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Pharyngoplasty represents one of the most widely performed surgical procedures for the treatment of obstructive sleep apnea (OSA) in the presence of palate-oropharyngeal collapse. The learning curve for pharyngoplasties is steep and success is conditional on the correct use of the sutures and the careful application of the surgical steps in a narrow surgical field. The use of synthetic models may be conveniently and safely employed for hands-on surgical practice in pharyngoplasties, especially when fresh frozen cadaveric specimens are not available. We present the "Pharyngolab", a new simulator for pharyngoplasties.

Background: The use of barbed sutures for pharyngoplasty techniques is a new trend in sleep apnea surgery, but little is known about its short-term results depending on the different techniques. The objective of this study was to compare the surgical results in two different centers using barbed sutures in which the main difference was the loops performed in the soft palate. Methods: This is a retrospective study of patients with obstructive sleep apnea (OSA) operated in two centers. A statistical analysis comparing the ENT department of the Ospedale Morgagni-Pierantoni from Forlí with the ENT department of Dr. Peset University Hospital was performed. Results: The final sample size was 138 patients (70 from Forlí and 68 from Valencia). In both series, a significant improvement was observed in OSA patients with significant reductions in respiratory events not related to weight reduction. The mean delta Apnea-Hypopnea index was 13.36 (SD 21.3) in Forlí and 22.8 (SD 22.05) in Valencia (p

Resumen Introduccion y objetivos El estadio tumoral al diagnostico es clave en el pronostico del cancer de cabeza y cuello. Pese a un sistema sanitario casi universal y ser tumores generalmente sintomaticos, una gran proporcion de tumores son diagnosticados en estadios avanzados. El objetivo es conocer el tiempo que se tarda en diagnosticar los tumores de cabeza y cuello en nuestro departamento de salud, analizar si existen factores asociados a su retraso y si este se asocia al diagnostico en estadios avanzados. Metodos Estudio retrospectivo de 137 pacientes con cancer de cabeza y cuello diagnosticados de 2016-2018. Se evaluo la demora del paciente en la busqueda de atencion medica, en la prestacion de la atencion y en la obtencion del diagnostico, asi como la existencia de factores asociados (tabaquismo, localizacion, estadio, etc.). Resultados El 44,5% de los pacientes se diagnosticaron en estadios avanzados. Los pacientes tardaron en consultar una mediana de 30 dias desde el inicio de los sintomas. Se tardo en derivar a Otorrinolaringologia una mediana de 3,5 dias. Se evidencio mayor retraso cuando la derivacion la hacia otro especialista (p = 0,008), si recibieron tratamiento previo (antibiotico, antiinflamatorios no esteroideos, etc.) (p = 0,000) y en tumores en estadios iniciales (p = 0,038). En la consulta de Otorrinolaringologia fueron valorados 15 dias despues de la derivacion. Este tiempo fue mayor en el 43% de los tumores que fueron remitidos de forma ordinaria (p = 0,000). Se obtuvo el diagnostico en 12 dias desde la primera visita a Otorrinolaringologia, mayor cuando se tomo la biopsia en quirofano (p = 0,000). La mediana de retraso medico fue de 58,5 dias y el retraso total 118,5 dias. Conclusiones Muchos tumores de cabeza y cuello siguen diagnosticandose en estadios avanzados. No se ha encontrado relacion entre el diagnostico en estadios avanzados y la demora en el diagnostico. Aun asi, es necesario adoptar medidas para disminuir estas excesivas demoras.

Introducción y objetivo: Dentro de las posibles causas de AOS, aunque poco frecuentes, están las alteraciones de la epiglotis. El objetivo de este trabajo es destacar su importancia e insistir en su diagnóstico activo ya que en casos bien seleccionados se puede tratar quirúrgicamente. Síntesis: Se detalla la importancia de la epiglotis como causa de AOS, su exploración y las alternativas quirúrgicas posibles. Conclusiones: La epiglotis es una estructura anatómica que generalmente pasa desapercibida como causa de AOS en adultos y que puede provocar una AOS de carácter incluso severo. Debe ser estudiada de una manera activa. Es probable que su participación en la AOS no se revele durante la exploración con el paciente despierto y sea necesario recurrir a la DISE para apreciar el modo en que colapsa durante la inspiración del paciente dormido. Se describen algunas técnicas quirúrgicas ya que supone una buena elección en muchos pacientes debidamente seleccionados.

