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Sonar PR, Panchbhai AS. Case Report: Masseter hypertrophy: A case and review. F1000Res 2024; 12:1263. [PMID: 39036345 PMCID: PMC11258545 DOI: 10.12688/f1000research.140341.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/23/2024] Open
Abstract
Masseter muscle hypertrophy is a rare condition with no known etiology that has become more prevalent due to growing aesthetic concerns. It is distinguished by either unilaterally or bilaterally enlarged masseter muscles. Its origin is still unknown. This study discusses a clinically confirmed case of unilateral masseter muscle hypertrophy and provides an outline of the condition's etiology, prevalence, diagnosis, and course of treatment.
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Affiliation(s)
- Prasanna R. Sonar
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
| | - Aarati S. Panchbhai
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, 442001, India
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2
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Herman H, Stern J, Alessi DM, Swartz KA, Gillespie MB. Office‐Based Multilevel Radiofrequency Ablation for Mild‐to‐Moderate Obstructive Sleep Apnea. OTO Open 2023; 7:e19. [PMID: 36998558 PMCID: PMC10046721 DOI: 10.1002/oto2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 02/19/2023] Open
Abstract
Objective Investigate multilevel radiofrequency ablation (RFA) as an alternative therapy for patients with mild-to-moderate obstructive sleep apnea (OSA). Study Design Prospective, open-label, single-arm, nonrandomized clinical trial. Setting Multicenter academic and private clinics. Methods Patients with mild-to-moderate OSA (apnea-hypopnea index [AHI] 10-30; body mass index ≤ 32) were treated with 3 sessions of office-based RFA to the soft palate and tongue base. The primary outcome was a change in the AHI and oxygen desaturation index (ODI 4%). Secondary outcomes included subjective sleepiness level; snoring level; and sleep-related quality of life. Results Fifty-six patients were enrolled, with 43 (77%) completing the study protocol. Following 3 sessions of office-based RFA to the palate and base of the tongue, the mean AHI decreased from 19.7 to 9.9 (p = .001), while the mean ODI (4%) decreased from 12.8 to 8.4 (p = .005). Mean Epworth Sleepiness Scale scores declined from 11.2 (±5.4) to 6.0 (±3.5) (p = .001), while Functional Outcomes of Sleep Questionnaire scores improved from a mean of 14.9 at baseline to 17.4 (p = .001). The mean visual analog scale snoring scale was reduced from 5.3 (±1.4) at baseline to 3.4 (±1.6) at 6 months posttherapy (p = .001). Conclusion Office-based, multilevel RFA of the soft palate and base of the tongue is a safe and effective treatment option with minimal morbidity for properly selected patients with mild-to-moderate OSA who are intolerant or refuse continuous positive airway pressure therapy.
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Affiliation(s)
| | | | | | | | - Marion Boyd Gillespie
- Department of Otolaryngology‐Head and Neck Surgery University of Tennessee Health Science Center (UTHSC) Memphis Tennessee USA
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4
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Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients. Am J Otolaryngol 2023; 44:103671. [DOI: 10.1016/j.amjoto.2022.103671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
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Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:362-369. [DOI: 10.1016/j.otoeng.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
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Verbraecken J, Dieltjens M, Op de Beeck S, Vroegop A, Braem M, Vanderveken O, Randerath W. Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheff) 2022; 18:220164. [PMID: 36340820 PMCID: PMC9584565 DOI: 10.1183/20734735.0164-2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
Treatment of obstructive sleep apnoea in adults is evolving, from a "one treatment fits all" to a more individualised approach. The spectrum of treatment options is broad and heterogeneous, including conservative, technological and pharmaceutical modalities. This raises the questions of which patients these modalities might be useful for, and if there are specific criteria for single or combined treatment. The most commonly used non-CPAP treatment is a mandibular advancement device. Furthermore, it appears from the available evidence that upper airway surgery, bariatric surgery, and maxillomandibular advancement can be effective in particular patient groups and should be indicated more readily in clinical practice. Technically, a tracheotomy is the most effective surgical treatment, but is not socially acceptable and is associated with major side-effects. Other treatment options are emerging, like positional therapy, hypoglossal nerve stimulation, and myofunctional exercises. Drug therapy is also promising when pathophysiological traits are considered. The range of currently available treatment options will be discussed in this review, with emphasis on the selection of appropriate patients, therapeutic efficacy and compliance, and reference to recent guidelines. In the selection process, routine application of drug-induced sleep endoscopy to assess the site(s) of collapse during sleep can increase the success rate of both surgical interventions and oral appliance therapy. Educational aims To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine, Antwerp University Hospital, Edegem (Antwerp), Belgium,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Corresponding author: Johan Verbraecken ()
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Anneclaire Vroegop
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Lombo C, Costa R, Martins M, Matos C, Fonseca R. Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Nazar G, Astorquiza C, Cabezón R. El paciente roncador: evaluación y alternativas terapéuticas. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shah FA, Moronta S, Braford M, Greene N. Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature. Cureus 2021; 13:e14575. [PMID: 34035997 PMCID: PMC8135661 DOI: 10.7759/cureus.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a disease process involving recurrent pharyngeal collapse during sleep, resulting in apneic episodes. Clinically, symptoms can include snoring, sudden awakening with a choking-like sensation, excessive somnolence, non-restorative sleep, difficulty in starting or maintaining sleep, and fatigue. It results in impaired gas exchange, subsequently causing various cardiovascular, metabolic, and neurocognitive pathologies. Historically, OSA has been underdiagnosed and undertreated, especially in women. OSA is associated with WHO (World Health Organization) class III pulmonary hypertension (PH) or PH due to lung disease. PH is a concerning complication of OSA and thought to occur in roughly 20% of individuals with OSA. The pathogenesis of PH in OSA can include pulmonary artery vasoconstriction and remodeling. Patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes. We present a thorough review of the literature examining the interplay between OSA and PH.
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Affiliation(s)
- Farhan A Shah
- Internal Medicine, Lewis Gale Medical Center, Salem, USA
| | - Shaidy Moronta
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Michalla Braford
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Nelson Greene
- Pulmonary and Critical Care, Lewis Gale Medical Center, Salem, USA
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Comparison of transoral robotic surgery with other surgeries for obstructive sleep apnea. Sci Rep 2020; 10:18163. [PMID: 33097783 PMCID: PMC7585414 DOI: 10.1038/s41598-020-75215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
This study compared the characteristic surgical parameters and clinical effects of transoral robotic surgery (TORS) and other available methods used to alleviate obstructive sleep apnea. Articles on TORS and other surgeries for obstructive sleep apnea were identified in the PubMed and EMBASE databases. Two investigators independently reviewed the articles and classified the data for meta-analysis. The pooled effect sizes of TORS (standardized mean difference; SMD = − 2.38), coblation tongue base resection (CTBR; SMD = − 2.00) and upper airway stimulation (UAS; SMD = − 0.94) revealed significant improvement in the apnea–hypopnea index (AHI; p < 0.05). The lowest O2 saturation reported was significantly increased following TORS (SMD = 1.43), CTBR (SMD = 0.86) and UAS (SMD = 1.24, p < 0.05). Furthermore, TORS (SMD = − 2.91) and CTBR (SMD = − 1.51, p < 0.05) significantly reduced the Epworth Sleepiness Scale (ESS) score. No significant difference in operation time, success rate, or instances of complication were observed between TORS and the other compared interventions. The use of TORS in obstructive sleep apnea has the same rate of success and failure as other methods of surgical intervention for obstructive sleep apnea with no statistical difference in operation times. The reported clinical effects on the AHI, lowest O2 saturation, and ESS scores of TORS were similar to those of other surgeries.
