Effect of Nasal Surgery in Patients with Remained Snoring and Sleep Apnea after Obstructive Sleep Apnea Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea syndrome is one type of sleep disorder breathing. During sleep, in respiration, nasal obstruction causes negative pressure, which in turn causes the pharyngeal airway to collapse during inspiration. We investigated how nasal surgery affects patients who have undergone OSA surgery but still suffer from the remaining symptoms of snoring and sleep disorder breathing. SUBJECTS AND METHOD: We reviewed 24 patients, who had undergone obstructive sleep apnea (OSA) surgery only to show no enhancement in snoring and qualities of sleep; they showed nasal septal deviation or inferior turbinate hypertrophy. Septal surgery or inferior turbinoplasty was performed by the same otolaryngologist. Over the period between preoperation and 1, 3, 6, 12 months after operation, we evaluated Apnea-Hypopnea Index (AHI) and oxygen saturation by polysomnography, degree of snoring by Visual Analogue Sacle (VAS) score, satisfaction for quality of sleep by Epworth Sleepiness Scale (ESS), minimal cross section area and volume of nasal cavity by acoustic rhinometry, respectively. RESULTS: After nasal surgery, the volume of nasal cavity and MCA increased. There were significant improvements of AHI, oxygen saturation, VAS and ESS score. CONCLUSION: As for OSA surgery, the evaluation of nasal cavity is an indispensible factor for improving the quality of sleep and snoring. When treating OSA patients who have nasal obstruction, nasal surgery including septoplasty and inferior turbinoplasty should be considered.

The Efficacy of Posterior Resection of Inferior Turbinate on Patients Who Have Recurred Nasal Obstruction after Inferior Turbinate Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical techniques have been tried to relieve nasal obstruction in patients who have hypertrophic inferior turbinate. Recently, coblators and microdebriders are the favored surgical procedure. This study is aimed at evaluating the long term efficacy of posterior resection of inferior turbinate performed on patients for whom the previous inferior turbinate surgery had not relieved the symptoms of nasal obstruction. SUBJECTS AND METHOD: We selected 27 patients who have had previous inferior turbinate surgery, but were not relieved of the symptom for nasal obstruction. Under local or general anesthesia, hypertrophied posterior part of inferior turbinate was removed. The symptom changes of nasal obstruction and patients satisfaction were checked pre and postoperatively at 1, 2, 3, 6, 12 month by Visual Analogue Scale (VAS) score. The minimal cross-sectional area of second notch and volume of nasal cavity were measured at 1, 2, 3, 6, 12 month after operation. RESULTS: There were significant improvement in the VAS score of nasal obstruction and patient satisfaction after the operation. The minimal cross-sectional area of second notch did not change significantly after surgery, but the nasal cavity volume was significantly improved after surgery. CONCLUSION: This study suggests that posterior resection of inferior turbinate is an effective surgical procedure for patients who have hypertrophic inferior turbinate especially on the posterior part.

The Long Term Efficacy of Microdebrider Assisted versus Coblation Assisted Inferior Turbinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The study aimed to evaluate the long term efficacy of micro-debrider assisted inferior turbinoplasty (MAIT) compared to coblation assisted inferior turbinoplasty (CAIT) for hypertrophic inferior turbinates. SUBJECTS AND METHOD: From January 2008 to December 2008 inclusively, 96 patients with persistent hypertrophic inferior turbinates mucosa refractory to medical therapy were enrolled into this study. All patients were suffering from nasal obstruction and related symptoms. Overall, 56 patients were treated with microdebrider assisted inferior turbinoplasty (MAIT group) and 40 patients were treated with coblation assisted inferior turbinoplasty (CAIT group). Postoperative changes in degree of nasal obstruction, sneezing, rhinorrhea, minimal cross sectional area (MCA), and nasal volume from the nostril to 7 cm posteriorly (V7), operation time, duration of crust formation, intraoperative bleeding and delayed bleeding were compared between the two surgical methods prospectively in the 1st and 6 months, and in the 1st and 2nd years after the procedure. Also patient's satisfaction with procedure was evaluated. RESULTS: The nasal obstruction and related nasal symptoms improved significantly in MAIT group and persisted within the periods of 2 years after surgery, while in CAIT group the significant improvements took place in the 1st and 6th months after surgery but no significant improvements from 1 to 2 years after were noted. Nasal patency (MCA and V7) also showed more improvement and persistence in MAIT group than CAIT group. There were no significant differences in operation time and intraoperative bleeding and delayed bleeding but the duration of crust formation was significantly shorter in MAIT group. And patient satisfaction in the MAIT group was higher than that in the CAIT group. CONCLUSION: From the analysis of this study, it can be said that MAIT is more effective and satisfactory for the long term relief of nasal obstruction, related nasal symptoms and reduction of hypertrophic inferior turbinate mucosa than CAIT.

A Case of Primary Ureteral Tumor / 대한비뇨기과학회지

Primary ureteral tumor accounts for an estimated about 1 percent of all tumors of the urinary tracts. We observed one case of the ureteral tumor in 65 years old male patient and he was treated by complete nephroureterectomy with an excision of a cuff bladder wall around ureteral orifice. A case of primary ureteral tumor was reported with a brief review of the literatures.