bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Palatal and Tongue Base Hyperaemia and Its Relationship to Snoring and Obstructive Sleep Apnea Using Narrow‐Band Imaging
Authors: Prasad Vyas , Kotecha Bhikhlal , Stimpson Paul , Heywood Rebecca , Chisholm Edward J. 
Published: September 2011

ObjectiveEvaluate digital still images and video recordings utilising narrow‐band imaging (NBI) in order to assess whether this modality of fiberoptic investigation can be used to predict a relationship between increased superficial vasculature of the upper airway in patients with snoring and obstructive sleep apnea.MethodProspective study with patients allocated in to 3 groups. Twenty‐five subjects (30‐77 years) had still photographs taken in normal and narrow‐band light settings of their oropharynx‐palatal and tongue base views. All images were compared to normal controls.ResultsDistinct patterns of hyperemia were seen in the regions of posterior pharyngeal wall, tongue base and epiglottis in some patients. It was also noted that the oral surface of the soft palate and tonsillar region vascular pattern was different in the three groups.ConclusionNBI has recently been used to diagnose neoplasia in‐vivo in the upper aerodigestive tract, colon, esophagus and lung. Our study explored an additional role to see if NBI with magnifying endoscopy (NBI‐ME) could also help predict likelihood of snoring and severity of OSA as well as response to treatment.
Hypoglossal Nerve Stimulator
Authors: Woodson B. Tucker , Netzer Aviram , Lin Hosheng , Maurer Joachim T , Hohenhorst Winfried , Van de Heyning Paul 
Published: September 2011

ObjectiveOSA is a common cause of sleep morbidity. A novel treatment for obstruction at the level of the tongue is a unilateral hypoglossal nerve implant system (Inspire, Inspire Medical, Minneapolis, Minnesota). Study objectives were to assess sleep outcomes in a multicenter academic setting feasibility trial.MethodNerve stimulation effect on AHI and self reported sleep outcomes were assessed at two and six months (Epworth Sleepiness Score (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ).ResultsThirty‐one subjects underwent placement of a unilateral hypoglossal nerve implant (two explanted). Fifty‐five percent of subjects at 6 months were AHI responders (AHI < 20/hr. and 50% reduction). In the entire group, ESS improved (baseline=10.7(4.9) 2 months= 8.2(4.0), 6 months= 7.7(4.2), P <. 005). At baseline, 2 months and 6 months: ESS improved in both responders (10.4 to 8.0 to 6.6) and non‐responders (11.8 to 9.4 to 8.9), and FOSQ improved and normalized in responders (15.6 to 17.1 to 18.0, P <. 05) but not non‐responders (13.6 to 14.2 to 15.2, P = NS).ConclusionSleep outcomes improved using a hypoglossal nerve implant. Consistent with other interventions, ESS improvements were unrelated to change in AHI. FOSQ improvements were observed in responders but not non‐responders. Data support a clinical device effect but highlight the need for controlled studies to evaluate sleep outcomes in surgical trials.
Impact of Obstructive Sleep Apnea Syndrome in P300 Latency
Authors: De Oliveira Barros Thiago , Mendez Raquel , Caiaffa Rosana , Tomita Shiro , Melo Tavares Lima Marco Antonio 
Published: September 2011

