Anthony M. Tolisano

Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta-analysis.

The primary objective was to determine if sleep study variables (e.g., apnea‐hypopnea index [AHI] and lowest oxygen saturation) and quantitative sleepiness data improve following isolated hyoid surgery for obstructive sleep apnea (OSA).

Rhinology and medical malpractice: An update of the medicolegal landscape of the last ten years

Malpractice claims pertaining to rhinological procedures are a potentially important source of information that could be used to minimize the risk of future litigation and improve patient care.

Sleep surgery and medical malpractice

To describe and analyze the causes and outcomes of lawsuits pertaining to sleep surgery to mitigate future litigation and improve physician education.

Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy. DATA SOURCES PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. REVIEW METHODS Searches were performed from inception through September 2, 2015. RESULTS Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies). CONCLUSIONS This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.

Oral pressure therapy (winx) for obstructive sleep apnea: a meta-analysis updating the systematic review.

Letter to the editor: We read with great interest the recent systematic review by Dr. Nigam and colleagues evaluating the effect of oral pressure therapy (Winx® Sleep Therapy System by ApniCureTM Redwood City, CA, USA) on obstructive sleep apnea (OSA) outcomes [1]. We commend the authors for their role in advancing the academic literature regarding treatment for OSA. We believe this article would be strengthened by inclusion of a meta-analysis of the data, as has previously been published for other medical treatments (e.g. myofunctional therapy [2] and nasal expiratory positive airway pressure devices [3] (Provent ®)) and surgical treatments (e.g. hyoid surgery [4] and supraglottoplasty surgery [5]) for OSA. We, therefore, offer this additional statistical analysis for oral pressure therapy. In order to perform the meta-analysis, we first reviewed the article by Dr. Nigam and colleagues and downloaded the included manuscripts. Subsequently, M.C. and S.A.S. performed an updated search through February 10, 2016 to ensure there were no additional studies. We found no additional studies. We reviewed the studies and did our best to exclude studies if they had potentially duplicate data. Next, we used STATA 14.1 (StataCorp, College Station, Texas, USA) and Review Manager Software (REVMAN) version 5.3 (Copenhagen: The Nordic Cochrane Centre: The Cochrane Collaboration, 2014) to perform the statistical analysis and the meta-analysis with random effects modeling. In total, 140 patients had pre and post-oral pressure therapy data for evaluation. The means and standard deviations for apnea-hypopnea index (AHI) preand post-oral pressure therapy treatment for adults was 37.18 ± 24.94 and 21.35 ± 23.72 events/h (relative reduction: 42.6 %). Random effects modeling was performed for the studies providing means and standard deviations in 139 patients (1 patient was excluded as a case report since case reports have no mean and standard deviation, therefore, case reports cannot be analyzed in REVMAN). For AHI, the mean difference was −16.11 [95 % Confidence Interval (CI) -21.53, −10.68] events/h, overall effect z = 5.83, p < 0.00001. The Cochrane Q-statistic for mean difference in AHI was 0.40 (no statistically significant heterogeneity) and the I was 0 % (no inconsistency). The standardized mean difference for AHI was −0.69 [95 % CI −0.97, −0.41], which corresponds to a moderate magnitude of effect using Cohen’s guidelines. The Cochrane Q-statistic for standardized mean difference was 0.31 (no statistically significant heterogeneity) and the I was 16 % (no to low inconsistency). Figure 1 summarizes the mean difference and standardized mean difference data comparing oral pressure therapy to baseline values as treatment for obstructive sleep apnea. Review of the individual studies’ outcomes does not clearly demonstrate whether select groups would most benefit from oral pressure therapy based on OSA severity (mild, moderate or severe); however, as summarized by Nigam et al. BOPT success rate varied in the range of 27-43% for mild OSA, 42-71% for moderate OSA, and 23-50% for severe OSA^. [1]. The first limitation in this meta-analysis is that the majority of the original work evaluating oral pressure therapy has been performed by a select few investigators using industry funded * Macario Camacho drcamachoent@yahoo.com

Nasal Dilators (Breathe Right Strips and NoZovent) for Snoring and OSA: A Systematic Review and Meta-Analysis

Objective. To systematically review the international literature for studies evaluating internal (NoZovent) and external (Breathe Right Strips) nasal dilators as treatment for obstructive sleep apnea (OSA). Study Design. Systematic review with meta-analysis. Methods. Four databases, including PubMed/MEDLINE, were searched through September 29, 2016. Results. One-hundred twelve studies were screened, fifty-eight studies were reviewed, and fourteen studies met criteria. In 147 patients, the apnea-hypopnea index (AHI) was reported, and there was an improvement from a mean ± standard deviation (M ± SD) of 28.7 ± 24.0 to 27.4 ± 23.3 events/hr, p value 0.64. There was no significant change in AHI, lowest oxygen saturation, or snoring index in OSA patients when using nasal dilators. However, a subanalysis demonstrated a slight reduction in apnea index (AI) with internal nasal dilators (decrease by 4.87 events/hr) versus minimal change for external nasal dilators (increase by 0.64 events/hr). Conclusion. Although nasal dilators have demonstrated improved nasal breathing, they have not shown improvement in obstructive sleep apnea outcomes, with the exception of mild improvement in apnea index when internal nasal dilators were used.

Author Self-Citation in the Otolaryngology Literature: A Pilot Study.

Objective To determine the prevalence of author self-citation in the field of otolaryngology. Study Design and Setting A retrospective review of bibliographic references in 5 otolaryngology journals. Subjects and Methods Five high-impact otolaryngology journals were reviewed over a 3-month period between January and March 2014 to identify the pattern of author self-citations. Data included study type, otolaryngology topic, authorship, total citations, author self-citations, and country of origin. Results Nearly two-thirds of articles contained at least 1 self-citation, with an average of 2.6 self-citations per article. Self-citations represented nearly 10% of total citations. Articles with at least 1 self-citation had more authors (5.8 vs 4.9, P < .01) and more citations (30.4 vs 22.2, P < .01) per article than did those without self-citations. There was no difference in self-citation practices between articles originating within the United States and abroad (P = .65). Last authors were the most frequent self-citers and were more likely than lead authors to cite themselves (P < .01). Original reports contained the highest percentage of self-citations per article as compared with reviews and case reports (P < .01). Conclusion Author self-citation in the otolaryngology literature is common and compares similarly to other medical specialties previously studied. Self-citation should not be considered inappropriate, as it is often done to expand on earlier research. Nevertheless, editors, researchers, and readers should be aware of this increasingly recognized phenomenon and its associated potential implications to the process of scientific inquiry.

Laryngology litigation in the United States: Thirty years in review.

Malpractice claims pertaining to laryngology procedures are a potentially important source of information that could be used to minimize the risk of future litigation and improve patient care.

Effect of a second primary thyroid carcinoma on patients with head and neck squamous cell carcinoma.

The purpose of this study was to characterize the timing, histology, and behavior of second primary thyroid carcinoma (SPTC) developing after a diagnosis of head and neck squamous cell carcinoma (HNSCC).

Adverse Events Following Vestibular Schwannoma Surgery: A Comparison of Surgical Approach

OBJECTIVE Compare complications of vestibular schwannoma (VS) resection by surgical approach. STUDY DESIGN Retrospective cohort. SETTING The 2008 to 2013 American College of Surgeons-National Surgical Quality Improvement Program. PATIENTS Adult patients with VS resection by an otolaryngologist. INTERVENTIONS VS resection via transtemporal (TT), retrosigmoid (RS), or middle cranial fossa (MCF) approaches. MAIN OUTCOME MEASURES Hearing preservation approaches were compared with hearing sacrificing approaches. Demographics and intraoperative factors were analyzed to identify predictors of medical and surgical complications, return to the operating room, and death. The effect of trainee presence was evaluated with respect to complications, operative length, and hospital length of stay. RESULTS One hundred eleven VS resections were identified. Patients were predominantly women (57%) and older than 50 years (69%). The TT approach accounted for 50% of the cases, while RS (36%) and MCF (14%) were less common. The risk of any postoperative complication was 17%. There were no patient deaths. There was no difference in the overall complication rate among surgical approaches, nor in the overall, surgical, or medical complication rates between hearing preservation and hearing sacrificing approaches. Trainee presence did not change operation length, hospital length of stay, or complication rates. CONCLUSIONS Complication rates of VS resection are no different when comparing TT, RS, or MCF approaches. Trainee involvement did not significantly affect complications. This study is limited by the inability to evaluate procedure-specific variables (e.g., facial nerve weakness and hearing preservation rates), but offers a unique survey of global 30-day complication rates reported to a large, multi-institutional, publically available database.