Andrew J. Senchak

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis.

To determine if sleepiness and sleep study variables (e.g., Apnea‐Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA).

The Effect of Tonsillectomy Alone in Adult Obstructive Sleep Apnea

Objective The purpose of this study was to determine the effect of tonsillectomy as a single procedure in the treatment of adult obstructive sleep apnea (OSA). Study Design Prospective multi-institutional study evaluating adults with tonsillar hypertrophy scheduled to undergo tonsillectomy as an isolated surgery. Setting Tertiary care medical centers within the US Department of Defense. Subjects and Methods Adult subjects with tonsillar hypertrophy who were already scheduled for tonsillectomy were enrolled from October 2010 to July 2013. Subjects underwent physical examination, Epworth Sleepiness Scale, Berlin Questionnaire, and polysomnogram before surgery and after. Collected data included demographics, questionnaire scores, apnea-hypopnea index (AHI), and lowest saturation of oxygen. Results A total of 202 consecutive subjects undergoing tonsillectomy were enrolled. The final analysis included 19 subjects testing positive for OSA. The mean age was 27.9 years; mean body mass index, 29.6; median tonsil size, 3; and most frequent Friedman stage, 1. The AHI before surgery ranged from 5.4 to 56.4 events per hour. The mean AHI decreased from 18.0 to 3.2 events per hour after surgery, a reduction of 82%. The responder rate—with subjects achieving at least a 50% reduction of AHI to a value <15—was 94.7%. Following tonsillectomy, there were statistically significant reductions in median lowest saturation of oxygen level and Epworth Sleepiness Scale and Berlin scores. Conclusions Adult tonsillectomy alone has beneficial effect in OSA management, particularly in young overweight men with large tonsils, moderate OSA, and low Friedman stage.

Low-Grade Esthesioneuroblastoma Presenting as SIADH: A Review of Atypical Manifestations

Esthesioneuroblastoma (ENB) is a neuroendocrine tumor that typically manifests as advanced stage malignancy in the superior nasal cavity. The hallmark symptoms include nasal obstruction and epistaxis, which result from local tissue invasion. Atypical clinical features can also arise and must be considered when diagnosing and treating ENB. These can include origin in an ectopic location, unusual presenting symptoms, and associated paraneoplastic syndromes. The case described here reports a nasal cavity ENB with atypical clinical features that occurred in a young female. Her tumor was low grade, appeared to arise primarily from the middle nasal cavity, and presented as syndrome of inappropriate antidiuretic hormone (SIADH). She also became pregnant shortly after diagnosis, which had implications on her surgical management. We review the atypical features that uncommonly occur with ENB and the clinical considerations that arise from these unusual characteristics.

The department of defense epidemiologic and economic burden of hearing loss study

Although studies have examined the relation between military-related noise and hearing, comprehensive data to calculate rates of hearing loss across all Services and to determine economic impact are lacking. The goal of the multiphase Department of Defense (DoD) Epidemiologic and Economic Burden of Hearing Loss (DEEBoHL) project is to examine rates of hearing impairment and noise-induced hearing injury, relevant noise exposures, and to determine the economic burden of these outcomes to the DoD and Service Members. The DoD Hearing Center of Excellence is supporting the following Phase I specific aims, among active duty Service Members to (1) calculate rates of hearing impairment and noise-induced hearing injury, and (2) develop a framework for the DoD to conduct comprehensive economic burden studies for hearing impairment and noise-induced hearing injury. The study is led by a multidisciplinary team from The University of Texas School of Public Health, The University of Texas Health Science Center at San Antonio, and The Geneva Foundation, with guidance from experts who make up the study advisory board. In this article, we focus on an overview of the DEEBoHL study, the methods for the first aim of this effort, and describe future plans for the study.

The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue.

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

Economic Burden of Hearing Loss for the U.S. Military: A Proposed Framework for Estimation.

The goal of this multiphased research is to develop methods to comprehensively determine the economic impact of hearing impairment and noise-induced hearing injury among active duty U.S. Service Members. Several steps were undertaken to develop a framework and model for economic burden analysis: (1) a literature review identifying studies reporting the cost of health conditions and injuries in the Department of Defense, (2) consultation with a panel of subject matter experts who reviewed these cost items, and (3) discussions with DoD data stewards and review of relevant data dictionaries and databases. A Markov model was developed to represent the cumulative economic effect of events along the career span, such as retraining after hearing impairment and injury, by synthesizing inputs from various sources. The model, as developed and proposed in this study, will be a valuable decision-making tool for the DoD to identify high-risk groups, take proactive measures, and develop focused education, customized equipping, and return-to-duty and reintegration programs, thereby maximizing the retention of skilled, experienced, and mission-ready Service Members.

P157: Treatment of Cutaneous Hemangiomas with Topical Imiquimod 5%

complication of acute otitis media, representing an estimated incidence of 0.005%. However, without appropriate therapy the prognosis is poor. This fact justifies a precise therapeutic protocol to accelerate recovery. METHODS: A retrospective study of all acute otitis media that came in to an emergency unit during the last six years. Six children who presented acute otitis media and facial paralysis were reviewed. Pathophysiological mechanisms and different treatment methods are discussed. RESULTS: The patient ages range from 22 months to 15 years. Facial palsies were identified a few hours to four days from the onset of acute otitis media. Two cases debuted with pain and otorrhea. In the other four cases the tympanic membrane was reddish and swollen. All patients received oral or endovenous treatment (antibiotics and corticosteroides). Myringotomy and local culture was performed in all nonotorrheic patients, except in one whose endovenous treatment immediately improved his paralysis. All patients showed rapid improvement after treatment and recovered completely. CONCLUSIONS: Immediate medical and surgical treatment was crucial to avoid permanent facial paralysis.

R049: Airway Injury Model for the Application of RNAi Therapy

airway during the pharyngeal stage of swallowing. But the relationships between mobility of the epiglottis and the hyoepiglottic ligament are not fully understood. METHODS: It is a retrospective comparative study. Hematoxylin-Eosin stain and Elastica Van Gieson stain were performed on paraffin-embedded sections from 20 normal postmortem larynx without laryngeal diseases. The hyoepiglottic ligament was compared between an elderly group (n 11, 81 to 91 yrs old) and nonelderly group (n 9, 31 to 48 yrs old) using an image analysis system (Image J 1.34S). RESULTS: Although it has been believed that the hyoepiglottic ligament anatomically attaches to the anterior surface of the epiglottic cartilage to the hyoid bone, this study showed it extended to the two parts (both lingual muscles and hyoid bone from the epiglottis). The team named the two parts of the ligament as pars lingualis and pars hyoideus. In the elder group, distributions of the muscle fibers, collagen fibers, and elastic fibers were significantly decreased than those in the nonelderly group. CONCLUSION: This study showed that there are age-related differences between elder adults and young adults in the hyoepiglottic ligament. SIGNIFICANCE: This study focused on the hyoepiglottic ligament in order to elucidate age-related changes and its functional characteristics in airway protection during swallowing. Results suggest that active regulation in positioning the epiglottis can be decreased in elders.