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Yaremchuk K. Why and When to Treat Snoring. Otolaryngol Clin North Am 2020; 53:351-365. [PMID: 32336469 DOI: 10.1016/j.otc.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.
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Affiliation(s)
- Kathleen Yaremchuk
- Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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13
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State-of-the Art in Reconstructive Palatal Surgery Techniques for Obstructive Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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14
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Kang T, Sung CM, Yang HC. Radiofrequency ablation of turbinates after septoplasty has no effect on allergic rhinitis symptoms other than nasal obstruction. Int Forum Allergy Rhinol 2019; 9:1257-1262. [PMID: 31449735 DOI: 10.1002/alr.22420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study we evaluated the effects of inferior turbinate radiofrequency ablation (RFA), performed after septoplasty, on patients with allergic rhinitis (AR) symptoms. METHODS This was a prospective, randomized, controlled study involving 60 patients with both a deviated nasal septum (DNS) and AR. Those who underwent septoplasty/sham surgery constituted the Septo-Sham group and those who underwent septoplasty/RFA formed the Septo-RFA group. Demographic factors, pre- and postoperative symptom scores for allergic rhinitis (SFARs), and Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) scores were calculated. We subdivided the total SFAR (tSFAR) scores into scores for nasal obstruction (SFAR-NO) and scores for symptoms other than nasal obstruction (SFAR-SONO); the latter included rhinorrhea, itching, and sneezing. RESULTS The baseline characteristics were similar between the groups. The 2 types of surgery improved both the NOSE and SFAR scores. In subgroup analysis according to the type of symptoms, both types of surgery showed improvement in SFAR-NO and SFAR-SONO scores. However, the extent of improvement did not differ between the groups, regardless of the type of symptoms. CONCLUSION For patients with both DNS and AR, both types of surgery afford postoperative symptomatic improvement. Both types of surgery yielded improvement in both nasal obstruction and symptoms other than nasal obstruction. However, performing RFA after septoplasty did not afford further short-term symptomatic improvements. Thus, septoplasty without RFA may be optimal for patients with both DNS and AR.
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Affiliation(s)
- Taegu Kang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Patel A, Kotecha B. MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing. Healthcare (Basel) 2019; 7:healthcare7030097. [PMID: 31426606 PMCID: PMC6787708 DOI: 10.3390/healthcare7030097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.
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Affiliation(s)
- Ankit Patel
- ENT Department, Queen's Hospital, Romford RM7 0AG, UK.
| | - Bhik Kotecha
- ENT Department, Queen's Hospital, Romford RM7 0AG, UK
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Frank E, Carlson B, Hu A, Randall DR, Tamares S, Inman JC, Crawley BK. Assessment and Treatment of Pain during In-Office Otolaryngology Procedures: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:218-226. [PMID: 30885070 DOI: 10.1177/0194599819835503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To qualitatively assess practices of periprocedural pain assessment and control and to evaluate the effectiveness of interventions for pain during in-office procedures reported in the otolaryngology literature through a systematic review. DATA SOURCES PubMed, CINAHL, and Web of Science searches from inception to 2018. REVIEW METHODS English-language studies reporting qualitative or quantitative data for periprocedural pain assessment in adult patients undergoing in-office otolaryngology procedures were included. Risk of bias was assessed via the Cochrane Risk of Bias or Cochrane Risk of Bias in Non-Randomized Studies of Interventions tools as appropriate. Two reviewers screened all articles. Bias was assessed by 3 reviewers. RESULTS Eighty-six studies describing 32 types of procedures met inclusion criteria. Study quality and risk of bias ranged from good to serious but did not affect assessed outcomes. Validated methods of pain assessment were used by only 45% of studies. The most commonly used pain assessment was patient tolerance, or ability to simply complete a procedure. Only 5.8% of studies elicited patients' baseline pain levels prior to procedures, and a qualitative assessment of pain was done in merely 3.5%. Eleven unique pain control regimens were described in the literature, with 8% of studies failing to report method of pain control. CONCLUSION Many reports of measures and management of pain for in-office procedures exist but few employ validated measures, few are standardized, and current data do not support any specific pain control measures over others. Significant opportunity remains to investigate methods for improving patient pain and tolerance of in-office procedures.
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Affiliation(s)
- Ethan Frank
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Bradley Carlson
- 2 School of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Amanda Hu
- 3 Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Derrick R Randall
- 4 Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Shanalee Tamares
- 5 University Libraries, Loma Linda University, Loma Linda, California, USA
| | - Jared C Inman
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Brianna K Crawley
- 1 Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
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Results of Radiofrequency Ablation of Inferior Turbinate Hypertrophy in Patients with Allergic and Non-Allergic Rhinitis. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:296-301. [PMID: 32774094 PMCID: PMC7406560 DOI: 10.14744/semb.2018.77992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
Objectives: For the treatment of the inferior turbinate hypertrophy that is unresponsive to medical treatment, turbinate surgery with radiofrequency is a widely used method. This study aims to evaluate the efficacy of turbinate surgery with radiofrequency ablation for the treatment of turbinate hypertrophy, and compare the results of patients with allergic rhinitis and non-allergic rhinitis. Methods: A total of 59 consecutive patients aged 18–67 years (mean 37±13) who underwent radiofrequency ablation to the inferior turbinate at our tertiary care hospital from September 2017 to January 2018 were enrolled in this prospective nonrandomized clinical study. The patients with allergic rhinitis (n=23) were classed as group 1, and the patients with non-allergic rhinitis (n=36) were classed as group 2. Endoscopic nasal examination and an acoustic rhinometer were applied, and a standard 0–10 visual analog scale (VAS) was used to assess nasal symptoms preoperatively and postoperatively at the third and sixth months. Results: The study found a significant reduction in nasal obstruction for both groups postoperatively. This reduction was higher in group 1. The decrease in nasal VAS scores for itching, rhinorrhea, and sneezing were statistically significant in group 1, whereas the decrease in nasal VAS scores for sneezing was significant in group 2. Conclusion: This study demonstrates that radiofrequency appears to be an effective and safe treatment option for inferior turbinate hypertrophy of patients with allergic rhinitis or non-allergic rhinitis. It also provides a better perception of all nasal symptoms in patients with allergic rhinitis, and a better perception of nasal obstruction and sneezing in patients with non-allergic rhinitis.
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Abstract
Surgery for obstructive sleep apnea/hypopnea syndrome (OSA) is not a substitute for continuous positive airway pressure (CPAP) but is a salvage procedure for those who failed CPAP and other conservative therapies and therefore have no other options. The hypopharyngeal/tongue base procedures for the treatment of OSA are usually challenging to most sleep surgeons. In recent years, several procedures for OSA patients with hypopharyngeal obstructions have been developed to achieve higher response rates with decreased postoperative morbidities.
