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Otolaryngologic Clinics of North America

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https://www.readbyqxmd.com/read/27742107/transoral-robotic-partial-glossectomy-and-supraglottoplasty-for-obstructive-sleep-apnea
#1
Mark A D'Agostino
The standard treatment for patients with obstructive sleep apnea syndrome is positive airway pressure (PAP) therapy. However when PAP therapy fails, surgery maybe an option to alleviate the obstruction. The base of tongue plays an important role in this obstruction, and addressing the tongue base surgically can be a challenge for the head and neck surgeon. Transoral robotic surgery (TORS) using the da Vinci Surgical System provides a safe and effective way to approach and manage the base of tongue and supraglottis...
October 11, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720463/nasal-surgery-for-obstructive-sleep-apnea-syndrome
#2
Samuel A Mickelson
Obstructive sleep apnea is a common condition, primarily caused by narrowing of the nasal and pharyngeal airway. Treatment with continuous positive airway pressure (CPAP) is considered the first line of therapy, but long-term compliance is only about 40%, often because of nasal obstruction. Any nasal obstruction can worsen CPAP compliance. Treatment of the nasal obstruction with topical nasal steroid sprays or nasal dilators has been shown to improve sleep disordered breathing. Surgical treatment of nasal obstruction, has been shown to improve sleep disordered breathing, as well as CPAP requirement and compliance with CPAP...
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720462/an-introduction-to-obstructive-sleep-apnea
#3
Boris Paskhover
Obstructive sleep apnea (OSA) is a prevalent disease entity that has become commonplace over the past few decades. Its surge in diagnosis can be linked to a better understanding of the process with a concurrent increase in prevalence. The social, economic, and personal impacts are significant; there continues to be a need to improve our treatment modalities for OSA.
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720461/oral-appliances-in-obstructive-sleep-apnea
#4
Anthony Dioguardi, Moh'd Al-Halawani
Oral appliance therapy (OAT) has become an increasingly popular nonsurgical option for the treatment of obstructive sleep disorders. Recent research supports its efficacy and high levels of compliance for patients with obstructive sleep disorders. Common side effects of OAT include temporomandibular joint-related symptoms, bite changes, and tooth movement. These side effects can be minimized by the use of exercises. The American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine have released joint clinical practice guidelines for the treatment of obstructive sleep apnea and snoring with OAT...
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720460/palatal-procedures-for-obstructive-sleep-apnea
#5
Kathleen Yaremchuk
Uvulopalatopharyngoplasty was the first surgical procedure described, other than tracheostomy, for the treatment of obstructive sleep apnea (OSA) in 1981. It was recognized then that there were responders who were cured of OSA with the procedure and others that were not. It took many years for a staging system to be described that categorized patients based on Mallampati score, tonsil size, and body mass index to better predict success rates. It was recognized that individuals with retro-palatal obstruction as the cause of the airway obstruction responded well but that the morbidity associated with the inpatient procedure was often problematic...
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720459/skeletal-surgery-for-obstructive-sleep-apnea
#6
José E Barrera
Multilevel surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea (OSA). Combined with uvulopalatopharyngoplasty, tongue-base surgeries, including the genioglossus advancement (GA), sliding genioplasty, and hyoid myotomy and suspension, have been developed to target hypopharyngeal obstruction. Total airway surgery consisting of maxillomandibular advancement (MMA) with/without GA has shown significant success. Skeletal procedures for OSA with or without a palatal procedure is a proven technique for relieving airway obstruction during sleep...
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27720169/drug-induced-sleep-endoscopy
#7
Natamon Charakorn, Eric J Kezirian
Drug-induced sleep endoscopy (DISE) is an upper airway evaluation technique in which fiberoptic examination is performed under conditions of unconscious sedation. Unique information obtained from this 3-dimensional examination of the airway potentially provides additive benefits to other evaluation methods to guide treatment selection. This article presents recommendations regarding DISE technique and the VOTE Classification system for reporting DISE findings and reviews the evidence concerning DISE test characteristics and the association between DISE findings and treatment outcomes...
October 6, 2016: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888920/refractory-chronic-rhinosinusitis
#8
EDITORIAL
Abtin Tabaee, Edward D McCoul
No abstract text is available yet for this article.
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888919/chronic-rhinosinusitis-a-simple-complex-condition
#9
EDITORIAL
Sujana S Chandrasekhar
No abstract text is available yet for this article.
