Diode laser versus radiofrequency treatment of the inferior turbinate - a randomized clinical trial.

BACKGROUND: Laser and radiofrequency induced volume reduction of the inferior turbinates are frequently used treatment modalities. Which of both is superior, however, is not clear to date due to a lack of controlled prospective studies. Here, we compare both methods regarding improvement of nasal breathing, complications, patient comfort and wound healing. METHODOLOGY: Prospective, randomized, single-blinded clinical trial with intra-individual design. After randomization, one side of the nose was treated with a 940nm diode laser and the other side with bipolar radiofrequency therapy. Pre- and postoperative evaluation was performed using visual analogue scales, nasal endoscopy and objective measurements of nasal patency. RESULTS: Of 27 enrolled patients, 26 completed the protocol. No severe complications were observed. Intraoperative discomfort was significantly more severe on the radiofrequency side. After three months, a significant reduction of nasal obstruction was observed for laser treatment and radiofrequency therapy with no significant difference between them. Objective parameters did not improve significantly. When asked which treatment modality they would chose again 50 % of the patients decided for radiofrequency treatment, 23 % for laser treatment, and 19 % for both. CONCLUSION: DLVR and RFVR are well-tolerated treatment modalities and both significantly reduce the degree of nasal obstruction in patients with hypertrophic inferior turbinates. There was no significant difference between both treatment modalities regarding efficiency.

[Pediatric OSAS and otitis media with effusion]. / Kindliches OSAS und Seromukotympanon.

BACKGROUND: Adenotonsillar hyperplasia is considered as a possible cause for two frequent ENT disorders in children: pediatric obstructive sleep apnea syndrome (OSAS) and otitis media with effusion (OME). The present study analyzes whether a link between pediatric OSAS and OME can also be presumed. METHODS: Polysomnographic data of 186 children with suspected OSAS were correlated to middle ear ventilation assessed by tympanometry. Tympanograms were classified according to Jerger. RESULTS: In a Kruskal Wallis test, children with an apnea-hypopnea index < 1 (exclusion of OSA by tight criteria), 1-5 or > 5 (definitively pathological value) did not statistically significantly differ in the prevalence of normally ventilated ears and OME. Accordingly, the Mann-Whitney U test showed that children with normally ventilated ears did not have a statistically different apnea-hypopnea, apnea, hypopnea or snoring index or varying minimal oxygen saturation to children suffering from OME. CONCLUSIONS: In the present study, no link was detected between pediatric OSAS and OME.

[Comparison of obstructive sleep apnea in normal weighted and obese patients]. / Obstruktive Schlafapnoe bei Normal- und Übergewichtigen im Vergleich.

INTRODUCTION: Obesity is a well established risk factor for developing an obstructive sleep apnea syndrome (OSAS). However, normal weighted patients can suffer from OSAS, too. This study compares breathing disorders and their effect on sleep of normal weighted and obese OSAS patients. PATIENTS AND METHODS: The main sleep parameters of 32 normal weighted OSAS patients (body mass index, BMI ≤ 25 kg/m2) were compared with those of 32 obese OSAS patients (BMI ≥ 35 kg/m2) with a virtually equal apnea-hypopnea index (AHI ± 3). RESULTS: The mean AHI in both groups was 27.9/h (BMI ≤ 25 kg/m2) and 28.0/h (BMI ≥ 25 kg/m2), respectively. Sleep efficiency, relative percentages of sleep phases S1-S4 and REM, mean, minimal and maximal heart rate were not significantly different in statistic analysis in normal weighted and obese patients. Normal weighted OSAS patients had a higher apnea index (11.4 vs. 6.4, p=0.040), a higher minimal (81.3% vs. 71.7, p=0.003) and mean (94.9% vs. 92.8%, p=0.007) oxygen saturation, but a smaller hypopnea index (16.5 vs. 21.6, p=0.047) and a lower index of snoring (175.2 vs. 394.1, p<0.001) than their obese counterparts. CONCLUSIONS: In OSAS patients with an equal AHI, the obese have fewer apneas, but more hypopneas, and a lower minimal oxygen saturation than normal weighted patients. The effect of OSAS on the sleep architecture, however, seems not to be associated with the patients' body weight.

[Obstructive sleep apnea syndrome in children--status quo of diagnostics and treatment]. / Das kindliche Schlafapnoe-Syndrom--Status quo in Diagnostik und Therapie.

BACKGROUND AND METHODS: In the diagnostics and treatment of obstructive sleep apnea syndrome (OSAS), established standards for adults cannot be conferred on children. To get an overview concerning the code of practice, we questioned sleep laboratories performing polysomnographies in children about the used techniques, the interpretation of the results and the recommended therapy of OSAS in children. RESULTS: 17 sleep laboratories participated in the study. It became evident that the individual German sleep laboratories use different criteria in the diagnostics of OSAS in children. For treating OSAS in children, surgery by an ENT specialist is recommended in most cases (75%). CONCLUSIONS: To enhance national and international comparability of diagnostic findings, adoption of the recommendations of the American Academy of Sleep Medicine (AASM) of 2007 for polysomnographic procedures and scoring is suggested.

Double-blind, randomised, controlled study of post-operative pain in children undergoing radiofrequency tonsillotomy versus laser tonsillotomy.

INTRODUCTION: In the last decade tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. Currently, most tonsils are reduced by utilise electrosurgery, radiofrequency or carbon dioxide laser. However, it is not clear whether radiofrequency tonsillotomy is as effective as laser or other surgical techniques in respect of post-operative pain and haemorrhage. MATERIAL AND METHODS: A prospective, randomised, double-blinded, controlled, clinical study was conducted in the otorhinolaryngology department of Ludwig Maximilians University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Exclusion criteria were: history of peritonsillar abscess, previous tonsil surgery, tonsillitis within two weeks, pain before surgery, psychiatric illness, asymmetrical tonsils, chronic analgesic usage, bleeding disorders and other surgical procedures during the same operation. Tonsillotomy was performed on one side with radiofrequency and on the other side with a carbon dioxide laser. All procedures were performed by a single surgeon, under general anaesthesia. A visual analogue scale was used to measure patients' pain on each side, administered by a 'blinded' nurse on the three post-operative mornings and evenings, within the hospital. RESULTS: There was no difference in post-operative pain scores or haemorrhage, comparing laser versus radiofrequency tonsillotomy. Patient's overall reported pain was very modest compared with post-tonsillectomy pain. No haemorrhage or other adverse effects were observed.

[Snoring: therapeutic options]. / Massnahmen gegen primäres Schnarchen. Endlich Ruhe im Schlafzimmer!

Primary snoring is mainly the bed partner's problem and not that of the snorer. The request for treatment arises from how annoying the snoring is and how sensitive the bed partner is to noise. In addition to a thorough medical history and an ENT examination, a polysomnography should be always performed to differentiate between primary snoring, upper airway resistance and obstructive sleep apnoea syndromes. Primarily weight loss and avoidance of alcohol in the evening as well as devices and surgery are used in the treatment of snoring.

[Use of pharyngeal pressure measurement to localize the source of snoring]. / Einsatz der ösophagopharyngealen Druckmessung zur Topodiagnostik des Schnarchens.

BACKGROUND: Depending on age and gender up to 60 % of the population snore regularly. As simple snoring is more a social than a medical problem, unlike OSAS, CPAP-therapy or multilevel surgery are not appropriate therapies for snoring. But alternative therapies, such as laser-assisted uvulopalatoplasty (LAUP) or uvulopalatopharyngoplasty (UPPP) address distinct sites of the pharynx. Therefore a correct identification of the snoring-source should optimise the selection of patients and improve the outcome of therapy. As there is no commonly recommended tool for identifying the snoring-source, the use of a new technique, based on pharyngeal pressure measurement, was tested. METHODS: 25 patients with suspected OSAS had standard polysomnography recordings during two nights with esophagopharyngeal pressure measurement on the second night. The pressure probe had 5 pharyngeal and 1 esophageal transducers. The curves of the pharyngeal pressure were examined for quick pressure changes superimposed on the slow pressure-changes caused by breathing. The appearance of these quick pressure changes was documented for each transducer throughout the whole night. RESULTS: The average (+/- SD) Apnea-Hypopnea-Index in the patients was 28.3 +/- 24.8. 17 patients (68 %) had an AHI of more than 10. All patients showed heavy snoring. 23 patients (92 %) showed a high frequency, sawtooth-pattern, superimposed on the slow breathing rhythm in at least one channel and in association with snoring. 91 % of the patients showed a sawtooth pattern in more than one channel, but the pattern was always more pronounced in one channel compared to others. The sawtooth-pattern of the highest amplitude was seen in the pressure curves from the velum in 56 % of the patients, from the tonsils in 24 %, and from the tonguebase in 12 % of the patients. CONCLUSIONS: Quick pressure changes from distinctive pharyngeal pressure transducers during snoring are common in OSAS patients and may indicate the source of snoring. Further investigations have to show whether this assumption is correct, and whether the quick pressure changes are also apparent in simple snorers.