Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon’s Experience

ORL ◽  
2020 ◽  
Vol 82 (6) ◽  
pp. 335-342
Author(s):  
Heejin Kim ◽  
Sung Won Li ◽  
Sung Min Park ◽  
Sung Kyun Kim ◽  
Seok Jin Hong ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Postoperative Pain ◽  
Pediatric Patients ◽  
Recurrent Tonsillitis ◽  
Obstructive Sleep ◽  
History Of ◽  
The Mean ◽  
Intracapsular Tonsillectomy

<b><i>Introduction:</i></b> Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. <b><i>Objective:</i></b> The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. <b><i>Methods:</i></b> A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2–14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. <b><i>Results:</i></b> In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (<i>p</i> = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. <b><i>Conclusions:</i></b> Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

Prevalence and natural history of obstructive sleep apnea in pediatric patients with laryngomalacia

2020 ◽  
Vol 133 ◽  
pp. 109967
Author(s):  
Darian Fard ◽  
Matthew L. Rohlfing ◽  
Alina Razak ◽  
Michael B. Cohen ◽  
Jessica R. Levi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Natural History ◽  
Pediatric Patients ◽  
Obstructive Sleep ◽  
History Of

Abstract WP417: Treatment of Obstructive Sleep Apnea and the Risk of Subsequent Stroke and Cardiovascular Events

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michael E Reznik ◽  
Alexander E Merkler ◽  
Alan Z Segal ◽  
Babak A Navi ◽  
Hooman Kamel
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiovascular Events ◽  
Hemorrhagic Stroke ◽  
Cardiovascular Outcomes ◽  
Secondary Outcome ◽  
Diagnostic Code ◽  
Obstructive Sleep ◽  
The Mean

Background: Growing evidence suggests that obstructive sleep apnea (OSA) is associated with an increased risk of stroke and adverse cardiovascular outcomes; however, there are limited data that treating OSA with positive airway pressure (PAP) devices significantly decreases this risk. We therefore examined the association between PAP therapy and the risk of subsequent stroke and cardiovascular outcomes in patients with OSA. Methods: We performed a population-based cohort study using outpatient and inpatient administrative claims data from a nationally representative 5% sample of Medicare beneficiaries from 2008 through 2014. Our cohort comprised patients with OSA, whom we identified using an algorithm of an ICD-9-CM procedure code for a home or lab sleep study along with at least two subsequent diagnostic code claims for OSA. Our predictor variable was prescribed therapy with continuous PAP or bi-level PAP, defined using CPT codes. Our primary outcome was a composite of hospitalization for ischemic stroke, hemorrhagic stroke (intracerebral or subarachnoid hemorrhage), myocardial infarction, or congestive heart failure. Kaplan-Meier survival statistics were used to calculate cumulative rates, and Cox regression analysis was used to calculate hazard ratios (HR) that adjusted for age, sex, race, and established vascular risk factors. Results: We identified 38,987 patients with OSA, of whom 1,195 were prescribed PAP therapy. The mean age of all patients with OSA was 73.0 (±5.5) years, and 43.6% were women. Patients prescribed PAP therapy had a higher baseline burden of vascular comorbidities. The mean follow-up was 2.2 (±1.6) years. By 5 years of follow-up, the cumulative rate of our composite outcome was 30.3% (95% CI, 25.4-35.9%) in patients prescribed PAP therapy versus 31.2% (95% CI, 30.4-32.0%) in untreated patients (adjusted HR, 0.8; 95% CI, 0.7-0.9). This association was similar but not statistically significant when assessing the secondary outcome of ischemic or hemorrhagic stroke (adjusted HR, 0.7; 95% CI, 0.5-1.1). Conclusion: Patients with OSA who were treated with PAP were less likely to experience stroke or adverse cardiovascular events compared to those who did not receive treatment.

Adjustable Tongue Advancement for Obstructive Sleep Apnea: A Pilot Study

2008 ◽  
Vol 117 (11) ◽  
pp. 815-823 ◽  
Author(s):  
Evert Hamans ◽  
An Boudewyns ◽  
Boris A. Stuck ◽  
Alexander Baisch ◽  
Marc Willemen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Clinical Adverse Event ◽  
The Mean ◽  
Substantial Morbidity

