1
|
Munjal S, Sharma A, Chhabra N, Panda N. Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity. J Voice 2024; 38:660-665. [PMID: 34969555 DOI: 10.1016/j.jvoice.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population. METHODOLOGY Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time. RESULTS Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group. DISCUSSION AND CONCLUSION Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.
Collapse
Affiliation(s)
- Sanjay Munjal
- Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, New OPD, Chandigarh, India; Department of Otolaryngology, Speech and Hearing Unit, New OPD, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Sharma
- Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, New OPD, Chandigarh, India; Department of Otolaryngology, Speech and Hearing Unit, New OPD, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Neha Chhabra
- Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, New OPD, Chandigarh, India; Department of Otolaryngology, Speech and Hearing Unit, New OPD, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Post Graduate Institute of Medical Education and Research, New OPD, Chandigarh, India
| | - Naresh Panda
- Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, New OPD, Chandigarh, India; Department of Otolaryngology, Speech and Hearing Unit, New OPD, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| |
Collapse
|
2
|
Johnsen SG. Computational Rhinology: Unraveling Discrepancies between In Silico and In Vivo Nasal Airflow Assessments for Enhanced Clinical Decision Support. Bioengineering (Basel) 2024; 11:239. [PMID: 38534513 DOI: 10.3390/bioengineering11030239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/17/2024] [Indexed: 03/28/2024] Open
Abstract
Computational rhinology is a specialized branch of biomechanics leveraging engineering techniques for mathematical modelling and simulation to complement the medical field of rhinology. Computational rhinology has already contributed significantly to advancing our understanding of the nasal function, including airflow patterns, mucosal cooling, particle deposition, and drug delivery, and is foreseen as a crucial element in, e.g., the development of virtual surgery as a clinical, patient-specific decision support tool. The current paper delves into the field of computational rhinology from a nasal airflow perspective, highlighting the use of computational fluid dynamics to enhance diagnostics and treatment of breathing disorders. This paper consists of three distinct parts-an introduction to and review of the field of computational rhinology, a review of the published literature on in vitro and in silico studies of nasal airflow, and the presentation and analysis of previously unpublished high-fidelity CFD simulation data of in silico rhinomanometry. While the two first parts of this paper summarize the current status and challenges in the application of computational tools in rhinology, the last part addresses the gross disagreement commonly observed when comparing in silico and in vivo rhinomanometry results. It is concluded that this discrepancy cannot readily be explained by CFD model deficiencies caused by poor choice of turbulence model, insufficient spatial or temporal resolution, or neglecting transient effects. Hence, alternative explanations such as nasal cavity compliance or drag effects due to nasal hair should be investigated.
Collapse
|
3
|
Pang Y, Xiao L, Liang J, Zhang F, Yao HB, Shu Y. Role of Nasal Ventilation Function in Obstructive Sleep Apnea Syndrome in Children. EAR, NOSE & THROAT JOURNAL 2023:1455613231205991. [PMID: 37864363 DOI: 10.1177/01455613231205991] [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: 10/22/2023] Open
Abstract
Background: The association between increased nasal resistance (NR) and obstructive sleep apnea syndrome (OSAS) is controversial. The purpose of this study was to examine nasal ventilation function (NVF) in children with OSAS, with a focus on its pathogenetic role. Methods: Children were recruited and divided into the OSAS group (n = 109) and control group (n = 116). The participants underwent polysomnography (PSG), measurement of NR, and acoustic rhinometry (AR). A combination of intranasal corticosteroids (ICS) and oral montelukast (OM) was administered to 90 children with mild to moderate OSAS for 12 weeks. After excluding participants who dropped out or were lost to follow-up, there were 58 children who responded to the treatment, who were divided into 2 groups-A and B. We compared the size of the tonsil adenoids, the PSG, NR, and AR before and after treatment in the 2 groups. Results: Children aged 6 to 12 years with OSAS had significantly higher NR than the control group (P < .05). The OSAS group had a smaller nasal minimal cross-sectional area (NMCA), nasal cavity volume (NCV) from 0 to 5 cm, and nasopharyngeal volume (NPV) from 6 to 8 cm than the control group, and the difference was statistically significant (P < .05 or P < .01). A total of 58 (84.1%) children responded to the 12-week ICS+OM treatment and 11 (15.9%) children did not respond to the treatment. Effective treatment was achieved in 32 children, as evidenced by a significant reduction in tonsil adenoid size and variations in NR and AR values. There were significant improvements in NR, NMCA, and NCV in the remaining 26 children who were successfully treated, but there was no change in tonsil adenoids and NPV value. Conclusion: NVF may play an important pathogenetic role in children with OSAS.