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Affiliation(s)
- Hsin-Ching Lin
- Department of Otolaryngology, Sleep Center, Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City 833, Taiwan.
| | - Michael Friedman
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA; Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657, USA
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Aynacı E, Karaman M, Kerşin B, Fındık MO. Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment. Acta Otolaryngol 2018; 138:502-506. [PMID: 29298526 DOI: 10.1080/00016489.2017.1417635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI). MATERIALS AND METHODS Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters. RESULTS When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS. CONCLUSIONS TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.
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Affiliation(s)
- Engin Aynacı
- The Department of Pulmonology, İstanbul Medipol University, İstanbul, Turkey
| | - Murat Karaman
- The Department of Otorhinolaryngology, Acıbadem University, Acıbadem Altunizade Hospital, İstanbul, Turkey
| | - Burak Kerşin
- The Department of Otorhinolaryngology, İstanbul Medipol University, İstanbul, Turkey
| | - Mahmut Ozan Fındık
- The Department of Otorhinolaryngology, Acıbadem University, Acıbadem Altunizade Hospital, İstanbul, Turkey
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Atef A, Mosleh M, El Bosraty H, El Fatah GA, Fathi A. Bipolar Radiofrequency Volumetric Tissue Reduction of Inferior Turbinate: Does the Number of Treatment Sessions Influence the Final Outcome? ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240602000105] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to determine if the number of treatment sessions has an influence on the final intermediate term results of submucosal bipolar radiofrequency volumetric tissue reduction of the inferior turbinate. Methods One hundred two patients were enrolled in this study prospectively. The procedure was done using the Coblation (Arthrocare Corp., Sunnyvale, CA). The assessment was done using the 10-cm visual analog scale and acoustic rhinometry. Surgical procedures and preand postoperative assessments were done at the Faculty of Medicine, Cairo University. Results Eighty eight percent of our study population achieved final relief of their nasal obstruction, and at least three sessions were needed to maintain the favorable outcome at 1-year follow up. Conclusion Increasing the number of bipolar radiofrequency volumetric tissue reduction treatment sessions was associated with better intermediate-term outcome. This was confirmed using subjective and objective methodology.
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Affiliation(s)
- Ahmed Atef
- Ear, Nose, and Throat Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Mohamed Mosleh
- Ear, Nose, and Throat Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Hossam El Bosraty
- Ear, Nose, and Throat Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Gamal Abd El Fatah
- Ear, Nose, and Throat Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
| | - Ahmed Fathi
- Ear, Nose, and Throat Department, Cairo University Hospitals, Cairo University, Cairo, Egypt
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Woodson BT, Tadokoro KS, MacKay SG. Radiofrequency ablation of the lateral palatal space for snoring. World J Otorhinolaryngol Head Neck Surg 2017; 3:106-109. [PMID: 29204588 PMCID: PMC5683595 DOI: 10.1016/j.wjorl.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 01/10/2023] Open
Abstract
Objective Pilot study to examine the effect of radiofrequency ablation (RFA) of the lateral palatal fat pad in patients with socially-disruptive snoring. Method Snoring outcomes and complications were compared between a group of patients with treated with RFA ablation of the lateral soft palate fat pad with or without inferior turbinate reduction (8 patients) and another group undergoing inferior turbinate reduction alone (12 patients). Results Snoring loudness and bothersomeness improved in the palate but not inferior turbinate group. Pain was mild and no major complications were observed. Conclusion The study supports RFA ablation of the lateral palatal space as a potential low morbidity procedure for snoring.
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Affiliation(s)
- B Tucker Woodson
- Department of Otolaryngology Division of Sleep Medicine and Sleep Surgery, Medical College Wisconsin, Milwaukee, WI, USA
| | - Kent S Tadokoro
- Department of Otolaryngology Division of Sleep Medicine and Sleep Surgery, Medical College Wisconsin, Milwaukee, WI, USA
| | - Stuart G MacKay
- Division of Otolaryngology, Head and Neck Surgery, University of Wollongong, Wollongong, NSW, Australia
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Soft palate fistula after radiofrequency ablation for primary snoring: a case report and literature review. Braz J Otorhinolaryngol 2017; 86 Suppl 1:20-22. [PMID: 28336273 PMCID: PMC9422429 DOI: 10.1016/j.bjorl.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/07/2016] [Accepted: 02/15/2017] [Indexed: 12/01/2022] Open
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Kania RE, Schmitt E, Petelle B, Meyer B. Radiofrequency Soft Palate Procedure in Snoring: Influence of Energy Delivered. Otolaryngol Head Neck Surg 2016; 130:67-72. [PMID: 14726912 DOI: 10.1016/j.otohns.2003.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE: We conducted a retrospective study to evaluate the influence of amount of energy delivered during radiofrequency procedure for soft palate reduction in snoring, to improve the cure rate. METHODS: Consecutive patients with chronic disruptive snoring presenting to our department were successively treated in an outpatient procedure. A visual analog scale was used to assess the severity of snoring by the bed partner and the pain by the patient, before treatment and after each treatment session. The soft palate was divided into 3 treatment sites: middle, lateral right, and lateral left. Any mucosal injury of the soft palate was classified as a complication. RESULTS: Forty-3 patients were classified into 2 groups according to energy assignment. The total amount of energy delivered was 1250 J in group 1 (n = 15) and 1500 J in group 2 (n = 28). Energy was predominantly distributed in the middle of the soft palate in group 1 (550 J) and group 2 (800 J). After each treatment session, the 1500-J delivery of radiofrequency energy (total per session) led to a better snoring grading reduction in comparison with the 1250-J delivery with a significant difference after 2 treatment sessions ( P < 0.05). The mean pain score and the incidence rate of complications per treatment were not statistically different in comparing both groups. CONCLUSION: Better snoring scores can be expected by increasing radiofrequency energy applied to the soft palate. Further randomized long-term investigations are required to confirm that the cure rate can be improved when increasing energy with a suitable distribution and good clinical tolerance.
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Affiliation(s)
- Romain E Kania
- Department of Otorhinolaryngology-Head and Neck Surgery, Assistance Publique-Hôpitaux de Paris, Paris VI University, Saint-Antoine Hospital, France
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Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Radiofrequency Volumetric Reduction of the Palate: An Extended Follow-Up Study. Otolaryngol Head Neck Surg 2016; 122:410-4. [PMID: 10699819 DOI: 10.1016/s0194-5998(00)70057-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE: The goal was to evaluate the effect of radiofrequency (RF) of the palate on speech, swallowing, taste, sleep, and snoring 12 to 18 months after treatment. METHODS: Twenty-two patients were evaluated by clinical examination, questionnaires, and visual analog scales. The patients with relapse of snoring were offered further RF treatment. RESULTS: After a mean follow-up of 14 months, no adverse effect was reported. Subjective snoring scores relapsed by 29% overall. Nine patients (41%) noted relapse of snoring from 2.1 ± 1.1 to 5.7 ± 2.7 ( P < 0.001). Eight of the patients underwent further RF treatment with a reduction of snoring from 5.8 ± 2.9 to 3.3 ± 3.1 ( P = 0.01). CONCLUSION: The success of RF volumetric reduction of the palate diminishes with time, as with other surgical procedures of the palate. However, the minimal invasiveness of the RF provided a high patient acceptance for retreatment, and relapse of snoring can be improved.
