The predictive value of mandibular advancement maneuvers during drug-induced sleep endoscopy for treatment success of oral appliance treatment in obstructive sleep apnea: a prospective study.

STUDY OBJECTIVES: To prospectively validate drug-induced sleep endoscopy with mandibular advancement maneuvers as a prediction tool for treatment success of oral appliance treatment (OAT). METHODS: Seventy-seven patients diagnosed with moderate obstructive sleep apnea were included and underwent drug-induced sleep endoscopy. The upper airway collapse was assessed using the VOTE classification. Additionally, three mandibular advancement maneuvers were performed to predict treatment success of OAT. If the maneuver was negative, the level and degree and configuration of the persistent collapse was described according to the VOTE classification. All patients were treated with OAT and completed a follow-up sleep study with OAT in situ without regard to their anticipated response to treatment. RESULTS: Sixty-four patients completed 6-month follow up. A positive jaw thrust maneuver proved to be significantly associated with favorable OAT response, whereas the chin lift maneuver and the vertical chin lift maneuver were not. Additionally, a persistent lateral oropharyngeal collapse when performing any mandibular advancement maneuver was significantly associated with unfavorable OAT response. CONCLUSIONS: The current findings suggest that a jaw thrust maneuver should be preferred over the chin lift maneuver for predicting OAT response. Patients with a positive jaw thrust maneuver should be counseled toward favorable OAT response, whereas those with persistent lateral oropharyngeal collapse should be advised about the likelihood of unfavorable OAT response. A negative jaw thrust maneuver did not prove to be a significant predictor for unfavorable response to OAT. Consequently, uncertainties arise regarding the justification of performing drug-induced sleep endoscopy solely for predicting the efficacy of OAT. However, the results of the current study could be influenced by heterogeneity in the assessment of respiratory parameters, variability in the performance of the mandibular advancement maneuvers, and the instability of bolus technique sedation. CLINICAL TRIAL REGISTRATION: Registry: Netherlands Trial Register; Name: Drug-induced Sleep Endoscopy: a prediction tool for success rate of oral appliance treatment; Identifier: NL8425; URL: https://www.onderzoekmetmensen.nl/en/trial/20741. CITATION: Veugen CCAFM, Kant E, Kelder JC, Schipper A, Stokroos RJ, Copper MP. The predictive value of mandibular advancement maneuvers during drug-induced sleep endoscopy for treatment success of oral appliance treatment in obstructive sleep apnea: a prospective study. J Clin Sleep Med. 2024;20(3): 353-361.

Variability in surgical techniques for cochlear implantation: an international survey study.

OBJECTIVE: This study aimed to gain insight into current practices regarding the surgical techniques used for positioning and fixation of internal components of the cochlear implant. METHODS: A questionnaire focused on surgical techniques used for cochlear implantation was distributed among 441 cochlear implant surgeons. Descriptive statistics were reported. RESULTS: The questionnaire was completed by 59 surgeons working in 13 different countries. The most preferred incision shapes were the S-shape (41%) and the C-shape (36%). The preferred implantation angle for the receiver/stimulator device was either 45° (64%) or 60° (30%), relative to the Frankfurter Horizontal Plane. Most respondents used a drilled bony well with (42%) or without a subperiosteal pocket (31%) to fixate the receiver/stimulator device. All respondents used the facial recess approach. Most used the round window insertion technique to enter the scala tympani (73%). Approximately half of the respondents preferred the lateral wall electrode array, whereas the other half preferred the perimodiolar electrode array. During their career, most (86%) changed their technique towards structure preservation and minimizing trauma. CONCLUSION: This study indicates variability in the surgical techniques used to position and fixate the internal components of the cochlear implant. Additionally, surgical preference transits towards structure preservation and minimal invasiveness.

The effect of hearing aids on cognitive function: A systematic review.

RATIONALE: Dementia currently affects 50 million people globally with this expected to triple by 2050. Even though hearing loss is associated with cognitive decline, the underlying mechanisms are not fully understood. Considering hearing loss is the largest modifiable risk factor for developing dementia, it is essential to study the effect of hearing aids on cognitive function. OBJECTIVE: To systematically review the existing literature to examine the evidence for using hearing aids intervention as a treatment for deteriorating cognitive function. DESIGN: A search of PubMed, Cochrane Library, Embase and grey literature was conducted revealing 3060 unique records between 1990-2020. Two reviewers independently selected longitudinal studies observing the effects of hearing aids on cognitive function in persons without dementia at onset of the study. Due to the heterogeneity of the data, a meta-analysis could not be performed. Outcomes are described in a summary of findings table and portrayed diagrammatically. RESULTS: We identified 17 unique studies, spanning 30 years of research and 3526 participants. The included studies made use of 50 different cognitive function tests. These tests were grouped into separate cognitive domains according to the DSM-V classification for further analysis. The most beneficial impact of hearing aids seems to be in the cognitive domain of executive function, with six studies showing improvement, two studies being inconclusive and three studies not demonstrating a significant effect. Three of five studies demonstrated significant improvement when screening for brief mental status. The least beneficial impact is seen in domain of complex attention, with eight studies showing no significant effects, compared with one demonstrating improvement with intervention. CONCLUSIONS: Based on this systematic review, we conclude that there is controversy about the effects of hearing aids on cognition. Additional research through randomized clinical trials with standardized cognitive assessment and longer follow-up is warranted to further elucidate this relationship.