimal obstruction. METHODOLOGY: All patients underwent preoperative evaluation (irrigation and probing of the lacrimal drainage system, fluorescein tests, computerized tomography scan of the paranasal sinuses, dacryocystography and endoscopic examination of the nasal cavity). In 19 patients further intranasal procedures were conducted simultaneously with DCR (10 FESS, 2 septoplasties, 5 functional endoscopic sinus surgery (FESS) and septoplasties, 2 septoplasties and turbinoplasties). Stents were placed intraoperatively and removed 4 to 12 weeks, postoperatively. Postoperative follow-up ranged between 12 and 24 months. RESULTS: Long-term success was achieved in 87/91 procedures. No major complications were observed. Failure was caused by granulation tissue formation in three patients and inappropriate stent removal in one patient. CONCLUSION: The success rate achieved is comparable to success rates of external DCR.

Difficulty Falling Asleep is Associated with Poorer Therapeutic Outcomes in Unilateral Hypoglossal Nerve Stimulation.

Purpose: The coexistence of insomnia and obstructive sleep apnea (OSA) is very prevalent. Hypoglossal nerve stimulation (HGNS) is an established second-line therapy for patients suffering OSA. Studies investigating the effect of the different aspects of insomnia on the therapeutic outcome are largely missing. Therefore, this study aimed to understand the impact of the different aspects of insomnia on the therapeutic outcome under HGNS therapy in clinical routine. Patients and Methods: This is a retrospective study including 30 consecutive patients aged 55.40 ± 8.83 years (8 female; 22 male) undergoing an HGNS implantation in our tertiary medical center between 2020 and 2023. All patients underwent preoperative polysomnography (PSG) according to AASM. First follow-up PSG was performed 95.40 ± 39.44 days after activation (30 patients) and second follow-up PSG was performed 409.89 ± 122.52 days after activation (18 patients). Among others, the following PSG-related parameters were evaluated: apnea-hypopnea index (n/h) (AHI) and oxygen desaturation index (n/h) (ODI). Insomnia was assessed by the insomnia severity index (ISI) questionnaire. Preoperatively, all patients included filled out each ISI item. Spearman's-rho correlation coefficient was calculated for correlations. Results: Preoperative score of ISI item 1 (difficulty falling asleep) was 1.93 ± 1.34 and preoperative cumulative ISI score (item1-7) was 18.67 ± 5.32. Preoperative AHI was 40.61 ± 12.02 (n/h) and preoperative ODI was 38.72 ± 14.28 (n/h). In the second follow-up, the mean difference in AHI was ∆ 10.47 ± 15.38 (n/h) and the mean difference in ODI was ∆ 8.17 ± 15.67 (n/h). Strong significant correlations were observed between ISI item 1 (difficulty falling asleep) and both ∆ AHI (r: -0.65, p=0.004) and ∆ ODI (r: -0.7; p=0.001) in the second follow-up. Conclusion: Difficulty falling asleep may hence negatively influence HGNS therapeutic outcome. Insomnia-related symptoms should be considered in the preoperative patient evaluation for HGNS.

Periodic limb movements in patients with suspected obstructive sleep apnea without comorbid conditions.

Background: Periodic limb movement disorder (PLMD) and obstructive sleep apnea (OSA) are overlapping clinical syndromes with common risk factors. However, current literature has failed to establish a clear pathophysiological link between them. Thus, little is known about periodic limb movements (PLM) in otherwise healthy patients with suspected OSA. Methods: We performed a retrospective analysis of 112 patients (age: 44.5 ± 12.0 years, 14.3% female) with suspected OSA who underwent full night polysomnography for the first time. Patients with chronic diseases of any kind, recent infections, malignancies, or daily or regular use of any type of medication were excluded. Group comparisons were made based on the severity of OSA (using the apnea hypopnea index, AHI) or the periodic limb movement index (PLMI). Results: Both, PLMI and the total number of periodic limb movements during sleep (PLMS), showed a significant increase in patients with severe OSA. In addition, AHI and apnea index (AI) were significantly higher in patients with PLMI >15/h, with a similar trend for hypopnea index (HI) (p < 0.001, p < 0.001, and p > 0.05, respectively). PLMI was significantly positive correlated with AHI, AI, and HI (r = 0.392, p < 0.001; r = 0.361, p < 0.001; and r = 0.212, p < 0.05, respectively). Patients with PLMI >15/h were significantly older (p < 0.001). There was no significant association between body mass index (BMI) and PLMI >15/h. Conclusion: We found a significant association between the severity of OSA and PLM in our study population with suspected OSA but without other comorbidities. PLMI and PLMS were significantly increased in patients with severe OSA. Future prospective studies with larger collectives should verify the presented results and should include mechanistic aspects in their evaluation.

Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords: Vascular and morphological changes of vocal folds in leukoplakia and cancer.

Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32-73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group-group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn't significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.

Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea.

BACKGROUND: Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups. METHODS: 20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting. RESULTS: Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01). CONCLUSION: These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.

Role of Memantine in Limiting Cochleotoxicity in Rats.

Οur aim was to test whether amikacin's well-known cochleotoxic effects could be suppressed, depending on whether an NMDA-antagonist (memantine) was administered simultaneously with or after amikacin treatment. Forty Wistar rats were used in this experiment. Ten rats acted as controls and received no medication (group A). Amikacin (200 mg/kg) was administered intraperitoneally (i.p.) once daily for 14 days to 10 animals in group B; amikacin (200 mg/kg) was administered concurrently with memantine (10 mg/kg, i.p., once daily) to the same 10 animals in group C. Group D was given intraperitoneal memantine (10 mg/kg, once daily) for 14 days following a 2-week amikacin treatment. The cochlear activity of the right ear was tested using DPOAE in conscious animals. All animals were sacrificed at the conclusion of the experiment and both cochleae were collected for histological and immunohistochemical analysis. All groups treated with amikacin showed decreased cochlear activity, as testified by decreased DPOAE-amplitudes compared to the pre-treatment state. In the rats of group B, the DPOAE reduction was more pronounced. On histologic exam, the cochlear structures of group C rats and, although to a lesser extent, group D rats showed less severe cochlea damage. Memantine plays a protective role, resulting in restoring partially cochlear structures when administered either simultaneously with or after completion of amikacin i.p. treatment in rats.