Parathyroid surgery: correlation between pre-operative localization studies and surgical outcomes.

OBJECTIVE: Pre-operative imaging techniques have enabled minimally invasive parathyroid surgery to supersede the traditional approach to hyperparathyroidism (HPT) surgery, which included cervical exploration. Cervical ultrasound (US) and sestamibi scan (MIBI) are commonly performed, but the results of these localization tests do not always match. This study correlated surgical outcomes with pre-operative localization findings, including matched positive US and MIBI studies, one positive study (US or MIBI), conflicting studies or negative results. DESIGN: Retrospective medical record review. PATIENTS: A hundred and sixty nine consecutive patients who underwent parathyroidectomy from January 2005 to December 2012. MEASUREMENTS: Correlation between surgical outcomes and pre-operative localization tests. RESULTS: All patients (134F/35M, 59·6 ± 13·5 years of age) had primary HPT. US and MIBI localization studies matched in 76%, whereas 10·7% had positive MIBI only and 8·3% US only. Studies were negative in 3·6% and contradictory in 1·8%. Minimally invasive parathyroidectomy was performed in 87% of the matched group and 89% of the MIBI-only group. Surgical success rate, defined as postoperative normalization of calcium and PTH levels, was similar in patients with a single positive study (MIBI or US) vs double-matched studies (MIBI and US). Patients were followed up for 6 weeks. Overall, pathology was consistent with adenoma in 95%. DISCUSSION: Parathyroidectomy success rate was similar in patients with primary HPT and MIBI-only or US-only positive localization studies compared to those with matched US/MIBI studies. The results support a clinical algorithm in which positive results from one imaging technique, either MIBI or US, are sufficient to refer a patient for parathyroid surgery.

Morphology of the human tympanic membrane annulus.

OBJECTIVE: To study the full panoramic view with figuring of the morphology and topography of the human tympanic annulus. STUDY DESIGN: Postmortem material analysis. SETTING: University-affiliated hospital. SUBJECTS AND METHODS: Twenty-three single, normal human adult tympanic membranes were completely extracted from formalin-fixed temporal bones. They were faced medially and placed at the same level of a graph paper mounted on a board. High-quality images of the tissue preparations were taken, and computer-aided measurements of the annular caliber were calculated at nine reference points. The 6 o'clock direction served as a midpoint, and another four reference points were set anteriorly and posteriorly in clockwise and counterclockwise directions. RESULTS: The annulus has a horseshoe-like shape with a small part absent above the neck of the malleus. The maximal mean caliber at the manubrial axis (6 o'clock direction) was 748 +/- 201 mum. The annulus gradually thins out almost symmetrically anteriorly and posteriorly, until it reaches about 15 percent of the maximal caliber at its end points (152 +/- 87 and 113 +/- 42 mum, respectively). Significant differences were found between adjacent reference points on both anterior and posterior sides. CONCLUSIONS: The annulus has a horseshoe-like shape and gradually thins out almost symmetrically, reaching anteriorly and posteriorly about 15 percent of the maximal caliber at the manubrial axis. These new data may provide guidance in transcanal middle ear exploration and suggest the possibility of varied functions attributable to the annulus regarding middle ear sound transmission and TM vibratory properties. The data may contribute to understanding the development of marginal perforations and posterior superior retraction pockets.

Old and new aspects of middle turbinate histopathology.

OBJECTIVE: To study the histology of the normal and pathologic middle turbinate (MT). STUDY DESIGN: Nonrandomized, controlled study. SUBJECTS AND METHODS: Qualitative and quantitative assessment of soft tissue and bony elements of 14 normal and 10 chronic rhinosinusitis (CRS) MT samples (patients' mean CT score, 6.5 +/- 6.7). A comparison with 14 normal inferior turbinate (IT) samples was accomplished. Quantitative assessment was limited to the lateral mucosal layer (LML). RESULTS: The thickness of the LML was significantly greater in pathologic MT than in normal MT (P = 0.002). Except for veins that underwent significant increase (P = 0.036), other soft tissue constituents of the pathologic MT did not change significantly. Glands were more abundant in normal MT and veins in normal IT (P < 0.001, P = 0.001, respectively). Qualitative assessment showed larger veins in the normal IT compared with the normal MT. Inflammatory cell infiltrate, edema, and fibrosis were found in CRS. None of our MT bones exhibited osteomyelitic changes. CONCLUSIONS: The different proportion of glands suggests varied functional roles for both the MT and IT. The significant involvement of the MT in the inflammatory process of CRS and the relatively small size and paucity of veins with relatively little effect on nasal airflow justify partial excision of the MT.

