Radiofrequency uvulopalatoplasty for primary snoring

Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP[uvulopalatopharyngo plasty], and laserassisted uvulopalatoplasty [LAUP]. Among the surgical methods, RAUP [radiofrequency assisted uvulopalatoplasty] is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score [soft palate position] one or two, an elongated uvula, grade one and two of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale [VAS] of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant [P=0.223]. When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant [From 1.8 to 1.9, P=0.78]. Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients [5.7%], nasal speech in 2 [5.7%] and exacerbation of snoring in 2 [5.7%] patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up.

Effect of adenotonsillectomy on adhd symptoms of children with adenotonsillar hypertrophy

Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder [ADHD]. The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental [before and after] study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes [predominantly inattentive type, predominantly hyperactiveimpulsive type and combined type]. Seventeen boys [49%] and eighteen girls [51%] with mean [ +/- SD] age of 7.4 +/- 3.8 years [range: 1-10 years] were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy [54.3% versus 22.9%, P=0.003]. ADHD inattention score [2.26 +/- 1.93 versus 0.96 +/- 0.45, P=0.005], hyperactivity score [4.23 +/- 3.57 versus 3.57 +/- 8, P=0.03] as well as ADHD combined score [9.66 +/- 2.58 versus 7.2 +/- 3.67, P=0.0001] improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.