The 2011 Annual Meeting & OTO EXPO of the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF), the largest meeting of ear, nose, and throat doctors in the world, will convene September 11-14, 2011, in San Francisco, CA.
Featuring more than 386 scientific research sessions, 468 posters, and several hundred instruction course hours for attendees, the annual meeting is a unique opportunity for journalists from around the world to cover breaking science and medical news. Reporters will have access to the latest research and clinical advances in the field of otolaryngology - head and neck surgery.
Information for the Media
The AAO-HNSF Annual Meeting & OTO EXPO Newsroom will be located in the Moscone Convention Center, Room 250. Hours of operation: Saturday, September 10, 12pm to 5pm; Sunday - Tuesday, September 11 - 13, 7:30 am to 5 pm; and Wednesday, September 14, 8:00 am - 2:00 pm. There will also be a Meet & Great for all press with Richard Rosenfeld, MD, MPH, Editor-in-Chief of Otolaryngology-Head and Neck Surgery on Sunday, September 11, 2011, from 12:30 - 1:15pm in the newsroom.
The newsroom serves as a work space for credentialed members of the news media. The newsroom is managed and staffed by the AAO-HNS Communications Unit. Please see the AAO-HNS website for media credentialing requirements for the event.
To register and view advance press releases, log onto the AAO-HNS website at http://tinyurl.com/657a292.
Facial Plastic and Reconstructive Surgery
Deviated Nose Affects Surgical Success and Quality of Life
Presenters: Cemal Cingi, MD (presenter); G-rkem Eskiizmir
Objective: Analyze and compare the surgical outcome and quality of life in patients with and without deviated nose in rhinoplasty.
Method: A total of 191 patients who underwent primary rhinoplasty between 2006 to 2009 were enrolled. The study population was separated into nondeviated or deviated groups. The surgical outcome, pre- and postoperative quality of life was assessed using rhinoplasty outcome evaluation (ROE) and EuroQol, and statistically analyzed.
Results: A hundred ten cases had deviated nose and 81 cases had nondeviated nose. The vast majority of cases were operated using endonasal approach except 3 cases. When nondeviated and deviated groups were compared according to satisfaction with appearance, breathing problems, friends' satisfaction with appearance, social interactions, self-confidence, need for additional procedures, ROE score, statistically significant differences were determined. The comparison of preand postoperative change in EuroQol (EQ-5 index, living quality index and visual analogue scale) between 2 groups also demonstrated statistically significant differences.
Conclusion: The deviated nose is a challenging nasal morphology which may lead to lesser satisfaction in surgical outcome and inadequate improvement in quality of life. Therefore, it should be precisely evaluated in candidates of rhinoplasty.
The Prevalence of Nose Base Asymmetry in General Population
Presenters: Ana Carolina Ottoline, MD (presenter); Carla Freire de Castro Lima; Eric V.L. Mayerhoff; Geraldo Augusto Gomes, MD; Shiro Tomita, MD, PhD
Objective: 1) Evaluate the prevalence of asymmetry of the nasal base in the general population. 2) Quantify among the individuals who carried nasal base asymmetry how many were aware of the fact.
Method: Photos of the nasal base of 43 volunteers chosen randomly were taken using a macro lens. Individuals were classified as carriers or noncarriers of nasal base asymmetry. When any asymmetry was present, the image was shown to the carrier, asking whether they were aware or not of the asymmetry.
Results: Forty-three individuals between 13 and 70 years old were photographed (16 male and 27 female). The mean age was 43.11 years. Nineteen (44.19%) individuals showed some asymmetry of the nasal basal view. Of these, only 4 (21.05%) individuals were aware of their deformity.
Conclusion: Nasal base asymmetry is a prevalent deformity. Most of the individuals (78.95%) are unaware of it. It can generate controversy if the cause of the deformity was or was not a result of surgery. Nasal base asymmetries should always be photographed.
A Need for Targeted Otolaryngology Education among Primary Care Providers
Presenters: Tanya Kim Meyer, MD (presenter); Maya G. Sardesai, MD
Objective: According to the National Center for Health Statistics, 3 of the top 10 most common reasons for physician visits pertain to otolaryngology, including cough, sore throat, and ear ache. We explored the gaps in otolaryngologic knowledge among a group of primary care providers attending an educational event.