Collapse
Affiliation(s)
- Ying Pang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jia Liang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Zhang
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Shu
- Department of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
4
|
Fujito N, Ohshima Y, Hokari S, Takahashi A, Nagai A, Suzuki R, Aoki N, Watanabe S, Koya T, Kikuchi T. The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome. PLoS One 2023; 18:e0283070. [PMID: 36920951 PMCID: PMC10016634 DOI: 10.1371/journal.pone.0283070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50-66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7-61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4-3.9)/hour and the usage time was 318 (IQR 226-397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.
Collapse
Affiliation(s)
- Nobuhiro Fujito
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Yasuyoshi Ohshima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
- * E-mail:
| | - Satoshi Hokari
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Atsunori Takahashi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Asuka Nagai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Ryoko Suzuki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Toshiyuki Koya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| |
Collapse
|
5
|
Eravci FC, Yildiz BD, Özcan KM, Moran M, Çolak M, Karakurt SE, Karakuş MF, Ikinciogullari A. Acoustic parameter changes after bariatric surgery. LOGOP PHONIATR VOCO 2021; 47:256-261. [PMID: 34213387 DOI: 10.1080/14015439.2021.1945676] [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: 10/21/2022]
Abstract
OBJECTIVE To investigate the acoustic parameter changes after weight loss in bariatric surgery patients. MATERIALS AND METHODS This prospective, longitudinal study was conducted with 15 patients with planned bariatric surgery, who were evaluated pre-operatively and at 6 months post-operatively. Fundamental frequency (F0), Formant frequency (F1, F2, F3, and F4), Frequency perturbation (Jitter), Amplitude perturbation (Shimmer) and Noise-to-Harmonics Ratio (NHR) parameters were evaluated for /a/, /e/, /i/, /o/, and /u/ vowels. Changes in the acoustic analysis parameters for each vowel were compared. The study group was separated into two groups according to whether the Mallampati score had not changed (Group 1) or had decreased (Group 2) and changes in the formant frequencies were compared between these groups. RESULTS A total of 15 patients with a median age of 40 ± 11 years completed the study. The median weight of the patients was 122 ± 14 kg pre-operatively and 80 ± 15 kg, post-operatively. BMI declined from 46 ± 4 to 31 ± 5 kg/m2. The Mallampati score decreased by one point in six patients and remained stable in nine. Of the acoustic voice analysis parameters of vowels, in general, fundamental frequency tended to decrease, and shimmer and jitter values tended to increase. Some of the formant frequencies were specifically affected by the weight loss and this showed statistical significance between Group 1 and Group 2. CONCLUSION The present study reveals that some specific voice characteristics might be affected by successful weight loss after bariatric surgery.HighlightsObesity reduces the size of the pharyngeal lumen at different levels.The supralaryngeal vocal tract size and configuration is a determinative factor in the features of the voice.Changes in the length and shape of the vocal tract, or height and position of the tongue can result in changes especially in formant frequencies in acoustic analysis.
