Quality of Life Outcomes following Treatment of Hypopharyngeal Cancer.
Authors: Mahalingam S, Spielmann P Abstract Quality of life (QoL) is an important consideration in the management of individuals with head and neck cancer. The poor prognosis and significant impact of treatment modalities on function of the salivary glands, larynx and pharynx combine to make hypopharyngeal carcinoma a particularly challenging condition to treat. The impact of diagnosis and treatment on health related QoL is substantial. There is increased understanding that organ preservation does not necessarily correlate with function preservation as was previously expected. The impact on QoL, of chemoradiotherap...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Future Perspectives in Hypopharyngeal Cancer Care.
Authors: Eckel HE, Bradley PJ Abstract Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently remains unlikely that these approaches will gain a more major universal impact on hypopharyngeal cancer care. In advanced stage hypopharyngeal cancer, the use of the traditional radical surgery, such as laryngo-pharyngectomy, is no longer accepted by many patients. In recent years, most would rather opt for less mutilating treatment, preferring a non-surgical option. Patients, fami...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Salvage Treatment Options after Failed Primary Treatment of Hypopharyngeal Cancer.
Authors: Simo R, Rovira A, Townley W Abstract Recurrent hypopharyngeal cancer (rHPC) is a high-risk fatal disease associated with poor prognosis and high risk of complications in patients who are suitable to undergo salvage treatment. The treatment of such patients should be managed by a dedicated multidisciplinary team, most frequently a tertiary centre. and with the agreement of the patient. Close follow-up is crucial in achieving early detection and being able to treat the recurrence with curative intention. When persistent or recurrent disease is suspected, cross-sectional computed tomography imaging (CT) and p...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Primary Treatment of T1-T2 Hypopharyngeal Cancer: Changing Paradigms.
Authors: Meulemans J, Delaere P, Vander Poorten V Abstract There has been a general shift in the treatment of hypopharyngeal cancer from open surgical techniques (either radical or partial "organ" preserving) toward non-surgi cal "organ preserving" strategies (radiotherapy [RT] or chemoradiotherapy [CRT]) and minimally invasive transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Oncologic outcomes reported are comparable whatever modality is chosen, but better functional outcomes are observed in the RT/CRT and TLM/TORS-treated patients. Because of the high rate of second prim...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Natural History of Treated and Untreated Hypopharyngeal Cancer.
Authors: Eckel HE, Bradley PJ Abstract Patients with hypopharyngeal cancers frequently present at advanced stage and in poor general health status. Their natural history is characterised by diffuse local primary disease, mucosal and submucosal spread, early cervical nodal metastasis, and a relatively high rate of distant spread. By the time of initial diagnosis, some 60% of all hypopharyngeal cancer patients will be with stage IV disease, some 5% will present with distant metastases, and almost 40% will have a significant reduction in performance status. Less than 20% are diagnosed with a localised early stage dise...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Surgical Treatment of Advanced Staged Hypopharyngeal Cancer.
Authors: Wei WI, Chan JYW Abstract It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while s...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Systemic Therapy, Palliation and Supportive Care of Patients with Hypopharyngeal Cancer.
Authors: Bradley PJ, Füreder T, Eckel HE Abstract Hypopharyngeal cancer patients have a very poor prognosis and limited therapeutic options. Seventy to eighty per cent of all hypopharyngeal cancer patients will require palliative and/or end-of-life care for incurable end-stage disease during the course of their illness. The overall proportion of hypopharyngeal cancer patients not qualifying for initial curative treatment, or requiring palliation and supportive care over time is higher than for any other subsite of the head and neck. Surgery and radiotherapy usually have a very limited role in this setting, whi...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Epidemiology of Hypopharyngeal Cancer.
Authors: Bradley PJ Abstract Hypopharyngeal cancer is uncommon in the developed world; it is mostly diagnosed in men who smoke tobacco and consume excessive alcohol and uncommon in women. However, recent trends in the developed world show that there has been an annual increase in the percentage of women with hypopharyngeal cancer. In France, there has been a significant annual percentage change in the incidence of this form of cancer - a decrease in men and a greater increase in women since the 1980s. In the developing world, India, Taiwan and other countries, the incidence of hypopharyngeal cancer has increased in...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Symptoms and Signs, Staging and Co-Morbidity of Hypopharyngeal Cancer.
Authors: Bradley PJ Abstract Early throat symptoms are common and a diagnosis of hypopharyngeal cancer rare; therefore, confirming or excluding a serious diagnosis is missed or overlooked by both the patient and the practitioner - however, symptoms such as throat clearing and food sticking, which persist in adult patients who have the social habit of tobacco usage and/or drink excessive alcohol should be examined by a specialist to exclude the presence of hypopharyngeal cancer. Late symptoms/signs include neck swelling (uni- or bilateral), dysphagia, odynophagia, otalgia, dysphonia, dyspnoea and stridor. Associated...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Treatment Options for Hypopharyngeal Cancer.
Authors: Eckel HE, Bradley PJ Abstract Patients with hypopharyngeal cancer are difficult to treat because they typically present with advanced disease, poor general health status and severe nutritional problems. Currently, treatment options for previously untreated and newly diagnosed hypopharyngeal cancer patients include surgery of the primary tumour and lymph nodes metastasis, radiotherapy, systemic medical treatment, including traditional chemotherapy and immunotherapy. Currently, a multimodal treatment approach is preferred using surgery, radiotherapy and systemic therapy with curative intent and best supporti...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Clinical and Radiological Evaluation of Hypopharyngeal Carcinoma.
Authors: Piazza C, Paderno A, Ravanelli M, Pessina C Abstract Pre-treatment clinical and radiological evaluations represent a key step in the proper management of hypopharyngeal carcinoma. First, office-based endoscopy allows the assessment of superficial tumor extension, signs of laryngeal infiltration, and the overall residual function of the laryngo-hypopharyngeal complex. Different tools, maneuvers, and techniques can improve this essential diagnostic step and should be considered a prerequisite to direct subsequent investigations and give an initial indication for the most appropriate treatment. Furthermore, r...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Outcomes of Tumour Control from Primary Treatment of Hypopharyngeal Cancer.
Authors: Siddiq S, Paleri V Abstract Hypopharynx cancer continues to pose a clinically challenging head and neck subsite, driven not only by the unique set of patient, anatomic and disease factors but also by the paucity of robust clinical data to guide clinical decision making. The standard of care of radical surgery (pharyngolaryngectomy) in combination with postoperative radiotherapy was the previously accepted norm in the setting of advanced hypopharynx cancer, but this was often at the expense of significant morbidity. In the absence of survival benefit for advanced staged disease with radical surgical approac...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Treatment Options for Hypopharyngeal Cancer in Developing Countries in Africa/South America/Asia.
Authors: Fagan JJ, Chaturvedi P, Kowalski LP Abstract Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited-resource public healthcare systems in developing countries and specifically in Sub-Saharan Africa, India and South America and by extension, most patients in the developing world. Management of hypopharyngeal cancer must be adapted to the availability of specialised diagnostic and therapeutic services, radiothera...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Current Indications for Non-Surgical Treatment of Hypopharyngeal Cancer.
Authors: de Bree R Abstract The management of hypopharyngeal cancer is challenging because of poor patient survival and the potential effects of treatment on breathing, voice and swallowing. In general, early stage hypopharyngeal cancer can be primarily treated by radiotherapy or conservative transoral or open surgery, whereas advanced stage hypopharyngeal cancer can be treated by non-surgical protocols if the patient has no loss of functions (dysfunctional larynx) and/or cartilage invasion (T4a). Factors to determine individualized patient treatment include resectability, tumour volume, distant metastases, comorbi...
Source: Advances in Oto-Rhino-Laryngology - February 14, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Sequelae and Complications of Treatment for Hypopharyngeal Cancer: Minimising the Risks.
Authors: Sewnaik A, Baatenburg de Jong RJ Abstract Treatment of hypopharyngeal cancer depends on the extent and location of the tumour, patient-specific or by factors (age, performance status, co-morbidity) and the presence of psychosocial support. Options available for the treatment of hypopharyngeal cancer consist of surgery and non-surgery - radiotherapy, chemoradiation, bioradiation, or a combination of these modalities. To maintain normal functioning as much as possible, functional organ preservation is widely recommended and generally utilizes radiotherapy and/or chemoradiation. Although functional organ-spar...
Source: Advances in Oto-Rhino-Laryngology - February 14, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Swallowing and Voice Outcomes following Treatment of Hypopharyngeal Cancer: The Need for Supervised Rehabilitation.
Authors: Eerenstein SEJ, Verdonck-de Leeuw IM, Leemans CR Abstract Advances in and intensification of treatment in hypopharyngeal cancer have led to an increase in organ preservation and in overall survival. Treatment intensification comes at the cost of more pronounced acute and long-term side effects causing functional impairments in voice and swallowing. Swallowing and voice problems have a significant impact on communication, eating and nutrition, social well-being and quality of life. Swallowing problems may be so severe that patients suffer profuse aspiration or are left gastrostomy-tube dependent. Pre-treatm...