ObjectiveEvaluate the impact and linear correlation between Obstructive Sleep Apnea Syndrome (OSAS) and P300 latency. It also aimed to identify which variables of polysomnography and scales of excessive daytime sleepiness best correlate with the increase in P300 latency.MethodThis is a survey study, conducted between March 2010 and January 2011, in which polysomnography, scales of sleepiness and P300 latency from 54 patients were analyzed. These results were evaluated in patients with different stages of OSAS, using as independent variables: sleep stages, arousals, apnea/hyponea index(AHI), oxyhemoglobin desaturation and limb movements (PLM).ResultsAll patients were male, mean age 41.3 ± 2.1 years, body mass index of 29.3 ± 1.2 kg/m2 and hearing threshold in17.1 ± 1.3 dB. According to the AHI, the patients were divided into normal (n = 15), mild (n = 14), moderate (n = 9), and severely increased (n = 16). It was found the following correlations with P300 latency: Epworth scale (r = 0.33; P =. 2), Karolinska scale (r=‐0.14; P =. 55), Stanford scale (r=0.01; P =. 29), sleep efficiency (r = 0.11; P =. 83), percentage of N3(r = ‐0.48; P =. 24) and REM (r = ‐0.18; P =. 13), arousals index (r=0.74; P <. 05), AHI (r = 0.99; P <. 01), oxyhemoglobin desaturation index (r = 0.99; P <. 01), PLM (r=0.44; P <. 01), mean oxyhemoglobin saturation (r = ‐0.84; P <. 01) and minimum oxyhemoglobin desaturation (r = ‐0.85; P <. 01).ConclusionThe apnea/hypopnea index, arousals, oxyhemoglobin desaturation index and periodic limb movements were positively correlated with P300 latency (P <. 05). The average and minimum oxyhemoglobin saturation exhibited negative correlation with P300 latency (P <. 01). No statistically significant correlation was seen between P300 latency and sleepiness scales, as well as REM and N3 sleep stage percentage.
Multilevel Coblation Therapy of OSA in Long Face Syndrome
Authors: Merugumala Srinivasa 
Published: September 2011

ObjectiveEvaluate the efficacy and safety of multilevel coblation surgery in patients with sleep‐disordered breathing (S‐D B/OSA) and in Long Face Syndrome and to understand these rare presentations for effective management.MethodEvaluate 5 Long Face Syndrome and 182 consecutive S‐BD patients, who had 423 coblation surgical procedures from October 2006 to September 2010. Multilevel S‐BD surgery was performed at nasal level (turbinate reduction, functional endoscopic sinus surgery, septorhinoplasty), palate level (somnoplasty, pharyngoplasty, coblation UPPP), and tongue base reduction.ResultsA total of 187 patients had adequate follow‐up, A total of 124 men and 63 women, with mean age of 47 years and mean BMI 30.2. ESS Score has improved from 16 ± 2 to 4 ± 2. The AHI improved in the patient with Long Face Syndrome from 69.3 to 11.8 and the patient is nondependent on CPAP. The overall complication rate 3.64%, none of the patients had any airway compromise requiring ICU care. The major complications include (a) two patients had palatal ulceration, (b) one negative pressure pulmonary edema (c) one patient had secondary hemorrhage (aspirin). Patients that had tongue procedure required overnight stay.ConclusionThis study illustrates that multilevel coblation surgery provides a minimally invasive technique with less morbidity and has good outcome for moderate to severe OSA. Long Face Syndrome is very rare in which primary surgery may be considered.
Objective vs Subjective Measurements of Palatine Tonsil Size in Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael , Wang Pa‐Chun 
Published: September 2011

ObjectiveStudy the difference between subjective and objective palatine tonsil size measurements in patients with obstructive sleep apnea (OSA) syndrome.MethodBilateral tonsillectomy was enrolled as a part of the OSA surgery. Subjective tonsil size was valuated using the 0‐4 scale. Tonsil size was also objectively measured. The relationship of the subjective and objective tonsil measurements and polysomnography (PSG) was assessed.ResultsFifty‐one OSA patients (46 men, 5 women; mean age 42.1 years; mean apnea/hypopnea index, AHI 47.5/h; mean BMI 26.9) were reviewed. Objective tonsil height, width, thickness, weight and volume were strongly correlated with subjective tonsil size by Spearman correlation. Evaluation of possible outliers with Pearson correlation indicated objective tonsil measurements were the better predictor of preoperative AHI and snoring index than subjective tonsil size.ConclusionBoth objective and subjective tonsil measurements were not correlated with age, BMI, or other anatomic parameters of the upper airway. Subjective tonsil size measurements correlate with objective tonsil measurements; however, only objective tonsil measurements may help the prediction of objective PSG‐measured OSA severity.
Orexin Genes Polymorphisms and Obstructive Sleep Apnea Syndrome
Authors: Ahmed Wael A. , Fujisawa Toshiyuki , Nishimura Yoichi 
Published: September 2011