Collapse
Affiliation(s)
- Fakih Cihat Eravci
- Department of Otorhinolaryngology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Barış Doğu Yildiz
- Department of General Surgery, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Münevver Moran
- Department of General Surgery, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey.,Department of General Surgery, Liv Hospital Ankara, Ankara, Turkey
| | - Mustafa Çolak
- Department of Otorhinolaryngology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Süleyman Emre Karakurt
- Department of Otorhinolaryngology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Aykut Ikinciogullari
- Department of Otorhinolaryngology, University of Health Science, Ankara Numune Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
6
|
Hismi A, Yu P, Locascio J, Levesque PA, Lindsay RW. The Impact of Nasal Obstruction and Functional Septorhinoplasty on Sleep Quality. Facial Plast Surg Aesthet Med 2020; 22:412-419. [PMID: 32429693 DOI: 10.1089/fpsam.2020.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: Functional septorhinoplasty (FSRP) has been shown to improve both global and disease-specific quality of life (QOL). However, the mechanism by which FSRP improves QOL has not been fully defined. We reasoned that NAO may impact sleep quality and, therefore, studied the relationship using validated patient-reported outcome measures. Objective: To investigate the correlation between NAO and sleep quality using Nasal Obstruction Symptom Evaluation (NOSE) and Functional Outcomes of Sleep Quality (FOSQ-10) questionnaires, and to evaluate the effect of FSRP on NAO and sleep quality. Design, Setting, and Participants: This is a prospective longitudinal study of 125 patients undergoing FSRP for the repair of NAO between November 2017 and April 2019 in a university-based tertiary care medical center. The individuals (mean age = 38 ± 15.6 years, 65 females; 52%) were invited to complete the FOSQ-10 survey preoperatively and at 2, 4, 6, and 12 months postoperatively, and 122 of these patients also completed the NOSE questionnaire. Sixty individuals who reported a history of snoring also completed the Snoring Outcomes Survey (SOS). Twelve of 125 patients had obstructive sleep apnea. Patient demographics, nasal surgery, and medical histories and outcomes were analyzed. Intervention: Functional septorhinoplasty. Main Outcomes and Measures: Comparison of pre- and postoperative sleep and NAO scores to determine the correlation between the severity of NAO and sleep quality and the impact of correction of NAO on sleep quality. Results: A total of 125 patients completed FOSQ-10 questionnaire with a median score of 18.00 (IQR = 15.33-19.66) at baseline. Among these individuals, 122 patients completed the NOSE questionnaire with a median score of 65 (IQR = 45-75). A negative correlation between NOSE and FOSQ-10 scores was found at baseline (r = -0.380, p < 0.001). There was a significant difference in baseline FOSQ-10 scores between individuals with (n = 12, mean FOSQ-10 score = 13.28 ± 3.19) (p < 0.001) and without sleep apnea (n = 100, mean FOSQ-10 score = 17.24 ± 3.21). After FSRP, the NOSE and FOSQ-10 scores improved at each postoperative follow-up time point. The change in FOSQ-10 scores was statistically significant at months 2, 4, and 6 (p < 0.001) but not at month 12 (p = 0.161). The NOSE scores were statistically different from baseline level for each postoperative follow-up visits (p < 0.001-months 2, 4, and 6 and p = 0.031-month 12). The distribution of NOSE scores was not different statistically (p = 0.984). The negative correlation between NOSE and FOSQ-10 mean scores that was demonstrated at baseline increases postoperatively (r = 0.508, p < 0.001). Conclusions and Relevance: FSRP can improve both symptoms of NAO and sleep quality. The increased correlation between NAO and sleep quality after surgery is consistent with the hypothesis that improvement in NAO improves sleep quality and QOL.