Source: Advances in Oto-Rhino-Laryngology - February 14, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Extended Applications for Cochlear Implantation.
Authors: Hempel JM, Simon F, Müller JM Abstract The indications for cochlear implantation (CI) have expanded over the last few years. There is evidence that some adult patients with pre- or perilingual onset of deafness may gain from implantation. Similarly, CI in patients with single-sided deafness may offer significant benefits in terms of quality of life and social as well as academic development. In this setting, directional hearing may be restored and speech comprehension, especially in noise, may be optimized. In patients with intractable tinnitus and profound hearing loss, CI not only improves speech pe...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advances in the Field of Bone Conduction Hearing Implants.
Authors: McLeod RWJ, Culling JF, Jiang D Abstract The number of marketed bone-conduction hearing implants (BCHIs) has been steadily growing, with multiple percutaneous devices and transcutaneous devices now available. However, studies assessing efficacy often have small sample sizes and employ different assessment methodologies. Thus, there is a paucity of evidence to guide clinicians to the most appropriate device for each patient. This paper outlines audiological guidelines for the latest devices, as well as research from the most up-to-date clinical trials. We also outline the evidence base for some potentially ...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Preliminaries.
Authors: PMID: 29794424 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Hearing Rehabilitation in Congenital Middle Ear Malformation.
In conclusion, hearing rehabilitation of congenital atresia should be performed as early as possible. This includes not only the bilateral but also the unilateral affected patients. PMID: 29794426 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Brain Plasticity and Rehabilitation with a Cochlear Implant.
Authors: McKay CM Abstract The functional changes that occur in the brain due to deafness may affect the way the auditory system processes sound after cochlear implantation. Brain plasticity plays a crucial role in the success of cochlear implantation to facilitate or develop spoken language in profoundly deaf individuals. The functional plasticity that occurs in postlingually deaf adults during periods of deafness can both support and hinder speech understanding with a cochlear implant, depending on the nature and degree of functional changes. Evidence so far suggests that the strategies people use to communicate ...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Optimizing Ossicular Prosthesis Design and Placement.
Authors: Bance M Abstract Middle ear hearing reconstruction is unpredictable. Difficulties arise because of host factors, such as ventilation or scarring, surgical technique factors, such as prosthesis placement and stabilization, and design and mechanical factors influencing the properties of the prosthesis. Often there is a balancing act between choosing optimal stability, and maximizing the mechanical vibrations of the prosthesis. We review our and other investigators' work, in design and ideal placement of middle ear prostheses. Middle ear prostheses need to be rigid enough to deliver acoustic forces without be...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Hearing Rehabilitation with Active Middle Ear Implants.
Authors: Donnelly NP, Pennings RJE Abstract Hearing implant technology is evolving at a rapid rate and more than ever patients with hearing loss are benefiting from these emerging hearing devices. Active middle ear implants are alternatives to hearing aids and bone conducting devices, offering patients an expanded range in improving their hearing. This chapter looks at the devices currently available, their indications and the literature regarding their outcomes. PMID: 29794434 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

New Imaging Modalities in Otology.
Authors: Bance M, Zarowski A, Adamson RA, Casselman JW Abstract Despite steady improvements in cross-sectional imaging of the ear, current technologies still have limitations in terms of resolution, diagnosis, functional assessment and safety. In this chapter, state-of-the-art imaging techniques in current clinical practice are presented including cone-beam computerized tomography, non-echo planar imaging magnetic resonance imaging, imaging for labyrinthine hydrops and imaging of the central auditory pathways. Potential future imaging modalities are also presented, including optical coherence tomography (OCT) and h...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Intraoperative Auditory System Monitoring.
Authors: Miyazaki H, Caye-Thomasen P Abstract A new electrophysiological system for intraoperative, continuous, near-real time monitoring of cochlear nerve function through acoustic stimulation in the ear canal and recording of the evoked dorsal cochlear nucleus potentials (DNAPs) by a specially designed DNAP electrode placed directly on the brainstem is described. The system is denominated "(cerebellopontine angle) CPA Master" and is designed for hearing preservation surgery in the cerebello-pontine angle, through the retro-sigmoid or the retro-labyrinthine approach. As an additional novelty within the f...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Future of Cochlear Implant Design.
