Analysis of Correlation between Results of Polysomnography and Obstructive Structure by Drug-Induced Sleep Endoscopy in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Polysomnography (PSG) is useful for the diagnosis of obstructive sleep apnea (OSA) and the analysis of its occurrence and severity. Nevertheless, physical examination and PSG are not sufficient to localize the obstructed structure before operation. Drug-induced sleep endoscopy (DISE), on the other hand, is expected to provide an accurate diagnosis as it can be used to evaluate the intensity of operative effect and can minimize additional unnecessary procedures. The aim of this study is to analyze correlation between the results of polysomnography and obstructive structure by DISE in OSA Patients. SUBJECTS AND METHOD: This study was conducted on 75 patients, who were diagnosed with OSA by PSG and DISE. Obstruction levels and individual structures were classified by modified VOTE classification. The patients were divided into groups according to the results of PSG and BSI; the correlation between DSI results and each of these groups were analyzed. RESULTS: There were no statistically significant differences in obstruction levels between PSG data and DISE finding. Obese patients, positional-dependent OSA and sleep stage non-dependent OSA (NREM OSA) groups showed more obstruction on the lateral pharyngeal wall. Severe OSA groups showed more obstruction on tonsils. Obese patient groups revealed more obstruction on tongue base, but did not contribute to statistically significant results. CONCLUSION: In our study, obese patients, severe OSA, positional-dependent OSA and NREM OSA groups tended to exert greater influence on the obstruction of lateral pharyngeal wall. Surgeons should be aware of these findings when performing sleep surgery.

Long-Term Follow-Up of Immunotherapy in Allergic Rhinitis to House Dust Mite / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to evaluate the long-term effect of immunotherapy on the allergic rhinitis patients to house dust mite (HDM) patients. SUBJECTS AND METHOD: Sixty-five patients were treated for allergic rhinitis in the allergy clinic. Every patient underwent immunotherapy for 3 to 5 years and did not receive any additional treatments after the completion of the initial one. The survey on the symptom improvement and the patients' satisfaction was carried out 3 and 10 years after the immunotherapy treatment. The results of skin prick test for each individual were analyzed before, 3 and 10 years after the immunotherapy, respectively. RESULTS: Overall symptom improvement surveyed 10 years after the immunotherapy decreased compared with that taken after 3 years of the treatment (p<0.05). In particular, symptom improvements on sneezing, itching sensation, and rhinorrhea was significantly decreased after 10 years (p<0.05). Patients' satisfaction level was 64.6% after 3 years and 49.2% after 10 years of the immunotherapy treatment. Skin prick test reactivity was significantly decreased after 3 years of the treatment compared to before the treatment. Although skin prick test reactivity measured in 10 years after immunotherapy increased compared with that measured in 3 years after, there was little statistical significance when compared with the reactivity before the treatment. CONCLUSION: The immunotherapy has long term efficacy on allergic rhinitis to HDM. However, the efficacy decreased after the discontinuance of the immunotherapy treatment.

The Outcome of Uvulopalatal Flap in Obstructive Sleep Apnea Syndrome Patients

BACKGROUND AND OBJECTIVES: Uvulopalatal flap (UPF), which is a modification of UPPP, is established in the treatment of snoring and obstructive sleep apnea syndrome (OSAS) with reduced velopharyngeal incompetence (VPI) risk. This study was performed to evaluate the subjective outcome of UPF among patients with simple snoring or obstructive sleep apnea. MATERIALS AND METHODS: Twenty patients with OSAS were examined (sixteen male, four female) in a prospective manner. Subjects who underwent UPF have completed pre or post operative (after 3 months) polysomnographic (PSG) studies. The parameters of PSG were apnea index (AI), respiratory disturbance index (RDI), mean SaO2, and lowest SaO2. Questionnaires composed of Eworth sleepiness scale (ESS) and snoring symptoms inventory (SSI) were completed by patients and bed partner before and after the UPF. Statistical analysis was performed using the Wilcoxon signed rank test. RESULTS: Subjective questionnaires indicated statistically significant improvements (SSI ; from 60.9 to 37, ESS ; from 11.6 to 7.4). The AI decreased from 18.6 to 9.3, RDI decreased from 29.8 to 16.6 (p<0.05). CONCLUSION: UPF seems to be more effective in mild OSAS than in moderate and severe OSAS. Long term follow up studies with more patients is deemed necessary.

Bacteriology of Tonsillar Cores in Obstructive Tonsillar Hypertrophy and Recurrent Tonsillitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to find whether bacteriological characteristics can affect the size and recurrent infections of the tonsil by comparing the type and number of bacteria located in the core of palatine tonsil in obstructive tonsillar hypertrophy (OTH) and recurrent tonsillitis (RT) patients. SUBJECTS AND METHOD: Palatine tonsils of patients who received tonsillectomy due to OTH and RT were studied. The excised tonsil was dissected into two pieces and one gram of the core tissue was obtained for examination. Mixture of normal saline and homogenized tissue was inoculated using various culture media. The types of isolates and bacterial concentrations in each isolate was compared between the two groups. RESULTS: Commonly isolated aerobic bacteria in the order of frequency for the OTH group were Streptococcus viridans, Staphylococcus aureus, and Neisseria spp., whereas it was Neisseria spp., Streptococcus viridans, Staphylococcus aureus, and Haemophilus influenzae for the RT group. Peptostreptococcus spp. was the most frequently isolated anaerobe in both OTH group and RT group. There was no statistically significant difference in types of isolates between the two groups except for Haemophilus influenzae and Bacteroides spp. The density of cultured bacteria (number of bacteria per 1 gram of tissue) was greater in the RT group than in the OTH group. CONCLUSION: There was no definite difference in the number of isolate types between the OTH group and RT group. Bacterial density was higher in the RT group than in the OTH group. Therefore, bacterial density might have an influence on the recurrence of tonsillitis.