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Advances in Oto-rhino-laryngology

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https://www.readbyqxmd.com/read/28738391/updated-palate-surgery-for-obstructive-sleep-apnea
#1
Hsueh-Yu Li
Initially described in 1981, uvulopalatopharyngoplasty was the first surgical procedure specially designed at the palatal level for snoring and obstructive sleep apnea (OSA). To date, palatal surgery remains the most commonly used surgery for OSA. The advancement of this surgery over the past 30 years has been a process of evolution in concepts, examination, and technique to increase safety and effectiveness in the treatment of OSA. Concept changes have emerged in the disease etiology, purpose of surgery, treatment priorities, staging of operations, integration therapy, and surgical endpoints...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738388/updated-friedman-staging-system-for-obstructive-sleep-apnea
#2
Michael Friedman, Anna M Salapatas, Lauren B Bonzelaar
In the practice of sleep medicine, the first step is identification of those patients at high risk for sleep apnea. Nearly every physician and every hospital has preferred methods of screening. Many patient questionnaires or surveys as well as some objective physical measurements have been suggested to predict the presence of sleep apnea. Screening is well established, and laboratory and home testing are widely available. An early assessment with a physical examination can help direct treatment planning. The Friedman tongue position, lingual tonsil hypertrophy grading, and the effects of oral positioning on the hypopharynx should be used in early assessment for treatment planning, and as screening tools to assess the sight of obstruction...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738382/advanced-concepts-in-the-pathophysiology-of-obstructive-sleep-apnea
#3
David P White
The primary pathological event in the disorder obstructive sleep apnea (OSA) is the partial or complete closure of the pharyngeal airway during sleep in an individual with a widely patent airway during wakefulness. This yields an apnea or hypopnea with resulting hypoxia and hypercapnia, and most often requires an arousal to terminate the event. These events occur in a repetitive manner during sleep, yielding intermittent hypoxia and sleep fragmentation with their associated adverse effects on the health and quality of life of the afflicted individual...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738377/updated-nasal-surgery-for-obstructive-sleep-apnea
#4
David M Johnson, Ryan J Soose
Numerous studies report that difficulty breathing through the nose is associated with reduced sleep quality, increased daytime dysfunction, and increased risk of snoring and obstructive sleep apnea (OSA). Additionally, chronic nasal obstruction often complicates and limits successful medical device therapy for OSA, particularly with continuous positive airway pressure (CPAP). When medical evaluation and management of the nose is inadequate, surgical therapy to lower nasal resistance has been shown to substantially improve sleep and breathing outcome measures...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738374/multilevel-obstructive-sleep-apnea-surgery
#5
Hsin-Ching Lin, Edward M Weaver, Ho-Sheng Lin, Michael Friedman
Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSA). Most sleep physicians are in agreement that a certain number of OSA patients cannot or will not use CPAP. Although other conservative therapies, such as oral appliance, sleep hygiene, and sleep positioning, may help some of these patients, there are many who fail all conservative treatments. As sleep surgeons, we have the responsibility to screen patients for both symptoms and signs of OSA...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738372/advances-in-oral-appliances-for-obstructive-sleep-apnea
#6
Ofer Jacobowitz
Oral appliances that advance the mandible are widely used as alternatives to positive airway pressure (PAP) devices or as primary therapy for obstructive sleep apnea (OSA) in adults. Although PAP is more efficacious at lowering the polysomnographic indices of OSA, the clinical effectiveness of PAP and oral appliances is similar, and patients are more likely to adhere to oral appliance therapy than to PAP treatment. Clinical examination is used to determine the candidacy of oral appliances and to select a particular appliance for a given patient...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738371/robotic-obstructive-sleep-apnea-surgery
#7
Song Tar Toh, Pon Poh Hsu