Method: A brief web-based anonymous survey regarding knowledge of basic otolaryngologic conditions was administered to primary care providers, both physicians and allied health practitioners.
Results: Thirty-seven surveys were collected from 50 participants, of which 59% were allied health and 41% were physicians. Participants practiced in adult, pediatric, and family medicine. Gaps in knowledge were identified across severalotolaryngologic subjects, including laryngology, rhinology, head and neck oncology, otology, sleep surgery, and pediatric otolaryngology.
Conclusion: There appear to be deficiencies in otolaryngologic knowledge among the primary care specialties. Increased exposure to otolaryngology rotations and lectures during training may increase understanding of common otolaryngologic diseases among these providers. It may also be beneficial to develop targeted programs for continuing medical education for these products.
Bitter Taste Receptor Gene in Patients with Taste Disorders
Presenters: Ryoji Hirai, MD (presenter); Minoru Ikeda, MD
Objective: Examine changes in the expression of taste receptor genes in patients who had loss of taste and those who had phantogeusia.
Method: The subjects of this study consisted of 51 patients with loss of bitter taste and 43 patients with phantogeusia. The control group consisted of 24 subjects. We took specimens by scraping their foliate papillae. T2R family and TAS2R family gene expression was detected using RT-PCR and electrophoresis.
Results: The patients with loss of bitter taste showed a significant decrease in the frequency of expression of taste receptor genes T2R8 (P = .002), 10 (P = .001), 13 (P = .003), 16 (pTAS2R40(p48 (P = .007) compared with the control group. The frequency of gene expression of TAS2R42 (P = .008) and T2R3 (P = .033) were significantly increased in patients with phantogeusia.
Conclusion: Expression of some genes was decreased in patients with loss of taste, while expression of other genes was increased in patients with phantogeusia. It was suggested that conflicting changes in taste receptor gene expression were involved in the pathogenesis of the loss of taste and phantogeusia.
CPR Outcomes in Hospitalized Patients with Tracheostomies
Presenters: Omer Sultan, MBBS (presenter); Vicki Loeslie; Jeff Rabatin, MD, MSc
Objective: 1) Outcomes of cardiac arrest in hospitalized patients with tracheostomies. 2) Disposition of patients at the time of hospital discharge.
Method: A retrospective electronic chart review was performed of 1102 patients who had cardiac arrest (absence of pulse or non-perfusing rhythm) at a tertiary care academic medical center between Jan 2005-Dec 2009. Data was abstracted and summarized using descriptive statistics.
Results: Twenty-six of 1102 (2%) had a tracheostomy at the time of arrest. Median age years = 61 years (range 24-83 years). A total of18 out of 26 (69%) were male. A total of 18 out of 26 (69%) had return of spontaneous circulation following resuscitation. Fourteen out of 26 (54%) were on mechanical ventilation (MV) at the time of arrest. Twenty-two out of 26 (84%) patients had tracheostomy secondary to prolonged MV. Twelve out of 26 (46%) patients were alive at 3 months and 7 out of 26 (26%) patients were alive at 1 year. Of the 11 patients who survived to discharge, disposition included: 6 out of 11 (54%) home; 3 out of 11 (27%) long-term acute care hospital (LTAC); 2 out of 11 (18%) skilled nursing facility (SNF).
Conclusion: The frequency of cardiac arrest in patients with a tracheostomy was 2.4%. Survival at 1 year was 26%. Of those who survived to discharge, 54% of patients went home and 45% were discharged to a LTAC or SNF.
Tick Bites for the Otolaryngologist
Presenters: Benjamin Walton, MD (presenter); Harold S Pine, MD
Objective: The human head and neck can provide multiple environments ideal for parasitic invasion. One of the more common parasites encountered is the tick. We report a specific case involving a tick bite involving the external auditory canal. There is a lack of evidence on the proper treatments.
Method: "Ticks," "tick bites," "head and neck," and "otolaryngology" were searched in PubMed, and relevant articles were selected and reviewed.
Results: Ticks and tick-borne diseases are outlined, and common presentations of head and neck involvement are examined. Ticks appear to be resistant to common anesthetic chemicals used in the ear. Proper removal is important in preventing transmission of disease and local skin infection. Geography and tick species dictate treatment and follow-up. We recommend antibiotic prophylaxis for certain tick species making proper tick identification important.
