Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Abstract Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of amultilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

Nasalance Changes Following Various Endonasal Surgeries

Abstract Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group.We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Early and Delayed Effect of Functional Endoscopic Sinus Surgery on Intraocular Pressure

Abstract Introduction Due to the close anatomical relationship between the paranasal sinuses and the orbit, involvement or injury of the orbit from paranasal sinuses procedures may occur. Objectives We aimed to study the early and delayed effect of endoscopic sinus surgery on intraocular pressure ( IOP ). Methods We included in the study 38 patients with chronic rhinosinusitis ( CRS), undergoing FESS. We performed FESS with the standard anterior to posterior approach. We measured IOP at the same time one day before surgery as well as day 1 and 6 weeks after surgery. Results One day after surgery, mean IOP in the right eye was 14.176 1.91 mm Hg and in the left eye was 13.79 2.42 mm Hg with statistically non-significant difference from preoperative values. Six weeks postoperative, the mean IOP in the right eye was 15.14 2.28 mm Hg. The difference between the mean preoperative and postoperative IOP values was found to be statistically significant (p 1/4 0.0012). While in the left eye, mean postoperative IOP was 15.14 þ 2.23mm Hg. The difference between the mean preoperative and postoperative IOP values was also found to be highly statistically significant (p 1/4 0.0005). Conclusion Delayed significant increase in IOP can occur after FESS, Thus, special measures must be taken to reduce IOP to protect the patient́s eye from the risk of increased IOP, especially in patients with glaucoma.

The Efficacy of Adjuvant Intratympanic Steroid Treatment for Otitis Media with Effusion in Children

Abstract Introduction Otitis media with effusion (OME) is a leading cause of hearing impairment in children. Therefore, early and proper management is essential. Objectives The objective of this research is to assess the efficacy of intratympanic (IT) steroids injection for management of otitis media with effusion (OME). Methods This study involved 42 children (84 ears) with bilateral OME. We used tympanometry to confirm the childreń s middle ear effusion and pure tone audiometry to determine hearing threshold. We performed myringotomy and inserted ventilation tubes (VTs) bilaterally, followed by a steroid injection of 0.4-0.6mLmethylprednisolone (40 mg/mL) into one randomly selected middle ear. This procedure was followed by once-weekly administration of steroids (0.5 mL methylprednisolone at a concentration of 40 mg/mL) into the middle ear for three consecutive weeks. Results We found recurrent OME after VT alone in nine (21.4%) ears; whereas, after VT combined with steroid administration, we found two (4.76%), with statistically significant difference. We noted tympanosclerosis postoperatively in six (12.9%) ears and in one of the injected ears (2.3%) (p = 0.0484). Otorrhea occurred in eight (19%) ears with VT alone and in three (7.1%) injected ears, with non-significant difference. The duration between VT insertion and its extrusion was 6.6 = 1.1months for ears with VT alone and 6.95 =1.12 months in injected ears (p = 0.1541 NS). Conclusion IT Steroids injection for treatment of OME is a safe and simple intervention with lower incidence of symptoms recurrence and postoperative complications. Thus, its use in management of OME is recommended.