Collapse
Affiliation(s)
- Anil Hismi
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Phoebe Yu
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA
| | - Joseph Locascio
- Department of Neurology, Massachussetts General Hospital, Harvard Medical School, Boston, Massachussetts, USA
| | - Patricia A Levesque
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachussetts, USA
| | - Robin Williams Lindsay
- Department of Otolaryngology, Massachussetts Eye and Ear, Boston, Massachussetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachussetts, USA
| |
Collapse
|
7
|
Fonseca ALF, Salgado W, Dantas RO. Maximum Phonation Time in People with Obesity Not Submitted or Submitted to Bariatric Surgery. J Obes 2019; 2019:5903621. [PMID: 31976088 PMCID: PMC6955128 DOI: 10.1155/2019/5903621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/06/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Our aim in this investigation was to evaluate maximum phonation time in people with obesity not submitted to surgery and in people with obesity submitted to bariatric surgery and compare it with maximum phonation time of healthy volunteers. The hypothesis was that the reduced maximum phonation time in people with obesity would be corrected after surgery due to weight loss. METHOD Maximum phonation time was evaluated in 52 class III patients (Group A), 62 class III patients who were treated by surgery 3 to 115 months before (Group B), 20 controls (Group C), and 15 class III patients whose maximum phonation time was evaluated before and two to six months after surgery (Group D). Maximum phonation time was measured in the sitting position with the vowels /A/, /I/, and /U/. RESULTS Maximal phonation time was shorter in groups A and B compared with that of controls. There was an increase in maximal phonation time after surgery (Group B); however, the difference was not significant when compared with that in group A. In group D, maximal phonation time for /A/ increased after the surgery. In group A, there was a negative correlation between maximal phonation time and weight or body mass index and a positive correlation between maximal phonation time and height. In group B, there was an almost significant positive relation between percentage of weight loss and maximal phonation time for /A/ (p=0.08) and /I/ (p=0.07). Mean values of spirometry testing (FEV1, FVC, and FEV1/FVC) in people with obesity (groups A and B), expressed as percentage of the predicted value, were within the normal range. CONCLUSION Compared with healthy controls, maximal phonation time is shorter in people with obesity, with a tendency to increase after bariatric surgery, as a possible consequence of weight loss.
Collapse
Affiliation(s)
- Ana Luara Ferreura Fonseca
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900 Ribeirão Preto SP, São Paulo 14049-900, Brazil
| | - Wilson Salgado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900 Ribeirão Preto SP, São Paulo 14049-900, Brazil
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900 Ribeirão Preto SP, São Paulo 14049-900, Brazil
| |
Collapse
|
8
|
Acar M, Cingi C, Sakallioglu O, San T, Yimenicioglu MF, Bal C. The Effects of Mometasone Furoate and Desloratadine in Obstructive Sleep Apnea Syndrome Patients with Allergic Rhinitis. Am J Rhinol Allergy 2018; 27:e113-6. [DOI: 10.2500/ajra.2013.27.3921] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) are worldwide prevalent diseases. These diseases impair patient quality of life. The aim of this study was to investigate and compare the efficacy of treatment of AR on OSAS by objective and subjective methods. Methods The study group was composed of 80 OSAS patients with AR between the ages of 30 and 50 years. The patients were admitted with the complaint of snoring, and they were asked about AR-related symptoms (nasal discharge, nasal itching, sneeze, and nasal obstruction). Daytime somnolence was measured by the Epworth sleepiness scale (ESS). Sleep parameters on polysomnography tests before and after treatment were compared, and the effects of different AR treatment protocols on sleep quality were evaluated. Results When pretreatment and posttreatment apnea–hypopnea index (AHI) values of the groups were compared, the most significant difference was observed in the nasal steroid (Ns) + antihistamine (Ah) group (p < 0.05). The ESS results were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). AHI oxygen saturation <90% were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). Conclusion Nasal obstruction due to nasal congestion causes increases in airway resistance and can lead to development of OSAS. We concluded that treating AR with Ns has both positive effects on OSAS and daily activity. However, adding Ah to this treatment did not show improved effects compared with placebo treatment.
