Analysis of snoring to determine the site of obstruction in obstructive sleep apnea syndrome.

BACKGROUND: The aim of this study was to integrate the physical findings of drug-induced sleep endoscopy with snoring sound analysis in patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and to compare the findings with previously published data. METHODS: This was a prospective, non-randomized study. Participants were all candidates for surgical treatment of OSAS and formed three groups, retropalatal (RP) obstructions, retrolingual (RL) obstructions, and multilevel (ML) obstructions. At the time of DISE, recordings of concurrent snoring sounds were made. Mean pitch frequency, peak sound frequency, and fundamental frequency (Fo) components were determined. RESULTS: A total of 55 participants had mean age 46.2 ± 7.3 years, mean BMI 30.0 ± 3.7 kg/m2, and included 11 women (20%). Differences in mean pitch frequency, Fo, and peak sound frequency were all statistically significant between the RP and RL (p = 0.001), between ML and RL (p = 0.025) but were not significantly different between RP and ML. Mean pitch frequency of RP was lower than RL, and ML frequency was between RL and RP. The sound analysis graphics revealed RP waves with sharp peaks and lower frequencies and RL with smooth curves and higher frequencies. ML showed irregular patterns. Mean pitch frequency of RL was always above 400 Hz, whereas RP was below this value. CONCLUSIONS: It is feasible to apply sound analysis to determine the site of obstruction during DISE. Combining the data may help surgeons make more accurate assessments of the pattern of the disease.

Comparative Analysis of Lateral Pharyngoplasty and Uvulopalatopharyngoplasty Techniques With Polisomnography and Epworth Sleepiness Scales.

Snoring is caused by the vibration of structures of the oral cavity, such as the soft palate, uvula, tonsils, base of the tongue, epiglottis, and lateral pharyngeal walls. When these structures collapse and obstruct the airway, apnea occurs. Obstructive sleep apnea syndrome (OSAS) is characterized by repeated periods of upper airway obstruction, a decrease in arterial oxygen saturation, and interrupted sleep. The prevalence of OSAS is 1% to 5% in men and 1.2% to 2.5% in women. Crucial factors in deciding the surgical approach include a detailed ear-nose-throat examination, Muller maneuver, sleep endoscopy, and apnea hypopnea index scores. Accepted treatments include continuous positive airway pressure (CPAP), surgeries of the base of the tongue and/or palate, and multi-level surgeries. It, however, is important to continue to evaluate the efficacies of such procedures. The authors evaluated the outcomes of 23 patients who underwent surgery for OSAS, using preoperative and postoperative polysomnography (PSG) and the Epworth sleepiness scale (ESS). The results were compared before and after surgery. In all, 14 patients had lateral pharyngoplasty and 9 had uvulopalatopharyngoplasty (UPPP). The PSG and Epworth scale values were significantly lower in both groups, postoperatively. Patients indicated that their quality of life had improved. In conclusion, the surgeries were successful. In line with the literature, our results indicate that lateral pharyngoplasty and UPPP can be used in appropriate patients. Longer-term studies on more patients will provide more detailed information in the future.

Comparison of conventional continuous positive airway pressure to continuous positive airway pressure titration performed with sleep endoscopy.

OBJECTIVES/HYPOTHESIS: To evaluate the effect and obtain a pressure value of continuous positive airway pressure (CPAP) under direct visualization using drug-induced sleep endoscopy (DISE) and compare the pressure values with values obtained using conventional CPAP. STUDY DESIGN: Prospective, double-blinded, cohort study. METHODS: Sixteen patients with obstructive sleep apnea syndrome (OSAS) were included in the study. Each patient underwent polysomnographic evaluation. After diagnosis of OSAS, patients underwent conventional CPAP titration. Patients were then taken to the operating theatre and put under sedation, where CPAP titration with nasendoscopy was performed (DISE CPAP). RESULTS: There were no statistically significant differences between the two techniques regarding pressure levels that decreased apneas in conventional CPAP and provided sufficient opening during DISE CPAP. CONCLUSIONS: Results with conventional CPAP titration and endoscopy-assisted CPAP titration showed no statistically significant difference. Endoscopy-assisted CPAP is a cheaper and less time consuming alternative to conventional CPAP and has similar results.

Bipolar radiofrequency-induced interstitial thermoablation for oral cavity vascular malformations: Preliminary results in a series of 5 children.

We report our assessment of the effectiveness of bipolar radiofrequency-induced interstitial thermoablation (BRIT) for the treatment of certain oral cavity vascular malformations in 5 children. Two of these patients had lymphangiomatous macroglossia (LM), 1 had lymphangioma circumscriptum (LC), and 2 had a venous malformation (VM). Each patient underwent BRIT at least twice; treatment was delivered at 4- to 8-week intervals according to each patient's circumstances. The 2 patients with LM required three treatment sessions; although their tongue volume decreased after each session, both still required a partial glossectomy to achieve a satisfactory reduction in volume. The patient with LC underwent two BRIT treatments, which reduced the size of the lesion by half; the remainder was excised. The 2 patients with a VM (1 buccal and 1 lingual) responded well to BRIT, and their malformations almost completely disappeared. Our early results with BRIT suggest that it is an effective treatment for oral cavity vascular malformations-more so for patients with venous rather than lymphangiomatous lesions.

