Changes of snoring sound after relocation pharyngoplasty for obstructive sleep apnoea: the surgery reduces mean intensity in snoring which correlates well with apnoea-hypopnoea index.

OBJECTIVE: To investigate objective changes of snoring after surgery in patients with obstructive sleep apnoea (OSA) and correlate these with changes in the apnoea-hypopnoea index (AHI). DESIGN: Prospective case series. SETTING: A novel measurement, Snore Map, was used to analyse full-night snore sounds in terms of the maximal/mean intensity, peak/mean frequency, snoring index and energy type (Snore Map type, 0-4). Snore sound was classified into three bands according to frequency energy spectrum: B1 (40-300 Hz), B2 (301-850 Hz) and B3 (851-2000 Hz). PARTICIPANTS: Thirty-four male and two female OSA patients (mean age, 39 years; mean AHI, 53.1/h; mean body mass index, 26.8 kg/m(2) ) with favourable anatomic structure were consecutively enrolled. MAIN OUTCOME MEASURES: Parameters of polysomnographies and Snore Maps at baseline and six months after operation were compared. Statistical significance was set at P < 0.05. RESULTS: Thirty-two patients completed this study. The mean reduction in the total-snoring index was insignificant but there were significant decreases in total mean intensity, total peak frequency, total mean frequency and Snore Map type after surgery. There were also significant decreases in the mean intensity in all three bands, the snoring index in B2/B3 and the mean frequency in B1 postoperatively. Changes in the total mean intensity, total mean frequency, B2 mean intensity and B3 snoring index positively correlated with change in the AHI. CONCLUSIONS: Relocation pharyngoplasty significantly decreases both the snoring sound intensity and snoring frequency. These reductions are directly proportional to the improvement of OSA.

Concomitant inverted papilloma and fungus ball in unilateral maxillary sinus.

PROBLEM: The concomitant appearance of an inverted papilloma and a fungus ball in unilateral maxillary sinus is rare. These disease entities may be difficult to distinguish before surgery. METHODOLOGY: A male patient presented with the characteristic symptoms of chronic rhinosinusitis. A preoperative sinus computed tomography scan revealed unilateral sinus opacification, hyperdense calcified spots, and bony erosion of the medial maxillary sinus wall. RESULTS: During the operation, a cheesy, clay-like fungus ball was removed. In addition, a papillary appearance of the sinus mucosa led to the suspicion of inverted papilloma behind the fungus ball and nasal polyps. The histopathology showed an inverted papilloma concomitant with a fungal ball and some inflammatory polyps. CONCLUSION: In addition to preoperative imaging, one should be aware of the potential etiology; careful intraoperative reevaluation is imperative for clinicians to avoid misdiagnosis and to provide adequate management of the underlying disease.