Collapse
Affiliation(s)
- Mustafa Acar
- Ear, Nose, and Throat Department, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Cemal Cingi
- Medical Faculty, Department of Otorhinolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Oner Sakallioglu
- Ear, Nose, and Throat Department, Elazığ Education and Research Hospital, Elazıg, Turkey
| | - Turhan San
- Ear, Nose, and Throat Department, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Cengiz Bal
- Medical Faculty, Department of Biostatistics, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
9
|
Murtolahti S, Crouse UK, Pahkala R, Warren DW, Laine-Alava MT. Perception and Respiratory Responses of the Upper Airway Mechanism to Added Resistance With Aging. Laryngoscope Investig Otolaryngol 2018; 2:417-422. [PMID: 29299517 PMCID: PMC5743172 DOI: 10.1002/lio2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/29/2017] [Accepted: 10/10/2017] [Indexed: 11/08/2022] Open
Abstract
Objectives To assess breathing behaviors and perception of added respiratory loads in young compared to old individuals, and to determine whether aging affects the perception and response to changes in nasal airway resistance. Study design In a clinical study, 40 young (11-20 years) and 40 older (59-82 years) subjects were evaluated during rest breathing and during the application of added airway resistance loads. Methods The pressure-flow technique was used to measure airflow rate (mL/s) and oral-nasal pressures (cmH2O) to calculate nasal resistance (cmH2O/L/s). To create calibrated resistance loads for the test conditions, we used a device modified from a precision iris diaphragm. Results During rest breathing airflow rate was significantly lower for the younger group compared to older group. Using the loading device, 11-20-year-olds detected increased resistance at the level of 2.26 cmH2O/L/s compared to 4.55 cmH2O/L/s in 59-82-year-olds. In contrast to the younger group, mean airflow rate was higher during expiration than during inspiration among 59-82-year-olds except at rest breathing. Conclusions The data revealed that the perception and respiratory response to increased airway resistance changed with aging. Younger subjects were more sensitive to changes within the airway. In both groups, subjects responded to increased airway resistance by decreasing airflow rate. However, expiratory phase became more active than inspiratory phase only in the older group. Level of Evidence N/A.
Collapse
Affiliation(s)
| | - Ulla K Crouse
- Department of Orthodontics University of Michigan Ann Arbor Michigan U.S.A
| | - Riitta Pahkala
- Institute of Clinical Medicine Kuopio Finland.,University of Eastern Finland and Kuopio University Hospital Kuopio Finland
| | - Donald W Warren
- UNC Craniofacial Center , University of North Carolina Chapel Hill North Carolina U.S.A
| | | |
Collapse
|
10
|
Shusterman D, Baroody FM, Craig T, Friedlander S, Nsouli T, Silverman B. Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:628-639. [PMID: 27923646 DOI: 10.1016/j.jaip.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. OBJECTIVES To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. METHODS Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. RESULTS Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. CONCLUSIONS Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing.
Collapse
|
11
|
The Evaluation of Relationship Between Body Mass Index and Nasal Geometry Using Objective and Subjective Methods. J Craniofac Surg 2016; 26:1861-4. [PMID: 26355974 DOI: 10.1097/scs.0000000000001930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION It is known that obesity causes obstructive sleep apnea syndrome by increasing upper airway resistance. Also, obese patients are admitted to the ear, nose, and throat clinic very often because of nasal obstruction complaint. The aim of this study is to identify the change and relation among body mass index (BMI), nasal resistance, reduction in nasal ariflow, nasal anatomy, and patients' subjective complaints. MATERIAL AND METHOD A total of 67 patients admitted to our clinic between August 2013 and January 2014 were included in the study.The study group comprised 33 patients who had a chief complaint-nasal obstruction and the other group consisted of 34 patients who had no complaint and nasal pathology. Both the groups were checked with acoustic rhinometry (AR), active anterior rhinomanometer, nasal obstruction symptom evaluation (NOSE), and visual analog study (VAS) questionnaire. RESULTS There is a significant statistical correlation between the body mass increase and VAS and NOSE score increase (P < 0.05). But the authors did not find any statistically significant relation between BMI and total inspiratory and expiratory MR and MF measured by anterior active rhinomanometer and left and right nasal cavity MCA, and volume measured by acoustic rhinometery (P > 0.05). CONCLUSIONS Contrary to belief, obesity does not change the nasal resistance, airflow, and anatomy but it can cause subjective nasal complaints.
Collapse
|
12
|
Hueto J, Santaolalla F, Sanchez-Del-Rey A, Martinez-Ibargüen A. Usefulness of rhinomanometry in the identification and treatment of patients with obstructive sleep apnoea: an algorithm for predicting the relationship between nasal resistance and continuous positive airway pressure. a retrospective study. Clin Otolaryngol 2016; 41:750-757. [PMID: 26923703 DOI: 10.1111/coa.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We tried to assess the relationship between nasal resistance measured by rhinomanometry and the pressure used in CPAP. DESIGN Retrospective medical case series review, January 2004 to December 2014. SETTING Tertiary care academic medical centre. PARTICIPANTS Thirty-eight patients (m = 56.55 years; male = 90.5%) with CPAP settings ≤8 and 39 patients (m = 57.49 years; male = 74.9%) with pressure settings ≥12. MAIN OUTCOME MEASURES Study variables were BMI, neck circumference, Epworth Sleepiness Scale score, nasopharyngeal examination and computerised anterior active rhinomanometry, sitting and supine, in basal conditions and after intranasal administration of oxymetazoline (0.05%). Nocturnal polysomnography was performed to calculate the apnoea-hypopnoea index without and with CPAP to analyse the effectiveness of the treatment. RESULTS BMI and resistance in supine position after vasoconstriction at 150 Pa were useful variables to predict the pressure setting that should be used. We obtained an equation to calculate the probability that a patient requires a pressure >12 cm H2 O as a function of their BMI and total nasal airflow at 150 pascal in supine position after vasoconstriction. CONCLUSIONS Rhinomanometry is useful to predict the impact of structural nasal modifications on the positive pressure to support decision-making in relation to surgery.
Collapse
Affiliation(s)
- J Hueto
- Otorhinolaryngology Service, University Hospital of Araba, Vitoria, Spain.,School of Medicine, University of the Basque Country, Bilbao, Spain
| | - F Santaolalla
- School of Medicine, University of the Basque Country, Bilbao, Spain.,Otorhinolaryngology Service, University Hospital of Basurto, Bilbao, Spain
| | | | | |
Collapse
|
13
|
de Souza LBR, Pernambuco LDA, dos Santos MM, Pereira RM. Neck Circumference and Vocal Parameters in Women Before and After Bariatric Surgery. Obes Surg 2015; 26:576-80. [DOI: 10.1007/s11695-015-1785-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Hamdan AL, Safadi B, Chamseddine G, Kasty M, Turfe ZA, Ziade G. Effect of Weight Loss on Voice After Bariatric Surgery. J Voice 2014; 28:618-23. [DOI: 10.1016/j.jvoice.2014.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/12/2014] [Indexed: 11/30/2022]
|
15
|
Sin S, Wootton DM, McDonough JM, Nandalike K, Arens R. Anterior nasal resistance in obese children with obstructive sleep apnea syndrome. Laryngoscope 2014; 124:2640-4. [PMID: 24615829 DOI: 10.1002/lary.24653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate nasal resistance in obese children with and without obstructive sleep apnea syndrome (OSAS), study the correlation between nasal resistance and severity of OSAS using the apnea-hypopnea index (AHI), and examine the association of gender and body mass index (BMI) with this measurement. STUDY DESIGN Retrospective analysis. METHODS Active anterior rhinomanometry was used to determine anterior nasal resistance (aNR) during wakefulness in the supine position during tidal breathing. Thirty obese children with OSAS (aged 13.8 ± 2.6 years, BMI z score 2.6 ± 0.4) and 32 matched obese controls (aged 13.6 ± 2.3 years, BMI z score 2.4 ± 0.4), were studied. Unpaired t tests and Spearman correlation were performed. RESULTS The OSAS group had significantly higher aNR than the non-OSAS group during inspiration (P = .012) and expiration (P = .003). A significant correlation between inspiratory aNR and AHI was found for the OSAS group (r = 0.39, P = .04). The aNR did not correlate with BMI z score or with either gender. CONCLUSIONS We noted a higher aNR in obese children with OSAS as compared to obese controls, and the aNR on inspiration correlated significantly with AHI. These findings suggest that a causal or augmentative effect of high inspiratory aNR may exist for obese children who exhibit OSAS. LEVEL OF EVIDENCE 3b.