GlideScope video laryngoscope-assisted tongue base radiofrequency for the treatment of obstructive sleep apnea: pilot study.

OBJECTIVE: The aim of this study was to evaluate the advantages and feasibility of using the GlideScope video laryngoscope (GSVL) (Saturn Biomedical Systems, Burnaby, BC) in radiofrequency tongue base reduction for patients with obstructive sleep apnea syndrome (OSAS). METHODS: Patients suffering from mild to severe OSAS associated with predominant tongue base obstruction (grade 3-4 Mallampati score) confirmed with physical examination who applied to our clinic during the first half of 2007 were included in our study. Seven-watt bipolar radiofrequency was applied to each patient's tongue base assisted by the GSVL at five to seven different locations for 30 to 35 seconds, resulting in energy application in a range of 210 to 245 J. All operations were carried out by the same surgeon, and patients were observed for 15 days postoperatively for any complications. RESULTS: Twelve patients were included in our study. Six of our patients were male and the other six were female. Each patient underwent a session of GSVL-assisted tongue base radiofrequency with a mean energy application of 210 to 245 J via five to seven punctures. The use of the GSVL assisted in a more thorough observation of tongue base anatomy, which aided in our aim to avoid the neurovascular bundle. The use of the GSVL during tongue base radiofrequency surgery creates a safer operation site and allows the surgeon to feel more confident during the procedure. The fact that we encountered no postoperative complications endorses our theory. CONCLUSION: The use of the GSVL in tongue base radiofrequency application not only creates a safer operative site and makes the procedure more uncomplicated but also could be an effective method that could be used in teaching hospitals for the education of otolaryngology surgeons regarding the tongue base radiofrequency procedure.

Use of microdebriders in common rhinologic disorders.

Powered instruments have been introduced into otorhinolaryngology practice over the last decade. These instruments were accepted immediately by many institutions, and continuing development has led to the current use of microdebriders in a variety of surgical procedures in otorhinolaryngology. In clinical rhinology, they were first used in endoscopic sinus surgery to facilitate working on deep planes, but have subsequently been adopted in various conditions. This article presents an evaluation of the use of microdebriders in common rhinological disorders.

Comparison of radiofrequency applied to the total inferior choncha with application to its anterior third.

OBJECTIVE: To compare radiofrequency application to the anterior 1/3 of the inferior choncha with application to the whole of the inferior choncha. MATERIAL AND METHOD: 40 patients with nasal obstruction due to isolated inferior choncha hypertrophy were evaluated. RF was applied in the first group only to the anterior 1/3 of the choncha, whereas in the second group the whole choncha was ablated. Anterior rhinomanometry measurements were obtained both before and 6 weeks after surgery along with visual analog scales. Complete data was used to compare the efficacy of both techniques. RESULTS: The combined nasal resistance showed a significant decrease in both groups. VAS scores were also substantial for both groups. Both groups showed similar data proving the two techniques to have similar efficacy. CONCLUSION: Application to the anterior 1/3 compared with application to the whole of the choncha show no significant differences. Simple RF application here not only provides adequate control but also is safer as there is less risk of interruption of continuity of the nasal mucosa.

Morphologic alteration induced by short-term smoke exposure in rats.

BACKGROUND: It is a well-established fact that cigarette smoking causes degenerative, inflammatory, and respiratory diseases in humans. Because many factors such as air pollution and harsh working conditions can easily be eliminated in animal studies, we conducted this study to identify the effect of tobacco on rat trachea. METHODS: 24 male Wistar rats were divided randomly into an experimental and a control group. The experimental group of rats was exposed to cigarette smoke for 2 h each day over a duration of 60 consecutive days and the control group was treated in an identical fashion yet exposed only to room air. A morphometric study was performed on tracheal specimens taken from 22 rats (10 smoke-exposed rats and 12 control rats). RESULTS: Our results show that many of the morphological changes of the tracheal epithelium were found in the experimental group and significant quantitative differences were observed between the two groups. Loss of cilia, basal cell hyperplasia, goblet cell hyperplasia and an increased number of subepithelial inflammatory cells were observed by light microscopic examination of the trachea of experimental rats. We found very high levels of plasma thiocyanate after exposure to smoke in the experimental group, but no increase in the control group. CONCLUSIONS: The oxidants contained tobacco which could play an important role in the development of these structural and functional abnormalities in the trachea after smoke exposure. In addition, smoking can recruit inflammatory cells to the trachea.

Negative effect of immediate hyperbaric oxygen therapy in acute acoustic trauma.

OBJECTIVE: The functional evaluation of the effect of the hyperbaric oxygen therapy (HBOT) onset time on cochlea by using distortion product otoacoustic emission. STUDY DESIGN: Animal study. METHODS: Twenty-four Wistar albino rats were divided into six groups and their right ears were directly exposed to a 110-dB sound pressure level (1-12 kHz) white noise for 25 minutes. The first group was considered the control group. HBOT was started at 1 hour postexposure for the second group, at 2 hours postexposure for the third group, at 6 hours postexposure for the fourth group, at 24 hours postexposure for the fifth group, and at 48 hours postexposure for the sixth group. Signal-to-noise ratios (SNRs) were recorded before the noise exposure; immediately after the noise exposure; and on the 3rd, 7th, and 10th day of postexposure. RESULTS: SNRs at 6 to 8 kHz were significantly decreased after the acoustic trauma. The evaluation on the third day of postexposure showed that recovery begun in all groups except the group in which the HBOT was started at 1 hour postexposure. SNRs in the control group and HBOT groups were back to the preexposure levels at 10 days postexposure, except the 1- and 2-hour postexposure groups. However, in the group in which the HBOT was started at 1 hour postexposure, distortion product otoacoustic emissions were lost except at 4 kHz. The recovery of the SNRs in hyperbaric oxygen administration at 2 hours postexposure almost completed on the 10th day after noise exposure. CONCLUSION: Immediate HBOT in acoustic trauma treatment is not necessary; on the contrary, it has an adverse effect.

Denervated or innervated flaps for the lower lip reconstruction? Are they really different to get a good result?

OBJECTIVE: This study compares innervated and denervated flaps for the lower lip reconstruction in terms of oral sphincter function and sensation. STUDY DESIGN AND SETTING: A prospective trial. METHODS: This study was carried out on 31 patients with lower lip carcinoma. They were divided in 2 groups: 18 patients with denervated local flaps and 13 patients with innervated flaps. During the follow-up period, all patients were evaluated by electromyography tests and an assessment of the sensation on the lower lip and sphincter function was undertaken by clinical parameters. RESULTS: Compound muscle action potential (CMAP) was obtained in all patients. The amplitudes of CMAP were below normal and the values for distal motor latency (DML) were slightly longer than normal values. Interference patterns were observed on whistling in all cases. There were no differences in terms of sphincteric function in each group. CONCLUSIONS: The denervated random local flaps used for the lower lip reconstruction have no functional inferiority when compared to the innervated-pedicled local flaps. SIGNIFICANCE: This study demonstrates that denervated flaps can be employed for a functional lip reconstruction. EBM RATING: B-2b.

What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo?

OBJECTIVE: To assess the correct incidence of horizontal semicircular canal (H-SCC) benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Retrospective assessment of patients with BPPV. METHODS: All patients with BPPV were included and the rates of involvement of posterior, horizontal, and anterior SCCs were determined. RESULTS: One hundred sixty-nine patients with the diagnosis of BPPV were evaluated. One hundred forty-four patients (85.2%) were found to have posterior SCC (P-SCC) involvement, and there were 20 patients (11.8%) with horizontal SCC (H-SCC) and 2 patients (1.2%) with anterior SCC (A-SCC) involvement. Three patients (1.8%) had simultaneous H-SCC and P-SCC BPPV ipsilaterally. Geotropic nystagmus was seen in 17 out of 23 patients (73.9%) in roll test, and ageotropic nystagmus was seen in the remaining 6 patients (26.1%). CONCLUSION: H-SCC constitutes 13.6% of all BPPV cases. H-SCC BPPV with geotropic nystagmus is more common. H-SCC BPPV can coexist with ipsilateral P-SCC BPPV. However, in some cases of H-SCC BPPV, Dix-Hallpike maneuver can cause vertigo and horizontal nystagmus. This may be confused with P-SCC BPPV. Therefore, the roll test must be performed in all cases in addition to Dix-Hallpike maneuver and both ears must be evaluated with respect to all SCCs for BPPV. EBM RATING: C-4.

Rhinocerebral mucormycosis: a report of two cases.

Rhinocerebral mucormycosis is an aggressive fungal disease that involves the nose, paranasal sinuses, orbit and central nervous system. It may rapidly be fatal. This infection usually occurs secondary to immune suppression, diabetic ketoacidosis, and prolonged use of antibiotics, steroids, and cytotoxic drugs. Management of the condition consists of treatment of the underlying disease and surgical debridement combined with intravenous amphotericin B. This paper presents two patients with rhinocerebral mucormycosis, both suffering from diabetes. Complete recovery was achieved in one patient with surgical debridement of necrotic tissue combined with systemic antifungal treatment, whereas in the other, the disease was complicated with subarachnoid hemorrhage and the patient died on the third day of treatment.