Since the first report of the use of the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in transoral robotic tongue base reduction for obstructive sleep apnea (OSA) was published in 2010, this surgical tool and technique has been used worldwide for the resection of tongue base tissue in the multilevel surgical treatment of OSA. The combined knowledge of the published literature on its use has enlightened sleep surgeons worldwide on this new yet evolving surgical tool. Here we will discuss the use of the da Vinci robotic system in the treatment of OSA, the pertinent surgical anatomy for a safe surgical procedure, the primary and secondary outcomes to expect in the multilevel and primary use of this technology in treating the tongue base, the predictors for success or failure, and the complications associated with this technique...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738368/updated-minimally-invasive-surgery-for-sleep-related-breathing-disorders
#8
Bhik Kotecha
Sleep-related breathing disorders (SRBD) consist of a variety of clinical entities, ranging from primary snoring to severe obstructive sleep apnoea at the opposite extreme. Although it has no official definition, minimally invasive surgery infers surgery where the procedure is clinically less aggressive and may involve a much smaller incision or none at all. It also implies that such procedures may result in a quicker recovery and reduced morbidity, and that they are often conducted under local anaesthesia as day cases...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738365/advances-in-box-surgery-for-obstructive-sleep-apnea-genioglossus-advancement-hyoid-suspension-and-maxillomandibular-advancement
#9
Yau Hong Goh, Winston Tan, Victor James Abdullah, Sung Wan Kim
Box surgery for obstructive sleep apnea (OSA) patients consists of mandibular surgery, including genioglossus advancement, hyoid suspension, and maxillomandibular advancement, as an airway reconstruction. This surgery was developed in the early 1980s. Thereafter, techniques were modified in each surgery for the enhancement of outcome and prevention of complications. However, the indication for surgery remains poorly defined due to the dynamicity of the upper airway, variability of the phenotype in OSA patients, and absence of a representative method for the obstruction site in the upper airway...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738362/advances-in-the-diagnosis-of-obstructive-sleep-apnea-drug-induced-sleep-endoscopy
#10
Madeline J L Ravesloot, Linda Benoist, Peter van Maanen, Eric J Kezirian, Nico de Vries
Drug-induced sleep endoscopy was introduced in 1991 and has recently evolved into a pivotal instrument for patients in whom obstructive sleep apnea surgery is considered. Here, we discuss the indications, contraindications, technique, anesthesia, scoring systems, validity, and insights of the literature.
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738358/innovative-surgery-for-obstructive-sleep-apnea-nerve-stimulator
#11
J Ulrich Sommer, Karl Hörmann
Obstructive sleep apnea (OSA) as a multifactorial disease is treated with continuous positive airway pressure (CPAP) as the gold standard. Yet, if patients suffer from CPAP incompliance, traditional OSA surgery only targets morphological changes of the upper airway while neglecting functional issues. With the advent of upper airway stimulation, and in particular hypoglossal nerve stimulation as a treatment option, a highly effective, clinically proven and functional therapy with good evidence is available. This article gives a comprehensive overview of current and upcoming hypoglossal nerve stimulation systems (Inspire, ImThera, and Nyxoah), the specific advantages of this approach, the selection criteria and screening process, relevant clinical data, and a description of the different implantation procedures...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738352/future-perspectives-in-sleep-surgery
#12
Michael Friedman, Anna M Salapatas, Lauren B Bonzelaar
Over the past few decades there has been a significant increase in research focusing on the pathophysiology, diagnosis, and treatment of sleep apnea. However, there is still a long way to go in creating standard evidence-based medical practice for the diagnosis, evaluation, and treatment of sleep apnea patients. Current and future directions of sleep surgery and other treatments are discussed here.
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738342/a-succinct-history-of-sleep-medicine
#13
Leh-Kiong Anne Huon, Christian Guilleminault
Although sleep and sleep disorders have been studied for centuries, it was the development of sophisticated tools to monitor eye movements, brain waves, and muscle tone in the mid-20th century that led to modern sleep research. These tools allowed neuroscientists to distinguish between different "states" or "phases" of sleep, and to relate these findings to sleep disorders. This review chronicles the groundbreaking work of the pioneers in this field, and the impact their findings have had on patients today.
