Category Archives: Otalaryngology

Surgical Implant for Sleep Apnea Shows Promise

Researchers surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty accepting or adhering to CPAP therapy.

According to an abstract in the New England Journal of Medicine, the primary outcome measures were the apnea–hypopnea index (AHI, with a score of ≥15 indicating moderate-to-severe apnea) and the oxygen desaturation index (ODI; the number of times per hour of sleep that the blood oxygen level drops by ≥4 percentage points from baseline).

NEJM Abstract Link

Secondary outcome measures were the Epworth Sleepiness Scale, the Functional Outcomes of Sleep Questionnaire (FOSQ), and the percentage of sleep time with the oxygen saturation less than 90%. Consecutive participants with a response were included in a randomized, controlled therapy-withdrawal trial.

The NEJM reports that in this uncontrolled cohort study, upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea.

Several media outlets, including Gizmodo, reported that the “pacemaker-like electronic implant could reduce symptoms by nearly 70%, by directly stimulating the muscles in the throat to keep the airway open during sleep. It’s like autopilot for breathing.”

Reporter Robert Sorokanich writes that the apnea device is implanted under the skin of the chest. “A sensor placed between the fourth and fifth ribs monitors breathing patterns, sending a signal to the hypoglossal nerve with each breath,” he writes. “The nerve signal stimulates the muscle at the back of the tongue, keeping the airway open to allow normal breathing. Patients use a remote control to turn the device on at bedtime, and switch it off when they get up.”

Source: AP

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New Clinical Practice Guidelines Issued for Tonsillectomy

The American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) has issued new which states most children with frequent throat infections do not need tonsillectomy surgery.

The practice guidelines is published in the January issue of – Head and Neck Surgery.

Click here to read the full article.

The AAO-HNS is the world’s largest organization representing specialists who treat the ear, nose, throat, and related structures of the head and neck. The Academy represents more than 12,000 otolaryngologist—head and neck surgeons (ENTs) who diagnose and treat disorders of those areas.

The guidelines was developed using a systematic literature search which was condensed into evidence-based statements with associated balance of benefit and harm. The guideline panel members were chosen to represent fields of sleep medicine, advanced practice nursing, anesthesiology, infectious disease, family medicine, otolaryngology–head and neck surgery, pediatrics, and consumers.

The panel notes “Guidelines are never intended to supersede professional judgment; rather, they may be viewed as a relative constraint on individual clinician discretion in a particular clinical circumstance.”

The guideline panel recommendations—

1. Watchful waiting for recurrent throat infection: Clinicians should recommend watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years.

2. Recurrent throat infection with documentation: Clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and one or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for Group A β-hemolytic streptococcus (GABHS).

3. Tonsillectomy for recurrent infection with modifying factors: Clinicians should assess the child with recurrent throat infection who does not meet criteria in Statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis), or history of peritonsillar abscess.

4. Tonsillectomy for sleep-disordered breathing: Clinicians should ask caregivers of children with sleep-disordered breathing and tonsil hypertrophy about co-morbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems.

5. Tonsillectomy and polysomnography (sleep study): Clinicians should counsel caregivers about tonsillectomy as a means to improve in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing.

6. Outcome assessment for sleep-disordered breathing: Clinicians should counsel caregivers and explain that SDB may persist or recur after tonsillectomy and may require further management.

7. Intraoperative steriods: Clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy.

8. Perioperative antibioticse: Clinicians should not routinely administer or prescribe perioperative antibiotics to children undergoing tonsillectomy.

9. Postoperative pain control: The clinician should advocate for pain management after tonsillectomy and educate caregivers about the importance of managing and reassessing pain.

10. Posttonsillectomy hemorrhage (bleeding): Clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually.

Source reference: ”Clinical Practice Guideline: Tonsillectomy in Children” Otolaryngoly Head Neck Surg 2011

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