Sleep nasendoscopy (SN) is claimed to identify the site of obstruction in habitual snoring and is used to select patients for palatal surgery. The validity of SN is, however, unproven. This is the first prospective blind assessment of the role of SN in the management of habitual snorers. Fifty-five consecutive patients listed for laser-assisted uvulopalatoplasty (LAUP) for simple snoring on clinical criteria underwent SN immediately before surgery. Snoring severity and Epworth Sleepiness Scales were completed before the operation and at least 3 months after the operation. The postoperative scores on the snoring severity scale had significantly improved after LAUP, for each SN grade: grade 1 (palatal obstruction; p = .04) and grade 2 (multisegmental obstruction; grade 2A, p = .003, and grade 2B, p = .01). The Epworth Sleepiness Scale showed significant improvement in the whole group (p = .02). We conclude that SN grading of sites of pharyngeal collapse is an insufficient basis to exclude patients from LAUP. Sleep nasendoscopy is thus not of value in the management of habitual snoring, as the measure is a poor predictor of favorable outcome after palatal surgery.

CT neck +/- chest plays an important role in the evaluation of VCP patients. The majority of pertinent radiologic findings involve malignant neoplasm.

Our findings suggest that FloSeal has a limited role in the management of epistaxis.

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The configuration of the lateral crus of LLC cannot be accurately assessed prior to exposure of the cartilage. A rhinoplastic surgeon who embarks on nasal tip surgery should be familiar with a number of techniques to address any tip deformity encountered after exposure, as the preoperative clinical and photographic assessments cannot reliably demonstrate the type of LLC deformity.

A Comparative Model in Sleep-Disordered Breathing vs. Alcohol Impaired Controls NELSON B POWELL MD (presenter); ROBERT W RILEY MD DDS; Palo Alto CA Objectives: Patients with sleep-disordered breathing suffer reaction time deficits that may lead to catastrophic accidents and loss of life. Although safety guidelines do not exist for unsafe levels of sleepiness, they have been established for unsafe levels of alcohol consumption. Since reaction time performance is altered in both, we prospectively used 7 measures of reaction time performance as a comparative model in alcohol-challenged normal subjects with corresponding measures in subjects with sleep-disordered breathing. Methods: Eighty healthy volunteers (29.1 _+ 7.5 years old, 56.3% female) performed 4 reaction time trials using a psychomotor test at baseline and at 3 subsequent rising alcoholinfluenced time points. The same test without alcohol was given to 113 subjects (47.2 _+ 10.8 years old, 19.3% female) with mild-to-moderate sleep-disordered breathing. Results: Blood-alcohol concentrations (BACs) in the alcohol subjects at baseline and 3 trials were a mean 0, 0.057, 0.080, and 0.083 g/dL. The sleep subjects had mean respiratory disturbance indices of 29.2 events per hour of sleep. On all 7 reaction time measures, their performances were worse than those of the alcohol subjects when BAC levels were 0.057 g/dL. For 3 of the measures, the sleep-disordered subjects performed as badly or worse than the alcohol subjects when alcohol levels were 0.080 g/dL. These results could not be explained by sex or age differences. Conclusion: The data demonstrate that sleep-disordered 10:46 AM