A novel OSA-related model of intermittent hypoxia in endothelial cells under flow reveals pronounced inflammatory pathway activation.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent episodes of upper airway obstruction and subsequent hypoxia. In patients with OSA, severity and number of these hypoxic events positively correlate with the extent of associated cardiovascular pathology. The molecular mechanisms underlying intermittent hypoxia (IH)-driven cardiovascular disease in OSA, however, remain poorly understood-partly due to the lack of adequate experimental models. Here, we present a novel experimental approach that utilizes primary human endothelial cells cultivated under shear stress. Oxygen partial pressure dynamics were adopted in our in vitro model according to the desaturation-reoxygenation patterns identified in polysomnographic data of severe OSA patients (n = 10, with 892 severe desaturations, SpO2<80%). Using western blot analysis, we detected a robust activation of the two major inflammatory pathways ERK and NF-κB in endothelial cells, whereas no HIF1α and HIF2α protein stabilization was observed. In line with these findings, mRNA and protein expression of the pro-inflammatory adhesion and signaling molecule ICAM-1 and the chemokine CCL2 were significantly increased. Hence, we established a novel in vitro model for deciphering OSA-elicited effects on the vascular endothelium. First data obtained in this model point to the endothelial activation of pro-inflammatory rather than hypoxia-associated pathways in OSA. Future studies in this model might contribute to the development of targeted strategies against OSA-induced, secondary cardiovascular disease.

The RonchAP® palatinal device: A conservative approach in treating obstructive sleep apnea syndrome-a randomized, controlled study.

PURPOSE: The aim of the present study was to assess the efficacy of the Ronch®AP palatal device in treating patients with moderate and severe forms of obstructive sleep apnea syndrome. METHODS: In a randomized controlled trial 22 patients were examined with the Ronch®AP palatal device after 4 weeks of usage. Their results were compared to a control group of 30 patients who did not receive any treatment during this time. All patients included did not tolerate CPAP therapy. Among other parameters the apnea-hypopnea index (AHI) was measured using nocturnal cardiorespiratory polysomnography. Daytime sleepiness was assessed using Epworth Sleepiness Scale. Pittsburgh Sleep Quality Index was used to analyze sleep quality. RESULTS: Using the Ronch®AP palatal device AHI was reduced from an average of 35.34 ± 14.9/h to 19.18 ± 14.93/h, whereas the control group only showed a minimal mean reduction from 31.32 ± 12.76/h to 29.37 ± 17.11/h. The difference in reduction between the two randomized groups was highly significant (d = - 14.2, 95% CI 5.9-22.6, t = 3.4, df = 49.9, p = 0.001). Epworth Sleepiness Scale score was lowered from 9.18 ± 4.73 to 7.82 ± 4.14 on average and sleep quality improved by - 1.91 ± 2.31. Both changes were also statistically relevant (p < 0.005). CONCLUSIONS: The Ronch®AP device is an effective alternative treatment option for patients suffering from moderate and severe forms of obstructive sleep apnea syndrome and not tolerating CPAP therapy. TRIAL REGISTRATION NUMBER: 407-16 with approval from the local ethical committee (Ethikkommission der Medizinischen Fakultät der LMU München).

Impact of the COVID-19 pandemic on head and neck cancer diagnosis: data from a single referral center, South Tyrol, northern Italy.

OBJECTIVE: The aim of the study was to evaluate the impact of the COVID-19 pandemic on new diagnoses of head and neck cancer (HNC) in South Tyrol, northern Italy in terms of the number of new diagnoses and worsening disease stage due to diagnostic delay. METHODS: Patients were divided into two groups: the control group with a first diagnosis of HNC in 10 months before the national lockdown (March 9th, 2020) and the study group with a first diagnosis of HNC in 10 months after lockdown. RESULTS: A total of 124 patients were included in the study. Before the spread of COVID-19, 79 new diagnoses of HNCs were registered, while in the period after the lockdown, 45 new cancers cases were diagnosed and the difference was statistically significant (p = 0.01278). Early clinical T-stage results showed 52 cases in the control group and 21 in the study group, again with a significant difference (p = 0.03711). Advanced T-stage results showed 27 cases in the control group and 24 in the study group. CONCLUSIONS: This study highlights the impact of the COVID-19 pandemic on HNCs, showing a statistically significant difference in the number of diagnoses before and after the lockdown which was related to the spread of the SARS-CoV-2 virus, and with a relevant decrease in early cT-staged HNCs.

Outcome of Auricular Reconstruction with Porous Polyethylene Frameworks: Our 10 Years of Experience with 113 Children and Adults.