Conclusion: The otolaryngologist must be aware of the many differing pathogens, their epidemiology, and their treatments. Proper removal and identification of the tick are very important in further follow-up and treatment. We present an invaluable but simplified tool in the identification, removal, and management of ticks and tick bites.
Head and Neck Surgery
Impact of Age on Chemotherapy Response in Head and Neck Cancer
Presenters: Emma Cashman, MBBCh (presenter); Jochen Lorch; Michael Posner
Objective: 1) Determine if an association exists between age and overall survival (OS) and progression-free survival (PFS) in induction chemotherapy (IC) for head and neck cancer (HNC). 2) Compare age-specific response to 2 different chemotherapy regimen in HNC.
Method: A total of 501 patients enrolled on TAX 324 study (1999 to 2003) were evaluated. Patients had nonmetastatic, unresectable stage III/IV HNC. A total of 255 patients received IC with docetaxel, cisplatin, 5FU (TPF), and 246 received cisplatin, 5 fluorouracil (PF). The cohort was split into 2 groups; 55 years.
Results: Fisher exact test and general linear model approach compared clinical and demographic characteristics between treatment arms. Kaplan-Meir method estimated OS and PFS. Stepwise Cox regression modeled OS and PFS functions. A total of 249 patients were 55 years, 127 were assigned to TPF arm and 125 to PF arm, Total failures reached statistical significance between the 2 arms; there were 50 total failures in the TPF arm and 58 in the PF arm (0.65, 0.42-0.98; 0.04).
Conclusion: Our study contradicts the small amount of published evidence on age-specific responses to chemotherapy regimen in breast, prostate, and lung cancer. It is the first study of its kind evaluating the role of age in overall survival in chemotherapy in HNC.
Qualitative Analysis of the Experience of Oral Tongue Cancer Survivors
Presenters: Steven Sperry (presenter); Genevieve Philiponis; Ara A. Chalian, MD; Kelly M. Malloy, MD; Sarah H. Kagan, RN, PhD
Objective: Patient experience of oral tongue cancer and life as a survivor is poorly understood and not well described in the literature. This qualitative analysis of interviews with oral malignancy survivors aims to: 1) Describe the common experiences of patients, and 2) Identify surprising findings previously under-recognized in this patient population.
Method: Oral tongue cancer survivors from a single surgical practice at a tertiary-care center participated in open-ended interviews discussing their experience. The interviews were transcribed and analyzed using constant comparative technique. Open and axial coding identified common themes that are discussed in this descriptive analysis.
Results: Sixteen patients, aged 30 to 80 years with stage II to IV disease, participated; all but one patient underwent surgery as primary treatment. Interviews were conducted 3 months to 12 years after treatment. Patients described variable levels of physical pain throughout their experience, but particularly during radiotherapy, when it was severe. Patients' emotional distress was most pronounced at the time of diagnosis; few described sustained emotional distress. Concerns about altered speech, taste, swallowing, and dry mouth persisted, while changed appearance and social isolation were rarely reported. Interestingly, the majority of patients focused on pervasive dry mouth sensation, regardless of radiotherapy treatment.
Conclusion: Our findings describe significant variation in physical and emotional pain during disease diagnosis and treatment, with persistent concerns regarding disrupted speech, taste, and swallowing function. Troubling dry mouth sensation is pervasive, independent of adjuvant radiation treatment. Further research should focus more specifically on these experiences and their causal relationships.
Survival Differences in American Indians with Head and Neck Cancer
Presenters: Sunshine M. Dwojak, MD (presenter); Thomas Sequist; Daniel G. Deschler, MD; Kevin S. Emerick, MD
Objective: American Indians and Alaska Natives (AI/AN) experience poor overall survival. The specific aim of this study was to analyze disparities in survival between AI/AN and white patients with squamous cell carcinoma of the head and neck.
Method: We identified all incident cases of oropharyngeal, oral cavity, and hypopharyngeal/laryngeal squamous cell carcinoma among AI/AN and white patients from 1996 to 2007 using the SEER database. Univariate, multivariate, and sequential Cox proportional hazard models were fit to analyze racial differences in sex, age, stage, treatment patterns, and overall survival.
Results: For cancer of the oropharynx, AI/AN experienced decreased overall survival after adjusting for age, sex, stage, and type of treatment (hazard ratio (HR) = 1.4, P = .008). For cancer of the oral cavity, AI/AN experienced decreased survival after adjusting for patient age and sex (HR =1.3, P = .05). This difference was eliminated after adjusting for type of treatment.