Objective1) Study the association between orexin and orexin receptor genes mutations and obstructive sleep apnea syndrome. 2) Examine the effects of the identified significant mutations on the gene transcription.MethodProspective genetic association study. It was conducted between April 2008 and March 2010. Seventy obstructive sleep apnea patients and seventy control subjects were enrolled. Tertiary university hospital. PCR amplification followed by sequencing for Orexin Gene and TaqMan SNP Genotyping Assay for Orexin Receptor Genes was done for all participants.ResultsA novel single nucleotide deletion (IVS1+188delG) was found in one patient. An intronic mutation (rs9902709) was identified in the Orexin gene with significant difference between patients and controls when using dominant model (P =. 04). A new mutation in the intron of Orexin gene was identified with significant difference between patients and controls as regards (P =. 02). By examining Splicing Site Programs, this mutation showed change of the splice donor site in some of them or change of the score in others. No significant changes between patients and controls as regard Orexin receptor genes abnormalities were detected.ConclusionThe plasma levels of Orexins have been previously evaluated in obstructive sleep apnea patients with contrary findings. This study identified two intronic mutations in the orexin gene with significant difference between patients and controls. These results suggest that orexin gene mutations may be involved in pathogenesis of obstructive sleep apnea.
Outcomes of Combined Pharyngoplasty and Midline Glossectomy
Authors: Vivero Richard J. , Ruiz Jose W. , Cofnas Paul 
Published: September 2011

Objective1) Discuss the theory of multilevel sleep surgery for obstructive sleep apnea (OSA) management. 2) Evaluate the outcomes of lateral pharyngoplasty and midline glossectomy.MethodRetrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care center with multilevel surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included change in preoperative and postoperative AHI, RDI, and oxygen nadir. Statistical analysis performed using Wilcoxon rank test.ResultsThirty‐three patients were identified that met inclusion criteria. The mean preoperative BMI was 30.4, and postoperative BMI was 29.1 (P =. 04). The mean decrease in AHI was 12.5 from 32.7 to 20.2 (P =. 027). The mean decrease in RDI was 16.4 from 37.2 to 20.7 (P =. 17). The mean improvement in oxygen nadir was 13% from 63.5 to 76.8 (P =. 09).ConclusionMultilevel sleep surgery results in a statistically significant improvement in polysomnographic metrics, such as AHI and RDI, for obstructive sleep apnea.
Pulling on Hyoid Reduces Airway Collapse in Human Cadavers
Authors: Rosenbluth Kathryn H. , Kwait Dillon , Harrison Michael , Kezirian Eric J. 
Published: September 2011

ObjectiveThis study examined the changes in upper airway dimensions and collapsibility associated with force applied to the hyoid bone using a suture and a novel magnetic system (internal magnet secured to the hyoid and external magnet) in un‐fixed human cadavers.MethodEight cadavers were tested with traction on the hyoid using 1) suture around the hyoid to apply 0.5‐5 Newtons of force and 2) a novel magnetic system. Changes in airway dimensions were measured with fluoroscopy and 3‐dimensional computed tomography reconstructions. Airway collapsibility was measured using a previously‐described flow‐based model.ResultsA 2N (0.5 lb) force applied to the hyoid bone increased airway dimensions, with greatest effect in the retrolingual region. The anterior direction of traction was more effective than inferior or superior. There was a linear association between the magnitude of force and critical airflow, at 1.5L/min/N (R2 = 0.75). All magnitudes of pull increased the critical airflow (P <. 001). At 2N, the hyoid was advanced 1cm, and the critical airflow was increased 3‐fold (3.0 ± 1.71L/min). The magnet system showed similar airway effects to the direct 2N applied force. An increase in upper airway dimensions occurred with inter‐magnet distances of 2cm.ConclusionForces applied to the hyoid improve upper airway dimensions and collapsibility in the human un‐fixed cadaver model. A novel magnet system may represent a promising therapy for treatment of upper airway obstruction in disorders such as obstructive sleep apnea.
Sleep Medicine Clinical and Surgical Training during Otolaryngology Residency: A National Survey of Otolaryngology Residency Programs
Authors: Shen Tianjie , Shimahara Erika , Capasso Robson 
Published: September 2011

