Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients.

OBJECTIVE: To evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence. DESIGN: Thirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session. RESULTS: Post-operatively, there were significant reduction in AHI (86.03 ± 20.5 vs. 54.65 ± 16.6 p < 0.001), arousal index (71.14 ± 17.7 vs. 35.90 ± 11.8 p < 0.001), and CPAP Pressure (17.13 ± 1.7 vs. 10.97 ± 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 ± 0.2 vs. 75 ± 0.1 p < 0.001), and CPAP using time in hours (1.57 ± 0.56 vs. 3.75 ± 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia. CONCLUSION AND RELEVANCE: Upper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.

Changes in Serum Leptin Level After Multilevel Surgery in Patients with Obstructive Sleep Apnea.

OBJECTIVE: Leptin hormone plays an important role in metabolic control and is elevated in obstructive sleep apnea (OSA). The aim of this study was to assess the hypothesis that surgical treatment will reduce leptin levels in OSA patients. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Twenty-three patients with multilevel OSA underwent modified genioglossus muscle advancement with anterolateral advancement pharyngoplasty between April 2018 and September 2019. Serum leptin level was measured preoperatively and 3 months postoperatively for all patients and 18 control subjects. All patients were evaluated before and 3 months after surgery by history taking, clinical examination, polysomnography, cephalometry, and Epworth Sleepiness Scale. RESULTS: Preoperatively, patients with OSA had a higher Leptin level (18.46 ± 4.73 ng/mL) than did control subjects (7.07 ± 1.26 ng/mL) (P < .001). Surgery resulted in a significant reduction in the level of leptin from 18.46 ± 4.73 ng/mL to 8.03 ± 2.22 ng/mL (P < .001). Reductions in leptin level was correlated with changes in apnea hypopnea index (AHI) (r = 0.61, P = .002) and minimum oxygen saturation (SaO2) (r = -0.54, P = .008). CONCLUSION: Effective multilevel surgery in the form of modified genioglossus muscle advancement with anterolateral advancement pharyngoplasty could significantly reduce leptin level in OSA patients and this reduction is correlated with the degree of OSA improvement in term of AHI and SaO2. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E665-E670, 2021.

Outcomes of Using Otoendoscopy During Surgery for Cholesteatoma.

To determine the impact of using otoendoscopy at the time of primary surgery of cholesteatoma in identifying hidden "cholesteatoma remnant". Study was prospective study. Setting was University tertiary care hospital. One hundred fifty, patients diagnosed clinically and by CT as having cholesteatoma, have been operated. 64 patients operated by using canal up technique and 86 patients operated by using canal down technique. Once all visible cholesteatoma was removed with standard microscopic techniques, otoendoscopy was utilized in every patient to identify any hidden "cholesteatoma remnant". Despite apparent total microscopic eradication of cholesteatoma of the operated cases, otoendoscopy at time of primary surgery revealed an overall incidence of hidden cholesteatoma remnants of 18%. The incidence of hidden cholesteatoma remnants identified by otoendoscopy was 23% in the canal up group and 14% in the canal down group. Otoendoscopy should be used as an adjunct with standard microscopic technique to identify hidden cholesteatoma remnants during surgery of cholesteatoma.