Conclusion: Significant disparities in survival exist among AI/ AN patients with head and neck cancer. These disparities are variably related to stage at presentation and differential treatment patterns. Future research is needed to understand how to implement programs to reduce these differences in care and outcomes.
Vocal Problems: Teachers' Attitudes and Healthseeking Behavior
Presenters: Tze Choong Charn (presenter); Paul Kan-Hwei Mok
Objective: Teachers are at high risk for vocal disorders due to their intrinsic occupational requirements. Numerous studies have reported on the prevalence and risk factors. Less is known about teachers' ideas and attitudes. We aimed to explore teachers': 1) attitudes towards voice problems and 2) health seeking behavior.
Method: A cross-sectional study was conducted by cluster sampling method across 6 primary schools in Singapore in 2008. 214 full time teachers were recruited. Self-administered questionnaires were answered during each school's teachers meeting after informed consent.
Results: A total of 89.9% of teachers agree that losing one's voice is an occupational hazard. A total of 92.8% agree that their profession depends on the health of their voices. A total of 79.6% think that attending voice workshops will help to prevent voice problems. A total of 65.4% have had taken medical leave for voice problems in the past 12 months, of which 9.3% of them had taken 6 days or more of leave. A total of 81.7% consulted a general practitioner, 3.6% an otolaryngologist, 0% a speech therapist, and 14.8% others.
Conclusion: The surveyed teachers have very similar demographics compared with the national teaching population and are hence broadly representative. The results showed that teachers do value their voices and deem them essential for carrying out their professional duties. Productivity losses to the education system and emotional losses are real entities.
A Prospective Study of an iPhone-Assisted Particle Repositioning Maneuver for BPPV
Presenters: Brock Organ (presenter); Matthew A. Bromwich, MD, FRCS
Objective: Determine if the use of an iPhone application (DizzyFIX - Clearwater Clinical Ltd) designed to assist in the performance of the particle repositioning maneuver (PRM) for benign paroxysmal positional vertigo (BPPV) had a significant impact on medical students' performance.
Method: Study design: Randomized, single-blinded, prospective trial. Setting: Tertiary Care Hospital. Participants: Medical students. Intervention(s): Forty-one participants performed the PRM and were scored by a blinded observer. Twenty-one participants used the application while the remainder used a sham. Main outcome measure(s): PRM score, graded on an 11-point scale, and total time.
Results: Participants randomized to the iPhone application group scored higher on their observed performance of the PRM than the placebo group (P < .0001) with a mean difference of 4.98 points. Participants randomized to the placebo group consistently performed the maneuver faster (P < .0001) than those who had a functional iPhone application. The average placebo participant performed the maneuver in only 79.9 seconds while participants in the test group averaged 245.8 seconds. In summary, initial testing demonstrated that participants using the DizzyFix iPhone application conducted the PRM more accurately and slowly than the participants using a placebo.
Conclusion: The use of this new iPhone application enables senior medical students to perform a more correct PRM than without assistance. This application represents a significant improvement from written instructions and standard medical school training.
Hearing Loss as Factor That Influences the Quality of Life in Tinnitus Patients
Presenters: Let-cia Petersen Schmidt Rosito, MD (presenter); Bruna Vanni; Konrado Deutsch; Vanessa de Brito Belline
Objective: Tinnitus is a sensation of noise. In most cases it is accompanied by hearing loss, but it can be an independent symptom occurring in patients with normal hearing. We want to compare the impact of tinnitus on quality of life in patients with or without associated hearing loss.
Method: We selected patients with chronic and disturbing tinnitus. They underwent audiometry and answered the Tinnitus Handicap Inventory (THI) in order to evaluate and quantify the impact of tinnitus. The criterion defined as the threshold of hearing loss records was less than 25 dB at all frequencies in either ear.
Results: From January 2005 to January 2011, 308 patients were included. The patients were divided into 2 groups: 1) with hearing loss (n = 272), and 2) with normal hearing (n = 34). Among patients with normal hearing, the average score on the THI was 33.8, whereas among patients with hearing loss, the average was 42.33, P = .04 (t test).
Conclusion: Patients with hearing loss have a mean THI significantly higher than patients with normal hearing. Thus, we found that although the tinnitus alone would lead to worse quality of life of patients, hearing loss is one factor that contributes additionally and independently.
