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.

Otosclerosis: Shift in bone conduction after stapedotomy.

OBJECTIVES: To analyze changes in bone conduction (BC) thresholds before and after stapedotomy in patients with clinical otosclerosis with a focus on the Carhart notch, which is defined as a significant loss of BC at a certain audiometric frequency. METHODOLOGY: Retrospective case review of pure tone audiometry (PTA) in 213 patients who underwent a stapedotomy at a tertiary referral center between 2004 and 2011. The patients were grouped by age and the frequency of the Carhart notch. The non-operated ear was also evaluated. RESULTS: The Carhart notch was present on pre-operative audiometry in 158 (74%) patients at 0.5 (n = 18, 8.45%), 1 (n = 25, 11.70%), or 2 kHz (n = 115, 54.0%). We measured a mean postoperative improvement in BC of 7.5, 8.4, and 8.8 dB HL. Pre-operatively, 55 (25.8%) patients did not exhibit a typical notch configuration. The mean gain in BC, defined on PTA according to the AAO-HNS criteria (0.5, 1, 2 and 3, or 4 kHz), was 1.8 dB HL after stapedotomy. CONCLUSION: The Carhart notch was not solely related to the 2 kHz frequency. The greatest gain in BC after stapedotomy for otosclerosis occurred at the notch frequency.