[VOTE versus ACLTE: comparison of two snoring noise classifications using machine learning methods]. / VOTE versus ACLTE: Vergleich zweier Schnarchgeräuschklassifikationen mit Methoden des maschinellen Lernens.

BACKGROUND: Acoustic snoring sound analysis is a noninvasive method for diagnosis of the mechanical mechanisms causing snoring that can be performed during natural sleep. The objective of this work is development and evaluation of classification schemes for snoring sounds that can provide meaningful diagnostic support. MATERIALS AND METHODS: Based on two annotated snoring noise databases with different classifications (s-VOTE with four classes versus ACLTE with five classes), identically structured machine classification systems were trained. The feature extractor openSMILE was used in combination with a linear support vector machine for classification. RESULTS: With an unweighted average recall (UAR) of 55.4% for the s­VOTE model and 49.1% for the ACLTE, the results are at a similar level. In both models, the best differentiation is achieved for epiglottic snoring, while velar and oropharyngeal snoring are more often confused. CONCLUSION: Automated acoustic methods can help diagnose sleep-disordered breathing. A reason for the restricted recognition performance is the limited size of the training datasets.

[S1 guideline on the "diagnosis and treatment of snoring in adults"]. / S1-Leitlinie "Diagnostik und Therapie des Schnarchens des Erwachsenen".

Due to the frequency of this phenomenon and the often considerable distress caused to the affected person, competent advice, diagnosis and treatment of snoring in adults is of particular importance. The aim of this guideline is to promote high-quality medical care for patients affected by this problem. According to the three-level concept of the AWMF, it corresponds to an S1 guideline. Prior to any therapeutic intervention, relevant sleep medical history, clinical examination, as well as a mandatory objective diagnostic measure are performed. Snoring is only treated if the patient asks for it. In general, invasive methods should be viewed critically and the patient should be advised correspondingly. In the case of surgical therapy, minimally invasive techniques are preferred. Reducing body weight (in the case of overweight snorers), abstinence from alcohol, nicotine and sleep medication, as well as maintaining a healthy sleep-wake cycle can be recommended from a sleep-medicine perspective, although convincing clinical studies are not yet available. Since evidence for the effectiveness of muscle stimulation or various methods for toning and training of the muscles of the floor of mouth is not available, these methods are not recommended. Snoring can be successfully treated with the use of an intraoral device; however, careful patient selection is important. Avoiding a supine position during sleep can be helpful in some cases. Only limited data is available on the success rates of the surgical approaches and long term data is often lacking, and not all techniques have been sufficiently evaluated from a scientific point of view. Nasal surgery is only indicated if the patient suffers from nasal obstruction. Extensive data supports the effectiveness of laser-assisted resection of excessive soft palate tissue (laser-assisted uvuloplasty, LAUP). In principle, however, such resections can be performed using other techniques. Placebo-controlled studies were able to prove the effectiveness of radiofrequency surgery of the soft palate. A reduction in snoring could also be achieved in many cases by means of soft palate implants with minimal post-operative morbidity. The indication for tonsillectomy and uvulopalatopharyngoplasty should be made cautiously due to the comparatively high morbidity associated with these procedures.

[Guideline: Treatment of obstructive sleep apnea in adults]. / Leitlinie: Therapie der obstruktiven Schlafapnoe des Erwachsenen.

The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.

[Obstructive sleep apnea syndrome and upper airway resistance syndrome. Gender-related differences]. / Obstruktives Schlafapnoesyndrom und Upper Airway Resistance Syndrom: Geschlechtsspezifische Unterschiede.

