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Objectives/Hypothesis To identify the prevalence and management of problematic residents. Additionally, we hope to identify the factors associated with successful remediation of unsuccessful otolaryngology residents. Study Design Self-reported Internet and paper-based survey. Methods An anonymous survey was distributed to 152 current and former program directors (PDs) in 2012. The factors associated with unsuccessful otolaryngology residents and those associated with the successful remediation of problematic residents were investigated. An unsuccessful resident is defined as one who quit or was removed from the program for any reason, or one whose actions resulted in criminal action or citation against their medical license after graduation from residency. Remediation is defined as an individualized program implemented to correct documented weaknesses. Results The overall response rate was 26% (40 PDs). Seventy-three unsuccessful or problematic residents were identified. Sixty-six problematic or unsuccessful residents were identified during residency, with 58 of 66 (88%) undergoing remediation. Thirty-one (47%) residents did not graduate. The most commonly identified factors of an unsuccessful resident were: change in specialty (21.5%), interpersonal and communication skills with health professionals (13.9%), and clinical judgment (10.1%). Characteristics of those residents who underwent successful remediation include: poor performance on in-training examination (17%, P

The purpose of this study was to examine the experiences of prior governing council (GC) members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Section for Residents and Fellows-in-Training (SRF) and assess the impact of early Academy involvement. A survey was conducted via email on all prior AAO-HNS SRF GC members. The AAO-HNS SRF has elected 52 GC members since its 2003 inception. Each member served an average of 1.5 year-long terms. The mean time since completion of training is 4.1 years. A subspecialty fellowship was pursued in 86%. Fifty-seven percent practice in academic settings, with 3 members advancing to subspecialty division director within their department. More than half (58%) have served on an AAO-HNS committee, and most are frequent attendees of the annual meeting. All prior members felt involvement in the SRF GC was beneficial, enabling them to gain leadership skills and deeper understanding of the specialty.

Transoral robotic glossectomy for obstructive sleep apnea offers a safe and effective alternative to conventional approaches for the treatment of hypopharyngeal obstruction. The robotic approach enables increased operative visualization, allows for greater control of tissue removal, and facilitates more aggressive volume reduction at the base of tongue.

To compare the efficacy of adenotonsillectomy (TA) with and without pharyngoplasty (tonsillar pillar closure) in the treatment of pediatric obstructive sleep apnea-hypopnea syndrome (OSAHS).Randomized single-blind controlled study.Tertiary care center.Sixty pediatric patients with a clinical diagnosis of OSAHS presenting between January 2009 and December 2010 were enrolled and randomized to undergo either standard TA (n = 30) or TA with pharyngoplasty (n = 30). Surgical cure was defined as apnea-hypopnea index (AHI)5 plus OSA-18 health-related quality-of-life (HRQL) score60. Other outcomes included postsurgical AHI and minimum oxygen saturation (SpO(2)) improvement, changes in OSA-18 scores at 1 month, and postsurgical days to resume normal diet and activity.Three patients from each group did not undergo surgery. Of the 54 patients treated, 8 from the pharyngoplasty group and 2 from the standard group were lost to follow-up. Intention-to-treat analysis revealed no difference in cure rate between groups (standard 60%, pharyngoplasty 56.6%, P = .793). Limiting analysis to those patients with complete data, a higher, but not significantly increased, cure rate with pharyngoplasty was noted (72% vs 89.5%, P = .155). Greater OSA-18 improvement (P = .036) and greater (although nonsignificant) AHI improvement and earlier return to normal function were noted with pharyngoplasty.The addition of pharyngoplasty to traditional adenotonsillectomy did not significantly improve OSAHS cure rates as measured by sleep testing and HRQL, although a nonsignificant increase in cure rate was observed in those who completed the study protocol. An unexpectedly high rate of patient dropout rendered the study statistically underpowered and therefore inconclusive.