Collapse
Affiliation(s)
- Sanghun Sin
- Division of Respiratory and Sleep Medicine, the Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | | |
Collapse
|
16
|
Parikh NG, Junaid I, Sheinkopf L, Randhawa I, Santiago SM, Klaustermeyer WB. Clinical Control in the Dual Diagnosis of Obstructive Sleep Apnea Syndrome and Rhinitis: A Prospective Analysis. Am J Rhinol Allergy 2014; 28:e52-5. [DOI: 10.2500/ajra.2014.28.3977] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Obstructive sleep apnea syndrome (OSAS) and allergic rhinitis (AR) are common coexisting disorders. Upper airway, specifically al resistance, is thought to increase during exacerbations of AR and nonallergic rhinitis (NAR), as well as in OSAS. The study objective was to determine if a correlation exists between clinical control of rhinitis and OSAS. Methods This prospective study followed 43 patients with concurrent OSAS and AR or NAR. OSAS was diagnosed by polysomnography, and AR or NAR was diagnosed by history, skin testing, serum-specific IgE, and total IgE levels. Measurements of control of OSAS included the Epworth Sleepiness Scale (ESS) survey and compliance with continuous positive airway pressure (CPAP) device. Measurements of rhinitis control included Assessment of Nasal Symptom Severity and Assessment of Nonnasal Symptom Severity (NSS refers to both) and Global Assessment of Nasal and Nonnasal Symptom Severity surveys (GSS). Higher NSS scores correlate with more rhinitis symptoms, whereas higher GSS scores correlate with less symptoms. Results All patients completed the study. There was a positive correlation between ESS and NSS scores (p < 0.001), inverse correlation between ESS and GSS scores (p < 0.001), inverse correlation between CPAP compliance and NSS scores (p < 0.001), and positive correlation between CPAP compliance and GSS scores (p < 0.001). There was no statistically significant difference between the AR, NAR, and AR/NAR groups. Conclusion Our study showed a statistically significant positive correlation between clinical control of rhinitis symptoms and clinical control of OSAS. This study emphasizes the importance of achieving concurrent optimal control of both OSAS and AR/NAR.
Collapse
Affiliation(s)
- Neil G. Parikh
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| | - Imran Junaid
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| | - Lee Sheinkopf
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| | - Inderpal Randhawa
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| | - Silverio M. Santiago
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| | - William B. Klaustermeyer
- Division of Allergy and Immunology, Veterans Affairs Greater Los Angeles Healthcare Systems/The David Geffen School of Medicine at University of California–Los Angeles, Los Angeles, California
| |
Collapse
|
17
|
Acoustic, perceptual and aerodynamic voice evaluation in an obese population. The Journal of Laryngology & Otology 2013; 127:987-90. [DOI: 10.1017/s0022215113001916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To investigate perceptual, acoustic and aerodynamic voice parameters in obese individuals.Methods:Twenty obese and 20 normal-weight volunteers underwent voice evaluation by laryngoscopy, acoustic analysis, aerodynamic measurement and perceptual analysis (using the grade-roughness-breathiness-asthenia-strain (‘GRBAS') scale and the Voice Handicap Index 10 scale). Data from both subject groups were compared.Results:No difference was found in acoustic analysis parameters between the two groups (p > 0.05). Maximum phonation time in the obese group (mean ± standard deviation, 19.6 ± 4.9 seconds) was significantly shorter than in controls (26.4 ± 4.1 seconds) (p < 0.001), although the s/z ratio was very similar between the two groups. In the obese and control groups, the mean ± standard deviation grade-roughness-breathiness-asthenia-strain scores were 1 ± 1.3 and 0.2 ± 0.6 (p = 0.002) and the mean ± standard deviation Voice Handicap Index 10 scores were 0.5 ± 1.2 and 1.2 ± 1.7 (p = 0.27), respectively.Conclusion:Obese individuals had poorer vocal quality as judged by the grade-roughness-breathiness-asthenia-strain scale, and reduced maximum phonation time. However, there was no change in voice quality as assessed by acoustic analysis and Vocal Handicap Index 10 score, compared with controls.
