Sumanth Journal Scan

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JOURNAL SCAN

Nasal surgery for snoring inpatients with obstructive sleep

apnea

Hsueh-yu Li,Li-ang lee, et al.

LARYNGOSCOPE

Feb 2008



INTRODUCTION

Patients with nasal obstruction & chronicnight time rhinitis± habitual snorers

Nasal obstruction causes snoring by 2mechanisms -

± Increased nasal resistance due to narrowingof nasal passages

± Mouth breathing leading to palatal flutter Altering airflow patterns after nasal

surgery may be effective for snoring relief.



Objective

To evaluate the efficacy of nasal surgery

to relieve snoring and to identify predictive

factors.

Study design

Prospective comparative study



Materials and methods

STUDY POPULATION(52 patients)

Inclusion criteria

± c/o nasal obstruction for >6 m

± DNS on ant. Rhinoscopy

± h/o habitual snoring

Exclusion criteria

± Cardiopulmonary diseases (CAD,COPD,BA) ± >60 years age

± Pathologic obesity (BMI >40 kg/m2)




Detailed explanation of operation

Written informed consent

Polysomnography(PSG) Snore outcome survey (SOS)

questionnaires

Nasal measures at baseline & 3 monthsafter surgery




SNORING AND NASAL OBSTRUCTIONSURVEY

Snore outcome survey (SOS)

± Valid reliable & disease specific ± 8 Likert type items

± Evaluate duration, loudness, frequency of snoring

Spouse/bed partner survey (SBPS) ± 3 Likert like items

Visual analogue scale (VAS) ± 0 -- no obstruction

± 10 -- complete obstruction




NASAL MEASURES

Nasal resistance (ant. rhinomanometry)

± NR = right NR x left NR cm of H2oright NR + left NR

Acoustic rhinometry

± Minimal cross sectional area (MCSA)measured




SLEEP STUDY

Overnight Polysomnography(PSG)

performed by pulmonologist. Apnea/hypoapnea index (AHI) measured

Apnea²10 sec breathing pause

Hypoapnea² 10 sec period when breathingcontinues but nasal pressure is reduced by 50%

from baseline.




SURGICAL PROCEDURES

Septomeatoplasty

± Correction of nasal septum

± Excising lateral part of inf. Turbinate

± Packing with Vaseline strips & merocel

POSTOPERATIVE CARE

Prophylactic oral antibiotic Humid O2 mask- reduces dryness of throat

Nasal packing removed after 1 day




OUTCOME MANAGEMENT

Primary measure -- change in SOS score

after nasal surgery Secondary measure ± baseline factors

influencing change in SOS score

Compared with previous study measured

after UPPP (uvulo-palato-pharyngo-plasty)



Materials and methodsSTATISTICAL ANALYSIS

Paired t test for variables before and after surgery

Independent t test to compare postoperativechanges in SOS with UPPP

Baseline factors (BMI,AHI,total NR) of studypopulation categorized into LOW and HIGHgroups

Results expressed as mean + SD

P value < 0.5 ± considered significant




LOW group

± Mallampati grade I & II

± Tonsil grade 0 &I

HIGH group

± Mallampati grade III & IV

± Tonsil grade II & III



RESULTS

BASELINE DATA

52 Patients(51 male,1 female)

Age range ± 23 to 57 yrs Mean age ± 39 + 10 yrs

Mean BMI ± 25.4 + 5.2 kg/m2



RESULTS

COMPLICATIONS

Septal hematoma ± 1 patient (drained on

3rd

post op day) Postoperative nasal bleeding ± 1 patient

(controlled by ice pack and bed rest)

No airway compromise was noted duringperioperative period



RESULTS

SURVEY OF NASAL IMPEDIMENT

Improved nasal breathing ± all patients

VAS scores decreased NR improved



RESULTS

SNORE OUTCOME SURVEY(SOS)

Post op SOS increased in 86%

Unchanged in 2%

Decreased in 12% Complete snoring relief ± 12%(according to bedpartners)

SOS scores improved from 41.6 to 60.7

Improvement in SBPS consistent.

Changes in SOS and SBPS achieved statisticalsignificance.