ObjectiveThe vast majority of otolaryngologists are involved in the medical and surgical care of patients with obstructive sleep apnea. ABOTO residency curriculum has quite extensive sleep medicine requirements. We sought to assess resident training experiences in adult sleep medicine and sleep surgery during their residency in the United States.MethodThis Internet survey study was emailed to the program directors from 103 US Accreditation Council for Graduate Medical Education (ACGME)‐approved otolaryngology residency programs in 2010.ResultsA total of 47 (46%) program directors responded. Only 24% of programs had faculty members who spent more than 50% of their clinical time on adult sleep medicine/surgery. The majority of programs (65%) had total training time less than 0.6 month during the residency training. While most residents were well prepared in commonly performed procedures for OSA, the training on hypopharyngeal surgeries such as hyoid suspension (51%), tongue suspension (40%), and geniotubercle advancement (26%) were less adequate. Only 29% of programs taught their residents both the interpretation of the study report and the original sleep study data.ConclusionThis survey suggests that current residency training in adult sleep medicine and sleep surgery is suboptimal to keep residents up to date with the evolution in this field in the majority of otolaryngology programs. The teaching on the evaluation and various therapeutic approaches should be improved during residency training.
The Effect of CPAP on Middle Ear Pressure
Authors: Lin Fred Y. , Popelka Gerald , Gurgel Richard , Capasso Robson 
Published: September 2011

ObjectiveWhile continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study is to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.MethodThis is a prospective cohort study conducted in January, 2011. 10 volunteers with no known history of Eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 5, 10, and 15 cm H20.ResultsPrior to a swallowing maneuver to open the Eustachian tube, average middle ear pressures were 21.67 daPA, 22.63 daPA, 20.42, daPA, and 21.58 daPA with CPAP pressures of 0, 5, 10, and 15cm of H20, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15cm of H20, respectively. The post‐swallow Pearson Correlation Coefficient correlating CPAP and middle ear pressures was 0.783 (P <. 001).ConclusionMiddle ear air pressure is directly proportional to CPAP air pressure in subjects with normal Eustachian tube function. While further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependant. These findings may also influence the perioperative practice of otologic and skull base surgeons.
Detection of Helicobacter Pylori in Oropharyngeal Diseases
Authors: Lukes Petr , Potuznikova Bela , Pavlik Emil , Nartova Eva , Astl Jaromir , Plzak Jan , Betka Jan 
Published: September 2011

ObjectiveHelicobacter pylori (HP) is a well‐known gastric pathogen. Recently it was also found in the oropharyngeal tissue. The direct impact of HP on oropharyngeal pathogenesis was not satisfactorily proven. HP strains differ according to the virulence factor genes carried. The presented study focused on detection and genotyping of oropharyngeal HP.MethodA total of 104 patients were enrolled. The blood and tissue specimens from patients with tonsillar cancer (n = 41), chronic tonsillitis (n = 38), and obstructive sleep apnea syndrome (OSAS) (n = 25) were collected. Anti‐HP antibody levels were detected. Detection of HP strains and genotyping for establishment of cagA and vacA genes status was performed by real‐time PCR.ResultsSerum antibodies were positive in 32 (78.05%) cancer patients, 13 (34.21%) chronic tonsillitis patients, and 18 (72%) OSAS patients. Statistically significant differences were found between tumor and tonsillitis groups and between OSAS and tonsillitis groups (Chi‐square, P =. 0001, P =. 0049). 56 specimens (23 carcinoma, 20 chronic tonsillitis, and 13 OSAS) were investigated using real‐time PCR. Tissue specimens were positive in 17 (73.91%) tumors, 14 (70.0%) tonsillitis, and 9 (69.23%) OSAS. No statistically significant differences were found among all groups. PCR genotyping of oropharyngeal HP strains showed the majority of s1b (56.7%) and m2 (59.5%) alleles of vacA and low presence of cagA gene (13.5%).ConclusionOropharyngeal HP was found in a high number of cases. Its distribution among different pathologies does not support the hypothesis of its direct carcinogenic potential. Presence of less virulent strains confirms this finding. The possibility of influencing local immune response leading to chronic inflammation or idiopathic hypertrophy of tonsillar tissue was not excluded.
Effect of Chin Position on Swallowing Assessed by Manometry
Authors: Hara Minoru , Takahashi Haruo , Takasaki Kenji 
Published: September 2011

