Hyoid myotomy and suspension without simultaneous palate or tongue base surgery for obstructive sleep apnea

Objective:Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA).Method:Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic.Those who underwent concurrent palatal or tongue base sleep surgery were excluded.Outcomes included simultaneous procedures,apnea-hypopnea index (AHI),lowest oxyhemoglobin saturation (LSAT),and Epworth Sleepiness Scale (ESS).Results:Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery.The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71％).Concurrent procedures included the following:torus mandibularis excision (n =1),endoscopic sinus surgery (n =4),septoplasty (n =10),inferior turbinate reduction (n =12),and nasal valve repair (n =2).AHI improved signiflcantly from (39.7 ± 21.2) eventslh to (22.6 ± 22.7) events/h after HMS (P ＜ 0.01),which represented a 43％ reduction.LSAT significantly increased from (82.2％ ± 9.9％) to (86.6％ ± 6.2％),P ＜ 0.01.There was no improvement in ESS after surgery (8.2 ± 4.4) to (8.3 ± 5.2),P =0.904.A subset of patients with severe OSA (AHI ＞ 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h,P ＜ 0.01.Conclusion:HMS without palatal or tongue base sleep surgery improves OSA severity.It can be considered as a valid option in the treatment of OSA in appropriately-selected patients.

Application of drug-induced sleep endoscopy in patients treated with upper airway stimulation therapy

Objective:To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE).Methods:The trial was designed as a single-blinded cross-sectional study.Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library.These videos were graded using the VOTE classification.Percentage agreement and Cohen's k (for inter-rater reliability) were calculated between pairs of reviewers,assessing palatal complete concentric collapse (CCC) and determining UAS eligibility.Subjects were also grouped based on collapse severity for each reviewer.Results:The reviewers had excellent (approximately 90％) agreement on findings at the level of the soft palate and tongue base.The inter-rater reliability for palatal CCC ranged from mod erate to substantial The agreement on determining the criteria for UAS implantation ranged from poor to moderate.All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE.Conclusion:Application of DISE remains a subjective examination,even among those experienced operators,therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos.