Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning.

BACKGROUND: Treatment of obstructive sleep apnea is crucial for long term health and reduced economic burden. For those considered for surgery, drug-induced sleep endoscopy (DISE) is a method to characterize location and pattern of sleep-related upper airway collapse. According to the VOTE classification system, four upper airway sites of collapse are characterized: velum (V), oropharynx (O), tongue (T), and epiglottis (E). The degree of obstruction per site is classified as 0 (no obstruction), 1 (partial obstruction), or 2 (complete obstruction). Here we propose a deep learning approach for automatic scoring of VOTE obstruction degrees from DISE videos. METHODS: We included 281 DISE videos with varying durations (6 s-16 min) from two sleep clinics: Copenhagen University Hospital and Stanford University Hospital. Examinations were split into 5-s clips, each receiving annotations of 0, 1, 2, or X (site not visible) for each site (V, O, T, and E), which was used to train a deep learning model. Predicted VOTE obstruction degrees per examination was obtained by taking the highest predicted degree per site across 5-s clips, which was evaluated against VOTE degrees annotated by surgeons. RESULTS: Mean F1 score of 70% was obtained across all DISE examinations (V: 85%, O: 72%, T: 57%, E: 65%). For each site, sensitivity was highest for degree 2 and lowest for degree 0. No bias in performance was observed between videos from different clinicians/hospitals. CONCLUSIONS: This study demonstrates that automating scoring of DISE examinations show high validity and feasibility in degree of upper airway collapse.

[Chronic rhinosinusitisand type 2 disease].

Diseases of the upper and lower airways are commonly described as global airway disease, which shares basic inflammatory mechanisms, and airway comobidity is frequently found. The prevalence of chronic rhinosinusitis (CRS) is 5-12%, characterised as CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). Inflammation in CRSwNP is often type 2, whereas CRSsNP often involves non-type 2. New monoclonal antibodies towards type-2 inflammation have been launched internationally to treat refractory severe CRSwNP, with effect on polyps, congestions and smell, as well as quality of life. This review gives a summary of the current treatment modalities.

[Transoral robotic surgery for the head and neck].

Transoral robotic surgery (TORS) has been utilized in the head and neck field for more than a decade. It is a minimally invasive technique which ensures flexible instrumentation and 3D visualization of the oropharynx. This has led to a paradigm shift in the treatment of early-stage oropharyngeal cancer and in the diagnostic management of unknown primary of the head and neck. Over time, the indications for TORS have broadened. This review discusses the development, current indications, and future perspectives of TORS within head and neck surgery.

Long-term health and socioeconomic outcome of obstructive sleep apnea in children and adolescents.

BACKGROUND: There is limited information about the long-term outcome of obstructive sleep apnea (OSA) diagnosed in children and adolescents for educational and social factors. Here, we estimate the long-term socioeconomic outcome and health care costs of OSA. METHODS: The historical case-control cohort study included Danish individuals with OSA diagnosed in childhood or adolescence between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. A total of 5419 were diagnosed during this period; of these we traced 1004 patients who we compared with 4085 controls (mean index age, 10.2 years; Standard Deviation (SD), 5.6 years) until the age of 20 years. Controls were matched for age, gender, and residency. RESULTS: Comparing the OSA patient and control groups at age 20 years we found: 1) lower parental educational level; 2) significantly lower educational level also after adjustment for parental educational level; 3) lower school grade-point averages; 4) lower employment rate and lower income, which was not fully compensated when transfer payments were considered; and 5) patients' initial health care costs were higher due to higher morbidity. Patients showed higher mortality rates than controls (Hazard Ratio (HR) = 7.63, 95% CI = 4.87-11.95, P < 0.001). CONCLUSIONS: OSA in children and adolescent is associated with a significant influence on morbidity, mortality, educational level, grading, social outcome, and welfare consequences.

Tonsillotomy in children with sleep-disordered breathing is safe and results in high parent satisfaction.

INTRODUCTION: Sleep-disordered breathing in children is often associated with tonsillar hypertrophy. For many years, total tonsillectomy (TE) was the treatment of choice, but performing an intracapsular tonsillotomy (TT) is becoming increasingly widespread. In this Danish study, we have investigated the long-term results on efficacy and parent satisfaction after TT performed on children. METHODS: This was a retrospective study based on a questionnaire that was sent to the parents of 335 children who underwent TT due to sleep-related obstructive symptoms. RESULTS: A total of seven children had unilateral re-TT due to tonsillar regrowth, leaving a total of 342 operations performed. The response rate was 71% and the median follow-up was 90 months. None of the patients in this study ex-perienced post-operative bleeding requiring medical assistance. A total of 97% of parents reported total or partial relief of all symptoms, whereas 3% experienced no effect of treatment on preoperative symptoms. A total of 5% of the children later underwent tonsillectomy after their primary TT. The majority of parents (89%) would choose the operation again in a similar situation. CONCLUSIONS: TT has previously been shown to have a lower morbidity and risk of post-operative bleeding and a better recovery than TE. In this study, we found it to be a long-term efficient and safe treatment for children with obstructive symptoms during sleep and it was associated with a high degree of parent satisfaction. FUNDING: none. TRIAL REGISTRATION: This was a retrospective study.

[Hunter's syndrome and hearing impairment]. / Hunters syndrom og hørenedsaettelse.

A 30 month-old boy with delayed language development was referred to the Department of Audiology in Aarhus. At the time of referral he had had 19 cases of acute otitis media and had been tubulated four times. Furthermore, the boy had not developed according to age in several respects: his motor functions and language were delayed, and he made audible respiratory sounds and was obviously nasally congested. The boy was referred for further investigations at the Department of Paediatrics. The tests showed that the boy suffered from Hunter Syndrome (MPSII) and he underwent relevant treatment.