Penetrating injury of the maxilla by needlefish jaws.

INTRODUCTION: Needlefish penetrating injuries have become a worldwide problem, inflicting critical morbidities and even mortalities. This is the first published case of needlefish injury in the Mediterranean basin. CASE REPORT: A 29 year old man was admitted to Meir Medical Centre in Israel with a penetrating facial wound caused by elongated needlefish jaws. The severity of the wound contrasted greatly with the expected injury from collision with a fish inflicting a small penetration lesion. The rigid jaws penetrated the maxilla transversely and obliquely from the left canine-fossae, through the nasal cavity, and to the right maxillary sinus, with its tip reaching the right medial-inferior orbital wall. The needlefish jaws were completely removed using a combined endoscopic and external approach. The course of surgery and hospitalization was uneventful and the patient was discharged with no complications. CONCLUSIONS: Fish inflicted critical facial injuries might be dangerously underestimated prima facie. The impact might be energetic enough to penetrate deep facial and vital cranial structures, hence thorough examination and imaging are recommended. Needlefish species are now common in the tropical and subtropical regions of all oceans and therefore this phenomenon is of interest to worldwide trauma medical providers, fishermen, divers, and also to marine-biologists.

Glycoconjugate expression of sinus mucosa in chronic rhinosinusitis: a lectin histochemical study.

BACKGROUND: Glycoproteins are responsible for the rheological properties of the mucus. Changes in mucus viscosity may interfere with mucociliary clearance, leading to stasis and aggravation of chronic rhinosinusitis (CRS). The purpose of this study was to assess the composition and concentration of various sinus mucosa glycoproteins in normal and chronically inflamed sinuses. METHODS: A semiquantitative scoring system was used to express the binding intensity of 10 lectins to 6 carbohydrates (galactose, sialic acid, N-acetylglucosamine, N-acetylgalactosamine [GalNac] [corrected], fucose, mannose) residing in the sinus mucosa of patients with CRS (N = 20) and normal controls (N = 10). RESULTS: The mean CT score, compatible with extensive sinus disease, was 13.9 +/- 6.7. All six carbohydrates were found in the epithelium and submucosal glands of patients and controls. Peanut agglutinin staining showed significantly higher concentration of disaccharide galactose beta 1,3 GalNac [corrected] in epithelial goblet cells and in submucosal mucous and mixed glands of patients compared with that of controls (p = 0.01, p = 0.03, and p = 0.018, respectively). The epithelial glycocalyx of patients was also significantly more abundant in fucose and in GalNac [corrected] (p = 0.015, and p < 0.001, respectively). CONCLUSION: Glycoconjugate expression of the sinus mucosa in CRS is markedly altered in extensive inflammatory conditions. The increased concentration of galactose beta 1,3 GalNac [corrected] in CRS probably contributes to the high viscosity of the nasal mucus and interferes with normal mucociliary clearance. Exposed peripheral galactose residues may serve as attachment receptor sites for pathogenic bacteria. Means interfering with the ability of bacteria to adhere to specific receptors on host tissues warrant additional research.

Histopathological changes after coblation inferior turbinate reduction.

OBJECTIVE: To assess the medium- to long-term histopathological changes after coblation (cold ablation) inferior turbinate (IT) reduction (CITR) surgery for refractory IT hypertrophy. DESIGN: Two-center, prospective, nonrandomized, controlled histological study. SETTING: University-affiliated hospitals. PATIENTS: The coblation-treated group included 22 samples from 16 men with IT hypertrophy in whom CITR had failed and who underwent endoscopically guided mucotomy. The control group included 18 samples from 14 men who had nasal obstruction due to refractory IT hypertrophy and who had undergone inferior turbinectomy. MAIN OUTCOME MEASURES: After processing the samples of both groups, we assessed the general histopathological features, the area fraction of various soft-tissue constituents, and the epithelial integrity. RESULTS: Qualitative analysis showed marked fibrosis and depletion of submucosal glands and venous sinusoids in the lamina propria after CITR. Compared with the control group, the coblation-treated group showed a significantly increased area fraction of connective tissue and a significantly decreased area fraction of submucosal glands and venous sinusoids (P < .001 for all 3 comparisons). A significantly decreased relative proportion of intact epithelium and a significantly increased relative proportion of partial epithelial shedding were also found in the coblation-treated group (P = .03 and P = .04, respectively). CONCLUSIONS: The long-term histological effects of CITR were significant fibrosis, glandular and venous sinusoid depletion, and partial epithelial shedding. The latter probably resulted from vascular damage, causing a reduction in epithelial perfusion. Questions remain concerning the long-term implications of the histopathological changes of CITR on nasal physiology.

