Penelope Harris

Upper airway reconstructive surgery long-term quality-of-life outcomes compared with CPAP for adult obstructive sleep apnea

OBJECTIVE: To measure long-term quality-of-life (QOL) improvement following contemporary multilevel upper airway reconstruction surgery, compared with continuous positive airway pressure (CPAP) therapy. Secondary aims were to investigate factors determining clinical effectiveness and QOL impact of reported side effects. DESIGN: Cohort study. SUBJECTS AND METHODS: Consecutive, simultaneously treated adult patients with moderate-severe obstructive sleep apnea (OSA) having upper airway surgery (N = 77) or CPAP (N = 89) therapy were studied by questionnaire. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean ± SEM 44.12 ± 5.78 months (3.68 ± 0.48 years) after commencement of therapy. RESULTS: No significant difference was seen between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Multivariate analysis showed reduction in Respiratory Disturbance Index (RDI) predicted postoperative snoring and ESS, but not GBI outcomes. Snoring control and GBI were related to CPAP compliance (P < 0.001). CPAP side effects (reported in 26%) significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44%) did not affect QOL treatment benefit. CONCLUSION: Patients with poor CPAP compliance and/or significant side effects of CPAP therapy (45% of cases in this series) should be evaluated for contemporary upper airway reconstructive surgery.

Tonsillectomy in Australia: An audit of surgical technique and postoperative care

Objective To assess current tonsillectomy practice among Australian otolaryngologists. Study Design An audit based on an anonymous 19-item postal questionnaire on tonsillectomy technique and perioperative management sent to all Australian otolaryngology specialists. Subjects and Methods Two hundred eighty-four otolaryngologists registered with the Australian Society of Otolaryngology-Head and Neck Surgery database were sent the questionnaire. Results A 72.5 percent response rate was obtained. Monopolar diathermy was the most common technique for dissection (45%) and hemostasis (54%). Bipolar diathermy was used for hemostasis in 20 percent. Cold-steel dissection was routinely used by 36 percent, ties were used for hemostasis only by 11 percent of surgeons. The use of local anesthetic, dexamethasone, and postoperative antibiotics was 45 percent, 40 percent, and 20 percent, respectively. Seventy-six percent of surgeons always observed tonsil patients overnight. Conclusion Australian surgeons still use monopolar diathermy as their preferred technique for tonsillectomy. Local anesthetic, dexamethasone, and postoperative antibiotics are used infrequently, and fewer than 1:4 surgeons perform day-case tonsillectomy.

Quality of life following surgery for sleep disordered breathing: subtotal reduction adenotonsillectomy versus adenotonsillectomy in Australian children.

Background:  Adenotonsillectomy (AT) is indicated for children with obstructive sleep disordered breathing; however it has associated well‐documented morbidity. A subtotal reduction AT has made a resurgence overseas, given a significantly reduced morbidity. This study hypothesized that full AT would provide a greater improvement in quality of life (QOL) when compared with a subtotal reduction AT (SRAT) in children with obstructive sleep disordered breathing.

Reflux changes in adenoidal hyperplasia: a controlled prospective study to investigate its aetiology

Objectives:  To compare pepsin, carbonic anhydrase III (CAIII), cyclooxygenase‐2 (COX‐2) and mucin 5AC (MUC5AC) expression in children with adenoid hypertrophy and normal controls.