Collapse
|
18
|
Schick SF, van den Vossenberg G, Luo A, Whitlatch A, Jacob P, Balmes J, Shusterman D. Thirty minute-exposure to aged cigarette smoke increases nasal congestion in nonsmokers. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2013; 76:601-613. [PMID: 23859154 DOI: 10.1080/15287394.2013.800811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study was to assess the effects of short exposures to experimentally aged cigarette smoke on the nose and upper airways. This crossover study compared the effects of 30-min exposures to (1) experimentally aged cigarette smoke at 1 mg/m³ particulate matter (PM)/14 ppm carbon monoxide (CO) and (2) conditioned filtered air on urinary metabolites of nicotine and tobacco-specific nitrosamines. Subjective nasal symptoms were assessed by questionnaire, objective nasal congestion was assessed by anterior rhinomanometry and nasal nitric oxide (NO) concentrations were determined. Experimentally aged cigarette smoke is a validated model for secondhand smoke (SHS). Twenty-six healthy nonsmokers (10 normal, 7 atopic/nonrhinitic, 7 atopic rhinitic, 2 nonatopic/rhinitic) were studied. A 30-min exposure to SHS increased nasal resistance in healthy nonsmokers. The rise in nasal resistance was most pronounced in rhinitic subjects. Significant increases were not noted when atopic subjects were considered independent of rhinitis status. Secondhand smoke exposure also elevated subjective nasal symptoms and urinary concentrations of metabolites of nicotine (cotinine and trans-3´-hydroxycotinine) and tobacco-specific nitrosamines [(4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)] in all subgroups of subjects. Exposure-related, subjective nasal symptoms were significantly higher in rhinitic than in normal subjects. Significant changes in nasal NO concentrations were not detected. Data indicate a 30-min exposure to secondhand smoke at 1 mg/m³ PM increases subjective upper respiratory symptoms, increases urinary cotinine and NNAL, and produces objective nasal airflow obstruction in human subjects.
Collapse
Affiliation(s)
- Suzaynn F Schick
- Department of Medicine, University of California, San Francisco, San Francisco, Box 0843, California 94143-0843, USA.
| | | | | | | | | | | | | |
Collapse
|
19
|
Choi JH, Kim EJ, Kim YS, Kim TH, Choi J, Kwon SY, Lee HM, Lee SH, Lee SH. Effectiveness of Nasal Surgery Alone on Sleep Quality, Architecture, Position, and Sleep-Disordered Breathing in Obstructive Sleep Apnea Syndrome with Nasal Obstruction. Am J Rhinol Allergy 2011; 25:338-41. [DOI: 10.2500/ajra.2011.25.3654] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The goal of this study was to evaluate the effect of nasal surgery alone on sleep quality, architecture, position, and sleep-disordered breathing (SDB) (including obstructive apnea and snoring) in adult patients with obstructive sleep apnea syndrome (OSAS) and nasal obstruction. Methods A total of 22 consecutive male patients (mean age, 41.3 ± 10.9 years) with OSAS and nasal obstruction, who underwent nasal surgery alone, were enrolled in the study. We compared polysomnographic data related with sleep quality (sleep efficiency [SE] and arousal index [ArI]), sleep architecture (stages N [nonrapid eye movement], 1, 2, and 3, and R [rapid eye movement]), the distribution of sleep positions, and SDB (apnea–hypopnea index [AHI], apnea index [AI], minimum arterial oxygen saturation [SaO 2 ], and snoring) before and after nasal surgery. Results SE (from 86.6 ± 6.3% to 89.7 ± 7.1%; p = 0.039), stage R (from 15.3 ± 4.8% to 18.6 ± 5.4%; p = 0.016) and snoring (from 32.2 ± 16.4% to 25.8 ± 18.6%; p = 0.045) significantly changed after nasal surgery. However, there were no significant changes in ArI, other sleep stages, the proportion of sleep time spent in the supine position, AHI, AI, and minimum SaO 2 after nasal surgery. Conclusion Nasal surgery alone was partially effective in improving sleep quality, architecture, and snoring, but it had no effect on the change of the distribution of sleep positions and obstructive apnea in patients with OSAS and nasal obstruction.
Collapse
Affiliation(s)
- Ji Ho Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Eun Joong Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yeon Soo Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - June Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Heung Man Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sang Hag Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology–Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|