Objectives: Surgical treatment of obstructive sleep apnea (OSA) caused by hypopharyngeal collapse of the upper airway can be considered in patients who are intolerant to continuous positive airway pressure (CPAP). The present procedures addressing the hypopharynx are invasive and have substantial morbidity and limited efficacy. Methods: Ten patients (mean age, 44 years) with moderate to severe OSA, ie, an apnea-hypopnea index (AHI) between 15 and 50, with CPAP intolerance were included in a prospective, nonrandomized, multicenter study to evaluate the feasibility, safety, and efficacy of a novel tongue advancement procedure. The procedure consists of the implantation of a tissue anchor in the tongue base and an adjustment spool at the mandible. Titration of this tissue anchor results in advancement of the tongue and a patent upper airway. Results: The mean AHI decreased from 22.8 at baseline to 11.8 at the 6-month follow-up (p = 0.007). The Epworth Sleepiness Scale score decreased from 11.4 at baseline to 7.7 at the 6-month follow-up (p = 0.094), and the snoring score decreased from 7.5 at baseline to 3.9 at the 6-month follow-up (p = 0.005). Four technical adverse events were noted, and 1 clinical adverse event occurred. Conclusions: Adjustable tongue advancement is a feasible and relatively safe way to reduce the AHI and snoring in selected patients with moderate to severe OSA and CPAP intolerance. Technical improvements and refinements to the procedure are ongoing.

scholarly journals Partial intracapsular tonsillectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a prospective study with 5-year follow-up

2021 ◽  
Author(s):  
Matteo Cavaliere ◽  
Pietro De Luca ◽  
Egidio De Bonis ◽  
Riccardo Maurizi ◽  
Claudia Cassandro ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Operative Evaluation ◽  
A Prospective Study ◽  
Hypopnea Syndrome ◽  
Intracapsular Tonsillectomy

Abstract Objective To assess efficacy and safety of tonsil reduction with bipolar forceps electrocautery as treatment of paediatric obstructive sleep apnea/hypopnea syndrome (OSAHS). Study design Prospective interventional study. Methods Two hundred and sixty-three children aged 4–10 years with OSAHS and an apnea hypopnea index (AHI) > 3 were enrolled from March 2013 to January 2016. Pre-operative evaluation included oropharyngeal clinical examination with fiberoptic nasopharyngoscopy, OSA-18 questionnaire and overnight sleep study. All children were treated with adenoidectomy and tonsillotomy with bipolar forceps. OSA-18 questionnaire and overnight sleep study were performed 30 days after surgery. Results Pre-operative average of the OSA-18 questionnaires was of 70.3 (SD = 9.7); 30-day post-operative score was 23.15 (SD = 8.2; p = 0.045). Pre-operative average Apnea Hypopnea Index (AHI) score was 9.41 (SD = 4.1); 30-day post-operative average of AHI score was of 1.75 (SD = 0.8; p = 0.012). Oxygen Desaturation Index (ODI) rate changed from 7.39 (SD = 4) to 1.34 (30-day post-operative) (SD = 4.7; p = 0.085). NADIR rate changed from 79% (SD = 6.32) to 90% (30-day post-operative) (SD = 5.18; p = 0.00012). Peri- and post-operative complications in our sample were mainly pain (average 75 doses of paracetamol), while bleeding did not occur (0%). All patients received a follow-up examination 5 years after surgery to evaluate tonsil size; at this time-point, a reduction in tonsil size from 3.6 (3–4; SD = 4.2) to 1.3 (1–2; SD = 5.5) was found, while tonsil regrowth was observed in five children (2%). Conclusion This study showed that partial tonsillotomy with bipolar forceps electrocautery associated to adenoidectomy is an effective technique in treating OSAHS symptoms in children and ensures less complications in terms of hemorrhage, postoperative pain and infections compared to traditional adenotonsillectomy. The very low tonsillar regrowth rate reported in this study may support the routine use of this technique.

scholarly journals Comparison of Functional Outcomes after Powered Intracapsular Tonsillectomy with Adenoidectomy and Conventional Extracapsular Tonsillectomy with Adenoidectomy for Pediatric Obstructive Sleep Apnea

2020 ◽  
Vol 63 (4) ◽  
pp. 167-171
Author(s):  
Jae-Min Jeon ◽  
Jeong-Rok Kim ◽  
Seung-Hwan Bang ◽  
Jong-Geun Lee ◽  
Jae-Min Shin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Postoperative Pain ◽  
Postoperative Bleeding ◽  
Acute Tonsillitis ◽  
Life Measurement ◽  
Obstructive Sleep ◽  
Adenotonsillar Hyperplasia ◽  
Osa Treatment ◽  
Intracapsular Tonsillectomy

Background and Objectives This study was investigated to compare the clinical outcomes and complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) with those of conventional extracapsular tonsillectomy and adenoidectomy (ECTA) in treatment of pediatric obstructive sleep apnea (OSA).Subjects and Method Eighty-one children with adenotonsillar hyperplasia underwent tonsillectomy and adenoidectomy (46 PITA and 35 ECTA) from December 2016 to July 2017 for OSA. The choice of surgical procedure (PITA vs. ECTA) was determined by the number of episodes of acute tonsillitis. The quality of life measurement was performed using Korean Obstructive Sleep Apnea Survey (KOSA-18) score. Postoperative bleeding was assessed as number of revisit or readmission. Postoperative pain was evaluated by visual analog scale (VAS) at postoperative day 1, 3, and 7.Results PITA and ECTA significantly reduced KOSA-18 scores postoperatively (p＜0.01, p＜0.01, respectively) and were equally effective in pediatric OSA treatment. Postoperative bleeding was lower in the PITA group, but there was no statistical difference due to small number of cases. VAS score for postoperative pain was significantly lower in the PITA group at day 1, 3, and 7 (p=0.03, p＜0.01, and p＜0.01, respectively).Conclusion PITA is effective in pediatric OSA treatment with less morbidity, and less complications.