ObjectiveEvaluate the effects of chin position during swallowing in the neutral, chin‐up, and chin‐tucked positions using a novel high‐resolution manometry (HRM) system.MethodTwenty asymptomatic volunteers were studied by HRM. We measured the maximum swallowing pressures at the velopharynx, mesohypopharynx, and upper esophageal sphincter (UES), the mean values of resting UES pressure, its length, the minimum swallowing pressure at UES, and the relaxation interval (RI) of UES, in each position.ResultsIn the chin‐up position, in comparison with the neutral position, the maximum UES pressure (311.1 mmHg vs 214.7 mmHg; P <. 01), the mean value of the resting UES pressure (67.0 mmHg vs 29.5 mmHg; P <. 01), the length of the UES (44.2 cm vs 32.7 cm; P <. 01), and the minimum UES pressure during the RI (−0.5 mmHg vs −6.9 mmHg; P <. 01) increased and the RI (0.29 sec vs 0.63 sec; P <. 01) decreased significantly. In the chin‐tucked position, significant change was seen only in the minimum UES pressure during the RI (−4.5 mmHg vs −6.9 mmHg; P <. 05).ConclusionThe chin‐tucked position showed no change except for the increase in UES pressure during RI, and seemed to have no appreciable benefit in the facilitation of swallowing. In contrast, the chin‐up position brought a marked disadvantageous effect against smooth swallowing by increasing the pressure in the region of the UES.
Analysis and Optimization of the Rhombic Flap Wound Closure
Authors: Topp Shelby Gates , Gaball Curtis , Lovald Scott , Khraishi Tariq 
Published: September 2011

Objective1) Develop a hyperelastic computational model of skin viscoelastic properties for analysis of wound closures, and 2) Apply the model to variations of the rhombic skin flap to quantify closure force vectors and optimize wound closure tension.MethodA computational model employing the finite element method was created to simulate skin defect closure employing rhombic transposition flaps. Variables of transposition angle, flap width, and tissue undermining were analyzed. Outcome measures of tissue stress, strain, and wound distortion were evaluated and optimized for a standard defect.ResultsA second order Yeoh hyperelastic model was fit to previously published experimental skin data with good approximation of observed properties. In the analysis of transposition flap closures of the 60 to 120 degree rhomboid defect, the model suggests that a biomechanically ideal flap design is constructed with distal flap angle of 30 degrees, as is employed in the Webster flap, with the donor site near margin oriented parallel to the short axis of the defect, as in the traditional Limberg flap. This configuration minimizes tissue stress and strain and most evenly distributes wound tension across the closure line.ConclusionThe model quantitatively demonstrates several recognized principles of the rhombic flap. Square defects, as compared with rhomboid defects, close with lower tissue strain, but form a larger standing cutaneous deformity. The Webster flap best distributes wound tension across the incision line, and the Dufourmental modification alters the closure force vector.
Does the Duration of Ofloxacin Otic Drops Matter in Immediate Post‐tube Otorrhea?
Authors: Asnaashari Amir M. H. , Darban Atefeh Amiri , Babaeian Mahasti , Taiarani Mohammad , Rezaei Saman , Fatemi Seideh Sedigheh , Shakeri Mohammad Taghi 
Published: September 2011

ObjectiveThe effect of upper respiratory tract diseases on phonation has been reviewed, but the effect of lower respiratory tract diseases on phonation has been little studied. The influence of asthma as a reversible obstructive small airway disease on phonatory variables is not clear yet.MethodThis cross sectional, case control trial was performed from March to September 2008 to evaluate the quality of phonation in asthma. Eight vocal parameters were evaluated in 34 asthmatic patients and a control group by a voice meter device using Dr Speech statistical software.ResultsVocal variables such as FO, Jitter, and Shimmer were almost similar in both groups statistically. This fact likely reflects the normal phonatory mechanism at the level of vocal cords in asthmatic patients, but harshness, hoarseness, NNE, S/Z ratio (P <. 01) and breathy voice (P =. 015) were different statistically. This indicates the role of the lower airway in the phonation process.ConclusionSmall airway diseases such as asthma may have direct effect on phonation, but we suggest further studies with more cases.