Adult vallecular cyst: thirteen-year experience.

OBJECTIVE: To assess the characteristics of adult vallecular cyst. STUDY DESIGN AND SETTINGS: A retrospective chart review from a university affiliated hospital. SUBJECTS AND METHODS: Clinical manifestations and airway management of 38 consecutive adult patients with vallecular cyst admitted between 1992 and 2004 were studied. RESULTS: Two distinct groups were identified: infected (n = 24) and noninfected (n = 14). Twenty-two (91.7%) patients of the former group had acute epiglottitis with an abrupt onset culminating in abscess formation in 19 (79.2%) and airway compromise in 9 (37.5%) compared with none in the noninfected group (P = 0.006). In 4 (18.2%) of 22 patients, the origin of the infected vallecular cyst was evident only after symptoms subsided. Three patients had recurrent acute epiglottitis. The noninfected group had a relatively prolonged mild clinical course. CONCLUSIONS: Two types of vallecular cysts were characterized. Abscess formation was the hallmark of adult infected vallecular cyst. SIGNIFICANCE: To improve patient care, endoscopic follow-up is advocated. In patients with recurrent episodes of acute epiglottitis, imaging is recommended.

Glycoconjugate expression in perennial allergic rhinitis: a lectin histopathological study.

CONCLUSIONS: The data show that differences in the concentrations of glycoconjugates of patients with perennial allergic rhinitis (PAR) and normal controls are modest, thus indicating that the composition of the mucus in allergic patients largely resembles that of healthy individuals. The findings may point to the need for volume reduction methods controlling mucus production in patients with PAR. OBJECTIVES: We aimed to study the composition and concentration of inferior turbinate glycoconjugates of patients with PAR. MATERIALS AND METHODS: Six specific oligosaccharides found in the inferior turbinate mucosa were stained with a battery of 10 lectins. The samples recruited for study were 15 sections from patients with PAR and 17 from healthy individuals who had no nasal disease and underwent rhinoplasty surgery for cosmetic reasons. Both groups were matched for age (p = 0.208). Results. No significant difference in the concentration of galactose, fucose, sialic acid, N-acetylglucosamine, and N-acetylgalactosamine in the epithelium and submucosal glands of the inferior turbinate was found between the groups. Likewise, neuraminidase digestion of peripheral sialic acid revealed similar concentration of the penultimate galactose residue. The only significant difference was a higher concentration of mannose in submucosal serous glands of patients with PAR compared with normal controls (p = 0.04).

Epithelial shedding of the inferior turbinate in perennial allergic and nonallergic rhinitis: a riddle to solve.

OBJECTIVE: To examine the epithelial integrity of the inferior turbinate in patients with perennial allergic rhinitis (PAR) and perennial nonallergic (vasomotor) rhinitis (PNAR). DESIGN: Nonrandomized, controlled morphometric study. SETTING: University-affiliated hospital. PATIENTS: Fifty-eight inferior turbinate samples were processed for histological study. Nineteen were from patients with PAR, and 20 were from patients with PNAR. Samples from 19 healthy individuals who underwent rhinoplasty for cosmetic reasons served as control specimens. MAIN OUTCOME MEASURES: The length of the basement membrane (BM) covered with intact epithelium, covered with a single layer of basal cells, and devoid of epithelium was measured. RESULTS: Intact respiratory epithelium and areas of partial and complete epithelial denudation were encountered in control specimens and in samples from patients with PAR and PNAR. A significant difference was found between the 3 groups (P = .001). The proportion of the BM covered with undamaged epithelium was significantly greater in control specimens and in samples from patients with PNAR than in samples from patients with PAR; the difference between the former 2 groups was nonsignificant. Most of the epithelial damage in patients with PAR occurred between columnar and basal cells rather than between basal cells and the BM (P = .02). CONCLUSIONS: Epithelial shedding of the inferior turbinate is a genuine feature of PAR and is not an artifact of tissue sampling. The finding of greater epithelial exfoliation between basal cells and the more superficial columnar cells than between basal cells and the BM probably reflects different attachment qualities of these cells.

The histopathology of the hypertrophic inferior turbinate.