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888918/systemic-and-odontogenic-etiologies-in-chronic-rhinosinusitis
#10
REVIEW
Edward C Kuan, Jeffrey D Suh
Systemic and odontogenic etiologies of chronic rhinosinusitis, although rare, are an integral consideration in the comprehensive management of patients with sinonasal disease. Proper knowledge and timely recognition of each disease process, with referrals to appropriate consultants, will facilitate treatment, because many of these conditions require both local and systemic therapy. In some instances, medical therapy plays a pivotal role, with surgery being a supplemental treatment technique. We review the most commonly encountered systemic etiologies of chronic rhinosinusitis and odontogenic sinusitis, including clinical presentation, diagnosis, management, and treatment outcomes...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888917/aspirin-exacerbated-respiratory-disease
#11
REVIEW
Evan S Walgama, Peter H Hwang
Aspirin-exacerbated respiratory disease (AERD) is characterized by the triad of asthma, sinonasal polyposis, and aspirin intolerance. The hallmark of the disease is baseline overproduction of cysteinyl leukotrienes via the 5-lipoxygenase pathway, exacerbated by ingestion of aspirin. Patients with AERD have high rates of recidivistic polyposis following sinus surgery, although the improvement in quality of life following surgery is similar to aspirin-tolerant patients. The diagnosis is secured by a positive aspirin provocation test, usually administered by a medical allergist...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888916/refractory-chronic-rhinosinusitis-with-nasal-polyposis
#12
REVIEW
Benjamin P Hull, Rakesh K Chandra
Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents a subset of chronic sinusitis with various causes. Some forms of the disease are driven by allergy, often in association with asthma. Refractory CRSwNP can be associated with cystic fibrosis and other clinical syndromes. More recent literature is presented regarding roles of innate immunity and superantigens. Effective treatment of CRSwNP requires careful endoscopic sinus surgery followed by an individualized treatment plan that often includes oral and topical steroids...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888915/biofilm-and-osteitis-in-refractory-chronic-rhinosinusitis
#13
REVIEW
Yi Chen Zhao, Peter-John Wormald
Our understanding of chronic rhinosinusitis (CRS) show biofilm and osteitis play a role in the disease's pathogenesis and refractory. Studies point to its role in pathogenesis and poor prognosis. Outside the research laboratory, biofilm detection remains difficult and specific treatment remains elusive. It is believed that osteitis is a nidus of inflammation and occurs more commonly in patients with refractory CRS. However, osteitis may be exacerbated by surgery and a marker of refractory disease, not a causative agent...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888914/bacterial-pathogens-and-the-microbiome
#14
REVIEW
Thad W Vickery, Vijay R Ramakrishnan
Bacterial pathogens and microbiome alterations can contribute to the initiation and propagation of mucosal inflammation in chronic rhinosinusitis (CRS). In this article, the authors review the clinical and research implications of key pathogens, discuss the role of the microbiome, and connect bacteria to mechanisms of mucosal immunity relevant in CRS.
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888913/a-practical-approach-to-refractory-chronic-rhinosinusitis
#15
REVIEW
Edward D McCoul, Abtin Tabaee
Patients with refractory chronic rhinosinusitis, by definition, have persistent, poorly controlled symptoms and objective inflammatory findings despite prior medical and surgical therapy. These patients represent a diagnostic and treatment challenge given the complexity of the underlying disease factors and the limitations in available management options. This article presents a practical framework for clinical evaluation and treatment. Germane to discussion are emerging concepts in refractory chronic rhinosinusitis that will likely have important implications in the near future...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888912/extended-endoscopic-and-open-sinus-surgery-for-refractory-chronic-rhinosinusitis
#16
REVIEW
Jean Anderson Eloy, Emily Marchiano, Alejandro Vázquez
This review discusses extended endoscopic and open sinus surgery for refractory chronic rhinosinusitis. Extended maxillary sinus surgery including endoscopic maxillary mega-antrostomy, endoscopic modified medial maxillectomy, and inferior meatal antrostomy are described. Total/complete ethmoidectomy with mucosal stripping (nasalization) is discussed. Extended endoscopic sphenoid sinus procedures as well as their indications and potential risks are reviewed. Extended endoscopic frontal sinus procedures, such the modified Lothrop procedure, are described...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888911/revision-functional-endoscopic-sinus-surgery
#17
REVIEW
Corinna G Levine, Roy R Casiano
Refractory chronic rhinosinusitis can be challenging to treat. Initial treatment focuses on medical and nonsurgical treatments. If these treatments fail, revision endoscopic sinus surgery is an option. A plan for revision surgery must address anatomic factors contributing to recurrence. Preoperative imaging and sinonasal endoscopy are systematically reviewed; areas of disease and "danger" zones are identified. Traditional anatomic landmarks are often obscured or absent; thus, a set of consistent landmarks (unchanged despite prior surgery) are used to navigate the revision endoscopic sinus surgery...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888910/genetic-and-immune-dysregulation-in-chronic-rhinosinusitis
#18
REVIEW
Ashleigh Halderman, Andrew P Lane
Chronic rhinosinusitis (CRS) is a prevalent condition that is heterogeneous in disease characteristics and multifactorial in cause. Although sinonasal mucosal inflammation in CRS is often either reversible or well-managed medically and surgically, a significant proportion of patients has a refractory form of CRS despite maximal therapy. Two of the several described factors thought to contribute to disease recalcitrance are genetic influences and dysfunction of the host immune system. Current evidence for a genetic basis of CRS is reviewed, as it pertains to putative abnormalities in innate and adaptive immune function...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888909/topical-therapies-for-refractory-chronic-rhinosinusitis
#19
REVIEW
Akshay Sanan, Mindy Rabinowitz, Marc Rosen, Gurston Nyquist
Topical therapy has become an important tool in the otolaryngologist's armamentarium for refractory chronic rhinosinusitis (CRS). Daily high-volume sinonasal saline irrigation and standard metered-dose topical nasal steroid therapy are supported by the most evidence. Nonstandard topical sinonasal steroid therapies are a potential option for refractory CRS. Current evidence recommends against the use of topical antifungal therapy and topical antibiotic therapy delivered using spray and nebulized techniques in routine cases of CRS...
February 2017: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/27888908/office-procedures-in-refractory-chronic-rhinosinusitis
#20
REVIEW
Andrew Thamboo, Zara M Patel
Office procedures in chronic rhinosinusitis (CRS) can be considered before and after medical management, as well as before and after surgical management. This article focuses specifically on refractory CRS, meaning those patients who have failed medical and surgical management already. The options available in the management of refractory CRS depend on the personnel, equipment, and instrumentation available in the office setting; surgeon experience; and patient suitability and tolerability. This article provides readers with possible procedural options that can be done in their clinics with indications, patient selection, potential complications, and postoperative considerations...
February 2017: Otolaryngologic Clinics of North America
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