Sleep apnea multi-level surgery trial: long-term observational outcomes.

Study Objectives: The sleep apnea multi-level surgery (SAMS) randomized clinical trial showed surgery improved outcomes at 6 months compared to ongoing medical management in patients with moderate or severe obstructive sleep apnea (OSA) who failed continuous positive airway pressure therapy. This study reports the long-term outcomes of the multi-level surgery as a case series.

Methods: Surgical participants were reassessed >2 years postoperatively with the same outcomes reported in the main SAMS trial.

Volumetric magnetic resonance imaging analysis of multilevel upper airway surgery effects on pharyngeal structure.

Study Objectives: The Sleep Apnea Multilevel Surgery (SAMS) trial found that modified uvulopalatopharyngoplasty with tonsillectomy (if tonsils present) combined with radiofrequency tongue ablation reduced obstructive sleep apnea (OSA) severity and daytime sleepiness in moderate-severe OSA. This study aimed to investigate mechanisms of effect on apnea-hypopnea index (AHI) reduction by assessing changes in upper airway volumes (airway space, soft palate, tongue, and intra-tongue fat).

Methods: This is a case series analysis of 43 participants of 51 randomized to the surgical arm of the SAMS trial who underwent repeat magnetic resonance imaging (MRI).

Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea: The SAMS Randomized Clinical Trial.

Importance: Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated.

Objective: To determine whether combined palatal and tongue surgery to enlarge or stabilize the upper airway is an effective treatment for patients with OSA when conventional device treatment failed.

Design, Setting, And Participants: Multicenter, parallel-group, open-label randomized clinical trial of upper airway surgery vs ongoing medical management.

An automated segmentation framework for nasal computational fluid dynamics analysis in computed tomography.

The use of computational fluid dynamics (CFD) to model and predict surgical outcomes in the nasal cavity is becoming increasingly popular. Despite a number of well-known nasal segmentation methods being available, there is currently a lack of an automated, CFD targeted segmentation framework to reliably compute accurate patient-specific nasal models. This paper demonstrates the potential of a robust nasal cavity segmentation framework to automatically segment and produce nasal models for CFD.

Chronic Rhinosinusitis: Potential Role of Microbial Dysbiosis and Recommendations for Sampling Sites.

Chronic rhinosinusitis (CRS) is an inflammatory condition that affects up to 12% of the human population in developed countries. Previous studies examining the potential role of the sinus bacterial microbiota within CRS infections have found inconsistent results, possibly because of inconsistencies in sampling strategies. The aim of this study was to determine whether the sinus microbiome is altered in CRS and additionally if the middle meatus is a suitable representative site for sampling the sinus microbiome.

Bacterial Communities Vary between Sinuses in Chronic Rhinosinusitis Patients.

Chronic rhinosinusitis (CRS) is a common and potentially debilitating disease characterized by inflammation of the sinus mucosa for longer than 12 weeks. Bacterial colonization of the sinuses and its role in the pathogenesis of this disease is an ongoing area of research. Recent advances in culture-independent molecular techniques for bacterial identification have the potential to provide a more accurate and complete assessment of the sinus microbiome, however there is little concordance in results between studies, possibly due to differences in the sampling location and techniques.

The putative herpes simplex virus 1 chaperone protein UL32 modulates disulfide bond formation during infection.

Unlabelled: During DNA encapsidation, herpes simplex virus 1 (HSV-1) procapsids are converted to DNA-containing capsids by a process involving activation of the viral protease, expulsion of the scaffold proteins, and the uptake of viral DNA. Encapsidation requires six minor capsid proteins (UL6, UL15, UL17, UL25, UL28, and UL33) and one viral protein, UL32, not found to be associated with capsids. Although functions have been assigned to each of the minor capsid proteins, the role of UL32 in encapsidation has remained a mystery.

Comparison of anatomical abnormalities in patients with limited and diffuse chronic rhinosinusitis.

Background: The role of anatomical abnormalities in the pathogenesis of chronic rhinosinusitis (CRS) remains unclear. We hypothesized that anatomical abnormalities causing obstruction of mucus drainage would be more prevalent in patients with limited CRS than in patients with pansinusitis, who are more likely to have a generalized mucosal abnormality.

Methods: The computed tomography (CT) scans of patients with limited sinusitis (maxillary sinus and/or the ostiomeatal unit), patients with diffuse bilateral disease, and asymptomatic controls were studied.

Silastic splints reduce middle meatal adhesions after endoscopic sinus surgery.

Background: Adhesions frequently form between the middle turbinate and lateral nasal wall after endoscopic sinus surgery (ESS) and are a possible cause for surgical failure. Many absorbable and nonabsorbable spacers have been tried to improve healing. This study was designed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase.

Efficacy of medical therapy in treatment of chronic rhinosinusitis.

Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required.

Simultaneous tonsillectomy and nasal surgery in adult obstructive sleep apnea: a pilot study.

Objective: Although adenotonsillectomy is the accepted treatment for obstructive sleep apnea (OSA) in the pediatric population, tonsillectomy has not been widely adopted in adults, and its success in this group has not been well reported. Despite the lack of current evidence, there may be an important role for tonsillectomy in selected adult cases, and further study is required. This is a pilot study from a larger group of subjects currently enrolled and awaiting surgery and repeat polysomnography.

Functional and cosmetic outcomes of external approach septoplasty.

Background: The external approach for septoplasty is an important surgical technique to manage severe septal deviations, caudal deformities, and mid-dorsal abnormalities when a simple endonasal approach may not suffice. The procedure is longer in duration and draws on more resources than endonasal septoplasty. The outcome reporting of the external approach for septoplasty is important to provide evidence of benefit for both patients and health care providers.

Novel approach of medialization thyroplasty with arytenoid adduction performed under general anesthesia with a laryngeal mask.

Objective: To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture.

Study Design: Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis.

Minimal clinically important differences in nasal peak inspiratory flow.

Introduction: Acoustic Rhinometry, Rhinomanometry, Nasal Spirometry and Nasal Peak Inspiratory flow (NPIF) all measure subtly different constructs of nasal function. All have limitations but NPIF is simple and quick to integrate into clinical practice. The minimum clinically important difference (MCID) for an outcome measure is an estimate of the smallest change that is experienced by a patient or group as being significant.

Functional outcomes of structured nasal tip refinement.

Objective: To describe a technique to refine the nasal tip and supratip while preserving structure; traditional attempts to reduce nasal tip bulbosity involve maneuvers that may result in loss of support, leading to poor functional and cosmetic outcomes.

Methods: A prospective study of patients undergoing open structure nasal tip refinement using scroll joint excision with a septal-lateral crural suture to flatten the lateral crus. Outcomes assessed were nasal peak inspiratory flow (NPIF), nasal obstruction scores, 22-item Sinonasal Outcome Test (SNOT-22), 36-item Short-Form questionnaires (SF-36), and anchor scores for breathing and cosmesis.

Superantigens.

Superantigens (SAgs) are derived from diverse sources, including bacteria, viruses, and human hepatic tissue. SAgs initially cause lymphocyte activation but then result in clonal deletion and anergy, leading to immune tolerance. They can also act as superallergens by stimulating a broad spectrum of mast cells and basophils in patients with allergic conditions.

Technique of temporoparietal fascia flap in ear and lateral skull base surgery.

Objectives: The temporoparietal fascia (TPF) is a distinct anatomic layer of the lateral scalp with a defined blood supply. The TPF flap has desirable properties for otologic surgery: high malleability, distinct vascularity, and close proximity to the temporal bone. This article describes our technique for preserving the TPF in approaches to the temporal bone and its subsequent use in otologic reconstructive surgery.

Cutting the chorda tympani: not just a matter of taste.

Introduction: Chorda tympani injury as a complication of middle-ear surgery has been extensively studied with regard to its effects upon taste. However, the chorda tympani also carries parasympathetic fibres to the salivary glands of the oral cavity. To date, little has been reported about the effect of chorda tympani section upon salivary function.

Screening for staphylococcal superantigen genes shows no correlation with the presence or the severity of chronic rhinosinusitis and nasal polyposis.

Background: Staphylococcus aureus secretes numerous exotoxins which may exhibit superantigenic properties. Whereas the virulence of several of them is well documented, their exact biological effects are not fully understood. Exotoxins may influence the immune and inflammatory state of various organs, including the sinonasal mucosa: their possible involvement in chronic rhinosinusitis has been suggested and is one of the main trends in current research.

Laryngeal cryptococcosis: Clinical presentation and treatment of a rare cause of hoarseness.

Objective: Laryngeal cryptococcosis is rare, with few reported cases in the literature. We present current investigation and treatment recommendations for this disease.

Study Design: A structured literature review; additional cases and expert opinion are presented.

Mutational analysis of the herpes simplex virus type 1 UL25 DNA packaging protein reveals regions that are important after the viral DNA has been packaged.

The herpes simplex virus type 1 (HSV-1) UL25 gene encodes a minor capsid protein, pUL25, that is essential for packaging the full-length viral genome. Six regions which contain disordered residues have been identified in the high-resolution structure of pUL25. To investigate the significance of these flexible regions, a panel of plasmids was generated encoding mutant proteins, with each member lacking the disordered residues in one of the six regions.

Olfactory disorders: the patients' view.

Objective: To investigate the level of knowledge that patients had about their olfactory disorder at the time of presentation to a specialist Olfaction Clinic.

Design: Multi-centered, cohort study of consecutive patients presenting to specialist Olfaction Clinics surveyed using a standardized questionnaire.

Setting: Tertiary referral Olfactory Clinics in Geneva, Switzerland and Dresden, Germany.