Radiographic and histologic characterization of tongue base tissues obtained by transoral robotic surgery in patients with obstructive sleep apnea.

OBJECTIVE: Our aim was to radiographically and histologically characterize the tongue base tissues removed after robotic surgery and to analyze their relationship with polysomnographic measurements in obstructive sleep apnea. METHODS: Medical records, radiographs and histologic specimen of the patients who underwent transoral robotic tongue base reduction surgery were retrospectively reviewed. Findings in computed tomography (CT) images, histopathological features of the removed tongue base tissues, and respiratory parameters in polysomnography were compared and analyzed. RESULTS: Surgical specimens and CT images were available from 13 patients (aged 29-61 years). Histologic examination showed that the removed tissues comprised four layers-epithelial, lymphoid follicular, glandular, and muscle tissue. The median (interquartile range) thickness of the epithelial, lymphoid, and glandular layers was 0.29 (0.24-0.44) mm, 3.37 (1.67-4.75) mm, and 3.75 (3.45-4.10) mm, respectively. The lymphoid layer thickness on CT was correlated with that in the histologic section (r=0.967, p<0.001). However, the thickness of each layer had no significant correlation with the polysomnographic parameters. CONCLUSION: The tongue base tissue removed by transoral robotic surgery in OSA patients comprised four distinctive layers including epithelial, lymphoid follicular, glandular and muscular layers. These layered structures could also be discriminated in the CT images.

Soft palate cephalometric changes with a mandibular advancement device may be associated with polysomnographic improvement in obstructive sleep apnea.

PURPOSE: It is unclear whether soft palate-associated changes in cephalometry associated with a mandibular advancement device (MAD) are independently associated with improvements in polysomnography (PSG) respiratory parameters in obstructive sleep apnea (OSA). METHODS: This retrospective review aimed to identify the association between soft palate-associated changes in cephalometry and PSG changes after application of an MAD. Korean patients diagnosed with OSA who underwent cephalometry with or without an MAD were enrolled. All the patients were evaluated after undergoing full-night PSG twice: once with an MAD and once without. Cephalometric findings were measured using an image analyzer. RESULTS: Mean apnea-hypopnea index significantly decreased with an MAD from 36.4/h to 14.7/h (p < 0.001). Retropalatal airway space significantly increased with an MAD from 6.6 to 7.3 mm (p = 0.013). Soft palate length also significantly decreased with an MAD from 43.6 to 42.3 mm (p = 0.02). Although these findings were shown by responders (patients with a reduction of apnea-hypopnea index by more than 50%), there were no significant changes in non-responders. However, retroglossal airway space did not significantly increase with an MAD even in responders. CONCLUSIONS: Improvement of OSA with an MAD can be predicted with soft palate-associated upper airway changes shown in cephalometry.

A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling.

STUDY OBJECTIVES: The definition and the criteria for the successful treatment of obstructive sleep apnea vary, depending on the study. This study aimed to compare different success criteria of non-continuous positive airway pressure (non-CPAP) treatment for obstructive sleep apnea in terms of sleep quality by using cardiopulmonary coupling. METHODS: We included 98 patients who had been treated with sleep surgery or with a mandibular advancement device at our sleep clinic from January 2011 to March 2013. The success and failure groups were divided by 6 criteria that have been used in the literature. The validity of each of the 6 criteria was evaluated by cardiopulmonary coupling-based sleep quality. RESULTS: The parameters of cardiopulmonary coupling indicated that sleep quality improved with non-CPAP treatment: low-frequency coupling decreased from 57.4% ± 17.7% to 46.9% ± 16.5%, whereas high-frequency coupling increased from 30.2% ± 17.1% to 37.4% ± 16.7%. In multiple regression analysis, only the criterion of a reduction in the apnea-hypopnea index greater than 50% was significantly associated with sleep quality improvement (p = 0.016; 95% confidence interval, 1.008-1.076 in the high-frequency coupling increment; p = 0.001; 95% confidence interval, 1.025-1.099 in the low-frequency coupling decrement). CONCLUSIONS: Cardiopulmonary coupling analysis showed that a reduction in the apnea-hypopnea index of more than 50% might be the optimal criterion to determine the success or failure of non-CPAP treatment in terms of sleep quality.

Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study.

BACKGROUND/OBJECTIVE: There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA) with those of power-assisted adenoidectomy. STUDY DESIGN: Prospective multi-institutional study. METHODS: Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C) or without cauterization (PAA-C) due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated. RESULTS: A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females) were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1) CA (n = 116); (2) PAA+C (n = 153); and (3) PAA-C (n = 119). Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001) and degree of intraoperative bleeding was significantly less (P < 0.001) compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016). CONCLUSIONS: This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding.

Effects of cigarette smoking on rhinologic diseases: Korean National Health and Nutrition Examination Survey 2008-2011.