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Affiliation(s)
- K K Li
- Stanford University Sleep Disorders and Research Center, Stanford, California, USA
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Li KK, Powell NB, Riley RW, Guilleminault C. Temperature-Controlled Radiofrequency Tongue Base Reduction for Sleep-Disordered Breathing: Long-Term Outcomes. Otolaryngol Head Neck Surg 2016; 127:230-4. [PMID: 12297815 DOI: 10.1067/mhn.2002.126900] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: Our goal was to evaluate the long-term outcomes of temperature-controlled radiofrequency reduction of the tongue base in sleep-disordered breathing. METHODS: The 18 patients from our initial pilot study were reevaluated. Clinical examinations, polysomnography (PSG), questionnaires, visual analog scales, and a comparative SF-36 were used to assess long-term outcomes. RESULTS: Sixteen of the original 18 patients completed this study; 2 patients were lost to follow-up. The mean follow-up was 28 months. There was a mean weight increase of 3.1 ± 7.9 kg. The original pretreatment Respiratory Disturbance Index (RDI) was a mean of 39.5 with a mean mean oxygen saturation nadir (LSAT) of 81.9%, and the posttreatment RDI was a mean of 17.8 with a mean LSAT of 88.3%. Follow-up PSG data showed a persistent improvement of the mean Apnea Index compared with pretreatment (5.4 vs 22.1) without significant changes compared with posttreatment (4.1). However, there were changes in the follow-up Hypopnea Index (HI) of 22.9 compared with the pretreatment and posttreatment HI values of 17.4 and 13.6, respectively. This resulted in a relapse of the RDI from a posttreatment value of 17.8 to 28.7. The LSAT also worsened from 88.3% to 85.8%. However, there was no significant deterioration in the quality-of-life measurements by SF-36 or in daytime sleepiness by Epworth Sleepiness Scale. CONCLUSION: The success of temperature-controlled radiofrequency tongue base reduction for sleep-disordered breathing may reduce with time. PSG demonstrated that long-term relapse is primarily reflected in the HI without significant detrimental effects on the patient's quality of life (SF-36) and sleepiness (Epworth Sleepiness Scale). Continual evaluation of this treatment modality is warranted.
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Affiliation(s)
- Kasey K Li
- Stanford University Sleep Disorders and Research Center, California, USA.
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Troell RJ, Powell NB, Riley RW, Li KK, Guilleminault C. Comparison of postoperative pain between laser-assisted uvulopalatoplasty, uvulopalatopharyngoplasty, and radiofrequency volumetric tissue reduction of the palate. Otolaryngol Head Neck Surg 2016. [DOI: 10.1067/mhn.2000.102184] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study compares the posttreatment discomfort between laser-assisted uvulopalatoplasty (LAUP), uvulopalatopharyngoplasty (UPPP), and radiofrequency volumetric tissue reduction (RFVTR) of the palate through the use of visual analog pain scales and a quantitative assessment of the analgesic medication taken. METHODS In one group, LAUP (n = 10) or UPPP (n = 9) was used to treat patients' snoring or sleep-disordered breathing (SDB), and the other group underwent RFVTR (n = 22). RESULTS The mean numbers of days with pain after RFVTR, LAUP, and UPPP were 2.6, 13.8, and 14.3 days, respectively. Narcotic analgesics were required in the RFVTR, LAUP, and UPPP groups in 9%, 100%, and 100% of the subjects, respectively. The mean number of these days requiring narcotic pain medications for RFVTR, LAUP, and UPPP was 0.2, 11.8, and 12.4 days, whereas the total narcotic equivalent was 0.3, 7.4 and 29.6 days, respectively. CONCLUSION RFVTR of the soft palate produced less posttreatment pain than LAUP or UPPP. LAUP and UPPP appeared to show little difference in the severity or duration of posttreatment discomfort.
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Affiliation(s)
- Robert J. Troell
- From the Stanford University Sleep Disorders Clinic, Center of Excellence, Stanford, California
| | - Nelson B. Powell
- From the Stanford University Sleep Disorders Clinic, Center of Excellence, Stanford, California
| | - Robert W. Riley
- From the Stanford University Sleep Disorders Clinic, Center of Excellence, Stanford, California
| | - Kasey K. Li
- From the Stanford University Sleep Disorders Clinic, Center of Excellence, Stanford, California
| | - Christian Guilleminault
- From the Stanford University Sleep Disorders Clinic, Center of Excellence, Stanford, California
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Coleman SC, Smith TL. Midline Radiofrequency Tissue Reduction of the Palate for Bothersome Snoring and Sleep-Disordered Breathing: A Clinical Trial. Otolaryngol Head Neck Surg 2016; 122:387-94. [PMID: 10699816 DOI: 10.1016/s0194-5998(00)70054-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study is a prospective, nonrandomized clinical trial initiated to assess the safety and efficacy of radiofrequency tissue reduction of the palate for the treatment of bothersome snoring and sleep-disordered breathing. Twelve healthy volunteers with socially disruptive snoring underwent a baseline polysomnogram along with a battery of visual analog scales (VASs) to measure daytime sleepiness, snoring level, pain, and disturbances of speech and swallowing. After radiofrequency tissue reduction of the palate, they were re-evaluated with a mean follow-up after the final procedure of 15.7 ± 5.1 (mean ± SD) weeks. As rated by the bed partner, a significant reduction in the level of snoring occurred in all 12 patients, with a mean pretreatment snoring level of 8.3 ± 2.1 to a mean posttreatment snoring level of 2.1 ± 1.4. (Student t test, P < 0.0001) These patients required an average of 2.3 treatment sessions each. Nine of 12 had a reduction in snoring from a bothersome level (VAS range 5–10) to a nonbothersome level (VAS range 0–3). Daytime sleepiness as measured by the Epworth Sleepiness Scale (0–24) decreased from 10.8 ± 4.4 to 8.3 ± 4.1 ( P = 0.011). Posttreatment pain was considered absent or minimal in 11 of 12 patients and was managed with acetaminophen. No significant adverse events or complications were reported.
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Affiliation(s)
- S C Coleman
- Department of Otolaryngology, Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Nashville, TN, USA
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Abstract
Although surgery for fecal incontinence has been shown to be effective, it is still very challenging and sometimes frustrating. Overlapping sphincteroplasty, by far the most common procedure, is effective in patients with sphincter defects; however, recent data suggest that success rates tend to deteriorate over time. A thorough preoperative evaluation incorporates numerous factors, including patient characteristics, severity of incontinence, type and size of the sphincter defect as assessed by physical examination, anal ultrasound, and anorectal physiology studies including anal manometry, electromyography, and pudendal nerve terminal motor latency assessment. The use of these evaluation methods has allowed better patient assignment for a variety of new alternative treatment options. Innovations in the surgical treatment of fecal incontinence range from simple, office-based sphincter augmentation techniques to surgical implantation of mechanical devices. This article reviews 5 alternative surgical treatment options for fecal incontinence: injection of carbon-coated beads in the submucosa of the anal canal, radiofrequency energy delivery, stimulated graciloplasty, artificial bowel sphincter, and sacral nerve stimulation.