SOS and SBPS scores improved 46% & 52%respectively



RESULTS

COMPARITIVE CHANGE IN SOS SCORESBETWEEN SMP AND UPPP

variable SMP UPPP

1)Sex (m/f) 52/1 52/32)BMI 25.5 26.3

3)Mean age 39.2 45.1

4)AHI 36.6 43.6

5)Improvement 19.2 38.8

in SOS



DISCUSSION

Current study shows that nasal surgeryimproves snoring in 86% of patients.

Changes in SOS score after nasalsurgery differed between groups withdifferent tonsil size.

Nasal surgery remains a final recourse for

correcting nasal obstruction, a symptomcommonly encountered in obstructivesleep apnea patients.



JOURNAL SCAN

LONG TERM QUALITY OF LIFE AFTER

TOTAL LARYNGECTOMY AND

POSTOPERATIVE RADIOTHERAPY VERSUS

CONCURRENT CHEMORADIOTHERAPY

FOR LARYNGEAL PRESERVATION

Paolo Boscolo, et al.

LARYNGOSCOPE

FEB 2008



Objective

To compare the quality of life (Qol) of

patients who underwent total laryngectomy

with voice prosthesis insertion and post-op

radiotherapy with those receiving

chemoradiotherapy for laryngeal

preservation.



Study design

Retrospective, cross sectional study in

tertiary academic center



Materials & Methods European organization for research and

treatment of cancer Qol questionnaires toassess 67 patients with laryngeal cancer

T1 & T2 cancers ± conservative surgery or exclusive RT

T3 & T4 cancers ± total laryngectomy with

neck dissection and primary voiceprosthesis insertion with PORT or concurrent chemoradiotherapy



RESULTS Functional scores for

± Physical functioning -

± Social contact better in the non surgical

group

± Speech

± Quality of life -

Surgical patients complained of ± Sleep disturbances

± Dyspnea

± Pain

± Difficulty in speech

± Decreased social contact

Non surgical patients complained of ± Dry mouth

± Sticky saliva



CONCLUSION

Better Qol in non surgical patients

Mainly because of better

± Physical functioning

± Social functioning

± Less problems with pain, respiration

± Better speech

± Less sleep disturbances



JOURNAL SCAN

CAN INTRATYMPANICDEXAMETHASONE ADDED TO

SYSTEMIC STERIODS IMPROVE

HEARING IN PATIENTS WITH SUDDENDEAFNESS

Joong ho Ahn,Myung hoon Yoo, et al

LARYNGOSCOPE

FEB 2008



Objective

To evaluate the therapeutic efficacy of

intratympanic dexamethasone (ITD)

injections + systemic steroids in patients

with sudden SNHL



Materials & Methods

120 pt¶s with sudden SNHL treated with

± ITD ± 0.3 ml on day 1,3,5. followed by 48 mg

methylprednisolone [test group]

± Methylprednisolone alone [control group]



RESULTS

Total recovery after treatment

± 73.3% in ITD group

± 70.0% in control group PTA results same in both groups

ITD group showed better hearing

improvement only at 250 Hz



CONCLUSION

The addition of ITD to systemic steroids

did not result in significant improvement in

the treatment of sudden SNHL.



JOURNAL SCAN

SUPERFICIAL MUSCULOAPNEUROTIC

SYSTEM ELEVATION & FAT GRAFT

RECONSTRUCTION AFTER

SUPERFICIAL PAROTIDECTOMY

Joseph M. Curry,Kyle W. Fisher, et al.

LARYNGOSCOPE

FEB 2008



OBJECTIVE/HYPOTHESIS

Elevation of superficial musculoaponeuritic

system (SMAS) with or without

interposition during superficial

parotidectomy prevents a concave facial

deformity and Frey¶s syndrome

STUDY DESIGN

Retrospective ,case control study



METHOD

Charts of 248 patients who underwent

superficial parotidectomy reviewed.

16 pt¶s underwent SMAS 34 pt¶s underwent SMAS with fat graft

interposition.

Non reconstructed pt¶s selected randomly. Both groups compared with controls.



RESULTS

SMAS elevation alone

± Greater facial symmetry

± Less symptomatic Frey's syndrome

SMAS elevation with fat graft interposition

± Greater facial symmetry

± Less symptomatic Frey's syndrome

Complications among study and control

groups were similar







CONCLUSION

Simultaneous reconstruction of a

superficial parotidectomy with or without

fat graft reconstruction

± Improves facial symmetry

± Less incidence of symptomatic Frey's

syndrome

± Without increasing complications



THANK YOU

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