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PURPOSE: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting Stakeholders from the United Kingdom. Subjects and methods Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was ‘diffuse inflammation of the ear canal skin of less than 6 weeks duration’. Conclusion The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

Objectives/Hypothesis Obstructive sleep apnea syndrome (OSAS) is a chronic condition, characterized by recurrent episodes of upper airway collapse during sleep, which affects up to 5% of adults in the Western population. The muscle tone of the human body ordinarily relaxes during sleep, thus causing airway obstruction and leading to sleep apnea. We report a case of a 68-years old male in which dystonic closure of the larynx during sleep caused OSAS. The sleep endoscopy was crucial in establishing the diagnosis of laryngeal dystonia. A botulinum toxin injection in the vocal cord improved the OSAS. These findings define a novel sleep-related breathing disorder.

There is a lack of consensus on how to assess and report upper airway obstruction based drug-induced sleep endoscopy findings, a lack of multiple information visualisation system for real-time drug-induced sleep endoscopy assessment and a lack of a relational model for drug-induced sleep endoscopy information management. The key objective of this thesis is to design and develop drug-induced sleep endoscopy data management systems. An integrated drug-induced sleep endoscopy classification model was developed to act as a referential model based on a systematic literature review conducted on drug-induced sleep endoscopy classification systems. A clinical feasibility study using drug-induced sleep endoscopy data fusion system was conducted for proof of concept validation based on 20 drug-induced sleep endoscopy assessments. A relational drug-induced sleep endoscopy model for drug-induced sleep endoscopy database information management was developed by reviewing 30 clinical folders of sleep-disordered breathing patients). Integrated drug-induced sleep endoscopy classification model was developed as an integrated and referential drug-induced sleep endoscopy classification system for four commonly used drug-induced sleep endoscopy classification systems. Drug-induced sleep endoscopy data fusion system was used to capture, merge, display and store upper airway obstruction events and its associated cardiorespiratory changes during drug-induced sleep endoscopy assessment for 20 sleep-disordered breathing patients. A conceptual and physical model of a relational drug-induced sleep endoscopy model for drug-induced sleep endoscopy database management system was developed consisting of 8 entities and 7 relationships. A referential drug-induced sleep endoscopy classification model provides a framework for comparing multiple drug-induced sleep endoscopy findings. A multiple information visualisation system provides critical information on anatomical severity and its associated cardiorespiratory changes during drug-induced sleep endoscopy assessment in real-time. A relational data model for drug-induced sleep endoscopy database management system provides a framework towards developing the first web drug-induced sleep endoscopy information management system and drug-induced sleep endoscopy informatics system. Open Access