Surgical treatments for snoring.

Surgical treatments for snoring. OBJECTIVES: To compare the results on snoring and sleepiness of different surgical treatments for sleep disordered breathing (SDB) including uvulopalatopharyngoplasty (UPPP), functional expansion pharyngoplasty (FEP), osteotomy, septoplasty with turbinoplasty, and somnoplasty. METHODOLOGY: Between May 2011 and December 2015, 329 patients presenting with SDB underwent a dedicated clinical examination, drug-induced sleep endoscopy (DISE), and polysomnography (PSG). Of these, 84 patients underwent surgical treatment. Treatments were evaluated through 4 questionnaires (snoring intensity, snoring severity, Epworth Sleepiness Scale [ESS], and global snoring score) before and 6 weeks and 6 months after treatment. Treatment success was defined as a global snoring visual analog scale score (VAS) ≤3 at 6 months. RESULTS: The average age of the surgical group was 43 ± 11 years; the mean body mass index was 26 ±3 kg/m; and 88% were male. The snoring scores decreased significantly for every surgical technique at 6 weeks and 6 months. A higher reduction in the median snoring scores was observed in patients receiving UPPP/FEP and osteotomy compared to somnoplasty and septoplasty. Treatment was successful in 88% of the UPPP/FEP group, 92% of the osteotomy group, 61% of the septoplasty group, and 64% of the somnoplasty group. CONCLUSIONS: All surgical treatments effectively and persistently reduced snoring and sleepiness symptom scores. The highest rates of success were observed with osteotomies and UPPP/FEP procedures.

Voice quality after narrow-margin laser cordectomy compared with laryngeal irradiation.

Voice quality remains the issue often used to support preference for radiotherapy in treatment of early glottic cancer. We therefore conducted a perceptual voice study in 2 groups, one treated with radiotherapy for malignant disease and the other with narrow-margin laser cordectomy for either malignant or extensive benign lesions. Sequential patients, 12 treated with radiotherapy and 30 with CO(2) laser excision, were included. Voice samples were recorded before and at intervals after surgery. Ratings of validated judges were used for statistical analysis of various voice characteristics at each time point. Voice deteriorated temporarily after surgery as compared with the radiated group; however, at 6 and 24 months no significant differences were found between the groups. Preferential use of narrow-margin laser cordectomy for appropriate early glottic tumors can be supported not only for oncologic reasons but also on the basis of voice results, cost, and efficiency considerations.

Prospective randomized comparative study of tracheoesophageal voice prosthesis: Blom-Singer versus Provox.

OBJECTIVES: Compare the most commonly used types of tracheoesophageal voice prostheses, Blom Singer and Provox. STUDY DESIGN: Prospective study of 113 prostheses placed in 52 patients randomly selected to receive Blom-Singer and Provox. METHODS: Postoperative voice was recorded at 1 and 4 months after valve placement. Survival time of the prosthesis and four objective voice parameters were analyzed. Eight judges rated all recordings in a random order for six subjective voice parameters. Subgroup analysis for primary versus secondary placements and type of procedure was performed. In addition, patients were asked for their subjective assessment. RESULTS: Overall, Blom-Singer and Provox prostheses give very similar voice quality, lifetime, and patient satisfaction. Cleaning management is somewhat better for Provox, but there is a trend toward better overall voice quality for the Blom-Singer prosthesis. In subgroup analysis secondarily placed prostheses score somewhat better than primary placements, and patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial pharyngectomy. CONCLUSIONS: Given the equal and good results in terms of voice quality, other factors (e.g., costs, surgery-related factors, maintenance, patient preference) should be taken into account when deciding which type of tracheoesophageal voice prosthesis to use.

Indirect larynx and pharynx surgery: a replacement for direct laryngoscopy.

During a 2-year period, 192 indirect surgeries on the laryngopharynx were performed in an outpatient videoendoscopy laboratory under topical anesthesia with or without intravenous sedation. These procedures included cancer staging and biopsy; vocal fold injections of Teflon, Gelfoam, botulinum toxin, or steroids; glottic web lysis; and granuloma removal. The techniques used to perform these procedures are elucidated. Careful chart review of these patients shows that indirect surgery was performed successfully in 96% of cases. Intravenous conscious sedation was utilized in 39% of patients. No significant complications were encountered. By avoiding the need for an operating room, hospitalization, or general anesthesia, this technique was clearly as safe or safer, more convenient for surgeon and patient, and more cost-effective than the same procedure would have been via the traditional direct laryngoscopy. As the authors have already done in their practices, the indirect method should therefore be reinstated as the preferred approach to the clinical circumstances described here.

Allergic fungal sinusitis: allergic, infectious, or both?

Allergic fungal sinusitis is a benign noninvasive sinus disease related to a hypersensitivity reaction to fungal antigens. A wide variety of fungal agents has been implicated, with the vast majority belonging to the Dematiaceae family. Allergic fungal sinusitis should be suspected in any atopic patient with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but not diagnostic. Diagnosis requires histopathologic examination, which shows characteristic allergic mucin. Hyphae can be demonstrated on special fungal stains or confirmed by a positive fungal culture. At surgery, the diagnosis should be considered if thick, tenacious allergic mucin is encountered in the atopic patient with nasal polyps. Fungal cultures should then be obtained, and the pathologist alerted to the possible diagnosis of allergic fungal sinusitis. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. This can often be accomplished endoscopically. Adjunctive short-term systemic steroids are often helpful, and nasal steroid sprays should be continued long term. The length and dose of steroid therapy is controversial. Persistence of allergic fungal sinusitis with recurrence of sinonasal symptoms is common, particularly when there has been incomplete eradication of allergic fungal mucin. Even when the patient is clinically disease free, recurrence can occur, presumably from reexposure to fungal antigens. Therefore close clinical, endoscopic, and radiographic follow-up is important.

Mucosal allergy in the absence of systemic allergy in nasal polyposis and rhinitis: a meta-analysis.

To better determine the role of allergy in rhinitis and nasal polyposis, we assessed the prevalence of nasal mucosal allergy in the absence of systemic allergy. After a thorough literature search we compiled and analyzed data from nine studies (287 patients) that tested for specific immunoglobulin E both intranasally and systemically. When meta-analysis was applied to the different populations, 19% of those who demonstrated specific immunoglobulin E manifested nasal mucosal allergy but no systemic allergy. We suggest that there is an important segment of rhinitis and nasal polyp patients who have nasal mucosal allergy.

Reconstructive aspects of malignant parotid surgery.

High grade malignant tumours of the parotid gland require radical resections. The surgeon is therefore confronted with the problem of a reliable and minimally deforming reconstruction. Due to different manifestations, locations and spread, one should be familiar with a variety of reconstructions. Four case histories are presented, illustrating the necessity of approaching each parotid tumour resection and the resulting defect individually. Technical aspects of different reconstructions are discussed.

Hemangiopericytoma of the head and neck: a report of four cases and a literature review.

Hemangiopericytoma is an infrequent vascular tumor that rarely appears in the head and neck. The nasal cavity and the paranasal sinuses are most often involved. Four cases are added to the literature and some important features are stressed. The clinical presentation is aspecific. Diagnosis is made only by careful histological examination with special stainings (reticulin, immunohistochemistry with Ulex Europaeus) and gives an idea about the grading. Treatment with radical surgery, if possible, is effective while preoperative embolisation can reduce the risk of hemorrhage. The median follow-up of the present cases is only 3 years. During this period no recurrence was observed. We suggest that more radical resections can probably reduce the local recurrence rate. However lifetime clinical follow-up is warranted since late recurrences have been reported in almost half of the patients.