Introduction and purposes: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20 years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results. Materials and methods: This is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6 months after surgery the subjective parameters were evaluated and a sleep study was performed. Results: Twenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture. Conclusions: This surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications. (C) 2020 Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. Published by Elsevier Espana, S.L.U. All rights reserved.

Antecedentes y objetivo: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España. Materiales y métodos: Estudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados. Resultados: Un total de 1043 pacientes COVID-19 leve. Edad media de 39 ± 12 años. 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p

Introduction Obstructive sleep apnea (OSA) is a common disorder with major neurocognitive and cardiovascular sequelae. The treatment of symptomatic patients with mild OSA remains controversial given that adherence to positive airway pressure (PAP) has historically been suboptimal. With this notion in mind, we assessed a daily transoral neuromuscular electrical stimulation (NMES) device for individuals with mild OSA. Methods The sample represents a subset of participants with a baseline AHI 5–14.9 events/hour, drawn from a parent study which also included participants with primary snoring. Outcome measures for the current study included changes in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and snoring levels before and after use of the NMES. Results Among 65 participants (68% men) with median age of 49 years (range 24 to 79) and median BMI of 27.7 kg/m2 (range 20 to 34), the NMES device was used daily for 6 weeks. We observed a significant improvement in the AHI from 10.2 to 6.8 events/hour among all participants and from 10.4 to 5.0 events/h among responders. Statistically significant improvements in the ESS, PSQI, objectively measured snoring, and bed partner-reported snoring were observed. Adherence among all participants was 85%. Discussion This NMES device has the benefit of being a treatment modality of daytime therapy which confers a high level of tolerability and patient acceptance. It alleviates the need for an in situ device during sleep and leads to improvements in OSA severity, snoring, and subjective sleep metrics, potentially crucial in mild OSA. Further studies are needed to define which individuals may benefit most from the device across the wider spectrum of OSA severity and assess long-term therapeutic outcomes. Trial registration ClinicalTrials.gov Identifier: NCT03829956.

This document introduces drug-induced sleep endoscopy to the specialist treating sleep breathing disorders and is intended as a guide for those willing to perform the procedure so that it can be reproducible.

Resumen Antecedentes y objetivo Las tecnicas quirurgicas para tratar el colapso velofaringeo de los pacientes con sindrome de apnea-hipopnea del sueno han evolucionado en los ultimos anos. Nuestro objetivo era conocer si estas nuevas tecnicas proporcionan mejores resultados quirurgicos. Materiales y metodos Es un estudio retrospectivo de los pacientes con sindrome de apnea-hipopnea del sueno moderado-severo tratados quirurgicamente del 2006 al 2018. Solo los pacientes adultos sin adherencia a la CPAP y en los que no se practico cirugia multinivel simultanea fueron incluidos. Durante este periodo se practicaron 4 tecnicas diferentes: reseccion parcial del paladar, faringoplastia lateral, faringoplastia de expansion y faringoplastia de reposicion con sutura barbada. La tasa de exito se calcula segun los criterios de Sher, segun el criterio de IAH Resultados Ochenta y dos pacientes fueron incluidos. El IAH se redujo significativamente de 43,4 ± 24/h a 15,6 ± 18,6/h. No se observaron cambios significativos en el indice de masa corporal. Los valores de Tc 90, el indice de desaturacion y la somnolencia segun la escala de Epworth mejoraron tras la cirugia. La mayor tasa de exito se obtuvo mediante la realizacion de la faringoplastia de reposicion con sutura barbada (78,26% segun criterios Sher, 65,22% para IAH Conclusiones La faringoplastia de reposicion con sutura barbada es una tecnica de reciente introduccion que mostro superioridad sobre el resto de faringoplastias en esta cohorte.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are infrequent mucocutaneous diseases, rapidly progressive and life-threatening. The clinical aspects and the management of TEN are exposed following a case.A man in his 40s presented to the emergency department with severe odynophagia, poor general condition and fever. His medical history was significant for HIV stage AIDS, and the treatment was discontinued 5 years before the present diagnosis. He was admitted for cerebral toxoplasmosis and discharged the previous 14 days with sulfadiazine. Erythematous-bullous lesions in the oral cavity, diffuse erythematous maculopapular rashes over his neck and chest, acute bilateral conjunctivitis and purulent urethritis was observed. The diagnostic suspicion was SJS/TEN due to sulfadiazine in immunosuppressed patients.This entity is infrequent but is a life-threatening dermatological emergency that requires immediate medical attention. Its diagnosis is mainly clinical, with a new drug history, prodromal symptoms and characteristic cutaneous–mucous lesions. Early diagnosis and rapid withdrawal of the drug improve the prognosis.