Limiting Hazardous Noise Exposure from Noisy Toys
Presenters: Noel Jabbour, MD (presenter); Heather Weinreich; Samuel C. Levine, MD; Bevan Yueh, MD, MPH
Objective: 1) Assess the decibel (dB) level of toys from the Sight & Hearing Association 2010 Noisy Toys List. 2) Evaluate the change in dB level of these toys after covering the speakers with tape or glue.
Method: Sight & Hearing Association 2010 Noisy Toys List (n =18) toys were tested at a distance of 0 cm and 25 cm from the sound source in a soundproof booth using a digital sound-level meter. Toys with speakers (n = 16) were tested before and after covering the speakers with packing tape or non-toxic glue.
Results: Mean dB level for non-taped toys at 0 cm and 25 cm was107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB Mean dB level for non-taped toys at 0 cm and 25 cm was 107.6 dB (SD 8.5) and 82.5 dB (SD 8.8), respectively. With tape, there was a statistically significant decrease in loudness at 0 cm and 25 cm: 84.2 dB and 68.2 dB (P <.001). With glue, there was a statistically significant decrease in loudness at 0cm and 25 cm (P < .001). The average duration of sound produced was 9.2 seconds.
Conclusion: Adding tape or glue to cover the speakers of noisy toys can significantly limit the dB level of these toys. These are simple measures that parents can perform to limit hazardous noise exposure from noisy toys.
Would Caffeine Consumption Have Some Effect on the Perception of Tinnitus?
Presenters: Let-cia Petersen Schmidt Rosito, MD (presenter); Bruna Vanni; Konrado Deutsch; Vanessa de Brito Belline
Objective: Caffeine has been implicated in the genesis of tinnitus. The current recommendation has been to avoid it, without any scientific evidence for this. Our objective is to examine whether the use of black coffee influences the tinnitus impact on quality of life.
Method: We included patients whose main complaint was tinnitus and its etiology presbycusis or noise-induced hearing loss. It was questioned about the ingestion of black coffee and the amount of cups per day. For evaluation of tinnitus impact, we used the visual analogue scale and Tinnitus Handicap Inventory (THI).
Results: The study included 136 patients. The mean age was 63.8 years, and 57.5% were female. Of the total sample, 52% drank black coffee regularly, with an average of 2.5 cups per day. The 2 groups did not differ regarding gender and age. When we analyzed the consumption of black coffee, we found no statistically significant difference in both the visual analogue scale score and THI between groups. There was no significant correlation between the amount of coffee consumed per day and the score of the THI or between the visual analog scale scores.
Conclusion: This study showed that daily intake of black coffee does not influence the degree of discomfort and quality of life of patients with chronic tinnitus. There is currently no sufficient scientific evidence that supports the recommendation of suspension of its consumption in this group of patients.
Factors Affecting Blood Loss during Pediatric Tonsillectomy
Presenters: Seok-Won Park, MD (presenter); Min-Seok Han; Chang-Gun Cho, MD; Seong-Keun Kwon, MD; Jae-Jun Song, MD, PhD
Objective: 1) Know the factors that can affect the amount of blood loss or the change of the hemoglobin or hematocrit level after adenotonsillectomy in children. 2) Find any quantitative correlations between factors and bleeding parameters.
Method: From 172 child patients receiving adenotonsillectomy, CBC was measured before and after surgery, and then hemoglobin and hematocrit loss percent was calculated respectively. We selected some factors that can affect operative bleeding parameters. Data were analyzed to find any correlation between the factors and bleeding parameters.
Results: Data were statistically analyzed with two-tailed Spearman's rho correlation test and multiple linear regression. Patient body weight factor correlated significantly with hemoglobin (P = .018) or hematocrit loss percent (P = .036), but not with estimated bleeding amount. Regression equation was [Hemoglobin loss percent = 7.172 - 0.096x (body weight) (P = .015)] and [hematocrit loss percent = 6.267 - 0.086x (body weight) (P = .029)]. Other factors such as surgeryindicated main symptom, technique, application of adenoid packing, subjective bleeding, and adhesion severity did not correlate with any operative bleeding parameters.
Conclusion: We can estimate the usual reduction amount of the postoperative hemoglobin (hematocrit) level in children receiving adenotonsillectomy. Amount of reduction of hemoglobin (hematocrit) is larger when the child's body weight is lower, though the absolute bleeding amount is not affected by body weight. The surgeon should be more careful when performing adenotonsillectomy on a lower weight child.
