Olfactory function in patients with obstructive sleep apnea and the effect of positive airway pressure treatment: a systematic review and meta-analysis.

OBJECTIVES: To investigate olfactory function (OF) in patients with obstructive sleep apnea (OSA) and evaluate whether or not the use of positive airway pressure (PAP) treatment has an impact on olfactory performance. METHODS: All studies published in English that gave satisfactory data regarding the assessment of OF in patients with OSA were included in this review. First, a baseline assessment of OF in patients with OSA who had not received any treatment was examined. Second, the effect of PAP therapy on OF was assessed to be able to make before and after comparisons. The primary outcome of this study was the threshold-discrimination identification (TDI) scores, obtained from the Sniffin' Sticks test. RESULTS: The database search identified 552 articles. According to the exclusion criteria, 11 studies involving 557 patients diagnosed with OSA were included in this meta-analysis. The general rate of olfactory dysfunction was 73% (95% CI: 56.481-87.057) among the patients with OSA. The patients with OSA had lower TDI scores compared to the control group and the difference was statistically significant (p < 0.001). PAP treatment significantly improved the TDI scores in patients with OSA (p < 0.001). There was a significant negative correlation between the severity of apnea-hypopnea index and TDI scores (p = 0.001, z = -3.377, r = -0.438) and between age and TDI scores (p = 0.007, z = -2.695, r = -0.236). CONCLUSION: This meta-analysis demonstrates that OSA impairs OF, while PAP treatment can reverse the olfactory performance of patients with OSA.

Voice outcomes for patients undergoing surgery for obstructive sleep apnea: a systematic review and meta-analysis.

PURPOSE: To evaluate the effect of the different surgical techniques used in the treatment of obstructive sleep apnea (OSA) on the postoperative voice and nasalance, and to conduct a meta-analysis through the assessment of postoperative changes. METHODS: Systematic literature review and meta-analysis of published data using the data sources, MEDLINE, Google Scholar, Cochrane, and SAGE. All studies published in English specifying any upper airway surgery for treatment of snoring and/or OSA were included, provided they indicated the pre- and postoperative mean ± standard deviation (SD) values for voice parameters and nasality. The primary outcomes were the changes in preoperative-postoperative mean values of fundamental frequency (mF0), jitter, shimmer, and nasalance scores. RESULTS: After removal of duplications, 214 studies were potentially relevant, and 25 studies ultimately met the criteria for inclusion in the present review. Of the 25 studies evaluated in this review, 12 studies with 379 patients were available for the meta-analysis calculations. In general, a fixed-effects model was used to analyze the data in the subgroups. The meta-analysis results showed no significant differences in either subgroup analysis between the preoperative and postoperative assessments of mF0, jitter, shimmer, oral nasalance, nasal nasalance, and oronasal nasalance (All had values of p > 0.05). CONCLUSION: The results of this meta-analysis indicated no significant effect of surgical treatments for snoring or OSA on glottic functioning and nasalance parameters, regardless of surgery type. Further prospective studies are needed to assess more parameters for detailed acoustic analyses.

Determining the Thyroid Gland Volume Causing Tracheal Compression: A Semiautomated 3D CT Volumetry Study.

Background and objectives: Increased thyroid gland volume (TV) may bring about tracheal compression, which is one of the causes of respiratory distress. The aim of this study was to investigate the relationship between TV and the severity of tracheal compression independent of patients' symptoms using semiautomated three-dimensional (3D) volumetry (S3DV) reconstructed from computed tomography (CT) scans. Cut-off TVs leading to different levels of tracheal narrowing were evaluated. Materials and Methods: One hundred sixty-three contrast-enhanced head and neck CT examinations were retrospectively assessed. TVs were measured by S3DV. The degree of tracheal compression was measured at the point where the greatest percent reduction in the cross-sectional area of the trachea adjacent to the thyroid gland was observed. To determine the severity of compression, the tracheal compression ratio (TCR) was defined (TCR = A1 (the narrowest cross-sectional area of trachea)/A2 (the largest cross-sectional area of trachea)). Results: The mean tracheal narrowing was 15% (TCR = 0.85 ± 0.15) in the study population. Patients with more than 15% tracheal compression had significantly higher TV values than those with less than 15% tracheal compression (p < 0.001). In addition, a significant correlation was found between TV and tracheal compression (p < 0.001). Moreover, the receiver operating characteristic (ROC) curve analysis revealed that the cut-off levels for TV that predict a tracheal narrowing of 10%, 20%, 30%, and 40% were 19.75 mL, 21.56 mL, 24.54 mL, and 30.29 mL, respectively (p < 0.05). Conclusions: This study objectively demonstrated that larger thyroid glands cause more severe compression on the trachea. The results may be helpful during the decision-making process for thyroidectomies to be performed due to compression symptoms.

Retrospective analyses of high-energy explosive devicerelated injuries of the ear and auricular region: experiences in an operative field hospital emergency room.

BACKGROUND: With the changing conditions of terrorism, particularly in urban areas, high-energy explosive devices such as improvised explosive devices (IEDs) and projectile missiles (PMs) are frequently used. Traumas caused by these devices particularly affect the maxillofacial region and typically lead to otologic problems. In this study, we aimed to evaluate otologic complaints, otoscopic and auricular examinations, and tuning-fork tests of patients who were exposed to high-energy blast-related injuries and perform a comparison between trauma patients injured by IEDs and PMs. METHODS: The medical data of patients admitted to an operational field hospital emergency room with injuries related to highenergy explosive devices such as IEDs and PMs between July 27, 2015 and July 22, 2016 was reviewed. The hearing impairment, tinnitus, otologic examination, auricular region examination, and tuning-fork tests of all patients were evaluated. The otologic evaluation, records of the patients (n=86) were evaluated using a scoring system established by the authors. The patients were categorized into two groups according to the device causing the injury: IEDs in group I and PMs in group II. RESULTS: A total of 241 combatants were injured by high-energy explosive devices. All patients were male with a mean age of 30.2 years (range, 20-54). Of these, 86 had hearing impairments that were detected by tuning-fork tests. Of those, 50 were injured by IEDs and 36 by PMs. Of the 86 patients, 18 had traumatic tympanic membrane perforation, and of those, 6 patients were injured by IEDs and 12 by PMs. Further, 68 of the 86 patients had sensorineural hearing loss, and of those, 44 were injured by IEDs and 24 by PMs. There was a statistically significant difference between the IED and PM groups according to otologic evaluation score (p=0.044). CONCLUSION: This study demonstrates that PMs can have a large impact on the human ear and may cause more severe otologic manifestations among combatants than those caused by IEDs. The early and accurate evaluation of patients exposed to high-energy explosive devices in an operational field is important for the appropriate management of these patients.

Anxiety, depression, and hopelessness in patients before and after treatment for peripheral facial paralysis.

We conducted a prospective study to investigate the effectiveness of pharmacologic treatment on alleviating facial paralysis, as well as the anxiety and depression that are associated with it. Our study population was made up of 105 patients-59 men and 46 women, aged 18 to 60 years (mean: 38.2)-who had acute idiopathic peripheral facial paralysis. Before treatment, paralysis was classified as House-Brackmann grade II or III in 44 patients (41.9%) and grade IV to VI in the remaining 61 (58.1%). After treatment, 73 patients (69.5%) improved to grade I, 29 (27.6%) were at grade II or III, and only 3 (2.9%) remained at grade IV or higher. Mean scores on the Beck anxiety inventory, the Beck depression inventory, and the Beck hopelessness scale were 20.30, 19.75, and 7.57, respectively, before treatment and 5.72, 5.68, and 2.85 afterward; the difference in all three measures was statistically significant (p < 0.001). We found no correlation between the degree of facial paralysis and anxiety levels (r = 0.094, p = 0.338) or depression levels (r = 0.181, p = 0.064). Clinicians should consider asking patients with peripheral facial paralysis about their feelings of anxiety, depression, and hopelessness and refer them for a psychiatric consultation if necessary.

Another cause of difficult airway in an elderly patient: Tongue-base abscess.

OBJECTIVE: An abscess of the tongue base is rare, but it can be a potentially life-threatening situation in elderly patients. CASE REPORT: A 72-year-old male patient presented with mid-anterior neck swelling, odynophagia, poor oral hygiene and severe dyspnoea. After a difficult intubation, the muscles were dissected via a submental suprahyoid approach and the abscess was drained. CONCLUSION: Poor oral hygiene may predispose elderly patients to tongue-base abscesses. An early decision should be made for surgical drainage due to the risk of airway obstruction.

Anterior Palatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Objective The aim of this study was to determine the general outcomes and surgical success rates of anterior palatoplasty (AP) in patients with obstructive sleep apnea (OSA). Data Sources A systematic review of the literature and meta-analysis of published data were performed by searching the Cochrane, SAGE, MEDLINE, and Google Scholar databases, from January 1, 2007, to March 27, 2017, using relevant keywords. Review Methods The search scanned for studies with patients who had undergone AP (with or without tonsillectomy) as a single-stage, single-level surgical intervention for treatment of OSA. Two independent reviewers (M.B. and O.K.) inspected titles and abstracts of the studies according to established criteria. The full texts were then reviewed to extract the clinical and polysomnographic data. The primary outcome was the surgical success rate, defined as a reduction in the apnea-hypopnea index (AHI) of 50% or greater and an AHI of less than 20 postoperatively. The PRISMA statement was followed. Results After systematic evaluation of potentially relevant articles, 14 studies were downloaded, and 6 studies, consisting of 170 patients, met the study criteria. A fixed effects model was used to analyze the data. The surgical success rate of AP was 60.6%. No serious complications were reported in the literature. Conclusion The results of the present meta-analysis support AP as a moderately effective surgical method for the treatment of OSA. Comparative and randomized controlled prospective studies showing long-term results, with pre- and postoperative data, should be conducted to demonstrate the exact outcomes and reliability of this surgical technique.

A tertiary center experience with velopharyngeal surgical techniques for treatment of snoring and obstructive sleep apnea.

OBJECTIVES: The aim of this study was to assess the outcomes of patients who treated with the relatively new surgical procedures; anterior palatoplasty (AP), Cahali lateral pharyngoplasty (CLP), and expansion sphincter pharyngoplasty (ESP) for habitual snoring or obstructive sleep apnea (OSA). METHODS: Prospective series of 93 patients were evaluated. The performed surgical techniques, polysomnographic outcomes, pre- and postoperative clinical parameters, and complication rates were assessed. RESULTS: There were 14 snorers and 79 OSA patients. The mean age was 40.7 years, mean BMI was 27.67kg/m2, and the mean follow-up time was 5.90 months. There were 30 subjects in AP, 30 subjects in CLP, and 33 subjects in ESP groups. Apnea hypopnea index (AHI) improved from 16.90 to 14.27 (p=0.135) in AP, from 17.69 to 12.05 in CLP (p=0.004), and from 26.83 to 9.08 in ESP groups (p<0.001). When surgical success criteria is defined as more than 50% reduction in AHI to final AHI <15events/h, success rates were 45%, 64%, and 74% in AP, CLP, and ESP groups, respectively. Epworth Sleepiness Scale and visual analog scale for snoring significantly decreased after all procedures (p<0.05). The minimum oxygen saturation significantly increased after all procedures, however, only ESP caused statistically significant improvements in oxygen desaturation index, mean SaO2 and the percentage of sleep time with SaO2 below 90%. During the follow-up period, 61 of 93 patients (65.6%) indicated one or more complaints, but none of them was persistent. CONCLUSION: We suggest that these relatively new velopharyngeal surgical techniques are effective in the management of snoring and OSA without causing persistent side-effects, and ESP is one step ahead of the other two techniques.

Various combinations of velopharyngeal and hypopharyngeal surgical procedures for treatment of obstructive sleep apnea: Single-stage, multilevel surgery.

OBJECTIVE: The aim of this study was to investigate the safety and outcomes of velopharyngeal surgeries combined with hypopharyngeal surgeries as single-stage interventions for treatment of obstructive sleep apnea (OSA). METHODS: Retrospective analysis of operated patients. The velopharyngeal surgical interventions were uvulopalatal flap, anterior palatoplasty, expansion sphincter pharyngoplasty, transpalatal advancement pharyngoplasty, Cahali lateral pharyngoplasty, Z-palatoplasty, and modified uvulopalatopharyngoplasty. The hypopharyngeal surgical interventions were tongue base suspension, mucosal sparing partial glossectomy, genioglossus advancement, mandibulohyoid suspension, thyrohyoid suspension, and epiglottoplasty. RESULTS: Forty-one patients were enrolled after inclusion and exclusion criteria. The evaluation of symptoms and polysomnographic findings were performed preoperatively and at a minimum of 3months postoperatively. The mean age was 42.17±9.50years and the mean follow-up time was 6.8±6.0months. After single-stage multilevel surgery, the mean apnea hypopnea index (AHI) improved from 29.13±15.87events/h to 14.28±16.14events/h (p<0.001). According to the classical definition of success criteria (>50% reduction in AHI and postoperative AHI<20events/h), the surgical success rate was 56%, with cure of OSA (AHI<5events/h) in 41% of study population. The combined surgeries also improved Epworth scores, snoring scores, and respiratory parameters significantly (in all p<0.05). The major complications were bleeding requiring re-admission in surgery room and severe tongue base edema which regressed by steroid administration. The minor complications were pain, difficulty in swallowing, velopharyngeal insufficiency, regurgitation, minor bleeding, and occlusion disorder. The mean postoperative period to beginning of normal feeding was 1.81±1.01days. The percentage of pain, the number of patients with major bleeding, and the need for patient-controlled analgesia were higher in patients undergoing tissue resection/ablative hypopharyngeal procedures. The mean postoperative period to beginning of normal feeding was shorter in patients undergoing suture/repositioning hypopharyngeal procedures. CONCLUSION: According to outcomes of this study, OSA patients with multilevel obstructions can benefit from combined surgeries for velopharyngeal and hypopharyngeal regions at the same operation stage, without experiencing persistent complaints. It is promising that, despite multiple levels of obstruction was operated at single-stage, airway safety was preserved in all patients.

Chronic sialadenitis due to the stone inside the accessory duct of submandibular gland.

PURPOSE: Sialolithiasis is the most common cause of chronic sialadenitis. In this case report, intraoperative finding of an accessory submandibular duct, obstructed with stone, originating from the same gland nearby the main Warthon's duct, is presented. CASE REPORT: A 22-year-old male patient, suffering from eating-related pain and swelling in his left submandibular region, was diagnosed with left sublandibular gland sialadenitis with radiologically manifested sialolithiasis, and gland excision was advised. Surgery was performed under general anesthesia. When the full anatomical scenery was delineated before excision of the gland, we surprisingly encountered two submandibular ducts originating from ipsilateral gland, one of them was obstructed with stone. After two ducts were ligated, the gland with sialolith was excised. According to histopathologic examination, the duct obstructed with stone was identified as the accessory duct and the other one was the main Wharton's duct. Postoperative days were uneventful; no neurologic complication was observed. CONCLUSIONS: Otolaryngologists should be aware of anatomic variations of the submandibular duct(s) to avoid possible complications, especially intraoperatively, because rutine preoperative radiologic preparation does not include investigation of possible accessory ducts.

A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea?

The aim of this study was to evaluate the change in serum levels of C-reactive protein (CRP) in patients with obstructive sleep apnea (OSA) before and after expansion sphincter pharyngoplasty (ESP) and continuous positive airway pressure (CPAP) treatment. Fifty-one patients with newly diagnosed OSA were prospectively enrolled in this study. We performed ESP in twenty-three patients in the surgery group and twenty-eight patients were included in the CPAP group. Serum levels of high-sensitivity CRP (hs-CRP) were analyzed by enzyme-linked immunosorbent assays before and 3 months after treatment. The relations between CRP and the apnea hypopnea index (AHI), visual analog scale (VAS), the Epworth Sleepiness Scale (ESS), and saturation parameters were evaluated. Both surgical and CPAP treatments caused significant improvements in the clinical and laboratory parameters. However, only the patients whose postoperative AHI levels improved to final AHI of <5 (n = 6) after ESP, had significant decrease in their serum CRP levels (p = 0.028). CPAP group and the rest of the patients in the surgery group did not show statistically significant difference in CRP levels after treatment. We suggest that the successful surgical treatment for OSA-ESP in this study-, which provides OSA cure, can decrease serum levels of CRP and reduce possible cardiovascular morbidity.

Solitary Supraclavicular Fossa Masses.

OBJECTIVE: The aim of this study is to present the diagnostic spectrum of solitary supraclavicular fossa (SCF) masses in a Turkish context. The demographic data of the patients and the effectivity of the diagnostic tools are also discussed to improve current diagnostic strategies. PATIENTS AND METHODS: The charts of patients who underwent surgical intervention for solitary SCF mass of an unknown etiology between January 2005 and January 2015 were reviewed. Patients presenting evidences of synchronous cancers and patients with a history of previous cancers were excluded. The data encompassing the demographics of the patients, the discriminative specifications, the histopathological diagnosis of the masses, and the diagnostic tools used in the workup period were noted. The descriptive data are presented and statistical analyses were performed using the Mann-Whitney test, Fisher exact test, and Chi-squared tests. RESULTS: In total, 44 male (76%) and 14 (24%) female patients were enrolled in the study. Thirty-five masses (60%) were located in the left SCF and 23 masses (40%) in the right. The masses were categorized as neoplastic (n = 31, 53%), inflammatory (n = 18, 31%), and congenital (n = 9, 16%). The 44 (76%) masses in our series were lymph nodes (LNs), and 25 (57%) of them were malign, whereas 19 (43%) were either inflammatory or benign. Male sex (P = 0.027) and the size of the mass (P = 0.017) were significantly related to malign LNs. The patients' ages and sides of the masses were not significantly different between the malign and benign LN groups. CONCLUSIONS: Lymph nodes constitute the majority of solitary SCF masses. Although imaging techniques and fine needle aspirations are routinely applied, excisional biopsies are necessary in most cases to reach an exact diagnosis and to plan a definitive treatment regime in this presented series.

Life Priorities in Head and Neck Cancer Patients Between Ages of 45 to 65.

Diseases in head and neck cancer patients and applied therapies according to former affect life quality to a higher extent. In this paper, life priorities in 49 patients with head and neck cancer who referred to Gulhane Military Medical Academy for diagnostic and therapeutic purposes and the relationship between these priorities and sociodemographic properties have been studied. Following life priorities have been observed more important for the patients: to communicate with people in social places, to eat without any help by themselves, external appearance, taste and odor sense, continuing sexual life. Other priorities have been observed less important for the patients: attending social activities like cinema and theater, swimming pool and sea sports, money required for check-ups, necessities like time. Besides, these necessities do not show dissimilarities to any significant extent according to sociodemographic properties of the patients.

A meta-analysis of surgical success rates in congenital stapes fixation and juvenile otosclerosis.

OBJECTIVES: To assess published reports in the literature on surgical success rates in patients with congenital stapes fixation (CSF) and juvenile otosclerosis (JO). DESIGN: Systematic review of the literature and meta-analysis of published data. DATA SOURCES: PubMed, SAGE, MEDLINE, and Cochrane. REVIEW METHODS: A literature search was performed and evaluated based on established criteria. Two independent reviewers (b.a., m.b.) inspected titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. An air-bone gap (ABG) of 0 to 10 dB hearing level was described as success of surgery. RESULTS: A random effects model was used to analyze the data. A total of 27 studies were included in the meta-analysis, whereas 934 were excluded. The total number of operated ears was 445 (256 ears with JO and 189 ears with CSF). At the time of surgery, the age of the patients ranged from 3 to 18 years. The success rate was 80.2% for JO and 54% for CSF. The overall success rate was 69.9%. The rate of postoperative sensorineural hearing loss was 3.4% for JO and 2.1% for CSF. CONCLUSIONS: Overall, stapes surgery in children with JO or CSF has a moderate success rate (69.9%) to provide ABG closure of 10 dB. The success rate for CSF in the setting of ossicular abnormalities is 54%. This meta-analysis suggests that if JO can be determined before surgery, a higher success rate is possible (80.2%).