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8/8/2019 Sumanth Journal Scan
http://slidepdf.com/reader/full/sumanth-journal-scan 1/37
JOURNAL SCAN
Nasal surgery for snoring inpatients with obstructive sleep
apnea
Hsueh-yu Li,Li-ang lee, et al.
LARYNGOSCOPE
Feb 2008
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INTRODUCTION
Patients with nasal obstruction & chronicnight time rhinitis± habitual snorers
Nasal obstruction causes snoring by 2mechanisms -
± Increased nasal resistance due to narrowingof nasal passages
± Mouth breathing leading to palatal flutter Altering airflow patterns after nasal
surgery may be effective for snoring relief.
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Objective
To evaluate the efficacy of nasal surgery
to relieve snoring and to identify predictive
factors.
Study design
Prospective comparative study
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Materials and methods
STUDY POPULATION(52 patients)
Inclusion criteria
± c/o nasal obstruction for >6 m
± DNS on ant. Rhinoscopy
± h/o habitual snoring
Exclusion criteria
± Cardiopulmonary diseases (CAD,COPD,BA) ± >60 years age
± Pathologic obesity (BMI >40 kg/m2)
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Materials and methods
Detailed explanation of operation
Written informed consent
Polysomnography(PSG) Snore outcome survey (SOS)
questionnaires
Nasal measures at baseline & 3 monthsafter surgery
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Materials and methods
SNORING AND NASAL OBSTRUCTIONSURVEY
Snore outcome survey (SOS)
± Valid reliable & disease specific ± 8 Likert type items
± Evaluate duration, loudness, frequency of snoring
Spouse/bed partner survey (SBPS) ± 3 Likert like items
Visual analogue scale (VAS) ± 0 -- no obstruction
± 10 -- complete obstruction
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Materials and methods
NASAL MEASURES
Nasal resistance (ant. rhinomanometry)
± NR = right NR x left NR cm of H2oright NR + left NR
Acoustic rhinometry
± Minimal cross sectional area (MCSA)measured
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Materials and methods
SLEEP STUDY
Overnight Polysomnography(PSG)
performed by pulmonologist. Apnea/hypoapnea index (AHI) measured
Apnea²10 sec breathing pause
Hypoapnea² 10 sec period when breathingcontinues but nasal pressure is reduced by 50%
from baseline.
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Materials and methods
SURGICAL PROCEDURES
Septomeatoplasty
± Correction of nasal septum
± Excising lateral part of inf. Turbinate
± Packing with Vaseline strips & merocel
POSTOPERATIVE CARE
Prophylactic oral antibiotic Humid O2 mask- reduces dryness of throat
Nasal packing removed after 1 day
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Materials and methods
OUTCOME MANAGEMENT
Primary measure -- change in SOS score
after nasal surgery Secondary measure ± baseline factors
influencing change in SOS score
Compared with previous study measured
after UPPP (uvulo-palato-pharyngo-plasty)
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Materials and methodsSTATISTICAL ANALYSIS
Paired t test for variables before and after surgery
Independent t test to compare postoperativechanges in SOS with UPPP
Baseline factors (BMI,AHI,total NR) of studypopulation categorized into LOW and HIGHgroups
Results expressed as mean + SD
P value < 0.5 ± considered significant
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Materials and methods
LOW group
± Mallampati grade I & II
± Tonsil grade 0 &I
HIGH group
± Mallampati grade III & IV
± Tonsil grade II & III
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RESULTS
BASELINE DATA
52 Patients(51 male,1 female)
Age range ± 23 to 57 yrs Mean age ± 39 + 10 yrs
Mean BMI ± 25.4 + 5.2 kg/m2
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RESULTS
COMPLICATIONS
Septal hematoma ± 1 patient (drained on
3rd
post op day) Postoperative nasal bleeding ± 1 patient
(controlled by ice pack and bed rest)
No airway compromise was noted duringperioperative period
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RESULTS
SURVEY OF NASAL IMPEDIMENT
Improved nasal breathing ± all patients
VAS scores decreased NR improved
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RESULTS
SNORE OUTCOME SURVEY(SOS)
Post op SOS increased in 86%
Unchanged in 2%
Decreased in 12% Complete snoring relief ± 12%(according to bedpartners)
SOS scores improved from 41.6 to 60.7
Improvement in SBPS consistent.
Changes in SOS and SBPS achieved statisticalsignificance.
SOS and SBPS scores improved 46% & 52%respectively
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RESULTS
COMPARITIVE CHANGE IN SOS SCORESBETWEEN SMP AND UPPP
variable SMP UPPP
1)Sex (m/f) 52/1 52/32)BMI 25.5 26.3
3)Mean age 39.2 45.1
4)AHI 36.6 43.6
5)Improvement 19.2 38.8
in SOS
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DISCUSSION
Current study shows that nasal surgeryimproves snoring in 86% of patients.
Changes in SOS score after nasalsurgery differed between groups withdifferent tonsil size.
Nasal surgery remains a final recourse for
correcting nasal obstruction, a symptomcommonly encountered in obstructivesleep apnea patients.
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JOURNAL SCAN
LONG TERM QUALITY OF LIFE AFTER
TOTAL LARYNGECTOMY AND
POSTOPERATIVE RADIOTHERAPY VERSUS
CONCURRENT CHEMORADIOTHERAPY
FOR LARYNGEAL PRESERVATION
Paolo Boscolo, et al.
LARYNGOSCOPE
FEB 2008
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Objective
To compare the quality of life (Qol) of
patients who underwent total laryngectomy
with voice prosthesis insertion and post-op
radiotherapy with those receiving
chemoradiotherapy for laryngeal
preservation.
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Study design
Retrospective, cross sectional study in
tertiary academic center
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Materials & Methods European organization for research and
treatment of cancer Qol questionnaires toassess 67 patients with laryngeal cancer
T1 & T2 cancers ± conservative surgery or exclusive RT
T3 & T4 cancers ± total laryngectomy with
neck dissection and primary voiceprosthesis insertion with PORT or concurrent chemoradiotherapy
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RESULTS Functional scores for
± Physical functioning -
± Social contact better in the non surgical
group
± Speech
± Quality of life -
Surgical patients complained of ± Sleep disturbances
± Dyspnea
± Pain
± Difficulty in speech
± Decreased social contact
Non surgical patients complained of ± Dry mouth
± Sticky saliva
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CONCLUSION
Better Qol in non surgical patients
Mainly because of better
± Physical functioning
± Social functioning
± Less problems with pain, respiration
± Better speech
± Less sleep disturbances
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JOURNAL SCAN
CAN INTRATYMPANICDEXAMETHASONE ADDED TO
SYSTEMIC STERIODS IMPROVE
HEARING IN PATIENTS WITH SUDDENDEAFNESS
Joong ho Ahn,Myung hoon Yoo, et al
LARYNGOSCOPE
FEB 2008
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Objective
To evaluate the therapeutic efficacy of
intratympanic dexamethasone (ITD)
injections + systemic steroids in patients
with sudden SNHL
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Materials & Methods
120 pt¶s with sudden SNHL treated with
± ITD ± 0.3 ml on day 1,3,5. followed by 48 mg
methylprednisolone [test group]
± Methylprednisolone alone [control group]
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RESULTS
Total recovery after treatment
± 73.3% in ITD group
± 70.0% in control group PTA results same in both groups
ITD group showed better hearing
improvement only at 250 Hz
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CONCLUSION
The addition of ITD to systemic steroids
did not result in significant improvement in
the treatment of sudden SNHL.
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JOURNAL SCAN
SUPERFICIAL MUSCULOAPNEUROTIC
SYSTEM ELEVATION & FAT GRAFT
RECONSTRUCTION AFTER
SUPERFICIAL PAROTIDECTOMY
Joseph M. Curry,Kyle W. Fisher, et al.
LARYNGOSCOPE
FEB 2008
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OBJECTIVE/HYPOTHESIS
Elevation of superficial musculoaponeuritic
system (SMAS) with or without
interposition during superficial
parotidectomy prevents a concave facial
deformity and Frey¶s syndrome
STUDY DESIGN
Retrospective ,case control study
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METHOD
Charts of 248 patients who underwent
superficial parotidectomy reviewed.
16 pt¶s underwent SMAS 34 pt¶s underwent SMAS with fat graft
interposition.
Non reconstructed pt¶s selected randomly. Both groups compared with controls.
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RESULTS
SMAS elevation alone
± Greater facial symmetry
± Less symptomatic Frey's syndrome
SMAS elevation with fat graft interposition
± Greater facial symmetry
± Less symptomatic Frey's syndrome
Complications among study and control
groups were similar
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CONCLUSION
Simultaneous reconstruction of a
superficial parotidectomy with or without
fat graft reconstruction
± Improves facial symmetry
± Less incidence of symptomatic Frey's
syndrome
± Without increasing complications