BACKGROUND: The aim of this study was to assess potential gender-related differences in the clinical presentation and polysomnographic parameters of patients with obstructive sleep apnea syndrome (OSAS) and upper airway resistance syndrome (UARS). PATIENTS AND METHODS: The polysomnographic variables and medical histories of 165 women with OSAS and 66 women with UARS from two sleep disorder clinics, presenting consecutively between 2000 and 2006 were retrospectively analyzed. These women were matched with an identical number of men, presenting during the same time frame, by diagnostic category (UARS/OSAS), age, and BMI. RESULTS: The relative percentage of women diagnosed with UARS varied dependent on their menopausal status. Postmenopausal women presented significantly less frequently with UARS than pre- and perimenopausal women. The adjusted odds ratio for a diagnosis of OSAS vs UARS was 5.5 (CI: 2.3;13.2; P=0.001) compared to premenopausal women. UARS women had a 30 min higher subjective sleep need than UARS men (8.2+/-1.1 vs 7.7+/-1.1 h/night; P=0.028). UARS women consumed significantly more prescription drugs than UARS men (P=0.017), and presented with a significantly lower quality of life score than their male counterparts (P=0.021). The quantitative snoring measure during sleep did not indicate significant gender differences between diagnostic categories and gender. CONCLUSIONS: Clinical presentation and polysomnographic parameters in patients with OSAS and UARS show distinct gender-related differences. These differences should be considered when patients present with signs and symptoms of OSAS or UARS.

Soft palate implants: a new option for treating habitual snoring.

One hundred six patients with proven habitual snoring were each treated with three implants consisting of a cylindrical-shaped segment of braided polyester filaments (18 mm in length with an outer diameter of 1.5 mm) in the soft palate. The implants, pre-loaded in a single-use delivery tool, were inserted into the soft palate under local anesthesia. Along with the initial examination, follow-up exams were done after the treatment to test the safety and efficacy of the procedure. Snoring post treatment was reported as "no snoring" or "slight/occasional" in the majority of the cases after treatment. The results indicate there were no serious adverse events reported. The most frequent minor adverse events were partial extrusions in which the patient often presented a minor foreign body sensation along with mild transient pain. This data has demonstrated the procedure as a minimally invasive, relatively painless, simple procedure that has been shown to be safe and effective.

[Microscopic endonasal sinus surgery (MESS) in nasal polyposis: long term results]. / Mikrochirurgia endonasalna zatok w leczeniu polipów nosa: wyniki odlegle.

The endonasal microscopic sinus surgery (EMSS) in polyposis nasi is a grateful and in most cases successful procedure with a relative low risk of complications. In 1988 and 1989 we operated on 302 patients with polyposis nasi following the "Heermann Concept of EMSS". In each case the total ethmoidectomy with maxillary, sphenoid and frontal sinus surgery was performed. After an average of 5.2 years we started a follow-up in 185 patients including a questionnaire and clinical examination with endoscopic control and olfactometry. We found recurrent polyposis in 17.3% and a reoperation was necessary only in 6.5%. The complaints in polyposis as nasal obstruction, frontal cephalgia and hyposmia could be improved in more than 80%. About 26.5% of our patients suffered from bronchial asthma. Every second of them (51%) saw an improvement of asthma complaints after the operation. It is remarkable, that the clinical and endoscopic findings do not correlate in all cases with the subjective judgement of the patients. We saw patients with manifest recurrent polyposis, who did not deplore any complaints and vice versa. At last 85.4% said, that they would undergo the operation again.

[The Heermann modification of intranasal microsurgery in lacrimal duct stenoses]. / Die Heermann-Modifikation der intranasalen Mikrochirurgie bei Tränenwegstenosen.

The authors demonstrated Heermann's modification of intranasal microsurgery on the tearways. Since 1912 all intranasal lacrimal sac operations at the Krupp Hospital (up to 98 cases yearly) have been performed according to Randolph and West (1909). During the last 36 years our patients have been operated on in a semisitting-(Fowlers)-position with the help of the binocular microscope and with hypotensive anaesthesia. This technique of lacrimal sac surgery is demonstrated "step-by-step" with the removal of the medial wall of the lacrimal sac in abscesses or dacryoliths. In rare cases of a presaccal stenosis, a circular resection of the stenosis after J. Heermann (1989/1991) was done to leave the common duct open by the retraction of the scar. That is the reason why the insertion of plastic prostheses is rarely necessary (only in patients with congenital aplasia or extensive stenosis of the horizontal lacrimal duct). Funnel-shaped prostheses of glass were developed in 1925 by J. Heermann sen., of steel 1930 by H. Heermann and made by plastic material 1966 by J. Heermann. During a ten-year period (1976-1986) we evaluated 659 cases of intranasal microsurgery on the tearways. The use of plastic prosthesis was necessary in 17 cases. Including reoperations (first operation after Toti) satisfactory results were obtained in 94% of all cases.