Li-Ang Lee

Impact of Adenotonsillectomy on Behavior in Children With Sleep-Disordered Breathing†

Objectives/Hypothesis: Children with sleep‐disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep‐related adverse events and behavioral problems in children with sleep‐disordered breathing.

Critical appraisal and meta-analysis of nasal surgery for obstructive sleep apnea.

Background Nasal surgery is commonly involved in surgical treatment for obstructive sleep apnea (OSA). The aim of this study was to investigate the outcomes of nasal surgery for OSA using evidence-based methodology. Methods The MedLine database (1999∼2009) was searched for original articles published in peer-reviewed journals concerning nasal surgery for snoring/sleep apnea. Data extracted from these articles were reviewed and analyzed using meta-analysis technology. Results Thirteen articles were critically appraised. Two studies provided control groups and 11 articles (84.6%) consisted of prospective noncontrolled clinical trials (level II in evidence strength). The weighted mean apnea/hypopnea index measured by polysomnography in nine studies decreased from 35.2 ± 22.6 to 33.5 ± 23.8 event/hour after nasal surgery (overall, p = 0.69). The pooled success rate of nasal surgery in treating OSA was 16.7%. Epworth Sleepiness Scale scores in eight studies decreased from 10.6 ± 3.9 to 7.1 ± 3.7 (overall, p <0.001). Nasal surgery for snoring assessed by individual questionnaires and visual analog scale reported significant improvement (p < 0.05). Conclusion The critical literature appraisal and meta-analyses show that nasal surgery can effectively reduce daytime sleepiness and snoring. However, the efficacy of nasal surgery in treating OSA is limited.

Treatment Outcomes of Adenotonsillectomy for Children with Obstructive Sleep Apnea: A Prospective Longitudinal Study

OBJECTIVE To evaluate the efficacy of adenotonsillectomy (AT) in the treatment of children with obstructive sleep apnea (OSA) in a 3-y prospective, longitudinal study with analysis of risk factors of recurrence of OSA. STUDY DESIGN An investigation of children (6 to 12 y old) with OSA documented at entry and followed posttreatment at 6, 12, 24, and 36 mo with examination, questionnaires, and polysomnography. Multivariate generalized linear modeling and hierarchical linear models analysis were used to determine contributors to suboptimal long-term resolution of OSA, and Generalized Linear Models were used for analysis of risk factors of recurrence. RESULTS Of the 135 children, 88 terminated the study at 36 months post-AT. These 88 children (boys = 72, mean age = 8.9 ± 2.7 yersus boys 8.9 ± 2.04 y, girls: 8.8 ± 2.07 y; body mass index [BMI] = 19.5 ± 4.6 kg/m(2)) had a preoperative mean apnea-hypopnea index (AHI0) of 13.54 ± 7.23 and a mean postoperative AHI at 6 mo (AHI6) of 3.47 ± 8.41 events/h (with AHI6 > 1 = 53.4% of 88 children). A progressive increase in AHI was noted with a mean AHI36 = 6.48 ± 5.57 events/h and AHI36 > 1 = 68% of the studied group. Change in AHI was associated with changes in the OSA-18 questionnaire. The residual pediatric OSA after AT was significantly associated with BMI, AHI, enuresis, and allergic rhinitis before surgery. From 6 to 36 mo after AT, recurrence of pediatric OSA was significantly associated with enuresis, age (for the 24- to 36-mo period), postsurgery AHI6 (severity), and the rate of change in BMI and body weight. CONCLUSIONS Adenotonsillectomy leads to significant improvement in apnea-hypopnea index, though generally with incomplete resolution, but a worsening over time was observed in 68% of our cases.

Relocation pharyngoplasty for obstructive sleep apnea

To investigate the efficacy of relocation pharyngoplasty as a surgical technique both to enlarge pharyngeal airspace and to decrease pharyngeal collapse in the treatment of obstructive sleep apnea (OSA).

Helicobacter pylori Colonization in the Larynges of Patients With Hoarseness

Objectives: Vocal nodules and polyps are two common noninfectious causes of hoarseness. Patients with persistent hoarseness often require microscopic laryngeal surgery to excise mass lesions of the larynx despite extensive voice resting and modification of voice use behavior. Helicobacter pylori has recently been reported to present in the upper aerodigestive tract. This study applies the rapid urease test to determine the colonization of Helicobacter pylori in surgical specimens of patients with vocal nodules and polyps.

Inflammatory cytokines in pediatric obstructive sleep apnea

Abstract Pediatric obstructive sleep apnea (OSA) is associated with chronic systemic inflammation and with cognitive impairments. This study aimed to investigate the status of proinflammatory cytokines, particularly interleukin 17 (IL-17) and interleukin 23 (IL-23) and cognition in pediatric OSA. Controls and OSA children participated in the study. Exclusion criteria were adenotonsillectomy, heart, neurological and severe psychiatric diseases, craniofacial syndromes, and obesity. Polysomnogram was followed by serum testing for inflammatory markers and neurocognitive tests such as continuous performance task (CPT) and Wisconsin card sorting test, questionnaires, analyses of plasma high-sensitivity C-reactive protein (HS-CRP), tumor necrosis factor alpha (TNF-&agr;), interleukin 1 (IL-1), interleukin 6 (IL-6), IL-17, and IL-23. Seventy-nine, 4 to 12-year-old subjects in 2 groups ended the study: 47 nonobese OSA children (mean age = 7.84 ± 0.56 years, body mass index [BMI] = 16.95 ± 0.47 kg/m2, BMI z-score = 0.15 ± 0.21, and mean apnea–hypopnea index [AHI] = 9.13 ± 1.67 events/h) and 32 healthy control children (mean age = 7.02 ± 0.65 years, with BMI = 16.55 ± 0.58 kg/m2, BMI z-score = −0.12 ± 0.27, and mean AHI = 0.41 ± 0.07 event/h) were enrolled. Serum cytokine analyses showed significantly higher levels of HS-CRP, IL-17, and IL-23 in OSA children (P = 0.002, P = 0.024, and P = 0.047). Regression test showed significant influence of HS-CRP, TNF-&agr;, IL-6, IL-17, and specifically IL-23, with the continuous performance test and Wisconsin card sorting test. OSA children have abnormal levels of IL-17, an interleukin related to T helper 17 cells, a T helper cell involved in development of autoimmunity and inflammation. This high expression level may contribute to the complications of pediatric OSA; we also found a significant influence of inflammatory cytokines, particularly IL-23, on abnormal neurocognitive testing.

Treatment of vallecular cysts in infants with and without coexisting laryngomalacia using endoscopic laser marsupialization: Fifteen-year experience at a single-center

OBJECTIVE To share our experience in treating a large cohort of infants with congenital vallecular cysts using endoscopic laser marsupialization. We describe the clinical characteristics of infants with pediatric vallecular cysts and compare these characteristics between infants with and without concurrent laryngomalacia and those who did or did not require preoperative airway support. METHODS Medical records of infants treated for vallecular cyst at Chang Gung Memorial Hospital between March 1994 and July 2008 were reviewed. Demographic and clinical characteristics and outcomes were recorded and compared. RESULTS Twenty-eight infants were included in our study: 11 (39.3%) males and 17 (60.7%) females. The incidence of vallecular cyst was 5.3 cases/100,000 live births. Median ages at symptom onset and diagnosis were 3.0 and 40.0 days, respectively. Mean symptom onset to diagnosis interval was 42.4 days. Eighteen (64.3%) infants had coexisting laryngomalacia and 11 (39.3%) required ventilatory support. The number of symptoms decreased in all patients after surgery (median no. symptoms before=4.5, after=0.5) and most symptoms were completely resolved within 3 months of surgery. Compared with infants who did not have laryngomalacia, infants with laryngomalacia: were younger at symptom onset (2 vs 10 days); had more symptoms before (5.0 vs 3.5) and after treatment (1.0 vs 0.0); had a longer length of hospital (14.6 vs 9.4 days) stay; and more commonly required airway intervention compared with infants without laryngomalacia (55.6% vs 10.0%: all P<0.05). Compared with infants who did not require ventilatory support, those that did: had a shorter interval between symptom onset and diagnosis (31.8 vs 49.3 days); were younger at the age of diagnosis (38.0 vs 49.0 days); had more symptoms before surgery (5.0 vs 4.0); had a higher prevalence of laryngomalacia (90.9% vs 47.1%); had a longer length of hospital (16.4 vs 10.4 days) stay (all P<0.05). CONCLUSIONS Our study included a large number of infants with vallecular cyst who were treated with endoscopic laser marsupialization. Of note, we found that a large proportion of infants had coexisting laryngomalacia, which appears to complicate the clinical presentation and management of vallecular cyst.

Alleviation of Wound Pain After Surgeries for Obstructive Sleep Apnea

Objectives: There has been growing awareness that alleviation of wound pain and associated symptoms after obstructive sleep apnea (OSA) surgeries may improve the quality of care. We performed a hospital‐based study to compare the effectiveness and safety of two different regimens in the treatment of postoperative pain.

Role of flexible transnasal esophagoscopy and patient education in the management of globus pharyngeus

BACKGROUND/PURPOSE Globus pharyngeus and dysphagia are common complaints of patients referred to ear, nose, and throat (ENT) clinics. We aimed to establish an efficient method to rule out the presence of malignancy in patients with globus pharyngeus and dysphagia. METHODS The use of flexible transnasal esophagoscopy (TNE) was evaluated in 30 patients with globus pharyngeus and 6 patients with dysphagia. The patients were immediately informed of the findings on TNE examination, and then treatments were planned. All patients were treated with lansoprazole for 2 weeks and provided education on lifestyle changes at the initial examination and at the 3-month follow-up. RESULTS The patients reported an improvement in symptoms of globus pharyngeus after treatment (p<0.001). Follow-up TNE confirmed improvement with less dysphagia, erythema, and vocal cord edema evident (all p<0.001). CONCLUSION The use of TNE and patient education are efficient management strategies for patients with symptoms of globus pharyngeus and dysphagia.

Clinical manifestations of pediatric obstructive sleep apnea syndrome: Clinical utility of the Chinese-version Obstructive Sleep Apnea Questionaire-18

Childhood obstructive sleep apnea syndrome (OSA) affects not only the childrens physical health, but also their mental development, behavioral problems and learning difficulties. Therefore, an early diagnosis is important. However, the assessment tools of polysomnography are demanding. The Obstructive Sleep Apnea Questionnaire‐18 (OSA‐18) is designed to screen OSA and has good reliability and validity. The goal of this study was to validate the Chinese version of the OSA‐18, to analyze the frequency of symptoms and find the most common symptoms of OSA in Taiwanese children.