Sharp Foreign Body Aspiration Patients: Are They Different?
Presenters: Saud Romaih AlRomaih, MBBS (presenter); Yaser Alrajhi, MD; Lily H. P. Nguyen, MD, CM, MSc
Objective: Compare and contrast patients with sharp foreign body aspiration (FBA) in the airways to other non-sharp FBA in terms of age, social background, presentation, and nature of foreign body.
Method: Case series of patients with FBA in airways and the upper digestive tract in multi-centers, between Jan 2004 to Dec 2009.
Results: Around 10 percent of patients had sharp FBA in the airway. We noticed that they are overall older. They mostly have the same social background. Most of them gave clear history of sharp FBA. Imaging was useful in the majority of patients. Most sharp FBA happened with the same object.
Conclusion: Patients with sharp FBA are different in terms of age, social background, presentation, and nature of FBA when compared to other non-sharp FBA.
The Relationship between Vitamin D, Otitis Media, and Weight
Presenters: Heather Weinreich (presenter); Kathleen Daly, PhD
Objective: 1) Assess vitamin D levels as a predictor of history of recurrent otitis media (ROM), tube treatment, and weight-for length (WFL). 2) Explore the relationship of vitamin D as a confounder in the relationship between OM and overweight status.
Method: Data were analyzed from a prospective cohort of mothers/children recruited between 1995 and 2002 from local HMO. ROM and tube status were obtained through physical exam and medical records, while WFL data was gathered from well-child checks. Vitamin D levels were assayed from cord blood. Chi-square and logistic regression were performed.
Results: A total of 47.9% of children had ROM, 13.2% received tubes. A total of 10.7% of children age 2 years had a WFL ≥ 95th percentile. A total of 56.7% of children had vitamin D levels below sufficient. Children with a sufficient vitamin D level were at greater risk of having a WFL ≥ 85th in multivariate analysis (OR 2.004, P = .04); however, vitamin D status did not predict ROM or tube status. Children with history of tube treatment had a significantly increased risk of a WFL ≥ 95th percentile after controlling for family income, maternal prenatal smoking, maternal education, gender, birth season, breastfeeding status, daycare attendance, and vitamin D level (OR 3.69, P = .01).
Conclusion: Vitamin D is not a predictor of ROM or tube status; however, children with a vitamin D status that is sufficient are more likely to be ≥ 85th WFL percentile. Vitamin D status is not a confounder in the relationship between a history of tube treatment and overweight status.
Local Anesthetic Nasal Polypectomy: The Patient Perspective
Presenters: Richard Green, MBBS (presenter); Kate Blackmore; Richard Hogg; Naveed Kara, MD
Objective: Assess patient satisfaction with endoscopic nasal polypectomy carried out under local anesthesia. Patient consultation allows us to review and amend practice and is a fundamental aspect of clinical governance, hence ensuring good medical practice.
Method: A 16-point questionnaire was sent to all patients who underwent the procedure over a 2-year period. They were asked about previous operative history, quality of operative information given, level of pain and how well it was managed, effectiveness of procedure on their symptoms, and overall perception of the experience.
Results: Of 32 patients the response rate was 81%. Half of the patients had previously had nasal polypectomy under general anesthetic. Ninety-four percent felt their pain was dealt with appropriately, and all patients were discharged uneventfully within 6 hours. Ninety-two percent reported symptomatic improvement and were happy with the procedure. All but one of the patients preferred avoiding a general anesthetic, and 88% would happily have the procedure performed again under a local anesthetic.
Conclusion: We demonstrate a high level of overall patient satisfaction with this procedure, and conclude that endoscopic nasal polypectomy can be safely and effectively carried out as a day-case local anesthetic procedure. This is in keeping with the Department of Health proposals to maximize day-surgery, and it also represents significant cost savings.
Nasal Symptoms and Sleep Problems in Chronic Rhinosinusitis
Presenters: Tetsushi Okushi (presenter); Daiya Asaka; Hiroshi Moriyama, MD; Nobuyoshi Otori, MD; Shintaro Chiba, MD; Tsuguhisa Nakayama, MD
Objective: In recent years various studies have been conducted regarding the effects of CRS on the patient's quality of life (QOL). There have, however, been few reports of its effects on the quality of sleep. Accordingly, we examined which factors are involved in sleep problems associated with CRS.