OBJECTIVE: To analyze the quantitative and qualitative characteristics of the hypertrophic inferior turbinate (IT). DESIGN: A prospective, nonrandomized, controlled, morphometric study. SETTING: University-affiliated hospital. Subjects Seventeen patients with refractory IT hypertrophy and 12 with normal ITs. INTERVENTIONS: Twenty ITs were removed from patients with refractory IT hypertrophy and 14 from patients with normal ITs. MAIN OUTCOME MEASURES: The soft tissue and bony elements and the relative proportions of the soft tissue constituents of the hypertrophic and normal ITs were measured and compared. The Bonferroni correction was used to adjust for multiple comparisons. Qualitative assessment was performed to assess possible pathologic changes in all IT tissues. RESULTS: The hypertrophic ITs were significantly wider. The medial mucosal layer, which thickened from a mean +/- SD of 1.39 +/- 0.28 mm to 2.53 +/- 0.56 mm (P

Inferior turbinate arterial supply: histologic analysis and clinical implications.

OBJECTIVE: To study the arterial architecture of the normal inferior turbinate. DESIGN: A prospective, nonrandomized, histologic study. MAIN OUTCOME MEASURES: Fourteen samples were removed at autopsy and during septoplasty operations, processed in the usual manner, stained with hematoxylin-eosin, and investigated microscopically. The analysis included data on the number, location within or outside the bone, the mean area, wall thickness, and distance the arteries traverse from the point of entrance into the bone to the point of exit into the soft tissue. RESULTS: One to three arteries enter the inferior turbinate posteriorly. In 7 of 14 inferior turbinates (50%), the arteries lie within the bone and in 2 (14%) within the soft tissue, and in 5 (36%), a mixed pattern was observed. The arteries run along a mean of 1.2 +/- 0.49 cm before piercing the bone into the soft tissue and split off to one to six branches. The mean area and the mean wall thickness of the arteries at the entrance into the bone posteriorly were significantly greater than that of the arteries emerging from the bone and entering the soft tissue anteriorly (0.099 +/- 0.056 mm2 vs 0.051 +/- 0.022 mm2 [p < .01] and 0.116 +/- 0.042 mm vs 0.083 +/- 0.031 mm [p < .05], respectively). The inferior mucosal layer lacks major arteries. CONCLUSION: Given the data presented here, the excision of the inferior mucosal layer and the anterior portion of the inferior turbinate bone distal to the point of arterial exit constitute a relatively low risk for postoperative arterial bleeding.

Glycoconjugate expression in normal human inferior turbinate mucosa: a lectin histochemical study.

BACKGROUND: Further study on the composition and concentration of normal nasal mucosal glycoconjugates is needed. METHODS: A battery of ten lectins was used to stain six carbohydrates residing in the inferior turbinate mucosa of 21 healthy individuals. RESULTS: The concentrations of glycoconjugates of the glycocalyx exceeded that of epithelial goblet, ciliated, and basal cells, and also of mucous, serous, and mixed submucosal glands. Epithelial goblet cells and submucosal mucous glands contained relatively high concentrations of glycoconjugates, whereas in epithelial ciliated and basal cells, similar to serous and mixed submucosal glands, concentrations were scanty. The concentrations of N-acetylgalactosamine and galactose were higher in goblet cells than in mucous glands (p = 0.006, and p = 0.056, respectively). Differences in the concentrations of N-acetylglucosamine, fucose, mannose, and sialic acid were insignificant. CONCLUSIONS: The findings provide a baseline for comparison of the composition and concentration of carbohydrates of the normal and pathologic inferior turbinate mucosa.

Endoscopy versus radiography for the diagnosis of acute bacterial rhinosinusitis.

The aim of the study was to estimate the sensitivity and specificity of endoscopy and the diagnostic value of clinical criteria for acute bacterial rhinosinusitis (ABRS). The hospital records of 117 consecutive patients who had symptoms compatible with ABRS and who underwent sinus radiography and flexible nasendoscopy were retrieved. A positive diagnosis was entertained when radiography demonstrated air fluid level, complete opacification or at least 6 mm mucosal thickening and/or endoscopy revealed purulent material within the drainage area of the sinuses. Using a modified version of the Hui and Walter procedure, the sensitivity and specificity of nasendoscopy was calculated against sinus radiography, a standard reference test, with known estimated sensitivity (76%) and specificity (79%). The findings show that 40 patients (34%) had positive endoscopy and radiography. Twenty patients (17%) had positive endoscopy and negative radiography, and vice versa in 15 (13%). In 42 patients (36%) both modalities were negative. Endoscopy yielded a sensitivity of 80% (95% CI, 0.55-1.00) and a specificity of 94% (95% CI, 0.33-1.00). Although estimates seem better than those of radiography, the confidence intervals are quite wide and no firm conclusion is drawn. Neither single nor combination of symptoms, concurrent with two major and one minor factor advocated by the AAO-HNS Task Force on Rhinosinusitis, were associated with a positive diagnosis of ABRS. The data suggest that endoscopy is no less effective than radiography in predicting ABRS, also that clinical criteria are of rather limited diagnostic value, and thus should be supported by other diagnostic tests. Endoscopy is recommended as a first line diagnostic tool for the diagnosis of ABRS in routine ENT practice. If the outcome is negative, radiography may follow.

