Before the invention of CPAP therapy, the only effective surgical treatment for obstructive sleep apnea syndrome was tracheotomy. Now, surgical approaches mainly focus on two anatomical sites. Each procedure influences either the retropalatal or retrolingual portion of the pharynx. They might be applied individually, synchronously with other procedures, or sequentially with other therapeutic devices. Common methods of velar surgery include uvulopalatopharyngoplasty (UPPP), Laser-assisted uvuloplasty (LAUP), radiofrequency or uvulaflap. These techniques are indicated mainly in patients with mild OSAS. Other procedures focus on the posterior airway space (PAS), including operations that reduce the volume of the tongue or base of tongue. In selected patients, an enlargement of the retrolingual airway is gained by osteosynthetic techniques. Improvement of the nasal airway passage is gained by performing a septoplasty and/or conchotomy. In this paper, the different methods and their indications for surgical therapy will be explained and the results are summarized.
There is undoubtedly a need for a safe disinfection method of optical instruments used by ENT specialists. So far, a standard method that sufficiently covers the risk of infection for patients and medical staff alike while serving the need of practicability in daily routine has not been established. Therefore, in the ENT departments of the hospitals of Mannheim, Kaiserslautern, and Tübingen, studies on the disinfection of rigid optical instruments without working channel were performed between February 1999 and May 1999. Instruments were wiped either with an aldehyde or alcohol (ethanol 80%) and germs were detected by quantitative swab cultures. As discussed in the article, disinfection with ethanol proved to be at least equally efficient if not better than disinfection with aldehyde. Therefore, it fully serves the requirements of a safe method for disinfecting optical instruments without working channels.
Oral appliances are used to treat snoring and sleep apnea. Yet, their success cannot be predicted without a therapeutical trial. This uncertainty and the high prices of the appliances are the reasons for their limited use. We tested a cheap, custom fit mandibular advancement device (SnorBan) for the treatment of sleep disordered breathing in order to assess its efficacy. 39 consecutive patients (51.1 +/- 9.2 years, BMI = 27.4 +/- 4.5 kg/m2) with different degrees of sleep disordered breathing (AHI = 16.6/h +/- 15.6/h) received the device after a thorough clinical examination. After getting used to the device a second polysomnography was performed. The AHI improved significantly from 16.6/h to 8.2/h (P < 0.01) in the whole group. The only patient who became worse could not get used to the device. Time with snoring dropped significantly from 16.3% to 6.6%, 59.1% of the sleep apnea patients were successfully treated as their RDI dropped below 10/h. The sleep efficiency remained unchanged. Slow wave sleep and REM-sleep increased significantly from 12% to 16% (P < 0.05). The overall compliance was 75%. The custom fit mandibular advancement device Snorban is a cheap and effective treatment for a number of patients with snoring and sleep apnea. The oral appliance is proven to be a useful and simple, non-surgical treatment option. Polysomnographic follow-up is mandatory as breathing may worsen with the device while asleep.
No statistical difference existed in change of AHI before and after surgery in all patients even though 14 patients had a statistically significant decrease in AHI (pre 19.2 +/- 19.6; after 8.2 +/- 9.8; p < 0.05). Snoring decreased clearly (p < 0.05) from 49.4% to 25.9%.
Spontaneous dissections of extracranial carotid arteries occur most frequently in the internal carotid artery. In contrast, common carotid artery dissection (CCA) is a rare cause of cerebral ischaemia with only a few cases having been reported. We present the case of a 59-year-old male patient who was referred to our clinic with left cervical pain. The patient was otherwise asymptomatic. Magnetic resonance imaging (MRI) showed enhancement and double lumen in the left CCA without affecting the carotid bulb, internal carotid artery or aortic arch. We discuss the diagnostic and therapeutic management of the disease, focusing on its differentiation from other causes of cervical pain.
Although there are several theories concerning the actual pathogenesis, it is generally agreed that an inflammatory process is the primary cause of Grisel's syndrome. Therefore, early antibiotic treatment is recommended. Further treatment depends on clinical findings and Fielding classification of the degree of the subluxation and includes muscle relaxations, soft collar or stiff neck, cervical traction or even arthrodesis of C1 and C2. If recognised early and appropriate treatment is applied, the prognosis is excellent. Severe cases can present with degenerative disorders of the cervical spine or even with neurological malfunction.
These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.
Sleep-related breathing disorders in children are common. Nearly 10% of preschool-aged children snore, and 1% of 4- to 5-year-old children present with an obstructive sleep apnea syndrome (OSAS), mostly due to an adenotonsillar hyperplasia. OSAS in children differs markedly from adults concerning etiology, clinical symptoms, polysomnographic findings, and course of the disease. Therefore, results of adult sleep medicine cannot easily be applied to children. The disease may result in pulmonary or systemic hypertension, failure to thrive, and neurocognitive misbehavior. Up to now, there is no consensus concerning diagnosis and therapy. In this article, we summarize and discuss what is known so far about sleep-related breathing disorders in children, focussing on the OSAS as the most important diagnosis for the ENT specialist.
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