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Affiliation(s)
- Benjamin Person
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston 33331, USA
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Aydin O, Iseri M, Ozturk M. Radiofrequency Ablation in the Treatment of Idiopathic Bilateral Palatal Myoclonus: A New Indication. Ann Otol Rhinol Laryngol 2016; 115:824-6. [PMID: 17165664 DOI: 10.1177/000348940611501105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We tested the effect of radiofrequency ablation in the treatment of palatal myoclonus refractory to other therapeutic regimens. Methods: A 20-year-old patient who presented with palatal myoclonus and annoying rhythmic objective clicking noise was treated with a radiofrequency generator with topical and local anesthesia in an outpatient setting. Results: The clicking noise was abolished within 3 to 4 days of the radiofrequency ablation. The rhythmic, jerky movements of the soft palate were confirmed to be absent 2 weeks later with electromyographic studies. The patient has been symptom-free for 6 months, and no side effects have occurred. Conclusions: As a new indication, radiofrequency ablation may effectively abolish abnormal movements of the soft palate and relieve associated tinnitus.
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Affiliation(s)
- Omer Aydin
- Department of Otolaryngology, Kocaeli University Medical Faculty, Kocaeli, Turkey
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Steward DL, Weaver EM, Woodson BT. Multilevel Temperature-Controlled Radiofrequency for Obstructive Sleep Apnea: Extended Follow-Up. Otolaryngol Head Neck Surg 2016; 132:630-5. [PMID: 15806059 DOI: 10.1016/j.otohns.2004.11.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To determine long-term effectiveness of multilevel (tongue and palate) temperature-controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN AND SETTING: Prospective, 2-institution case series. Twenty-nine subjects with mild to moderate OSAS and who were at least 1 year from completion of multilevel TCRFTA were included, representing a subset of subjects who were enrolled in a previously published controlled trial. Exclusion criteria for this extended follow-up study included any additional treatment for OSAS after completion of TCRFTA. RESULTS: Median follow-up was 23 months. Daytime sleepiness and OSAS-related quality of life were significantly improved at extended follow-up (both P 0.001). Median reaction time testing and apnea-hypopnea index (AHI) were also significantly improved at long-term follow-up ( P = 0.03 and 0.01). Body mass index was unchanged ( P = 0.94). CONCLUSIONS: Multilevel TCRFTA treatment of mild to moderate OSAS resulted in prolonged improvement in daytime somnolence, OSAS-related quality of life, psychomotor vigilance, and AHI in this group of subjects at extended follow-up.
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Affiliation(s)
- David L Steward
- Department of Otolaryngology-Head and Neck Surgery, ML 0528, University of Cincinnati, Cincinnati, OH 45267-0528, USA.
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Skjøstad KW, Stene BK, Norgård S. Consequences of Increased Rigidity in Palatal Implants for Snoring: A Randomized Controlled Study. Otolaryngol Head Neck Surg 2016; 134:63-6. [PMID: 16399182 DOI: 10.1016/j.otohns.2005.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 10/06/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: Palatal implants have seen an increased role in the treatment of snoring. In this study, we evaluate the safety and possible treatment effect of adding further stiffness to the palate through the use of a more rigid implant. STUDY DESIGN: Randomized double-blind study of 20 patients with primary snoring. Three polyethylene teralphate implants were placed in the soft palate with the patient under local anesthesia. Ten patients received regular implants (rigidity 1.0) and 10 patients received stiffer implants (rigidity 1.8). The patients and their bed partners were followed for 6 months with questionnaires and office visits. A sleep study was performed preoperatively and at the last follow-up. RESULTS: Four of the 10 patients with stiffer implants had 5 partial extrusions in the observation period. There was a nonsignificant reduction in snoring intensity from 8.1 to 6.1 evaluated by the bed partner on a visual analogue scale in this group. No extrusions were seen in the group with regular implants. This group showed a significant reduction in snoring intensity from 7.7 to 4.7. No other major adverse events were observed. CONCLUSIONS AND SIGNIFICANCE: Rigid implants cause short time extrusions with loss of treatment effect. Regular implants reduce palatal snoring intensity with high patient and bed partner satisfaction. EBM rating: A-1b
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Affiliation(s)
- Ketil W Skjøstad
- Department of Otolaryngology-Head and Neck Surgery, St Olav University Hospital, 7006 Trondheim, Norway.
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Friedman M, Vidyasagar R, Bliznikas D, Joseph NJ. Patient Selection and Efficacy of Pillar Implant Technique for Treatment of Snoring and Obstructive Sleep Apnea/Hypopnea Syndrome. Otolaryngol Head Neck Surg 2016; 134:187-96. [PMID: 16455363 DOI: 10.1016/j.otohns.2005.10.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Pillar implant (PIT) is a simple, office-based procedure with minimal morbidity that was introduced in 2003 to treat snoring and mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). We studied the: (1) success rate using subjective symptoms and objective polysomnographic improvement; (2) success rate based on BMI, OSAHS severity and Friedman tongue position (FTP); and (3) its value as an adjunctive or revision procedure. STUDY DESIGN AND SETTING: Retrospective review of 125 patients who underwent the PIT for snoring and OSAHS. Patients were grouped: Group I had PIT only ( n = 29); Group II received adjunctive nasal procedures ( n = 37), Group III received adjunctive oropharyngeal procedures ( n = 55); and Group IV had failed previous UPPP ( n = 4). RESULTS: Overall subjective and objective “cure” rates were 88.0% and 34.4%, respectively. Group IIb had the best objective cure rate of 46.7%. Neither AHI nor BMI correlated with outcome measures, whereas FTP did correlate. (FTP I and II had improved success vs FTP III and IV). Ten patients had partial extrusion of the PIT. These were removed and new PIT were carried out at a later date. CONCLUSIONS: Based on a short-term study, the Pillar implant is an effective treatment for snoring and OSAHS in selected patients and can be combined with adjunctive procedures to treat OSAHS.
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Affiliation(s)
- Michael Friedman
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL, USA
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Nordgård S, Stene BK, Skjøstad KW, Bugten V, Wormdal K, Hansen NV, Nilsen AH, Midtlyng TH. Palatal Implants for the Treatment of Snoring: Long-Term Results. Otolaryngol Head Neck Surg 2016; 134:558-64. [PMID: 16564372 DOI: 10.1016/j.otohns.2005.09.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 09/21/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE: To evaluate the safety and long-term effectiveness of a new treatment for snoring using permanent palatal implants. STUDY DESIGN: Prospective study with 35 patients referred to the clinic for the treatment of snoring. The patients were followed for 1 year, and a sleep analysis was performed and repeated at 360 days. During the procedure, 3 braided polyethylene terephthalate implants were placed in the palate of each patient. RESULTS: The average duration for nonnarcotic analgesics was 1.3 days. No adverse events were observed. The mean snoring intensity was reduced from 7.1 at baseline to 4.8 at 1 year ( P < 0.001). Bed partner satisfaction rate was very high at 70.6% after 1 year. Six patients (17.8%) experienced a total of 9 partial extrusions. CONCLUSIONS: The palatal implant system is safe, and the effectiveness in treating snoring is comparable to other surgical methods. Advantages are virtually no tissue damage and minimal patient discomfort as a result of one standardized, low-cost procedure.
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Affiliation(s)
- Ståle Nordgård
- Department of Otolaryngology-Head and Neck Surgery, St Olav University Hospital, Trondheim, Norway.
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Maurer JT, Verse T, Stuck BA, Hörmann K, Hein G. Palatal implants for primary snoring: Short-term results of a new minimally invasive surgical technique. Otolaryngol Head Neck Surg 2016; 132:125-31. [PMID: 15632923 DOI: 10.1016/j.otohns.2004.09.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring. STUDY DESIGN AND SETTING: Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 ± 8.6 years with a body mass index of 26.2 ± 2.5 kg/m 2 . The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively. RESULTS: All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 ± 1.6 to 2.5 ± 2.1 (VAS, P < 0.01) and from 347 ± 239 to 264 ± 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged. CONCLUSION: The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results.
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Affiliation(s)
- Joachim T Maurer
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, Germany.
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Rosato C, Pagliuca G, Martellucci S, de Vincentiis M, Greco A, Fusconi M, De Virgilio A, Gallipoli C, Simonelli M, Gallo A. Effect of Radiofrequency Thermal Ablation Treatment on Nasal Ciliary Motility: A Study with Phase-Contrast Microscopy. Otolaryngol Head Neck Surg 2016; 154:754-8. [PMID: 26861228 DOI: 10.1177/0194599815626132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/17/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the efficacy of nasal ciliary motility after radiofrequency ablation treatment in patients with isolated inferior turbinate hypertrophy and to clarify how long until normal ciliary function is restored. STUDY DESIGN Prospective, single-group, pretest-posttest design. SETTING Academic tertiary care medical center. SUBJECTS AND METHODS This study involved 34 adult patients affected by nasal obstruction due to inferior turbinate hypertrophy who underwent radiofrequency ablation treatment between June and December 2014. Diagnosis was assessed according to clinical history, nasal endoscopy, and active anterior rhinomanometry. Cytologic samples were collected by nasal scraping before surgery and 1, 2, and 3 months after surgery. Ciliary motility was evaluated by nasal cytology with phase-contrast microscopy. Functional aspects of nasal mucosa were studied, with a focus on 3 parameters: (1) nasal mucociliary clearance, assessed by saccharin nasal transit time test; (2) percentage of ciliated cell motility, measured as the ratio between cells with motility and cells without motility; and (3) efficacy of ciliary motility, measured as the ratio between cells with valid motility and cells with hypovalid motility. RESULTS Ciliary motility and ciliary efficacy showed a significant reduction after 1 and 2 months from surgery, returning to normal values within 3 months. No significant changes in saccharin nasal transit time were recorded during the follow-up. CONCLUSIONS The outcomes of this study suggest that radiofrequency ablation treatment causes ciliary motility changes of nasal mucosa that are completely restored after at least 3 months after surgery. These cytologic abnormalities do not affect nasal functionality.
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Affiliation(s)
- Chiara Rosato
- Department of Medico-surgical Sciences and Biotechnologies, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Giulio Pagliuca
- Department of Medico-surgical Sciences and Biotechnologies, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Salvatore Martellucci
- Department of Medico-surgical Sciences and Biotechnologies, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Massimo Fusconi
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Armando De Virgilio
- Department of Sensorial Organs, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Camilla Gallipoli
- Department of Medico-surgical Sciences and Biotechnologies, ENT Section, Sapienza University of Rome, Rome, Italy
| | - Marilia Simonelli
- Speech and Swallowing Rehabilitation Service, Santa Lucia Foundation, Rome, Italy
| | - Andrea Gallo
- Department of Medico-surgical Sciences and Biotechnologies, ENT Section, Sapienza University of Rome, Rome, Italy
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Tseng H, Lin SE, Chang YL, Chen MH, Hung SH. Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration. Exp Ther Med 2015; 11:763-768. [PMID: 26997990 PMCID: PMC4774398 DOI: 10.3892/etm.2015.2956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022] Open
Abstract
The radiofrequency ablation (RFA) lesion size is posited to be disproportionate to the total delivered energy, and temperature-time integration (TTI) may have a more critical effect on lesion size. The present study aimed to evaluate this hypothesis by determining the temperature threshold and temperature distribution over tissues during the RFA lesioning process. Using an ex vivo chicken tissue model and an in vivo rabbit model with RFA applied for 2 min under various target temperature settings, the resultant lesions were evaluated histologically using Masson's trichrome stain. The temperature distribution over the tissue during the RFA lesioning process was also determined using a VT02 Visual IR Thermometer. It was revealed that the thermal injury threshold for RFA in the chicken tissues was ~65°C, but that it ranged from 55–65°C in mammals. Using infra-red thermal imaging, the temperature gradient (from the center to the periphery) during the RFA lesioning process demonstrated a uniform heat diffusion pattern. This data supports the proposed hypothesis that TTI is a critical parameter in determining RFA lesion size and can be applied clinically using the following equation: [Target temperature − 55 (°C)] × time (sec) is proportional to RFA lesion size.
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Affiliation(s)
- How Tseng
- Department of Biochemistry, Taipei Medical University, Taipei 110, Taiwan, R.O.C
| | - Sey-En Lin
- Department of Pathology, Taipei Medical University Hospital, Taipei 110, Taiwan, R.O.C
| | - Yen-Liang Chang
- Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei 106, Taiwan, R.O.C.; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan, R.O.C
| | - Ming-Hsu Chen
- Department of Otolaryngology, Head and Neck Surgery, Cathay General Hospital, Taipei 106, Taiwan, R.O.C
| | - Shih-Han Hung
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110, Taiwan, R.O.C.; Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei 110, Taiwan, R.O.C
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Treatment of snoring with positional therapy in patients with positional obstructive sleep apnea syndrome. Sci Rep 2015; 5:18188. [PMID: 26657174 PMCID: PMC4676069 DOI: 10.1038/srep18188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022] Open
Abstract
Position therapy plays a role in treating snoring and obstructive sleep apnea syndrome (OSAS). The purpose of this study was to investigate whether position therapy using a head-positioning pillow (HPP) could reduce snoring sounds in patients with mild-to-moderate positional OSAS, taking into account the potential confounding effects of body weight. A total of 25 adults with positional OSAS (apnea-hypopnea index [AHI]supine:AHInon-supine ≥ 2) were prospectively enrolled. Patients were asked to use their own pillows at home during the first night (N0), and the HPP during the second (N1) and third (N2) nights. The primary outcome measures included the subjective snoring severity (SS, measured on a visual analogue scale ranging from 0 to 10) and the objective snoring index (SI, expressed as the number of snoring events per hour measured on an acoustic analytical program). Both endpoints were recorded over three consecutive nights. From N0 to N2, the median SS and SI values in the entire study cohort decreased significantly from 5.0 to 4.0 and from 218.0 events/h to 115.0 events/h, respectively. In the subgroup of overweight patients, SS showed a significant improvement, whereas SI did not. Both SS and SI were found to be significantly improved in normal-weight patients.
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Murphey AW, Nguyen SA, Fuller C, Weber AC, Camilon MP, Gillespie MB. TranQuill sling snoreplasty for snoring: A single-arm pilot study for safety and effectiveness. Laryngoscope 2015; 126:243-8. [PMID: 26536156 DOI: 10.1002/lary.25361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea. STUDY DESIGN Prospective, unblinded, single-center pilot study. METHODS From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index < 15, minimum oxygen saturation > 85%, and body mass index (BMI) < 32 were included. Outcomes were assessed comparing the results of quality-of-life questionnaires, bed partner-assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90-day follow-up. RESULTS Thirteen males and seven females were enrolled. Average age was 49.1 (range 31-67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty-five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events. CONCLUSION TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy.
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Affiliation(s)
- Alexander W Murphey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Colin Fuller
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Aimee C Weber
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Marc P Camilon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Fecal Incontinence: Etiology, Diagnosis, and Management. J Gastrointest Surg 2015; 19:1910-21. [PMID: 26268955 DOI: 10.1007/s11605-015-2905-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 07/27/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Fecal incontinence is a debilitating condition affecting primarily the elderly. Many patients suffer in silence resulting in both underdiagnosis and undertreatment often culminating in an overall poor quality of life. METHODS We sought to review the etiology, diagnosis, and treatment of fecal incontinence based on current literature. Additionally, newer treatment methods such as Solesta will be evaluated. RESULTS There are many diagnostic modalities available to assess the degree and severity of the patient's incontinence; however, a thorough history and physical exam is critical. Initial attempts at treatment focus on medical management primarily through stool texture modification with the aid of bulking agents. Failure of medical therapy is often followed by a graded increase in the complexity and invasiveness of the available treatment options. The selection of the most appropriate surgical option, such as overlapping sphincteroplasty and neuromodulation, is multifactorial involving both surgeon and patient-related factors. Neuromodulation has received increased attention in the last decade due to its documented therapeutic success, and newer office-based procedures, such as the Solesta injection, are showing promising results in properly selected patients. Finally, diversion remains an option for select patients who have failed all other therapies. CONCLUSION The etiology of fecal incontinence is multifactorial, involving a complex interplay between stool consistency and anatomic integrity. The diagnosis and treatment of fecal incontinence continue to evolve and are showing promising results.
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Factors Associated with Successful Treatment by Radiofrequency Treatment of the Soft Palate in Obstructive Sleep Apnea as the First-Line Treatment. SLEEP DISORDERS 2015; 2015:690425. [PMID: 26339508 PMCID: PMC4539206 DOI: 10.1155/2015/690425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/21/2015] [Indexed: 11/17/2022]
Abstract
Background. Radiofrequency ablation (RFA) is recommended as the second-line treatment for obstructive sleep apnea (OSA). This study aims to study the factors associated with successful treatment by RFA in OSA patients as the first-line treatment. Methods. All patients diagnosed as mild to moderate OSA were enrolled prospectively and treated with RFA. Three points of soft palate were ablated: midline, left, and right paramedian sites. Baseline characteristics and clinical factors including snoring score (SS), Epworth Sleepiness Scale (ESS), and apnea-hypopnea index (AHI), with minimal oxygen saturation, were recorded at baseline and three months after treatment. Results. During the study period, there were 51 patients who met the study criteria and received RFA treatment. At three months, the SS, ESS, and AHI were significantly lower than baseline values, while the minimal oxygenation was significantly increased from the baseline values. There were 16 patients (31.37%) who had an AHI of < 5 times/h. Only baseline AHI was significantly associated with an AHI of < 5 times/h at three months after RFA treatment. The adjusted odds ratio was 0.804 (95% CI: 0.699, 0.924). Conclusion. Transoral RFA treatment may be effective in mild to moderate OSA as the first-line treatment. Baseline AHI is associated with preferable outcome by RFA treatment.
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Tan KB, Toh ST, Guilleminault C, Holty JEC. A Cost-Effectiveness Analysis of Surgery for Middle-Aged Men with Severe Obstructive Sleep Apnea Intolerant of CPAP. J Clin Sleep Med 2015; 11:525-35. [PMID: 25700871 PMCID: PMC4410926 DOI: 10.5664/jcsm.4696] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/09/2014] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Conventional OSA therapy necessitates indefinite continuous positive airway pressure (CPAP). Although CPAP is an effective treatment modality, up to 50% of OSA patients are intolerant of CPAP. We explore whether surgical modalities developed for those intolerant of CPAP are cost-effective. METHODS We construct a lifetime semi-Markov model of OSA that accounts for observed increased risks of stroke, cardiovascular disease, and motor vehicle collisions for a 50-year-old male with untreated severe OSA. Using this model, we compare the cost-effectiveness of (1) no treatment, (2) CPAP only, and (3) CPAP followed by surgery (either palatopharyngeal reconstructive surgery [PPRS] or multilevel surgery [MLS]) for those intolerant to CPAP. RESULTS Compared with the CPAP only strategy, CPAP followed by PPRS (CPAP-PPRS) adds 0.265 quality adjusted life years (QALYs) for an increase of $2,767 (discounted 2010 dollars) and is highly cost effective with an incremental cost-effectiveness ratio (ICER) of $10,421/QALY for a 50-year-old male with severe OSA. Compared to a CPAP-PPRS strategy, the CPAP-MLS strategy adds 0.07 QALYs at an increase of $6,213 for an ICER of $84,199/QALY. The CPAP-PPRS strategy appears cost-effective over a wide range of parameter estimates. CONCLUSIONS Palatopharyngeal reconstructive surgery appears cost-effective in middle-aged men with severe OSA intolerant of CPAP. Further research is warranted to better define surgical candidacy as well as short-term and long-term surgical outcomes. COMMENTARY A commentary on this article appears in this issue on page 509.
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Affiliation(s)
- Kelvin B. Tan
- Stanford University, Management Science and Engineering Department, Stanford, CA
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
| | | | | | - Jon-Erik C. Holty
- Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA
- Pulmonary, Critical Care and Sleep Section, VA Palo Alto Healthcare System, Palo Alto, CA
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The treatment of snoring by radiofrequency-assisted uvulopalatoplasty and results after one-session protocol: a prospective, longitudinal, non-randomized study. Eur Arch Otorhinolaryngol 2015; 272:3059-63. [PMID: 25837987 DOI: 10.1007/s00405-015-3617-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Snoring is usually caused by the vibration of walls of the soft palate at the pharyngeal level. Its worldwide prevalence is estimated to range between 2 and 85% depending on age, gender or population group. The aim of this study is to determine the degree of improvement that can be subjectively evident in patients treated by snoring with radiofrequency-assisted uvulopalatoplasty based on a one-session protocol. This is a prospective, longitudinal, non-randomized study. Patients of both sexes, aged 18 years, who attended to the ENT consultation in a tertiary hospital with snoring during the period of July 2012-July 2013 were included. Age, body mass index, Epworth sleepiness scale were calculated. The volume of snoring of each subject was assessed using a visual analog scale. A total of 27 patients were included in the study; the average age of the sample was 49 years (±8.7; min 36/max 74); of these 22 (81.5%) were male and 5 (18.5%) females. The average BMI was 27.07 ± 2.5 (min 23.15/max 29.39) before the test and after 1 year was 26.75 ± 2.32 (min 23.11/max 29.56) with no statistically significant differences in BMI before and after surgery (p = 0.407). Preoperative snoring intensity was 8.10 ± 0.93 according to VAS. We found a statistically significant difference in the post-operative intensity at 3 months of 3.93 ± 0.88 (p ≤ 0.05) at 6 months of 4.41 ± 1.08 (p ≤ 0.05), and after 1 year 4.90 ± 0.77 (p ≤ 0.05). The average rate of ESS was significantly higher preoperatively than post-operative, being 8.76 ± 3.1 preoperative and 6.93 ± 1.68 post-operative (p ≤ 0.05). We conclude that the use of radiofrequency in simple snorers with an apnea/hypopnea index <15 events per hour and a BMI < 30 kg/m(2) in whom clinically proven that the source of snoring is the soft palate, can be treated by one-session protocol, being possible to obtain an improvement of snoring up to 70% of cases by a short follow-up period.