This study evaluates the surgical outcome and patient benefit after auricular reconstruction with porous polyethylene frameworks and temporoparietal fascia flaps in both children and adults. A total of 161 patients who had undergone auricular reconstruction between 2003 and 2014 by doctors in our department were asked to answer both a validated health-related quality-of-life questionnaire (Glasgow Benefit Inventory or Glasgow Children's Benefit Inventory) and a questionnaire reporting satisfaction, complaints, and complications with the reconstructed pinna. Furthermore, postoperative surgical complications were recorded. A total of 113 patients (89 individuals older than 14 and 24 children under the age of 14) returned the questionnaires. About 80% of the patients were satisfied with the results of their auricular reconstruction. The main complaints concerned scars and the shape. Patients' quality of life was correlated with their postoperative aesthetic satisfaction. Thus, framework extrusion was the principal factor affecting patients' satisfaction, whereas treatable postoperative complications did not interfere with the overall quality of life. Interestingly, children indicated greater benefit from auricular reconstruction than older patients. With regard to the patient's feeling of being physically healthy after auricular reconstruction, partial pinna reconstruction and reconstruction without simultaneous hearing restoration should be very carefully considered. Auricular reconstruction using a porous polyethylene framework significantly increases the patients' health-related quality of life and leads to significant patient satisfaction, especially in the case of younger patients.

Total versus subtotal tonsillectomy for recurrent tonsillitis - a prospective randomized noninferiority clinical trial.

Background: For many years experts have called for randomized controlled trials to resolve the question whether tonsillectomy, which is associated with significant comorbidity, can be replaced by partial tonsillectomy in patients with recurrent tonsillitis.Objective: To find out whether subtotal tonsillectomy is a suitable therapeutic alternative to total tonsillectomy in adult patients with recurrent episodes of acute tonsillitis.Material and methods: Study design - Single-blind prospective non-inferiority randomized clinical trial with intraindividual design. Setting - 80 patients were recruited at a tertiary referral center. Subjects - Adult patients with recurrent tonsillitis received total tonsillectomy on one side and subtotal tonsillectomy on the other side after randomization. Main outcome measure was frequency of postoperative tonsillitis on the side of subtotal tonsillectomy and postoperative pharyngitis in the former tonsil area on the side of total tonsillectomy. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00015628).Results: Within 12 months none of the subjects suffered from recurrent tonsillitis after subtotal tonsillectomy. Subtotal tonsillectomy caused less pain than total tonsillectomy.Conclusion: Subtotal tonsillectomy might be an alternative treatment option associated with lower morbidity than total tonsillectomy in adults with recurrent tonsillitis.

Partial auricular reconstruction with porous polyethylene frameworks and superficial temporoparietal fascia flap.

Untreated acquired auricular damage can be a psychological burden, especially for younger patients. The significance of auricular reconstruction in patients with microtia in terms of quality of life has already been demonstrated. In these patients the use of porous polyethylene combined with a temporoparietal fascia flap has proven to be a suitable method for achieving good cosmetic results. Here, we describe how to use porous polyethylene combined with an endoscopically harvested temporoparietal fascia flap and autologous skin grafts for the reconstruction of acquired partial auricle defects and present outcomes and patient benefit. Ten consecutive patients were asked to answer validated questionnaires [modified Glasgow Benefit Inventory (GBI)] determining the effects of partial ear reconstruction on their health-related quality of life. These patients were seen regularly in our outpatient clinic for documentation and postoperative counseling. All patients returned a valid questionnaire; 80% were satisfied with the esthetic result. In retrospect, all patients would again decide to undergo surgery. The mean total GBI score was 27.8 (median 29.2, p < 0.05) reflecting an improvement of the health-related quality of life due to the operation. Odd feeling, numbness and the formation of scar tissue were the main complaints. Partial auricular reconstruction using porous polyethylene combined with an endoscopically harvested temporoparietal fascia flap and autologous skin grafts yields good esthetic results and can significantly increase patient's health-related quality of life.

1-year follow-up after radiofrequency tonsillotomy and laser tonsillotomy in children: a prospective, double-blind, clinical study.

In the last decade, tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. In a previous study, the tonsillotomy with laser or radiofrequency therapy proved as a safe and effective procedure with minimal pain and hemorrhage. This follow-up study determines which method is more effective with respect to long-term outcome, recurrence of tonsillar hyperplasia and recurrence of tonsillitis. A prospective, randomised, double-blinded controlled clinical study was conducted at the Department of Otorhinolaryngology of the Ludwig-Maximilians-University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Tonsillotomy was performed on one side with monopolar radiofrequency and on the other side with a carbon dioxide laser. Exactly 1 year after the procedure, all 26 patients were documented by digital photography to define a possible recurrence of tonsillar hyperplasia. All parents were asked for occurring tonsillitis and fulfilled the Glasgow Children's Benefit Inventory (GCBI) for health-related quality of life after surgical procedures. In seven children, a slightly visible recurrence of the tonsillar hyperplasia occurred, without any symptoms or correlation to the different methods and sides. One child with recurrent tonsillitis and hyperplasia had to be tonsillectomized 8 months after the initial tonsillotomy procedure. The specimen showed open crypts with bacterial infection in the deep. The GCBI resulted in highly significant benefits of the surgery in all categories and subcategories. In conclusion, both methods, the laser tonsillotomy and the radiofrequency method, were equal concerning the effectiveness and safety after 1 year. Further investigations have to aim at the long-term outcome after tonsillotomy in patients with recurrent infections.

