Allergic reaction to hypoglossal nerve stimulator: a case report.

Unlabelled: Little is documented about the frequency and management of allergic reactions to hypoglossal nerve stimulator implants. This case report describes a 69-year-old female with obstructive sleep apnea who received a hypoglossal nerve stimulator device and had an adverse reaction concerning for an allergic reaction to the medical device. The complication was managed via topical steroids, and although the patient's symptoms initially resolved she experiences continued intermittent maculopapular pruritic rashes approximately once per week.

Differences in Positive Airway Pressure Requirements in Obstructive Sleep Apnea Between Black and White Patients.

Objective: There are disparities between Black and White patients in the utilization of positive airway pressure (PAP) alternatives for obstructive sleep apnea (OSA). Given low utilization rates among Black patients, there is limited knowledge of PAP alternative outcomes in this group. Therapeutic PAP levels are clinically accessible measures that have been shown to predict PAP alternative outcomes.

The Repeatability of Pharyngeal Opening Pressure Under Drug-Induced Sleep Endoscopy.

Objective: Pharyngeal opening pressure (PhOP) is a measure of upper airway collapsibility that can be obtained during drug-induced sleep endoscopy (DISE) using a continuous positive airway pressure (CPAP) titration. However, the stability of PhOP over the course of sedation during DISE remains unclear. This study aims to compare repeat measures of PhOP over the course of DISE.

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study.

Objective: Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion.

Methods: This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022.

Hypoglossal Nerve Stimulator Explantation Technique and Outcomes: A Retrospective Case Series.

Introduction: Upper airway stimulation via the hypoglossal nerve stimulator (HGNS) implant is a surgical method for treating obstructive sleep apnea. However, patients may need the implant removed for a variety of reasons. The purpose of this case series is to assess surgical experiences with HGNS explantation at our institution.

International Consensus Statement on Obstructive Sleep Apnea.

Background: Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).

Methods: Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats.

The Accuracy and Reliability of Visually Assessed Pharyngeal Opening Pressures During Drug-Induced Sleep Endoscopy.

Objective: To examine the accuracy and interrater reliability of a visually assessed vs airflow-based measure of pharyngeal collapsibility obtained in patients with obstructive sleep apnea undergoing drug-induced sleep endoscopy (DISE).

Study Design: Prospective observational study.

Setting: Academic tertiary care practice.

The role of craniofacial maldevelopment in the modern OSA epidemic: a scoping review.

Objectives: There is increasing recognition that environmental factors affect human craniofacial development and our risk for disease. A scoping review of the literature was performed looking at environmental influences on craniofacial development to better understand this relationship and investigate what further study is needed to determine how this relationship may impact obstructive sleep apnea.

Methods: A comprehensive literature search was performed using the Ovid Medline database from inception to May 2020 with relevance to craniofacial development in 5 clinically oriented variables: diet, secular change, breastfeeding/nonnutritive sucking habits, nasal obstruction/mouth breathing, and masticatory muscle function.

A comparison of ultrasound echo intensity to magnetic resonance imaging as a metric for tongue fat evaluation.

Study Objectives: Tongue fat is associated with obstructive sleep apnea (OSA). Magnetic resonance imaging (MRI) is the standard for quantifying tongue fat. Ultrasound echo intensity has been shown to correlate to the fat content in skeletal muscles but has yet to be studied in the tongue.

Influence of apnea vs hypopnea predominance in predicting mean therapeutic positive airway pressures among patients with obstructive sleep apnea.

Study Objectives: Lower therapeutic positive airway pressure (PAP) levels are associated with improved response to non-PAP therapies in the treatment of obstructive sleep apnea. The aim of this study was to evaluate the prevailing notion that patients with apnea-predominant obstructive sleep apnea require higher therapeutic PAP levels compared to patients with hypopnea-predominant obstructive sleep apnea.

Methods: An institutional review board-approved retrospective review was performed using strict inclusion criteria: presence of type I or III sleep study, apnea-hypopnea index > 10 events/h, and adherence to auto-adjusting continuous positive airway pressure.

Relation between arousability and outcome of upper airway stimulation in the Stimulation for Apnea Reduction (STAR) Trial.

Study Objectives: Upper airway stimulation (UAS) is an innovative surgical treatment for obstructive sleep apnea; however, the treatment failure rate is approximately 22%. Easy arousability may limit the tolerability of stimulation and, by extension, its effectiveness. The odds ratio product (ORP) is a continuous electroencephalographic metric of arousal propensity (range: 0 [deep sleep] to 2.

Updates on management of pediatric obstructive sleep apnea.

Obstructive sleep apnea (OSA) affects about 1%-5% of the pediatric population. The consequences of untreated OSA in children include neurocognitive deficits, behavioral problems, poor school performance as well as systemic and pulmonary hypertension. The treatment options for pediatric OSA are numerous with a variety of surgical and non-surgical interventions.

Prospective Determination of Airway Response to Upper Airway Stimulation: A New Opportunity for Advanced Device Titration.

Objectives/hypothesis: Response to upper airway stimulation (UAS) is associated with the degree of airway opening during stimulation. UAS programming may affect this opening. The objective of this study was to examine airway changes in response to five different electrode configurations programmable within the Inspire UAS system.

Utility of the modified Mallampati grade and Friedman tongue position in the assessment of obstructive sleep apnea.

Study Objectives: The modified Mallampati (MM) grade and Friedman tongue position (FTP) are commonly used scales that assess the oropharynx during evaluation for obstructive sleep apnea (OSA). Though used by many practitioners, there is controversy in the literature regarding their practical utility. The goal of this review will be to review the history of how the MM and FTP were developed, to discuss current evidence for their usefulness in the workup of OSA, and to provide future direction to better understand their utility in the workup of OSA.

Hypoglossal Nerve (Cranial Nerve XII) Stimulation.

Hypoglossal nerve stimulation is a novel strategy for the treatment of obstructive sleep apnea (OSA). Its anatomy allows for easy surgical access, and its function as a motor nerve allows for tolerable neurostimulation. It has shown success as a therapy for the treatment of OSA with a greater than 80% success rate.

Upper airway stimulation therapy and sleep architecture in patients with obstructive sleep apnea.

Objectives/hypothesis: To quantify changes in sleep architecture before and after upper airway stimulation (UAS) therapy in patients with obstructive sleep apnea.

Study Design: Retrospective chart review.

Methods: This study was performed at a single-institution tertiary academic care center.

Transoral robotic surgery versus upper airway stimulation in select obstructive sleep apnea patients.

Objectives: Transoral robotic surgery (TORS) has been used to treat obstructive sleep apnea (OSA) since 2009, with recent meta-analysis showing an average reduction of apnea-hypopnea index (AHI) from 44.3 to 17.0.

Postnasal drip and postnasal drip-related cough.

Purpose Of Review: This article describes the pathophysiology and management of postnasal drip (PND) with and without cough.

Recent Findings: PND is a common complaint in primary care and ear-nose-throat offices, and is often, but not always, associated with chronic cough. Because it lacks objective testing and its symptoms can be vague and variable, PND has become a catch-all diagnosis for a variety of nasal and throat-related symptoms.

Frontal sinus volume predicts incidence of brain contusion in patients with head trauma.

Background: The function of the paranasal sinuses is a topic of debate. One hypothesis suggested has been that sinuses act as a "crumple zone," serving to protect the contents of the head from impact. In this study, we examine the interactions of the frontal sinus and the brain in the setting of head trauma.