Authors: Mitchell-Innes A, Saeed SR, Irving R Abstract This chapter discusses the multifaceted future of cochlear implant design. Current research is focused on novel strategies relating to the electrode array, aiming to improve the neuronal health and spatial selectivity, and reduce the power consumption. Future design iterations will most likely improve the neuronal health by reducing insertion trauma, minimizing the inflammatory pathway that follows electrode insertion or through the use of neurotrophins or stem cells. Improvements in spatial selectivity and in speech recognition in difficult listening environme...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The Role of the Eustachian Tube in Middle Ear Disease.
We describe the anatomy and physiology of the Eustachian tube, define ETD, discuss the methods for measuring ETD and describe recent advances in treatment. PMID: 29794454 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Diagnosis and Treatment of Perilymphatic Fistula.
Authors: Deveze A, Matsuda H, Elziere M, Ikezono T Abstract Perilymphatic fistula (PLF) is defined as an abnormal communication between the fluid (perilymph)-filled space of the inner ear and the air-filled space of the middle ear and mastoid, or cranial spaces. PLF is located in the round or oval window, fractured bony labyrinth, microfissures, anomalous footplate, and can occur after head trauma or barotrauma, chronic inflammation, or in otic capsule dehiscence. This clinical entity was initially proposed more than a century ago, yet it has remained a topic of controversy for more than 50 years. The difficulty of...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Pharmacological Issues in Hearing Rehabilitation.
Authors: Bird PA, Bergin MJ Abstract Surgery aimed at hearing rehabilitation risks damaging residual inner ear function, especially cochlear implant surgery. Pharmacological intervention to reduce this risk has shown great promise in animal models. The challenge is to deliver medication to the appropriate part of the inner ear in appropriate concentrations for long enough to be effective. Barriers to achieving these goals include: the blood/labyrinth barrier, limiting systemic drug delivery to the inner ear, slow rates of diffusion from the base of the cochlea to the apex, limiting intratympanic delivery from the m...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Management of Cochlear Nerve Hypoplasia and Aplasia.
Authors: Freeman SR, Sennaroglu L Abstract Approximately 2% of congenital profound deafness cases are due to cochlear nerve (CN) deficiency. MRI is essential to confirm if the nerve is deficient, but because of limitations with resolution, especially when the internal auditory canal is narrowed, it is often unable to distinguish between hypoplasia and aplasia. A full audiometric test battery should always be performed, even if the MRI suggests CN aplasia, as there will sometimes be evidence of audition. Electrically evoked auditory brainstem response testing can be carried out transtympanically via the round window...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Hearing Rehabilitation in Neurofibromatosis Type 2.
Authors: North HJD, Lloyd SKW Abstract Bilateral vestibular schwannomas are almost pathognomonic of neurofibromatosis type 2 (NF2). As a result of these tumors, hearing loss is the presenting symptom in 60% of adults and 30% of children with NF2. It is often bilateral. The best means of preserving hearing in patients with NF2 is conservative management. Even so at least 28% of patients have progression of hearing loss following diagnosis. The likelihood of progression of hearing loss is, at least in part, determined by the type of mutation. Treatment of vestibular schwannomas often has a detrimental effect on heari...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Hearing Preservation Cochlear Implant Surgery.
Authors: Bruce IA, Todt I Abstract Cochlear implantation (CI), with attempted preservation of residual natural low-frequency hearing, is an increasingly accepted application of this technology, with potential benefits to the patient when listening in noise and in music appreciation. The full extent of the benefits of combining preserved natural hearing and electrical stimulation remain under evaluation. Various factors appear to influence the success of hearing preservation (HP) during CI, including electrode design, surgical approach, insertional trauma, steroid usage and patient factors. Currently, combining or c...
Source: Advances in Oto-Rhino-Laryngology - May 30, 2018 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Pediatric Obstructive Sleep Apnea: Where Do We Stand?
In conclusion, we have made progress in our understanding of pediatric OSA, and we can even recognize factors leading to its development or worsening. However, pediatricians and pediatric subspecialists are often unaware of the advances and the remedies available. PMID: 28738322 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Updated Concepts on Treatment Outcomes for Obstructive Sleep Apnea.
Authors: Certal V, Capasso R Abstract Obstructive sleep apnea is a highly prevalent and poorly understood condition that not only leads to significant individual patient health damage, but carries a large societal cost secondary to excessive healthcare utilization, motor-vehicle accidents, and work absenteeism. While a significant fund of knowledge about its damaging effects on the cardiovascular system and neural pathways has been gathered over the past few decades, the translation to direct patient care still presents numerous challenges. With the exception of clear issues such as socially unacceptable snoring an...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Future Perspectives in Sleep Medicine.
