Effective Continuous Positive Airway Pressure Changes Related to Sleep Stage and Body Position in Obstructive Sleep Apnea during Upward and Downward Titration: An Experimental Study

Are Sleep Questionnaires Valid in All Adult Age Groups as Screening Tools for Obstructive Sleep Apnea?

Background and Objectives@#Evaluation of Epworth Sleepiness Scale (ESS), Berlin, STOP, and STOP-Bang questionnaire validities for obstructive sleep apnea (OSA) screening among various adult age groups.Materials and Method: Results for each of those questionnaires were compared with diagnostic overnight polysomnography (PSG) data obtained for 396 patients suffering either insomnia, sleep apnea, excessive daytime sleepiness, or chronic snoring who had been divided into three age groups (20-39, 40-59, or ≥60 years). For each questionnaire, the sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated. @*Results@#Among the OSA group [apnea hypopnea index (AHI) cutoff ＞5], Berlin and STOP questionnaire sensitivity and specificity were significantly different among the age groups. Among the moderate-to-severe OSA sub-group (AHI cutoff ＞15), the specificity of Berlin, STOP, and STOP-Bang questionnaire was significantly different among age groups. @*Conclusion@#The Berlin and STOP questionnaires differed with patient age in OSA screening. The ESS questionnaire, by contrast, did not show any age-related differences of sensitivity and specificity in OSA screening or moderate-to-severe OSA screening.

Management of Attic Cholesteatoma While Preserving Intact Ossicular Chain; “Modified Bondy Technique” vs. “Canal Wall Up Mastoidectomy with Tympanoplasty Type I & Scutumplasty” / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.

A Case of the Carotid-Cavernous Fistula Due to the Internal Carotid Artery Injury During Endoscopic Sinus Surgery

Rupture of the internal carotid artery (ICA) during endoscopic sinus surgery is a rare complication. However, it can potentially result in death within minutes. In the event of a traumatic injury to the ICA during sphenoid sinus exploration, it is very difficult to control the bleeding. We present a case of carotid-cavernous fistula after an accidentally-developed ICA bleed during endoscopic sphenoidotomy. The patient was successfully treated with endovascular embolization techniques that included detachable microcoils.

Dexamethasone Induces Apoptosis of Nasal Polyp-Derived Tissue Cultures Through JNK and p38 MAPK Activation

OBJECTIVES: Glucocorticoids, such as dexamethasone (DEX), increase apoptosis in a variety of white cells in nasal polyps and apoptosis is an important factor in the resolution of inflammation. However, the mechanism of glucocorticoids induced apoptosis in nasal polyp remains unclear. In this study the authors evaluated which pathways were engaged in apoptosis induced by DEX in an ex vivo model of nasal polyps. METHODS: Nasal polyp tissues were cultured using an air-liquid interface method. Cultures were maintained in the absence or presence of DEX (10 or 100 microM) for 24 hours. To investigate the involvement of the apoptotic signaling pathways in nasal polyp, such as caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 mitogen-activated protein kinase (MAPK)/JNK pathway, the authors performed reverse transcription-polymerase chain reaction and Western blotting. RESULTS: The expression ratios of FasL, activated form of caspase-8, caspase-9, and caspase-3 were significantly higher in DEX-treated polyps (P<0.01). In the Bcl-2 family expression, the anti-apoptotic molecules, Bcl-2 and Bcl-XL decreased, but pro-apoptotic molecules, Bax increased, and Bid and Bad were activated. In the conventional MAPKs, JNK, and the phospho-p38 MAPK were significantly higher, but phospho-extracellular signal-regulated kinase (ERK)1/2 was significantly lower in DEX-treated polyps (P<0.01). CONCLUSION: DEX induces apoptosis of nasal polyp via caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 MAPK/JNK pathway.

A Case of Extranasopharyngeal Angiofibroma Arising from the Inferior Turbinate Removed without Pre-Operative Embolization

The angiofibroma is a highly vascular and histologically benign neoplasm that usually arises in the nasopharyx in adolescent male patients. It accounts for less than 0.5% of all head and neck neoplasm. Reports of primary extra-nasopharyngeal angiofibroma have appeared sporadically in the literature. The inferior turbinate is a very rare site of extra-nasopharyngeal angiofibroma, with only 5 cases reported in the medical literature. Also, the value of embolization in surgery for extra-nasopharyngeal angiofibroma is a controversial matter. We report a case of extra-nasopharyngeal angiofibroma arising from the inferior turbinate of a 37-year-old male. The tumor was completely removed through endonasal, endoscopic technique without pre-operative embolization. Histopathology confirmed it to be a case of angiofibroma. The patient is currently free of relapse 6 months after surgery. Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolization in every case of endoscopic angiofibroma resection.

A Case of Extranasopharyngeal Angiofibroma Arising from the Inferior Turbinate Removed without Pre-Operative Embolization

The angiofibroma is a highly vascular and histologically benign neoplasm that usually arises in the nasopharyx in adolescent male patients. It accounts for less than 0.5% of all head and neck neoplasm. Reports of primary extra-nasopharyngeal angiofibroma have appeared sporadically in the literature. The inferior turbinate is a very rare site of extra-nasopharyngeal angiofibroma, with only 5 cases reported in the medical literature. Also, the value of embolization in surgery for extra-nasopharyngeal angiofibroma is a controversial matter. We report a case of extra-nasopharyngeal angiofibroma arising from the inferior turbinate of a 37-year-old male. The tumor was completely removed through endonasal, endoscopic technique without pre-operative embolization. Histopathology confirmed it to be a case of angiofibroma. The patient is currently free of relapse 6 months after surgery. Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolization in every case of endoscopic angiofibroma resection.

A Case of Abducens Nerve Palsy Caused by Isolated Sphenoid Fungal Sinusitis

Isolated sphenoid sinusitis is a rare disorder. There are some difficulties in its diagnosis; therefore the first presentation of this disorder might be with complications. These complications are essentially due to the anatomical location of the sinus and its proximity to the intra-cranial and orbital contents, to which infection may easily spread. A case of isolated sphenoid fungal sinusitis with unilateral abducent nerve palsy is being reported which was successfully treated by parenteral antibiotic therapy and endonasal endoscopic sphenoidotomy.