Sleep on lateral position as a treatment of obstructive sleep apnea syndrome

Sleep on lateral position was supposed to be the most conservative method for treatment of patients with obstructive sleep apnea syndrome [OSAS]. This study was performed to objectively evaluate the effect of sleep position on one hundred-eight cases suffering from OSAS with mean age 46.7+12.4 years and mean body mass index [BMI] 26.6+3.7 Kg/m[2]. Polysomnographic recording was done for each patient after insertion of a soft silicon catheter with 4 barosensors. The terminal sensor was adjusted at the lower half of the esophagus to be confirmed by roentogenography. The study was conducted during the afternoon period; one hour on supine position and one hour on lateral position. Analysis of the pressure recording indicated that the negative intrae-sophageal pressure decreased from 54. 7+24.2 cm H[2]O on supine position to 33.9+25.7 cm H[2]O on lateral position [38%, P<0.001, n= 108]. Sixty-three patients [58.3%] indicated a remarkable response during sleep on lateral position [Le. 75-100% decrease of either intraesophgeal pressure or apnea/ hypopnea index]. We concluded that prescription of lateral position as a treatment of OSAS can be useful for some patients without surgery and can be adjuvant for others after performing sleep apnea surgery. This should be based on upper airway pressure recording to exclude patients who indicate no improvement and those who become worse

Dysphagia after total laryngectomy: motility report.

Detailed motility studies of the pharynx and esophagus with its two sphincters were performed in 31 patients having cancer larynx to find the correlation between postoperative motility changes and occurrence of dysphagia. After the operations, there was only one patient complained of dysphagia although all patients showed a well-defined decrease in the intraluminal pressures in the pharynx and upper esophageal sphincter. The upper and middle thirds of the esophageal body showed normal contractions in eight patients and weaker contractions in 23 of the cases postoperatively. All cases showed weaker contractions in the lower esophageal body. All the postoperative recordings resulted in an incomplete relaxation of the upper esophageal segment [UES] and incoordination. Although total laryngectomy completely interrupted the continuity of the proximal digestive tube and may caused derangement in the esophageal motility, dysphagia was not a striking postoperative symptom in those patients

Evaluation of laryngopharyngeal manifestations of gastroesophageal reflux disease

Thirty-one patients with recurrent severe reflux symptoms were studied for esophageal motility, endoscopy, radiology as well as 24-hour pH esophageal monitoring. All patients were subjected to full history taking and fiberoptic laryngopharyngoscopy. 23 patients had persistent laryngopharyngeal symptoms mainly dysphonia. Erythema was a constant sign in all complaining patients and there were 8 cases with contact granuloma and 6 cases had cordal nodules. The occurrence of laryngopharyngeal manifestations [LPHM] in GERD patients was not related neither to the severity of endoscopic esophagitis nor to the lower esophageal sphincter pressure [LESP] and esophageal body peristaltic abnormalities. On the other hand, the LPHM were more related to hiatal hernia [88.9%] and abnormally relaxed upper esophageal sphincter. The 24-hour pH esophageal monitoring was a valuable tool in detecting pathologic acid reflux in 76.9% of the patients and its results were proportionate to the severity of LPHM

Videoscopic study of adenoids and adenoidectomy

Videoscopic study was applied in this work for 2 main purposes. Firstly, to diagnose the size of adenoids depending on fixed landmark, that is the posterior lip of the torus tubarius. This was done on 230 patients above 3 years old and resulted in classification of adenoids size into 3 degrees. First degree "normal" has its anterior limit behind the posterior lip of the torus. Second degree has its anterior limit in line with the posterior lip of the torus. Third degree has its anterior limit in front of the posterior lip of the torus [high indication of adenoidectomy]. Secondly, to perform adenoidectomy under magnified vision on monitor and this was applied on 86 patients. By this maneuver, trauma to Eustachian tube orifice and posterior nasopharyngeal wall was avoided, any remnants and control bleeding points could be removed. During the period of follow up of 1-3 years, no case developed complications of recurrence, postoperative bleeding and middle ear troubles