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738340/novel-positional-devices-for-the-treatment-of-positional-obstructive-sleep-apnea-and-how-this-relates-to-sleep-surgery
#14
Madeline J L Revesloot, Linda Benoist, Peter van Maanen, Nico de Vries
If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with severe OSA can reverse to less severe positional OSA or, in other words, the AHI drops more in the lateral position than in supine position...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738337/the-history-of-sleep-surgery
#15
Kathleen Yaremchuk, Laura Garcia-Rodriguez
Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of 81%...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738333/updated-hypopharyngeal-surgery-for-sleep-apnea
#16
B Tucker Woodson
The failure of traditional upper airway surgery such as uvulopalatopharyngoplasty has been attributed to lower airway obstruction related to base of tongue collapse. Multiple procedures, including glossectomy, tongue base radiofrequency, genioglossus advancement, and tongue suspension techniques, have been advocated to improve success rates. No consensus exists on which subsets of patients are best treated by individual approaches and direct comparative data are lacking. The selection of procedures must be based on individual patient needs and the relative potential benefits and risks...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738331/future-perspectives-in-sleep-medicine
#17
Leh-Kiong Anne Huon, Christian Guilleminault
"Sleep Medicine" is now a specialty in its own right. Currently, there is increasing recognition of the very negative impact sleep disorders have on learning, education, safety, and quality of life. Technological advances will help us to break down diagnoses (e.g., narcolepsy has now been subdivided into types 1 and 2, depending upon the hypocretin levels in the spinal fluid) and to discover relationships to other bodily systems (e.g., type 1 narcolepsy potentially being an autoimmune disorder). The modern lifestyle of many, as characterized by a shortening of sleep periods, shift work, jet lag, and the need to be constantly available, means that advances in sleep medicine may result in a major understanding of more balanced "work-rest lifestyle" modifications...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738327/updated-concepts-on-treatment-outcomes-for-obstructive-sleep-apnea
#18
Victor Certal, Robson Capasso
Obstructive sleep apnea is a highly prevalent and poorly understood condition that not only leads to significant individual patient health damage, but carries a large societal cost secondary to excessive healthcare utilization, motor-vehicle accidents, and work absenteeism. While a significant fund of knowledge about its damaging effects on the cardiovascular system and neural pathways has been gathered over the past few decades, the translation to direct patient care still presents numerous challenges. With the exception of clear issues such as socially unacceptable snoring and breathing irregularities, the exact cause and effect relationship between airway narrowing, hypoxemia, and sleep fragmentation with subjective sleep-related complaints and neurocognitive symptoms is less clear...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28738322/pediatric-obstructive-sleep-apnea-where-do-we-stand
#19
Yu-Shu Huang, Christian Guilleminault
Pediatric obstructive sleep apnea (OSA) was initially described in 1976. In 1981, Dr. Guilleminault emphasized that pediatric OSA was different from the clinical presentation reported in adults. It was characterized by more disturbed nocturnal sleep than excessive daytime sleepiness, and presented more behavioral problems, particularly school problems, hyperactivity, nocturnal enuresis, sleep terrors, depression, insomnia, and psychiatric problems. The underlying causes of pediatric OSA are complex. Such factors as adenotonsillar hypertrophy, obesity, anatomical and neuromuscular factors, and hypotonic neuromuscular disease are also involved...
2017: Advances in Oto-rhino-laryngology
https://www.readbyqxmd.com/read/27466858/outcomes-in-medical-and-surgical-treatment-of-nasal-polyps
#20
REVIEW
Aria Jafari, Adam S DeConde
Chronic rhinosinusitis with nasal polyps is a heterogeneous disease with a variety of medical and surgical options available to the patient and provider. Consensus statements and recent trends in outcomes research advocate that treatment be driven by patient-reported outcome measures. To this end, there has been increasing sophistication and nuance in both the outcome instruments themselves, as well as the method in which they are collected and interpreted. This is reflected in concepts such as the minimally clinically important difference and domain stratification, which have helped clinicians understand patient motivations and response to treatment...
2016: Advances in Oto-rhino-laryngology
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