BACKGROUND: Several studies have shown a relationship between cigarette smoking and general diseases of the nose in a large Asian population. The current study was conducted to better understand the effect of cigarette smoke exposure on rhinologic diseases in Koreans. METHODS: Data were obtained from the 2008-2011 Korea National Health and Nutrition Examination Survey, a cross-sectional survey of the noninstitutionalized population in Korea. Of the 37,753 people surveyed, 11,589 adult participants had completed questionnaires on rhinologic symptoms and smoking behaviors, had undergone nasal endoscopy, and had provided urine collection were enrolled. Rhinologic diseases investigated in this study included subjective olfactory dysfunction, rhinitis symptoms, chronic rhinosinusitis (CRS), and nasal septal deviation with obstructive symptoms. The relationship between disease and cigarette smoking was evaluated using multivariate regression analyses. RESULTS: In South Korea, the weighted prevalence of subjective olfactory dysfunction, rhinitis symptoms, CRS, and nasal septal deviation with obstructive symptoms was 4.6%, 27.2%, 6.2%, and 4.0%, respectively. The only disease significantly associated with active smoking was CRS in participants 40 years of age and older after adjusting for age, sex, residency, house income, education, and occupation (adjusted odds ratio = 1.427, 95% confidence interval = 1.050 to 1.938). For each year of active smoking, CRS prevalence increased by 1.5%. None of the rhinologic diseases examined were associated with passive smoking. CONCLUSION: Our study showed that CRS seems to be associated with active smoking in older participants. Considering the relatively high prevalence of CRS in Korea, further longitudinal researches for their association and prevention are required.

Splicing variant of AIMP2 as an effective target against chemoresistant ovarian cancer.

Chemoresistance is a main cause for the failure of cancer management and intensive investigation is on-going to control chemoresistant (CR) cancers. Although NF-κB has been suggested as one of the potential targets to alleviate chemoresistance of epithelial ovarian cancer (EOC), direct targeting of NF-κB may result in an unexpected effect due to the complex regulatory network via NF-κB. Here we show that AIMP2-DX2, a splicing variant of tumor suppressor AIMP2, can be a therapeutic target to control CR EOC. AIMP2-DX2 was often highly expressed in CR EOC both in vitro and in vivo. AIMP2-DX2 compromised the tumor necrosis factor alpha-dependent pro-apoptotic activity of AIMP2 via the competitive inhibition of AIMP2 binding to TRAF2 that plays a pivotal role in the regulation of NF-κB. The direct delivery of siRNA against AIMP2-DX2 into abdominal metastatic tumors of ovarian cancer using a microneedle converged on microendoscopy significantly suppressed the growth rate of tumors. The treated cancer tissues showed an enhanced apoptosis and the decreased TRAF2 level. Thus, we suggest that the downregulation of AIMP2-DX2 can be a potent adjuvant therapeutic approach for CR EOC that resulted from an aberrant activity of NF-κB.

Resolved effusion on myringotomy: a study of dry tap without general anesthesia.

OBJECTIVES: Finding a resolution of middle ear effusion using myringotomy, or dry tap (DT), is relatively common, but its clinical outcome is confounded by general anesthesia (GA). The confounding effect of GA and a time delay can be removed because laser myringotomy can be completed under topical anesthesia, which is a routine procedure for otitis media with effusion (OME) before GA in our clinic. DT without GA would clarify the clinical outcome, and the percentage of recurrence for OME after DT would be clinically relevant. The objectives of the present study are (1) to clarify the clinical nature of DT without including the confounding effect of GA and a time delay and (2) to determine if OME recurs when a ventilation tube (VT) is not used for DT. METHODS: The control group consisted of 308 children who received an unilateral myringotomy due to a natural resolution in the contralateral ear. The experimental group consisted of 296 children who had a bilateral myringotomy, and a ventilation tube was not inserted for DTs after laser myringotomy under topical anesthesia. The rate of DT and the recurrence rate of OME without tube insertion was the main outcome measure. RESULTS: In the control group, which showed a natural resolution, the rate of DT was 16.9% (52/308) of patients, and DT was more common in non-B tympanometry, which only had a recurrence rate of 17.3% (9/52). In the study group, 3.7% of patients showed unilateral DT (UDT) with contralateral positive effusion, and 5.4% of patients showed bilateral DTs (BDTs). BDT showed a non-B tympanometry pattern and a low rate of recurrence (25.0%), which was similar to the control group. UDT showed a B-type tympanometry in 81.8% of the patients, and the recurrence rate was significantly higher (68.2%; 15/22) than the BDT and control patients. BDT or DT with signs of natural resolution showed a low rate of OME recurrence regardless of tympanometry, and thus, patients do not need a VT. CONCLUSIONS: DT was not rare even without GA and the associated time delay, and DT was more common in the children that showed a natural resolution. However, microscopy and tympanometry was imperfect to predict dry tap, and thus, the surgeon needs to be prepared for individualized management of DT. UDT with B-type tympanometry and contralateral persistent effusion frequently recurred without tubes, and thus, VT for UDT appeared to be necessary.