Obstructive sleep apnea and hypothyroidism

Excessive daytime somnolence, apathy and lethargy are known to occur in persons with hypothyroidism, the same symptoms have been recognized in some persons who have obstructive sleep apnea. The occurrence of these symptoms in both conditions raises the question to define the exact incidence, relation in-between and to settle down a rational for management. In the department of otolaryngology of Kasr El-Aini Beni Suif University and new dar al sheaf [Kuwait] hospitals, 2 groups of patients; 1[st] group with hypothyroidism and a 2[nd] group with obstructive sleep apnea were included in this study, from September 2004 to March 2006. The records of these patients were reviewed. In the 1[st] group, eight patients, from total number of eleven, had episodes of apnea, with the number of episodes per hour of sleep, apnea index, ranging from 18 to 169 [mean 69.7]. Six of the eight patients were obese and had 92.6 episodes per hour compared with 17.3 episodes per hour in the 2 non obese patients [p<0.001]. After 4-12 months of thyroxine replacement therapy, the mean apnea index decreased from 69.7 to 12.5 episodes per hour, without reduction in body weight [p<0.001]. In the 2[nd] group [36 patients], the incidence of hypothyroidism among the patients suggestive to have obstructive sleep apnea [OSA] was 5.6% [2 patients]. In patients diagnosed as hypothyroidism, OSA was controlled to a significant degree with thyroxine replacement therapy, even without changes in body weight. The incidence of hypothyroidism among the patients suggestive to have OSA is low and so measurement of thyroid hormones is not a routine step in this type of patients

Major airway obstruction as a cause of chest wheezes

Asthma is a disorder characterized by narrowing of airways which is reversible with time either spontaneously or as a result of treatment. Asthma presents mainly with dyspnea wheezes and or cough which are mainly nocturnal. Many diseases can either mimic or worsen asthma. Patients are often subjected to full anti-asthma therapy without improvement. The aim of our study was to investigate the possible causes of chest wheezes rather than bronchospasm. Our study included 50 patients [25 in pediatric age group and 25 in adult age group]. They were all having longstanding wheezy chest with failure to respond to the usual anti-asthma medications. All the patients were subjected to thorough history taking with special emphasis on foreign body inhalation especially in the children's group; complete general as well as local examination; chest radiology; routine laboratory investigations and fiberoptic bronchoscopy. Our results showed that the commonest cause among all patients was laryngotracheomalacia present in 13 patients. The second most common cause was inhaled neglected foreign body in 9 cases, 8 children and one adult with history of foreign body inhalation at age of 10. The third common cause was malignant neoplasm in 6 adult cases. In conclusion when a patient presents with persistent or recurrent wheezing and the typical features of asthma are lacking, other causes for noisy breathing should be considered and one must be very careful in order not to miss another etiology. In childhood laryngotracheomalacia and foreign body inhalation are the commonest while in adults we should think in malignant obstruction. Fiberoptic bronchoscopy and laryngoscopy are essential tools for investigating these patients

Single stage partial cricotracheal resection [CTR] with thyrotracheal anastomosis for the management of severe post intubation tracheal and subglottic stenosis: a short term report

Subglottic stenosis [SGS] and tracheal stenosis can be caused by a wide variety of disease processes, but mechanical trauma from endotracheal tubes remains the most common cause. The management of laryngotracheal stenosis continues to challenge the head and neck surgeon. In this work we review our experience in managing 14 adult patients with severe [Cotton's grade III and IV] SGS and upper tracheal stenosis using partial cricotracheal resection with end to end thyrotracheal anastomosis,and we proved that this treatment modality is an effective, safe, and single stage treatment modality that can be applied safely to cases of severe subglottic and upper tracheal stenosis.

Evaluation of diode laser and radiofrequency [coblation] tonsillectomy in comparison to conventional dissection technique

This study included 45 patients with chronic tonsillitis. They were selected and randomly divided into three groups [each including 15 patients]: Group I was subjected to diode laser tonsillectomy, group II was subjected to coblation tonsillectomy and group III were subjected to conventional dissection technique. All patients had to answer a questionnaire recording their pain score [from 0 to 5]. Each technique was assessed concerning the operative time, intraoperative bleeding, postoperative pain score and postoperative complications. The data were collected and subjected to a statistical analysis. The mean operative time was 25, 23 and 15.3 minutes in groups I, II and III, respectively. The mean intraoperative blood loss was 12.8 ml in group I, 14.5 ml in group II and 80.4 in group III. The mean pain scores were less in groups I and II than group III. The maximum pain was felt at the 7th postoperative day in groups I and II comparing with group III who had their peak at the 4th postoperative day. There were no cases of reactionary or secondary hemorrhage