Sex differences in mandibular repositioning device therapy effectiveness in patients with obstructive sleep apnea syndrome.

PURPOSE: Mandibular repositioning devices (MRDs) are an effective treatment option for obstructive sleep apnea syndrome (OSAS), particularly in patients who refuse or cannot tolerate continuous positive airway pressure (CPAP). However, sex differences in the response to therapy and predictors of response are not clearly defined. This analysis of data from the long-term prospective ORCADES trial compared MRD efficacy in men and women with OSAS. METHODS: The ORCADES study included patients with newly diagnosed mild-to-moderate or severe OSAS who refused or were non-compliant with CPAP. MRD therapy was titrated over 3-6 months. The primary endpoint was treatment success (≥ 50% decrease in apnea-hypopnea index (AHI)). Complete response was defined using a range of AHI cut-off values (< 5/h, < 10/h, < 15/h). RESULTS: Overall treatment success rates were 89% in women and 76% in men (p = 0.019); corresponding rates in those with severe OSAS (AHI > 30/h) were 100% and 68% (p = 0.0015). In women vs. men, overall complete response rates at AHI cut-off values of < 5/h, <10/h, and < 15/h were 49 vs. 34% (p = 0.0052), 78 vs. 62% (p = 0.016), and 92 vs. 76% (p = 0.0032). On multivariate analysis, significant predictors of MRD treatment success were overbite and baseline apnea index in men, and neck circumference and no previous CPAP therapy in women. There were sex differences in the occurrence of side effects. Temporomandibular joint pain was the most common reason for stopping MRD therapy. CONCLUSIONS: MRD therapy was effective in women with OSA of any severity, with significantly higher response rates compared with men especially in severe OSAS. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01326143).

EK Sign: A Wrinkling of Uvula and the Base of Uvula in Obstructive Sleep Apnea-Hypopnea Syndrome.

Introduction. Diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) is suspected in the presence of symptoms and/or pharyngeal alterations and skeletal abnormalities of maxilla and mandible. Our aim is to find a new clinical sign that leads to suspicion of OSAHS in snorers. Methods. We reviewed the clinical data of 69 snoring patients with or without OSAHS. We defined EK sign as the presence of horizontal wrinkling of uvula and the base of uvula and tried to correlate its presence with OSAHS. Results. EK sign was present in 25 of 69 patients. The positive predictive value of EK sign is 100%. The presence of EK sign significantly correlated with OSAHS (44% if AHI ≥ 5 and 0% if AHI < 5; p = 0.01) and severity of OSAHS (7% if AHI < 15 and 58% with AHI ≥ 15; p < 0.001). Conclusions. The EK sign is a strong predictor of OSAHS with a specificity of 100%. We recommend performing sleep tests in presence of EK sign in snorers even in the absence of other abnormalities or symptoms.

Hydroxyapatite versus titanium ossiculoplasty.

OBJECTIVE: To compare the results of ossicular chain reconstruction using hydroxyapatite (HA) and titanium (TI) prostheses. STUDY DESIGN: Retrospective study and case series. SETTING: Tertiary referral center. PATIENTS: One hundred sixty-eight patients presenting chronic otitis media with or without cholesteatoma. INTERVENTION: Ossiculoplasty using partial or total HA and TI ossicular replacement prostheses (TORP and PORP, respectively). MAIN OUTCOME MEASURES: Patients were assessed at 2 months postoperatively to establish short-term results. Results of treatment for conductive hearing loss were reported according to guidelines. Available audiometric data at 1, 2, 3, and 5 years were used to assess prosthesis stability. Average postoperative air-conduction gain, air-bone gap, and sensorineural hearing level were measured at four frequencies: 0.5, 1, 2, and 4 kHz. Statistical analyses compared outcomes for HA TORP versus TI TORP and HA PORP versus TI PORP. RESULTS: Postoperative air-bone gap of less than 20 dB was obtained in 50% of HA TORP versus 45.8% of TI TORP cases and in 63.2% of HA PORP versus 72% of TI PORP cases. Preoperative middle ear status and presence/absence of malleus significantly influenced postoperative audiometric results. All types of prosthesis demonstrated significant postoperative air-conduction gain decrease on follow-up. Prosthesis exclusion was observed in three cases (1.78%). CONCLUSION: Prostheses using both types of biomaterial gave good functional results and stability with low exclusion rates, with no statistically significant differences between the two. Trends could be observed for slightly better results for HA in total reconstruction and for TI in partial reconstruction. The degradation in postoperative functional gain seemed to be independent of prosthesis type.

Natural history of adult-onset laryngeal papillomatosis following multiple cidofovir injections.

OBJECTIVES: A prospective study was performed to assess the intermediate and long-term efficacy of intralesional cidofovir therapy associated with surgical excision in laryngeal papillomatosis in adults. METHODS: Endoscopy with intralesional injection of cidofovir 5 mg/mL was performed 3 times at 4-week intervals. The concentration was later increased to 7.5 mg/mL and the interval between injections shortened to 2 weeks. Further treatment was performed at 3 or 6 months, depending on the evolution of the papillomas. After complete remission, the treatment was stopped and the patients were reviewed every 6 months. RESULTS: Nineteen patients completed the protocol, with a mean of 4.5 injections each. Complete remission was obtained in 17 cases (89%) after a mean of 3.8 procedures. Remission was stable after a mean follow-up of 24 months (range, 8 to 57 months). With higher cidofovir concentrations at shorter intervals, patients needed fewer injections to achieve remission (mean, 2.1 versus 4.7 injections). CONCLUSIONS: The effectiveness of intralesional cidofovir therapy in adult-onset recurrent respiratory papillomatosis was impressive. Once obtained, complete remission was stable on intermediate or long-term follow-up. The concentration and the interval between injections seemed to influence the number of injections necessary to achieve remission.

CT-assisted surgery in choanal atresia.

OBJECTIVE: To limit restenosis after surgical repair of choanal atresia. MATERIAL AND METHODS: A total of 20 children (age range 3 days to 11 years) with choanal atresia underwent surgical repair using a microdebrider via an intranasal approach. Surgery was guided by CT. Mitomycin was administered at the end of the procedure. RESULTS: An average of 1.7 procedures per child were required. CT combined with peroperative endoscopy revealed postoperative neo-osteogenesis and insufficient bone resection. CONCLUSIONS: CT-assisted intranasal repair led to extended bone resection of the atretic plate, the predominant cause of which was restenosis resulting from neo-osteogenesis.