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.

Prevention of adhesion after endoscopic sinus surgery: role of mitomycin C

Adhesions after endoscopic sinus surgery [ESS] are a potential cause of surgical failure. Mitomycin-C [MMC] is recently proposed as a solution for these adhesions. This study was performed to investigate the effect of Mitomycin C in reducing scar formation and adhesion in the nasal mucosa after endoscopic nasal surgery. This double blind randomized clinical trial study was performed on 37 patients with bilateral chronic rhinosinusitis. At the end of ESS, randomly impregnated mesh with MMC was placed in one side and another mesh impregnated with saline in the opposite side for 5 minutes. Patients were followed at least for three months, and the results of diagnostic endoscopy were recorded. Post operative adhesion occurred in 12 [32.4%] patients [2 bilateral/10 unilateral]. Among total of 14 adhesions, 4 [10.8%] were in the MMC side and 10 [27%] in the control side. This differences was close to statistically significant [P=0.058]. MMC may reduce adhesions after ESS, but further studies with different doses, sample size and frequent use of topical MMC is recommended

Hearing status in neonatal hyperbilirubinemia by auditory brain stem evoked response and transient evoked otoacoustic emission

Hyperbilirubinemia at neonatal period is one of the major deteriorating factors of the auditory system. If left untreated, it may cause certain cerebral damage. This study aims to evaluate the impact of hyperbilirubinemia on the hearing of neonate. This study was conducted on 35 newborn babies with jaundice [bilirubin more than 20 mg/dL]. Auditory brainstem response [ABR] and transient evoked otoacoustic emission [TEOAE] tests were performed, after treatment and one year after. ABR test results indicated that 26 children [74.3%] had normal hearing but 9 [25.7%] suffered from an impairment. As for TEOAE test, 30 children [85.7%] passed whereas the remaining [14.3%] seemed to be failures. The comparative results of the two tests pointed to autonomic neuropathy /autonomic dysreflexia symptoms in 5 babies. Due to the high incidence of Autonomic neuropathy/autonomic dysreflexia among hyperbilirubinemic babies, screening in this regard seems reasonable. Our result emphasizes the necessity of more experiments on the afflicted areas