Surgical correction of palatal obstruction is frequently needed as part of the multilevel treatment of moderate and severe obstructive sleep apnea/hypopnea syndrome. The classic uvulopalatopharyngoplasty technique described by Fujita has limited success rates. Uvulopalatopharyngoplasty has been modified in the form of Z-palatoplasty. Although this technique was first described for patients without tonsils, it has been further modified to include tonsillectomy along with pharyngoplasty. We describe the author's technique and experience with this new modification.

To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR).Case series with planned data collection.Tertiary care center.On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed.No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients (P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively.Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.

In previous reports of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), patients underwent routine tracheotomy. We aim to assess the feasibility of performing robotically assisted partial glossectomy without tracheotomy and to assess efficacy by comparing OSAHS outcomes with those of established techniques.Historical cohort study with planned data collection.Tertiary care center.Forty consecutive patients underwent TORS for OSAHS between October 2010 and June 2011 and were followed up with regard to complications, morbidity, and subjective and objective outcomes. Data from 27 of these patients who underwent concomitant z-palatoplasty with 6-month follow-up were compared with those of 2 matched cohorts of patients, who underwent either radiofrequency (radiofrequency base-of-tongue reduction [RFBOT]) or coblation (submucosal minimally invasive lingual excision [SMILE]) reduction of the tongue base and z-palatoplasty.No major bleeding or airway complications were observed. Postoperative pain and length of admission were similar between groups. All groups saw Epworth score and snore score improvement. Patients undergoing robot-assisted surgery took longer than their SMILE and RFBOT counterparts to tolerate normal diet and longer than RFBOT patients to resume normal activity. Apnea hypopnea index (AHI) reduction averaged 60.5% ± 24.9% for TORS versus 37.0% ± 51.6% (P = .042) and 32.0% ± 43.3% (P = .012) for SMILE and RFBOT, respectively. Only the robotic group achieved statistically significant improvement in minimum oxygen saturation. Surgical cure rate for TORS (66.7%) was significant compared with RFBOT (20.8%, P = .001) but not compared with SMILE (45.5%, P = .135).Robotically assisted partial glossectomy feasibly can be performed without the need for tracheotomy. This technique resulted in greater AHI reduction but increased morbidity compared with the other techniques studied.

Central neck dissection is commonly performed for metastatic thyroid cancer. We describe a technique for central neck dissection extending into level VII, removing the the nodes extending into the anterior mediastinum.

The purpose of this study was to investigate the relationship between nasal obstruction and sleep-disordered breathing. The effect of postoperative nasal packing on sleep parameters was compared between patients with mild obstructive sleep apnea (OSA) and those with moderate/severe OSA.A prospective, nonrandomized controlled study.Tertiary care center.Participants were recruited among adult patients with a history of snoring scheduled to undergo nasal surgery from November 2009 to February 2010. All subjects underwent polysomnogram (PSG) testing within 30 days prior to surgery. Patients underwent nasal surgery and received postoperative nasal packing, and a PSG was repeated on the first postoperative night with nasal packing in place. Outcome measures included a change in respiratory disturbance index (RDI), minimum oxygen saturation, oxygen desaturation index (ODI), and duration of snoring.Forty-nine patients were included in the study. Patients were stratified into 2 groups: those with RDI ≥15 (n = 23) and those with RDI15 (n = 26). Nasal packing was found to significantly increase RDI (5.2 ± 4.0 vs 10.4 ± 10.0; P = .0001), duration of snoring (86.5% ± 13.1% vs 79.3% ± 15.3%; P = .008), and ODI (7.6 ± 7.1 vs 9.9 ± 7.4; P = .001) in patients with mild OSA but not in patients with moderate/severe OSA. Mean minimum arterial oxygen saturation was unchanged in both groups.Postoperative nasal packing aggravated measures of OSA in patients with mild OSA but not in patients with moderate/severe OSA.