Authors: Huon LA, Guilleminault C Abstract "Sleep Medicine" is now a specialty in its own right. Currently, there is increasing recognition of the very negative impact sleep disorders have on learning, education, safety, and quality of life. Technological advances will help us to break down diagnoses (e.g., narcolepsy has now been subdivided into types 1 and 2, depending upon the hypocretin levels in the spinal fluid) and to discover relationships to other bodily systems (e.g., type 1 narcolepsy potentially being an autoimmune disorder). The modern lifestyle of many, as characterized by a shortening of sl...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Updated Hypopharyngeal Surgery for Sleep Apnea.
Authors: Woodson BT Abstract The failure of traditional upper airway surgery such as uvulopalatopharyngoplasty has been attributed to lower airway obstruction related to base of tongue collapse. Multiple procedures, including glossectomy, tongue base radiofrequency, genioglossus advancement, and tongue suspension techniques, have been advocated to improve success rates. No consensus exists on which subsets of patients are best treated by individual approaches and direct comparative data are lacking. The selection of procedures must be based on individual patient needs and the relative potential benefits and risks. ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

The History of Sleep Surgery.
Authors: Yaremchuk K, Garcia-Rodriguez L Abstract Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cu...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Novel Positional Devices for the Treatment of Positional Obstructive Sleep Apnea, and How This Relates to Sleep Surgery.
Authors: Revesloot MJL, Benoist L, van Maanen P, de Vries N Abstract If untreated, obstructive sleep apnea (OSA) develops as a gradual progressive disease. In the early stage of the disease most patients with OSA are positional. The archetypical patient might progress from simple positional snoring via positional early-stage mild disease to less positional moderate and finally nonpositional severe OSA. At first, the apnea-hypopnea index (AHI) is high only in the supine position, and later is high in all sleeping positions. The phenomenon is reversible. After partial effective treatment, patients with severe OSA can...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

A Succinct History of Sleep Medicine.
Authors: Huon LA, Guilleminault C Abstract Although sleep and sleep disorders have been studied for centuries, it was the development of sophisticated tools to monitor eye movements, brain waves, and muscle tone in the mid-20th century that led to modern sleep research. These tools allowed neuroscientists to distinguish between different "states" or "phases" of sleep, and to relate these findings to sleep disorders. This review chronicles the groundbreaking work of the pioneers in this field, and the impact their findings have had on patients today. PMID: 28738342 [PubMed - in process] (Sour...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Future Perspectives in Sleep Surgery.
Authors: Friedman M, Salapatas AM, Bonzelaar LB Abstract Over the past few decades there has been a significant increase in research focusing on the pathophysiology, diagnosis, and treatment of sleep apnea. However, there is still a long way to go in creating standard evidence-based medical practice for the diagnosis, evaluation, and treatment of sleep apnea patients. Current and future directions of sleep surgery and other treatments are discussed here. PMID: 28738352 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Innovative Surgery for Obstructive Sleep Apnea: Nerve Stimulator.
This article gives a comprehensive overview of current and upcoming hypoglossal nerve stimulation systems (Inspire, ImThera, and Nyxoah), the specific advantages of this approach, the selection criteria and screening process, relevant clinical data, and a description of the different implantation procedures. Upper airway stimulation and hypoglossal nerve stimulation appears to be a long-term, low-morbidity treatment for moderate-to-severe OSA patients suffering from CPAP incompliance. PMID: 28738358 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advances in the Diagnosis of Obstructive Sleep Apnea: Drug-Induced Sleep Endoscopy.
Authors: Revesloot MJL, Benoist L, van Maanen P, Kezirian EJ, de Vries N Abstract Drug-induced sleep endoscopy was introduced in 1991 and has recently evolved into a pivotal instrument for patients in whom obstructive sleep apnea surgery is considered. Here, we discuss the indications, contraindications, technique, anesthesia, scoring systems, validity, and insights of the literature. PMID: 28738362 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advances in Box Surgery for Obstructive Sleep Apnea: Genioglossus Advancement, Hyoid Suspension, and Maxillomandibular Advancement.