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Holmlund T, Levring-Jäghagen E, Franklin KA, Lindkvist M, Berggren D. Effects of Radiofrequency versus sham surgery of the soft palate on daytime sleepiness. Laryngoscope 2014; 124:2422-6. [PMID: 24390800 DOI: 10.1002/lary.24580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the effect of radiofrequency surgery of the soft palate on daytime sleepiness in snoring men with mild or no sleep apnea. STUDY DESIGN Randomized controlled trial. METHODS Thirty-five men were recruited from consecutive patients referred to the Ear, Nose, and Throat Clinic due to snoring and complaints of daytime sleepiness. The inclusion criteria were an apnea-hypopnea index (AHI) of ≤ 15, male gender, and age 18 to 65 years. Patients were randomized to either radiofrequency or sham surgery of the soft palate. All but one chose and received the option of three treatments. All patients participated in a follow-up, including an overnight sleep apnea recording and questionnaires 12 months after the last treatment. The primary outcome was daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) and other questionnaires. Secondary outcomes were effects on the AHI and subjective snoring. RESULTS Thirty-two of 35 patients-19 of 20 patients in the radiofrequency surgery group and 13 of 15 patients in the sham surgery group-completed the study. No differences between the two groups in relation to the ESS or AHI were found at follow-up. CONCLUSION Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring, or apnea frequency in snoring men with mild or no sleep apnea 1 year after surgery. LEVEL OF EVIDENCE 1b. Laryngoscope 124:2422-2426, 2014.
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Affiliation(s)
- Thorbjorn Holmlund
- Department of Otorhinolaryngology, Umeå School of Business and Economics, Sweden
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Balsevičius T, Uloza V, Sakalauskas R, Miliauskas S, Jarutienė I. Efficacy of radiofrequency treatment of the soft palate for patients with mild to moderate obstructive sleep apnea hypopnea syndrome: treatment protocol with nine lesions to the soft palate. Sleep Breath 2014; 19:1003-9. [PMID: 24839238 DOI: 10.1007/s11325-014-1004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed at assessing the efficacy and safety of a radiofrequency treatment (RFT) protocol with nine lesions to the soft palate in the treatment of mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS Twenty-eight mild to moderate OSAHS patients underwent two sessions of RFT (CelonLab ENT system) at the palatal level within the interval from 6 to 8 weeks. Nine lesions (power setting of 10 W) were made per session. The baseline and posttreatment polysomnography and clinical tests battery consisting of visual analogue scales (VAS), Sleep Apnea Quality of Life Index (SAQLI), Beck Depression Inventory--second edition (BDI-II), and Epworth sleepiness scale (ESS) were applied to assess the RFT outcomes. RESULTS Mild to moderate OSAHS patients demonstrated statistically significantly reduced posttreatment mean VAS values for most of the OSAHS-related complaints. A significant improvement in sleepiness (ESS score 6.7 ± 3.7 vs 8.5 ± 4.1, p < 0.01), depressivity (BDI-II score 7.5 ± 6.5 vs 13.1 ± 11.7, p < 0.01), and health-related quality of life (SAQLI score 5.3 ± 0.8 vs 4.7 ± 0.9, p < 0.01) was observed after the RFT. The mean AHI decreased from 13.7 ± 5.9 to 8.3 ± 4.9 points (p < 0.01) in the entire group of patients. According to Sher's criteria of success, 17 out of 28 (60.7 %) patients improved after RFT. No major complications were noted with RFT. CONCLUSIONS RFT protocol with nine lesions to the soft palate seems to be an effective and safe treatment modality associated with low morbidity in selected mild to moderate OSAHS patients.
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Affiliation(s)
- Tomas Balsevičius
- Department of Otolaryngology, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, 50009, Lithuania,
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Lee LA, Yu JF, Lo YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial. PLoS One 2014; 9:e97186. [PMID: 24816691 PMCID: PMC4016275 DOI: 10.1371/journal.pone.0097186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring. Objective To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis. Patients and Method Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time. Results Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group. Conclusions Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures of subjective and objective snoring. Multi-stage radiofrequency surgery was not tested. Trial Registration ClinicalTrials.gov NCT01955083
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian Province, China
| | - Jen-Fang Yu
- Graduate Institute of Medical Mechatronics, Taiouan Interdisciplinary Otolaryngology Laboratory, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Yu-Lun Lo
- Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Ning-Hung Chen
- Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Wen-Nuan Cheng
- Graduate School of Recreation and Sports Management, Taipei Physical Education College, Taipei, Taiwan, R.O.C
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C
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48
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Veer V, Yang WY, Green R, Kotecha B. Long-term safety and efficacy of radiofrequency ablation in the treatment of sleep disordered breathing: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 271:2863-70. [PMID: 24510179 DOI: 10.1007/s00405-014-2909-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/22/2014] [Indexed: 01/10/2023]
Abstract
Radiofrequency ablation (RFA) is used in the treatment of sleep disordered breathing (SDB), particularly in the alleviation of snoring. The literature provides evidence that the short-term results are promising; however, the long-term efficacy is a matter of contention. In this article, we present the results of a literature search of studies that use RFA in the treatment of SDB which have a follow-up time of greater than a year. RFA was found to be a safe technique with minimal morbidity. The overall Visual Analogue score from six studies showed the overall mean improvement to be 4.3 (confidence intervals 3.4-5.12). Apnea Hypopnea Index (AHI), improved significantly in five of the studies analysed. Epworth Sleepiness Score (ESS), improved significantly in six of the studies analysed. In conclusion, the evidence suggests that RFA for SDB results in a significant improvement in follow-up times of at least a year. Since RFA can be applied in a clinic setting and leads to minimal disruption to daily life, this treatment option can be considered for those unwilling to participate in the more traditional surgical options for SDB.
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Affiliation(s)
- Vik Veer
- James Cook University Hospital, Middlesbrough, England,
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49
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Chang YL, Tseng TM, Chen PY, Lin CJ, Hung SH. Using temperature–time integration as a critical parameter in using monopolar radiofrequency ablations. Eur Arch Otorhinolaryngol 2014; 271:1973-9. [DOI: 10.1007/s00405-014-2917-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
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50
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Anterior palatoplasty for selected mild and moderate obstructive sleep apnea: preliminary results. Eur Arch Otorhinolaryngol 2013; 271:1777-83. [DOI: 10.1007/s00405-013-2701-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
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