Laser cryptolysis for the treatment of halitosis.

OBJECTIVE: To evaluate the tonsils as a source of halitosis and to assess the efficacy of laser CO(2) cryptolysis for the treatment of oral bad breath caused by chronic fetid tonsillitis. METHODS: Fifty-three patients with halitosis originating from chronic fetid tonsillitis, who completed laser cryptolysis were enrolled in the study. The origin of halitosis was demonstrated by Finkelstein's tonsil smelling test, which included massaging the tonsils and smelling the squeezed discharge. All patients were treated by laser cryptolysis, an office procedure done under topical anesthesia. Subjective and objective postoperative assessment was based on self-and-family report and clinical assessment. Patients were reexamined 4 to 6 weeks post-treatment, and when the need for further laser treatment was determined. RESULTS: Complete elimination of halitosis required one session in 28 patients (52.8%), 2 sessions in 18 patients (34%), and 3 sessions in 5 patients (9.4%). Follow-up period ranged from 3 to 36 months (mean, 20.8 +/- 8.5 months). No adverse effects or complications were encountered. CONCLUSIONS: After excluding dental or periodontal, sinonasal, oral, pulmonary, or gastroenterological diseases as the origin of halitosis, chronic fetid tonsillitis remains a common cause of halitosis. Patients suffering from halitosis should be treated relying on their examination including Finkelstein's tonsil smelling test. Laser CO(2) cryptolysis is an effective, safe, and well-tolerated procedure for the treatment of halitosis.

The rising incidence of adult acute epiglottitis and epiglottic abscess.

OBJECTIVE: To examine preliminary observations that the incidence of adult acute epiglottitis has risen between 1986 and 2000. MATERIALS AND METHODS: Demographics, annual and seasonal occurrences, clinical presentation, diagnostic procedures, treatment, airway management, and complications of 116 consecutive adult patients with laryngoscopically confirmed acute epiglottitis are presented. RESULTS: The mean annual incidence of acute epiglottitis per 100,000 adults significantly increased from 0.88 (from 1986-1990) to 2.1 (from 1991-1995) and to 3.1 (from 1996-2000) (P <.001). This rise seems to be unrelated to Haemophilus influenzae type b infection but related to miscellaneous pathogenic bacteria. During these periods, the number of epiglottic abscesses increased concomitantly with the rise in the incidence of acute epiglottitis (from 4/14 episodes [29%], to 8/38 [21%], and to 16/66 [24%], respectively), showing a relatively constant ratio between both phenomena (P =.843). Twenty-five patients (21%) underwent airway intervention, 16 because of objective respiratory distress and 9 because of imminent respiratory obstruction. Stepwise logistic regression showed that drooling, diabetes mellitus, rapid onset of symptoms, and abscess formation were associated with airway obstruction. Diverse origins for the epiglottic abscess, either from coalescent epiglottic infection or from mucopyocele of the tongue base, are suggested. CONCLUSIONS: A rise in the incidence of acute epiglottitis and a concomitant rise in the number of epiglottic abscesses were established. Although the course of acute epiglottitis is often benign and can be safely treated with a conservative management approach, delayed airway obstruction may develop from a few hours to days after admission.

Temporomandibular joint involvement in malignant external otitis.

