Paul Schalch

Impact of Treatment of Gastroesophageal Reflux on Obstructive Sleep Apnea-Hypopnea Syndrome

Objectives: We test the hypothesis that treatment of gastroesophageal reflux disease (GERD) can improve obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: One hundred forty-six patients with OSAHS underwent a complete history-taking, physical examination, and laboratory testing, including questions related to GERD symptoms. Full-night attended polysomnography, 24-hour wireless pH study at the upper esophagus, snoring level evaluation, Epworth Sleepiness Scale, and quality-of-life surveys were completed for each patient. Patients who tested positive for GERD were treated with esomeprazole magnesium 40 mg once daily for 2 to 12 months. The 24-hour pH study was repeated, and those patients with elimination of GERD were reevaluated by polysomnography, snoring level evaluation, Epworth Sleepiness Scale, quality-of-life surveys, and subjective data collection. Results: Forty-one patients completed single-dose treatment with esomeprazole, but the repeat 24-hour pH study showed that 9 patients had persistent GERD. In the 29 patients who completed phase 2 with normal pH study findings, the snoring level decreased from 9.7 ± 0.5 to 7.9 ± 1.3 (p < .0001), the Epworth Sleepiness Scale score decreased from 14.2 ± 2.5 to 11.1 ± 2.4 (p < .0001), the apnea-hypopnea index decreased from 37.9 ± 19.1 to 28.8 ± 11.5 (p = .006), and the minimum saturation of oxygen increased from 84.1% ± 7.8% to 86.9% ± 5.0% (p = .055). Conclusions: Treatment of GERD had a significant impact on the reduction of the apnea-hypopnea index, snoring, and daytime sleepiness. Elimination of GERD should be part of a comprehensive treatment plan for patients with OSAHS.

Middle turbinate medialization with bovine serum albumin tissue adhesive (BioGlue).

Middle turbinate (MT) medialization without resection is an approach designed to both preserve the MT and prevent lateralization, which may cause obstruction of the outflow of the ethmoid, maxillary, and frontal sinuses after endoscopic sinus surgery. Many techniques for medialization have been described. We present a quick and easy technique that involves using the microdebrider to create small areas of denuded mucosa on opposite surfaces of the MT and the nasal septum followed by an application of a bovine serum albumin tissue adhesive to promote the formation of controlled synechiae without the need for nasal packing.

The macroscopic and microscopic effects of radiofrequency injury in the porcine tongue: A pilot study

OBJECTIVE: Current treatment protocols for obstructive sleep apnea/hypopnea syndrome with radiofrequency ablation of the base of the tongue are empiric. Injecting local anesthetics and saline into the treatment site is believed to shorten treatment duration and improve results. Our objective is to compare lesions at different energy levels, both macroscopically and histologically, and to determine if electrolyte solution injection results in a larger lesion. STUDY DESIGN: A prospective, experimental animal study. SETTING: University-affiliated institution. SUBJECTS AND METHODS: Five pigs each received four treatments on the right and four on the left side of the tongue. Three of four treatments were applied sequentially by increasing length of exposure (15, 30, or 60 seconds), and the fourth was conducted over 15 seconds after injecting 1 cc of a 1:1 local anesthetic-saline solution into the treatment site. The animals were recovered for three days and then sacrificed. Macroscopic measurements for each lesion were analyzed, and histological comparison was performed. RESULTS: The average volume of the lesions was 57.36, 65.18, and 60.50 mm3 for treatment durations of 60, 30, and 15 seconds, respectively, and there was no significant difference. Lesion volume at sites where anesthetic-saline was injected had a mean volume of 36.72 mm3. Paired comparison against the three treatment durations revealed significantly smaller lesion volume size (P = 0.0041, 0.0007, 0.0047, respectively). CONCLUSION: The lesions created with radiofrequency energy were consistent and predictable. The volumes of the lesions did not differ significantly with regard to different energy levels. The lesion was significantly smaller after injection of anestheticsaline at the treatment site.

Palatal stiffening after failed uvulopalatopharyngoplasty with the Pillar implant system