Authors: Goh YH, Tan W, Abdullah VJ, Kim SW Abstract Box surgery for obstructive sleep apnea (OSA) patients consists of mandibular surgery, including genioglossus advancement, hyoid suspension, and maxillomandibular advancement, as an airway reconstruction. This surgery was developed in the early 1980s. Thereafter, techniques were modified in each surgery for the enhancement of outcome and prevention of complications. However, the indication for surgery remains poorly defined due to the dynamicity of the upper airway, variability of the phenotype in OSA patients, and absence of a representative method for the obstr...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Updated Minimally Invasive Surgery for Sleep-Related Breathing Disorders.
Authors: Kotecha B Abstract Sleep-related breathing disorders (SRBD) consist of a variety of clinical entities, ranging from primary snoring to severe obstructive sleep apnoea at the opposite extreme. Although it has no official definition, minimally invasive surgery infers surgery where the procedure is clinically less aggressive and may involve a much smaller incision or none at all. It also implies that such procedures may result in a quicker recovery and reduced morbidity, and that they are often conducted under local anaesthesia as day cases. Minimally invasive surgery in SRBD may be performed on its own or ma...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Robotic Obstructive Sleep Apnea Surgery.
Authors: Toh ST, Hsu PP Abstract Since the first report of the use of the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA) in transoral robotic tongue base reduction for obstructive sleep apnea (OSA) was published in 2010, this surgical tool and technique has been used worldwide for the resection of tongue base tissue in the multilevel surgical treatment of OSA. The combined knowledge of the published literature on its use has enlightened sleep surgeons worldwide on this new yet evolving surgical tool. Here we will discuss the use of the da Vinci robotic system in the treatment of OSA, the pertinent...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advances in Oral Appliances for Obstructive Sleep Apnea.
Authors: Jacobowitz O Abstract Oral appliances that advance the mandible are widely used as alternatives to positive airway pressure (PAP) devices or as primary therapy for obstructive sleep apnea (OSA) in adults. Although PAP is more efficacious at lowering the polysomnographic indices of OSA, the clinical effectiveness of PAP and oral appliances is similar, and patients are more likely to adhere to oral appliance therapy than to PAP treatment. Clinical examination is used to determine the candidacy of oral appliances and to select a particular appliance for a given patient. Endoscopic examination of the pharynx m...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Multilevel Obstructive Sleep Apnea Surgery.
Authors: Lin HC, Weaver EM, Lin HS, Friedman M Abstract Continuous positive airway pressure (CPAP) is the primary treatment of obstructive sleep apnea/hypopnea syndrome (OSA). Most sleep physicians are in agreement that a certain number of OSA patients cannot or will not use CPAP. Although other conservative therapies, such as oral appliance, sleep hygiene, and sleep positioning, may help some of these patients, there are many who fail all conservative treatments. As sleep surgeons, we have the responsibility to screen patients for both symptoms and signs of OSA. As experts of upper airway diseases, we often view a...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Updated Nasal Surgery for Obstructive Sleep Apnea.
Authors: Johnson DM, Soose RJ Abstract Numerous studies report that difficulty breathing through the nose is associated with reduced sleep quality, increased daytime dysfunction, and increased risk of snoring and obstructive sleep apnea (OSA). Additionally, chronic nasal obstruction often complicates and limits successful medical device therapy for OSA, particularly with continuous positive airway pressure (CPAP). When medical evaluation and management of the nose is inadequate, surgical therapy to lower nasal resistance has been shown to substantially improve sleep and breathing outcome measures. Although nasal su...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Advanced Concepts in the Pathophysiology of Obstructive Sleep Apnea.
Authors: White DP Abstract The primary pathological event in the disorder obstructive sleep apnea (OSA) is the partial or complete closure of the pharyngeal airway during sleep in an individual with a widely patent airway during wakefulness. This yields an apnea or hypopnea with resulting hypoxia and hypercapnia, and most often requires an arousal to terminate the event. These events occur in a repetitive manner during sleep, yielding intermittent hypoxia and sleep fragmentation with their associated adverse effects on the health and quality of life of the afflicted individual. Here, we focus on the events leading ...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research

Updated Friedman Staging System for Obstructive Sleep Apnea.
Authors: Friedman M, Salapatas AM, Bonzelaar LB Abstract In the practice of sleep medicine, the first step is identification of those patients at high risk for sleep apnea. Nearly every physician and every hospital has preferred methods of screening. Many patient questionnaires or surveys as well as some objective physical measurements have been suggested to predict the presence of sleep apnea. Screening is well established, and laboratory and home testing are widely available. An early assessment with a physical examination can help direct treatment planning. The Friedman tongue position, lingual tonsil hypertroph...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research