Auricular reconstruction with porous polyethylene frameworks: outcome and patient benefit in 65 children and adults.

BACKGROUND: This study evaluates outcome and patient benefit after plastic auricular reconstruction using a porous polyethylene framework and a temporoparietal fascia flap in both pediatric and adult patient collectives. METHODS: Seventy-eight patients were asked to answer validated questionnaires determining the effects of the reconstruction on the patients' health-related quality of life (Glasgow Benefit Inventory or Glasgow Children's Benefit Inventory); Glasgow Benefit Inventory and Glasgow Children's Benefit Inventory scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). Furthermore, patients were questioned regarding satisfaction, complaints, and complications with the reconstructed ear. RESULTS: Sixty-five patients (83.3 percent) returned a valid questionnaire. In the adult collective (n = 45), the mean total Glasgow Benefit Inventory score was 21.2 (p < 0.001); 72.7 percent were satisfied with the aesthetic result, and 86.7 percent would again decide in favor of the operation. In the pediatric collective (n = 20), the mean total Glasgow Children's Benefit Inventory score was 27.7 (p < 0.001); 70.0 percent of the parents and 85.0 percent of the children were satisfied with the aesthetic result; 95.0 percent of the parents and 90.0 percent of the children would again decide in favor of the operation. The health-related quality of life was raised in 75.6 percent of the adults and 100 percent of the children. Scars and feel of the reconstructed ear were the main complaints in both collectives. Patients with acquired auricular defects were approximately two times as likely not to be satisfied with the result compared with patients with congenital defects. CONCLUSIONS: Auricular reconstruction using a porous polyethylene framework can significantly increase patients' health-related quality of life, and leads to a high rate of patient satisfaction.

The annoyance of snoring.

Is the annoyance of snoring a reliable tool for the measurement of snoring or does it depend more on the sensitivity of the listener? During an automatized hearing experiment, 550 representative snoring sequences, recorded during polysomnography, were randomly presented to ten examiners for the evaluation of their annoyance (0-100). The mean annoyance score for each snoring sound and the covariance parameters for rater and snoring sounds (restricted maximum likelihood method) were calculated. The average annoyance rating of all snoring sequences was 63.9+/-23.0, the most acceptable snoring sequence rating was 49.2+/-28.0, the most annoying rating was 77.7+/-16.4. The covariance parameters were estimated as 28.7% for the rater and 22.3% for the snoring sound. Our results show that the listeners' noise sensitivity is at least equally relevant for the snoring annoyance as the snoring sound itself.

Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: polysomnographic results.

INTRODUCTION: The therapy of choice in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) consists of tonsillectomy or tonsillotomy combined with adenoidectomy. While tonsillectomy unfortunately has a notable risk of secondary hemorrhage and postoperative pain, tonsillotomy is safer and less painful for children. The effect of both surgical methods on symptoms of OSAS seems to be equal, but up to now postoperative polysomnographic data for children treated by tonsillotomy are missing. MATERIALS AND METHODS: Twenty children aged 2-9 years (mean age: 4.1+/-2.0 years) with OSAS diagnosed by full-night polysomnography were included in the study. OSAS was defined as an apnea-hypopnea index (AHI) of 5 or more with minimum oxygen saturation (SaO(2) min) of less than 90%. Exclusion criteria were obesity, craniofacial abnormalities or other pulmonary, cardiac or metabolic diseases as well as a history of recurrent tonsillitis. All children were treated by CO(2) laser tonsillotomy and adenoidectomy. Three to 12 months (mean: 7.7 months) after the procedure a control-polysomnography was performed in all children. RESULTS: No statistically significant changes were seen in the pre- and postoperative distribution of sleep stages, sleep efficacy and total sleep time. The AHI decreased from 14.9+/-8.7 to 1.1+/-1.6 (p<0.001), SaO(2) min increased from 71.1+/-11.1% to 91.2+/-3.5% (p<0.001). Thus, all children were cured by the operation. DISCUSSION: These polysomnographic data show that CO(2) laser tonsillotomy in combination with adenoidectomy is highly effective in the treatment of pediatric OSAS and should be preferred over tonsillectomy because of less postoperative pain and a lower risk of postoperative bleeding.