Treatment of laryngopharyngeal reflux (LPR) often suffers from poor patient compliance and hence poor symptom improvement. The aim of this study was to determine whether 24-hour oropharyngeal pH monitoring was associated with higher rates of treatment compliance and symptom improvement compared with empirical treatment for LPR.Retrospective, case-control study.Tertiary care center.Charts were reviewed from 170 consecutive adult patients diagnosed with LPR from January 2008 to March 2010. After clinical diagnosis, all patients were offered the option of empiric treatment with a proton pump inhibitor versus treatment based on a 24-hour oropharyngeal pH study using the Dx-pH system (Restech, San Diego, California). Treatment compliance and pretreatment and posttreatment reflux symptom index (RSI) scores were compared for the 2 groups. Only consecutive patients with complete data were included.One-hundred and seventy patients were included in 2 groups. Group I consisted of 73 patients who underwent pH monitoring. Group II consisted of 70 patients treated empirically. Compliance with medication therapy (68.5% vs 50.0%, P = .019) and lifestyle modification (82.2 vs 25.7%, P = .0001) were greater among patients in group I. Symptom improvement was greater among patients in group I following treatment compared with patients in group II, with a significantly greater reduction in RSI (36.6% vs 24.4%, P = .023).Among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.

The Laryngoscope C 2015 The American Laryngological, V Rhinological and Otological Society, Inc. How I Do It Using Google Glass to Solve Communication and Surgical Education Challenges in the Operating Room Omid Moshtaghi, BS; Kanwar S. Kelley, MD, JD; William B. Armstrong, MD; Yaser Ghavami, MD; Jeffery Gu, BS; Hamid R. Djalilian, MD Key Words: Google glass, otolaryngology, surgery, wearable technology, camera. Laryngoscope, 125:2295–2297, 2015 INTRODUCTION Although the use of video recording became popu- larized in otolaryngology beginning in 1959, a new generation of wearable technology has evolved. 1 One of these technologies includes a device called Google Glass (Google, Inc., Mountain View, CA), hereafter referred to simply as Glass. This device allows the capture of video from the perspective of the wearer. In addition, it provides an interface to access the Inter- net, communicate with others, and use applications hands free—relying mostly on voice commands. Google is not the only company developing wearable technol- ogy; other products such as Vuzix Smart Glasses M100 (Rochester, NY) have similar features to Glass. 2 Despite the many existing products, none is as popular and as widely implemented for use in medicine as Glass, which has been used experimentally in special- ties including primary care, dermatology, and pediatric surgery. 3–5 With this in mind, we set out to demon- strate the utility of this technology specifically within the context of otolaryngologic surgery. Furthermore, we utilized Glass to assess the potential to augment surgical education and enhance communication with the surgical team. MATERIALS AND METHODS Patient Population Three different physicians were tracked as they performed a wide range of otolaryngologic procedures to demonstrate the efficacy of Glass in various operative settings. A neurotologist, head and neck surgeon, and a general otolaryngologist were fol- lowed. Written consent was obtained from every patient before Glass was used. Procedures involving only endoscopes and microscopes were not included in this study. Device Glass connects to a computer or smartphone via Bluetooth or a wireless network, providing users with the ability to access the Internet in a hands-free manner. By means of a 720p high- definition camera and microphone, Glass records video and audio while giving the user control via various voice commands. 6 Addi- tionally, a bone-conduction speaker conveys sound to the user (Fig. 1). The device requires a wireless network in the hospital for fast streaming of video; however, an additional battery pack was used for this study to allow for longer usage during surgery. In addition, the device in our study was stripped of the inte- grated social media software to prevent accidental upload of sur- gical video on social media sites. Currently, Glass is sold only in the Explorer edition, a beta version of the product, which is being sold for $1,500 on the Google Play store. 7 RESULTS Benefits of Glass: Real-Time Intraoperative Uses Additional Supporting Information may be found in the online version of this article. From the Division of Neurotology and Skull base Surgery, Department of Otolaryngology–Head and Neck Surgery ( O . M ., K . S . K ., W . B . A ., Y . G ., J . G ., H . R . D .); and the Department of Biomedical Engineering ( H . R . D .), University of California, Irvine, Irvine, California, U.S.A. Editor’s Note: This Manuscript was accepted for publication February 12, 2015. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Hamid R. Djalilian, MD, Director of Otology, Neurotology, and Skull Base Surgery, University of California Irvine, 101 City Drive South, Bldg 56, Ste 500, Orange, CA 92868. E-mail: hdjalili@uci.edu DOI: 10.1002/lary.25249 Laryngoscope 125: October 2015 Communication. During head-and-neck cancer surgery, Glass proved to be useful to the surgeon. As an example, during one procedure involving a laryngeal cancer, the surgeon utilized Glass to speak to another physician at a remote location for an intraoperative con- sultation. Despite proving its use for communication, in this instance the physician at the remote location was not able to visualize the epiglottis through the video feed. Further follow-up studies are necessary to explore how much anatomy the viewer can distinguish. During another case involving an auricular squa- mous cell carcinoma and an application called Pristine, Moshtaghi et al.: Using Google Glass in the Operating Room