Purpose Positional therapy (PT) has become more reliable for obstructive sleep apnea (OSA) patients with the use of new devices. The objectives of this study were to determine the preoperative prevalence of positional OSA (POSA) in our population of surgically treated patients and the proportion of patients who developed POSA after surgery and might improve with additional positional therapy. Methods This was a retrospective study of surgically treated OSA patients from 1999 to 2017. The Cartwright definition was used to define POSA. All patients completed a sleep study before and 6 months after surgery and a complete upper airway (UA) exploration (awake +/- DISE). A total of 125 patients were included. Results The global prevalence of POSA before surgery was 31.2%. In those who were cured by surgery, the preoperative prevalence of POSA was 38.3%. Having POSA was not related with surgical success outcome. For patients not cured by surgery, the proportion of POSA significantly increased from 25.64 to 53.85% after surgery. Eighteen patients of them (23.1%) achieved AHI < 5/h in a lateral position. In those patients, PT with Night-Shift (TM) was suggested, 50% of them accepted it and 88.9% of them experienced excellent satisfaction. Lateral velum collapse and the absence of concentric collapse at the tongue base had statistical relationships with the development of POSA. Conclusions The prevalence of POSA is increased after surgery in patients with persistent OSA after surgery. In these patients, the development of POSA gives an extra therapeutic chance as 23.1% of these cases can be successfully treated by using PT.

To review whether drug-induced sleep endoscopy (DISE) aids in obstructive sleep apnea surgical planning, if it changes the initial proposal, and if so, does it contribute to increased surgical success or unnecessary morbidity? A DISE and surgical outcomes multicenter cohort study (n = 275) reported no association for surgical outcomes with velopharyngeal and epiglottic collapse. Oropharyngeal and tongue base collapse on the other hand were associated with lower odds of surgical response. DISE changes surgical planning mainly in regard to the approach of the tongue base and epiglottis, as these structures usually do not collapse in the awake state. The decision of velopharyngeal surgery usually does not change, as the vast majority demonstrate velopharyngeal collapse in DISE. Whether DISE increases or not, surgical success is controversial, with conflicting published data. However, poorer surgical outcomes have been associated with velopharyngeal concentric, oropharyngeal lateral wall, and tongue base collapse.

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd, London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p &lt, 0.001). Bed partner-reported snoring reduced significantly by 39% (p &lt, 0.001). ESS and total PSQI scores reduced significantly (p &lt, 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects.

Purpose Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed. Methods This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included. Results Following surgery, the apnea-hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07). Conclusion The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability.

Introduction: The treatment of choice for pediatric OSAHS is surgical. However, its etiopathogenesis is multifactorial and surgery does not always solve it. Therefore, other modalities of treatment are used. The main objective of this study is to shed light on the efficacy of surgery compared to other treatments. Methods and materials: Prospective cohort study with 317 children ages 1-13 years and apnea-hypopnea index (AHI) >= 3/h with no previous treatment. The treatment was organised into 3 categories: surgical (n = 201), medical (n = 75) and observation (n = 41). Quality of life and sleep was assessed by two validated questionnaires (PSQ & Esteller et al.) The upper airway was explored, and nocturnal polysomnography (PSG) performed in every patient. After 12 +/- 3 months of treatment was completed, a new PSG and questionnaires were evaluated. Results: The surgical group improved significantly both subjectively and objectively. Mean AHI decreased from 7.95/h to 2.57/h and T 90 (time spent with arterial oxygen saturation

The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results.This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI10/h and mean relative AHI reduction (MRR) were compared.82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI10/h criteria and 74.1% by the MRR). The differences observed were statistically significant.Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort.