Surgical failure guided by DISE in patients with obstructive sleep apnea: a systematic review and meta-analysis.

OBJECTIVES: The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This review aims to analyze the failure rate of upper airway surgery with DISE and identify obstruction sites for surgical failure. METHODS: A systematic review was conducted using PubMed, Embase, Web of Science, and Google Scholar until May 20th, 2023. We included studies that used DISE to assess obstructive sites before upper airway surgery and reported surgical failure rates and outcomes in patients with OSA. RESULTS: 25 studies with a total of 1522 patients were included in the systematic review and meta-analysis. Upper airway surgery guided by DISE had a relatively low failure rate of 37% (95% CI 0.31-0.44) in the random effects model (I2 = 85.97%, P < 0.001). According to the velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system, major risk factors for surgical failure included circumferential collapse at the velum, lateral wall collapse and small tonsils at the oropharynx, anterior-posterior lingual collapse and complete collapse at the tongue base. High body mass index and large preoperative apnea hypopnea index were also risk factors for OSA surgical failure. CONCLUSIONS: Upper airway surgery guided by DISE in patients with OSA had a low failure rate of 37%. DISE can identify obstruction sites associated with surgical failure and guide single-level and multi-level surgeries.

Necessary Factors for Efficient Frontal Sinus Irrigation After Endoscopic Sinus Surgery: A Systematic Review.

OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. CONCLUSION: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. LEVEL OF EVIDENCE: NA.

[Intervention effects of bone conduction hearing aids in patients with single-sided deafness and asymmetric hearing loss].

The incidence of single-sided deafness（SSD） is increasing year by year. Due to the hearing defects of one ear, the ability of sound localization, speech recognition in noise, and quality of life of patients with single-sided deafness will be affected to varying degrees. This article reviews the intervention effects of different types of bone conduction hearing aids in patients with single-sided deafness and asymmetric hearing loss, and the differences of intervention effects between bone conduction hearing aids, contralateral routing of signal（CROS） aids, and cochlea implant（CI）, to provide a reference for the auditory intervention and clinical treatment of single-sided deafness and asymmetric hearing loss.