Frequency of Prosthetic Complications Related to Implant-Borne Prosthesis in a Sleep Disorder Unit

2017 ◽  
Vol 43 (1) ◽  
pp. 19-23
Author(s):  
Eduardo Anitua ◽  
Juan Saracho ◽  
Gabriela Zamora Almeida ◽  
Joaquin Duran-Cantolla ◽  
Mohammad Hamdan Alkhraisat
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Bruxism ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
The Mean ◽  
Fracture Complication ◽  
Prosthetic Complications

Sleep bruxism and higher clench index have been associated with obstructive sleep apnea (OSA). However, there is no study that reports on the prosthetic complications in patients with OSA. Records of patients who had performed a sleep study to diagnose OSA were examined for the occurrence of prosthetic complications in implant-borne reconstructions. The primary outcome was the frequency of prosthetic complications. The secondary outcomes were anthropometric data, type of complication, type of prosthesis, type of retention, number of supporting implants, number of prosthetic units, and the presence of obstructive sleep apnea. Of the 172 patients, 67 had an implant-supported prosthesis, and all were included in the study. The mean age was 61 ± 10 years, and 36 were female. Thirty complications in 22 prostheses were identified in 16 patients. The complications were porcelain fracture (14 events), screw/implant fracture (8 events), screw loosening (3 events), and decementation (5 events). The follow-up time was 117 ± 90 months after placement of the prosthesis. The average time for complications to occur was 73 ± 65 months after the placement of the prosthesis. According to the apnea-hypopnea index (AHI), 49 patients had OSA. Thirteen of the 16 patients having a prosthetic complication also had OSA. The highest AHI and thus the severity of OSA was identified in patients with a fracture complication related to an implant, a screw, or a porcelain. The frequency of prosthetic complications has been higher in patients with obstructive sleep apnea.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

CHEST Journal ◽  
2002 ◽  
Vol 121 (3) ◽  
pp. 739-746 ◽  
Author(s):  
Marie-Louise Walker-Engström ◽  
Åke Tegelberg ◽  
Bo Wilhelmsson ◽  
Ivar Ringqvist
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Dental Appliance

scholarly journals Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

2021 ◽  
Author(s):  
Thyagaseely Sheela Premaraj ◽  
Jacob Stadiem ◽  
Shyamaly Arya Premaraj ◽  
Charles R. Davies ◽  
Matthew Dennis ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

Association between obstructive sleep apnea and persistent-postural perceptual dizziness

2021 ◽  
pp. 1-6
Author(s):  
Anand K. Bery ◽  
Jayson Lee Azzi ◽  
Andre Le ◽  
Naomi S. Spitale ◽  
Judith Leech ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Berlin Questionnaire ◽  
Future Studies ◽  
Obstructive Sleep ◽  
Chronic Dizziness ◽  
Patients At Risk ◽  
The Mean ◽  
The Relationship

BACKGROUND: Obstructive sleep apnea (OSA) has been linked to vestibular dysfunction, but no prior studies have investigated the relationship between Persistent Postural Perceptual Dizziness (PPPD), a common cause of chronic dizziness, and OSA. OBJECTIVE AND METHODS: We determined the frequency of OSA in an uncontrolled group of PPPD patients from a tertiary dizziness clinic based on polysomnogram (PSG). We then assessed the sensitivity and specificity of common OSA questionnaires in this population. RESULTS: Twenty-five patients with PPPD underwent PSG (mean age 47, 60% female, mean BMI 29.5). A majority, or 56%, of patients were diagnosed with OSA, and in most, the OSA was severe. OSA patients were older (56 years versus 40 years, p = 0.0006) and had higher BMI (32 versus 26, p = 0.0078), but there was no clear gender bias (56% versus 64% female, p = 1.00). The mean sensitivity and specificity of the STOP BANG questionnaire for detecting OSA was 86% and 55%, respectively. Sensitivity and specificity of the Berlin Questionnaire was 79% and 45%, respectively. CONCLUSIONS: The prevalence of OSA was much higher in our small PPPD group than in the general population. Screening questionnaires appear to demonstrate good sensitivity to detect PPPD patients at risk of OSA in this small study. Future studies should confirm these findings and determine whether treatment of OSA improves symptoms in PPPD.

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