OBJECTIVE: The purpose of this study was to present 6 patients with malignant external otitis (MEO) that resulted in temporomandibular joint (TMJ) involvement and to discuss the incidence, clinical presentation, and treatment modalities. STUDY DESIGN: All patients diagnosed with MEO between 1994 and 2002 were reviewed for cases in which the TMJ was invaded by the infectious process. Only patients in whom TMJ involvement was documented radiographically and in whom the clinical course was well documented were included in this study. RESULTS: MEO was diagnosed in 42 patients over an 8-year period; TMJ involvement was recorded in 6 patients (14%). The medical history revealed controlled type 2 diabetes mellitus in 4 of the 6 patients. All patients reported early ear symptoms, mainly otalgia and otorrhea. Local signs included an ear canal filled with granulation material, edematous overlying skin, and sensitivity to palpation. Cultures taken from the external ear were positive for either Pseudomonas aeruginosa, Staphylococcus epidermidis, Aspergillus, or Proteus mirabilis. TMJ symptoms developed between 1 and 5 months after admission and included painful periauricular swelling and trismus. In 3 patients, healing was uneventful; 3 also died of the disease. CONCLUSIONS: TMJ involvement in MEO is associated with a resistant disease process, often with several recurrences. Prolonged administration of antibiotics is the treatment of choice. Surgical debridement of the TMJ is necessary for the positive identification of the pathogenic organism, in cases of abscess formation, or when osteomyelitic bone destruction of the condyle and glenoid fossa develop.

The normal inferior turbinate: histomorphometric analysis and clinical implications.

OBJECTIVE: To study the histological and morphometric features of the normal inferior turbinate. STUDY DESIGN: A prospective, nonrandomized study. METHODS: Sixteen specimens were removed at autopsy and during septoplasty operations, stained with H&E, and investigated microscopically. The soft tissue and bony elements were measured. Morphometric analysis included measurements of the relative proportions of the soft tissue constituents. RESULTS: The medial mucosal layer is thicker than the bone and the lateral mucosa; the difference between the mucosal layers is statistically significant. The inferior turbinate is almost exclusively covered with a pseudostratified ciliated columnar epithelium that houses more goblet cells on its lateral side. It has a well-defined basement membrane zone that is significantly thicker on the medial side. The main bulk of the inferior turbinate is the lamina propria that is built of loose connective tissue and superficially harbors an inflammatory cell infiltrate. The area fraction of glands in the lateral mucosa significantly exceeds that of the medial and inferior mucosal layers, whereas that of venous sinusoids varies significantly, with the greatest difference inferiorly. Decreased proportion of glands and an increase in venous sinusoids are associated with advanced age. The cancellous central bony layer is made of interwoven trabeculae and houses the major arterial supply of the turbinate. After the major arteries exit the bone, they lie in the deepest portions of the medial and lateral mucosal layers but are missing from the inferior layer. CONCLUSION: In-depth histomorphometric analysis can assist in developing new function-preserving approaches to turbinate surgery.

Is there a better way to do laser-assisted uvulopalatoplasty?

OBJECTIVE: To assess the subjective and objective short- and medium- to long-term results of laser-assisted uvulopalatoplasty (LAUP) for snoring and obstructive sleep apnea. DESIGN: A nonrandomized, prospective, before-after trial. PATIENTS AND INTERVENTIONS: Twenty-five patients underwent a modified procedure of LAUP termed one-stage LAUP, and a matched control group of 24 patients underwent uvulopalatopharyngoplasty. MAIN OUTCOME MEASURES: Subjective analysis of LAUP included a preoperative and 2 postoperative evaluations of the state of snoring (4 weeks and after a mean +/- SD of 12.2 +/- 9.9 months). A score on 5 other sleep-related symptoms was recorded before and after completion of LAUP. The objective polysomnographic outcomes were compared with a control group undergoing uvulopalatopharyngoplasty. RESULTS: In 25 patients, improvement in the state of snoring significantly declined from 76% (n = 19) to 32% (n = 8), and worsening increased from 12% (n = 3) to 32% (n = 8) (P<.001). Evaluation of 5 other sleep-related symptoms showed that 52% of patients (n = 13) improved and 20% (n = 5) worsened. Polysomnography of LAUP patients showed that the mean postoperative respiratory disturbance index worsened significantly (33.1 +/- 23.1) compared with the preoperative one (25.3 +/- 14.3) (P =.05); also, 20% of the procedures were successful and 36% revealed marked worsening. The respiratory disturbance index of uvulopalatopharyngoplasty patients changed from 26.0 +/- 18.0 to 18.7 +/- 21.3, yet improvement did not reach statistical significance (P =.09). Furthermore, 58% (n = 14) of the surgical procedures were successful and only 8% (n = 2) revealed marked worsening. CONCLUSIONS: The favorable, subjective, short-term results of modified LAUP deteriorated over time. The procedure might also lead to aggravation of existing apnea. These findings are probably related to progressive palatal fibrosis and velopharyngeal narrowing originated by the laser beam.