JOURNAL SCAN

Nasal surgery for snoring in

patients with obstructive sleep
apnea

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

LARYNGOSCOPE
Feb 2008
 INTRODUCTION
• Patients with nasal obstruction & chronic
night time rhinitis– habitual snorers
• Nasal obstruction causes snoring by 2
mechanisms -
– Increased nasal resistance due to narrowing
of 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)
 Materials and methods
• Detailed explanation of operation
• Written informed consent
• Polysomnography(PSG)
• Snore outcome survey (SOS)
questionnaires
• Nasal measures at baseline & 3 months
after surgery
 Materials and methods
SNORING AND NASAL OBSTRUCTION
SURVEY
• 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
 Materials and methods
NASAL MEASURES
• Nasal resistance (ant. rhinomanometry)
– NR = right NR x left NR cm of H2o
right NR + left NR
• Acoustic rhinometry
– Minimal cross sectional area (MCSA)
measured
 Materials and methods
SLEEP STUDY
• Overnight Polysomnography(PSG)
performed by pulmonologist.
• Apnea/hypoapnea index (AHI) measured
• Apnea—10 sec breathing pause
• Hypoapnea— 10 sec period when breathing
continues but nasal pressure is reduced by 50%
from baseline.
 Materials and methods
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
 Materials and methods
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 methods
STATISTICAL ANALYSIS
• Paired t test for variables before and after
surgery
• Independent t test to compare postoperative
changes in SOS with UPPP
• Baseline factors (BMI,AHI,total NR) of study
population categorized into LOW and HIGH
groups
• Results expressed as mean + SD
• P value < 0.5 – considered significant
 Materials and methods
• 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 during
perioperative 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 bed
partners)
• SOS scores improved from 41.6 to 60.7
• Improvement in SBPS consistent.
• Changes in SOS and SBPS achieved statistical
significance.
• SOS and SBPS scores improved 46% & 52%
respectively
 RESULTS
COMPARITIVE CHANGE IN SOS SCORES
BETWEEN SMP AND
UPPP
variable SMP UPPP
1)Sex (m/f) 52/1 52/3
2)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 surgery
improves snoring in 86% of patients.
• Changes in SOS score after nasal
surgery differed between groups with
different tonsil size.
• Nasal surgery remains a final recourse for
correcting nasal obstruction, a symptom
commonly encountered in obstructive
sleep 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 to
assess 67 patients with laryngeal cancer
• T1 & T2 cancers – conservative surgery or
exclusive RT
• T3 & T4 cancers – total laryngectomy with
neck dissection and primary voice
prosthesis 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 INTRATYMPANIC
DEXAMETHASONE ADDED TO
SYSTEMIC STERIODS IMPROVE
HEARING IN PATIENTS WITH SUDDEN
DEAFNESS
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