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

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

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

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

Intratemporal facial nerve neurofibroma causing facial paralysis in an infant: Case report and review of the literature.

This article describes the first recorded case of intratemporal neurofibroma in an infant. A literature review of all other existing cases of intratemporal neurofibroma is performed, finding that the majority of cases involve multiple segments and can be found in the mastoid segment most often. Most common symptoms described included facial paralysis, otalgia, and conductive hearing loss, respectively.

Impact of dual electronic and conventional cigarette use on diagnosis and surgery for chronic rhinosinusitis: A multicenter study.

KEY POINTS: Dual EC/CC users had a significantly greater risk of CRS or FESS when compared to solo users. Dual EC/CC users did not have a significantly greater risk of polyposis when compared to solo users. This effect likely relates to bacterial, immune cell, genetic, and mucociliary alterations.

Neurosurgical Causes of Pulsatile Tinnitus: Contemporary Update.

Traditionally in the domain of the otolaryngologist, pulsatile tinnitus (PT) has become increasingly relevant to neurosurgeons. PT may prove to be a harbinger of life-threatening pathology; however, often, it is a marker of a more benign process. Irrespectively, the neurosurgeon should be familiar with the many potential etiologies of this unique and challenging patient population. In this review, we discuss the myriad causes of PT, categorized by pulse-phase rhythmicity.

Eye manifestations in the NSUN2 intellectual disability syndrome.

The NSUN2-intellectual disability syndrome is a rare disorder of the cellular transcriptome that prevents proper t-RNA splicing. This disorder interrupts cellular function and leads to an accumulation of RNA fragments, producing a constellation of symptoms including dysmorphic facies, hypotonia, microcephaly, and short stature. Eye manifestations have been reported but not well characterized. Our study presents a new case involving a 4-year-old boy with novel NSUN2 variants and clinical features consistent with the syndrome. In addition, through a systemic review, we discuss the 24 previously reported cases of the syndrome with an emphasis on the eye and ocular adnexa clinical features.