OBJECTIVE/HYPOTHESIS The objective of this study was to measure subjective and objective improvement after palatal stiffening in patients after uvulopalatopharyngoplasty (UPPP) who were experiencing persistence or recurrence of snoring with or without daytime sleepiness symptoms. STUDY DESIGN The authors conducted a prospective, nonrandomized study of 26 patients after UPPP who underwent the Pillar Implant Technique (PIT) as a revision procedure. METHODS Patients were selected to undergo revision PIT if they presented with recurrence or persistence of snoring after UPPP. Patients had mild or moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) (apnea-hypopnea index [AHI] >5 and < or =40), persistent retropalatal obstruction, and a residual palate > or =2 cm. Some patients experienced daytime somnolence as well. Patients with severe OSAHS (AHI > or =40), Friedman anatomic stage IV, and/or nasopharyngeal stenosis were excluded. Pre-/postoperative snoring levels, Epworth Sleepiness Scale (ESS), SF-36v2 Quality of Life (QOL) questionnaires, and polysomnograms were obtained. RESULTS We completed data on 23 patients. Postoperative snoring levels (3.4 +/- 1.8) and ESS (8.7 +/- 1.8) significantly improved (P < .0001) compared with preoperative values (8.7 +/- 1.8 and 13.2 +/- 2.9). A total of 73.9% of patients improved subjectively. Seven of eight SF-36v2 QOL domains showed significant improvement (P < .05). Postoperative AHI and minimum oxygen saturation also improved significantly (P < .05). Objective cure was only achieved in 21.7% of patients. CONCLUSIONS Revision PIT is effective in achieving subjective improvement of recurrent symptoms after UPPP. Objective cure was only obtained in 21.7% of patients. As a result of the safety and low morbidity of the procedure, it is an alternative to improve symptoms, especially snoring, in patients not willing to accept continuous positive airway pressure permanently or patients who refuse revision surgery.

Optical coherence tomography applications in otolaryngology

Optical coherence tomography is a novel imaging technique providing high-resolution bidimensional images of tissue microstructures. Several studies have been published on the use of this technique in different fields of medicine, particularly ophthalmology. There are very few studies in the field of otolaryngology. This paper presents various applications of optical coherence tomography in the different sub-specialties of otolaryngology, as well as the benefits of this technique over traditional diagnostic methods.

Middle turbinate medialization with bovine serum albumin tissue adhesive (BioGlue)

Middle turbinate (MT) medialization without resection is an approach designed to both preserve the MT and prevent lateralization, which may cause obstruction of the outflow of the ethmoid, maxillary, and frontal sinuses after endoscopic sinus surgery. Many techniques for medialization have been described. We present a quick and easy technique that involves using the microdebrider to create small areas of denuded mucosa on opposite surfaces of the MT and the nasal septum followed by an application of a bovine serum albumin tissue adhesive to promote the formation of controlled synechiae without the need for nasal packing.

Aplicaciones de la tomografía de coherencia óptica en otorrinolaringología

Optical coherence tomography is a novel imaging technique providing high-resolution bidimensional images of tissue microstructures. Several studies have been published on the use of this technique in different fields of medicine, particularly ophthalmology. There are very few studies in the field of otolaryngology. This paper presents various applications of optical coherence tomography in the different sub-specialties of otolaryngology, as well as the benefits of this technique over traditional diagnostic methods.

3D CT for Diagnosis of Facial/Mandibular Fractures

Objective To describe how the use of 3-D reformatted computer tomographic (CT) images increases the accuracy of diagnosis of facial and mandibular fractures and influences surgical planning. Methods Retrospective review of 20 patients with facial and/or mandibular fractures between 2005 and 2006, diagnosed with CT facial bones (axial and coronal images and 3-D renderings). The study was conducted at a university- affiliated institution. Standard CT facial bones protocol consisting of 1.5mm contiguous axial and coronal sections were performed on a 40-slice scanner (Philips Medical Systems, Cleveland, OH). 3-D reconstructions were then obtained. Scans were reviewed by the consulting surgeon. Pre-operative diagnoses were confirmed intraoperatively. Results Patient mean age was 31 years (17–46). Pre-operative diagnoses included: 18 mandible fractures, 8 zygomatico-maxillary/orbital floor, and 4 midface fractures. Mechanisms of injury included assault, motor-vehicle accidents, sports- and work-related injuries, and falls. Diagnosis and surgical planning was influenced in 1/3 of fractures after reviewing 3-D reformatted images. 3-D reformatting did not add any cost to the CT scans performed, did not expose patients to additional radiation, nor did it significantly increase the time to obtain the study. Conclusions 3-D CT reformatting is an inexpensive, easy-to-obtain diagnostic imaging modality that increases the accuracy of diagnosis and helps improve planning of surgical repair of facial and mandibular fractures.

P046: Aesthetic Superficial Parotidectomy: Technique and Outcomes

OBJECTIVES: A minimally invasive approach is indicated in solitary parathyroid adenoma when precisely localized with imaging. The aim of this report is to outline precise surgical indications and patient benefits of this procedure. METHODS: Retrospective study of 26 patients (67 years on average), with solitary parathyroid adenoma managed in a university hospital from 1997 to 2006. Every patient had a preoperative imaging study including neck ultrasonography and sestamibi scanning. Adenoma removal under local anesthesia was performed by the same surgeon. RESULTS: A minimally invasive approach under local anesthesia was performed for 26 patients with an operative time between 15 and 30 minutes. A second procedure under general anesthesia was performed for only one patient because of a posterior localization, behind the trachea. The mean postperative stay was 2,56 days. There was no recurrence of hyperparathyroidism. No intraoperative complications were noted. CONCLUSIONS: Minimally invasive approach can be performed when a parathyroid adenoma is precisely localized by neck ultrasonography and sestamibi scanning. In most cases, local anesthesia is the usual procedure. This technique appears to be cost–effective and efficient over the long term.