Method: Multicenter prospective study. We analyzed 685 consecutive CRS patients between April 2007 and March 2008. All patients completed a QOL questionnaire and background parameters. The patients who had sleep problems (SP group) were compared with other patients in regard to nasal symptoms and background parameters.
Results: A total of 148 patients (21.6%) had sleep problems. The scores for each of the nasal symptoms were significantly higher in the SP group. In addition, the sleep score was significantly higher in the patients with a complication of allergic rhinitis and the patients with high peripheral and tissue eosinophil counts. Logistic regression analysis found that nasal congestion, cough, and ear fullness were nasal symptoms that contributed to the SP group.
Conclusion: This study indicated that, in addition to nasal symptoms, inflammatory conditions such as allergic rhinitis and eosinophilic inflammation have the potential to directly affect sleep problems. Logistic regression analysis revealed that subjective symptoms, such as nasal congestion, cough, etc, are closely related to sleep problems.
Obesity and Allergic Rhinitis: Any Relationship?
Presenter: Edoardo Cervoni, MD (presenter)
Objective: Allergic rhinitis is a very common comorbidity in asthma, both in children and in adults, but its relationship with obesity, often associated with asthma, has not been established. The aim of this paper is to ascertain if there is a statistically significant relationship between allergic rhinitis and obesity.
Method: A population search using Primary Care software EMIS on a cluster of 5499 subjects was undertaken to identify prevalence of allergic rhinitis among obese patients.
Results: There was a statistically significant relationship between allergic rhinitis and obesity only in the group aged 5 to 16 years (P = .0003).
Conclusion: Perhaps surprisingly, the relationship between allergic rhinitis could be present, but only in the younger population, while there is a consistent relationship between asthma and obesity.
Predictive Factors of Depression on Outcomes in Chronic Rhinosinusitis after Endoscopic Sinus Surgery
Presenters: Francisco G. Pernas, MD (presenter); Sharon Hughes; Andrew M. Coughlin, MD; Patricia Maeso, MD
Objective: The improvement in quality of life after endoscopic sinus surgery (ESS) has been well documented. However, oftentimes patients' mental health is not assessed, ignored, or attributed to other causes. There is a lack of evidence that chronic rhinosinusitis can cause mental anguish and depression, which affects outcomes after FESS.
Method: Patients were selected from a busy rhinology tertiary care center. Prior to ESS, participants were given a depression scale and a SNOT-20 sinonasal symptomatology questionnaire, and endoscopic scores were noted. Participants repeated questionnaires at 6 weeks and 3 months after ESS. Endoscopic scores were noted at all three visits.
Results: The most useful instrument to predict outcomes was the SNOT-20 scale. The SNOT-20 scale was highly correlated with the HDS. ESS did not result in any significant changes in apatient's score on HDS, but it did improve SNOT-20 scales. Patients with lower preoperative values on HDS had significantly better surgical outcomes as defined by Lund-Kennedy and SNOT-20. Higher preoperative values on HDS had significantly less improvement on Lund-Kennedy and SNOT-20.
Conclusion: The data presented here confirm a high incidence in depressive-like symptoms in patients who have CRS. We have demonstrated that patients with moderate and severe depression on HDS have worse outcomes after ESS independent of their preoperative scores. We also demonstrated SNOT-20 to be highly correlated to HDS.
Acoustic Features of Voice in Patients with Snoring
Presenters: Luca Guastini, MD (presenter); Barbara Crippa; Francesco Mora, MD; Francesco-Antonio Salzano, MD; Renzo Mora, MD; Valentina Santomauro, MD
Objective: Determine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice.
Method: Group A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and I were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too.
Results: Compared with control group, in group A: the acoustic parameters presented a statistically significantly higher value (P < .05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of group B).
Conclusion: The study indicates that snoring affects voice production by changing its acoustic parameters. A voice analysis program MDVP can be used for snoring sound analysis as a noninvasive procedure for examination of sleep-related breathing disorders.
Effect of Uvulopalatopharyngoplasty on Retropalatal Region
Presenters: Hasan Tanyeri (presenter); Gediz M. Serin, MD; Senol Polat, MD
Objective: Retropalatal region is a part of upper airway contributing to obstructive sleep apnea (OSA). We aimed to demonstrate the changes in the retropalatal surface area (RPSA) after uvulopalatopharyngoplasty (UPPP) in an attempt to exhibit enlargement as a predictor of surgical treatment.
Method: Twenty patients with OSA who underwent UPPP were retrospectively evaluated. Pre and postoperative respiratory disturbance index (RDI), RPSA measurements were studied. Retropalatal region photos were captured at the base of uvula during fiber optic nasopharyngolaryngoscopy to measure RPSAs using AutoCad2004. RDI levels, RPSA measurements were compared using paired t test.
Results: The RPSA measurements in the preoperative subjects were between 20 and 72 (mean 44.18). The RPSA measurements in the postoperative patients were between 37 and 107 (mean 72.82). The RPSA significantly increased in postoperative patients (P = .001). The mean RDI decreased from 27.5 - 22.2 to 14.6 - 12.4 (P > .05).
Conclusion: RPSA increases in UPPP patients postoperatively with evidence of an enlarged retropalatal region. Decreased RDI levels indicate amelioration in OSA. RPSA measurements can be used to predict UPPP surgical treatment success.
Sleep Medicine Clinical and Surgical Training during Otolaryngology Residency: A National Survey of Otolaryngology Residency Programs
Presenters: Tianjie Shen, MD (presenter); Erika Shimahara; Robson Capasso, MD
Objective: The vast majority of otolaryngologists are involved in the medical and surgical care of patients with obstructive sleep apnea. ABOTO residency curriculum has quite extensive sleep medicine requirements. We sought to assess resident training experiences in adult sleep medicine and sleep surgery during their residency in the United States.
Method: This Internet survey study was emailed to the program directors from 103 US Accreditation Council for Graduate Medical Education (ACGME)-approved otolaryngology residency programs in 2010.
Results: A total of 47 (46%) program directors responded. Only 24% of programs had faculty members who spent more than 50% of their clinical time on adult sleep medicine/surgery. The majority of programs (65%) had total training time less than 0.6 month during the residency training. While most residents were well prepared in commonly performed procedures for OSA, the training on hypopharyngeal surgeries such as hyoid suspension (51%), tongue suspension (40%), and geniotubercle advancement (26%) were less adequate. Only 29% of programs taught their residents both the interpretation of the study report and the original sleep study data.
Conclusion: This survey suggests that current residency training in adult sleep medicine and sleep surgery is suboptimal to keep residents up to date with the evolution in this field in the majority of otolaryngology programs. The teaching on the evaluation and various therapeutic approaches should be improved during residency training.
Upper Airway Surgery for the Treatment of Obstructive Sleep Apnea: Surgical Outcomes and the Effect on CPAP
Presenters: Douglas H. Cowan, MD (presenter); Ann Romaker; Christopher G. Larsen, MD; R. Vanneman Spake, MD; Kevin J. Sykes, MPH
Objective: 1) Elucidate the efficacy of upperairway surgery for the treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). 2) Observe the change in polysomnography, continuous positive airway pressure (CPAP) therapy, and sleepiness following upper airway surgical intervention. 3) Objectively measure CPAP compliance using smart card CPAP devices.
Method: Surgical and clinical records were reviewed on patients (N =51) who underwent upper airway surgery for the treatment of moderate-severe OSAHS from January 2008 to June 2010 at an urban tertiary-care center. Outcome measurements recorded pre and postoperatively include BMI, Epworth sleepiness score, CPAP settings and compliance, and polysomnography.
Results: Data was collected and is currently undergoing analysis in a collaborative effort between the otolaryngology and pulmonology departments at our tertiary care center. A unique requirement for this study is the use of smart card CPAP devices on all patients allowing an objective measure of CPAP compliance. All patients underwent traditional uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty or expansion sphincter pharyngoplasty. Additionally, patients underwent turbinate reduction (N = 29), septoplasty (N = 20) and base of tongue reduction (N = 16). Initial analysis indicates a significant improvement in polysomnographic data and CPAP compliance. There does not appear to be problems associated with air-leak postoperatively.
Conclusion: Mucosa-sparing pharyngoplasty and multilevel upper airway surgery are effective treatment options for moderatesevere OSAHS. These surgical interventions can significantly reduce CPAP pressure settings and improve CPAP compliance. All patients undergoing CPAP therapy should be required to use smart card devices in order to objectively measure compliance.