Program Description:Physicians must confront significant financial issues over the course of their careers. These issues can be especially problematic for young physicians entering practice, although decisions around professional and personal finance must be made throughout one’s career. Matters such as professional liability, asset protection, practice management, employment contracting, and retirement planning all must be addressed proactively and confidently for maximal financial benefit. This miniseminar will include presentations from physicians and financial professionals that highlight these important decisions and considerations for otolaryngologists. Representatives of Academy committees will participate in an interactive discussion around central topics of vital interest to practicing physicians.Educational Objectives:(1) Recognize the importance of building and protecting their practices. (2) Preserve their investment in their futures. (3) Examine employment contracts and retirement planning.

Objectives:(1) Examine resident interest in otolaryngology subspecialty fellowship and factors affecting that interest over time and throughout residency. (2) Examine changes in fellowship availability and match rate over time.Methods:Data regarding fellowship interest, influencing factors, and demographics were extracted from the 2008-2013 Section for Residents and Fellows-in-Training annual survey and examined in uni- and multivariate analyses. Historic fellowship match data available through match resources for pediatric otolaryngology, laryngology/broncho-esophagology surgery, rhinology, and neurotology were collected.Results:Over 6 years, a total of 1958 residents and fellows responded to the survey. A statistically significant decrease in fellowship interest was seen between junior (PGY-1 or PGY-2/3) and senior residents (PGY-4/5), with 79.9%, 73.3%, and 61.6% of PGY-1, PGY-2/3, and PGY-4/5 residents, respectively, planning to pursue subspecialty training (P < .001). Of the portion planning fellowsh...

To identify the prevalence and management of problematic residents. Additionally, we hope to identify the factors associated with successful remediation of unsuccessful otolaryngology residents.Self-reported Internet and paper-based survey.An anonymous survey was distributed to 152 current and former program directors (PDs) in 2012. The factors associated with unsuccessful otolaryngology residents and those associated with the successful remediation of problematic residents were investigated. An unsuccessful resident is defined as one who quit or was removed from the program for any reason, or one whose actions resulted in criminal action or citation against their medical license after graduation from residency. Remediation is defined as an individualized program implemented to correct documented weaknesses.The overall response rate was 26% (40 PDs). Seventy-three unsuccessful or problematic residents were identified. Sixty-six problematic or unsuccessful residents were identified during residency, with 58 of 66 (88%) undergoing remediation. Thirty-one (47%) residents did not graduate. The most commonly identified factors of an unsuccessful resident were: change in specialty (21.5%), interpersonal and communication skills with health professionals (13.9%), and clinical judgment (10.1%). Characteristics of those residents who underwent successful remediation include: poor performance on in-training examination (17%, P .01) and inefficient use of time (11.4%, P = .02).A large proportion of otolaryngology PDs in this sample identified at least one unsuccessful resident. Improved methods of applicant screening may assist in optimizing otolaryngology resident selection.

Objectives:1) Look at the experiences of prior governing council (GC) members of the American Academy of Otolaryngology (AAO) Section for Residents and Fellows (SRF), and 2) assess the impact of early Academy involvement.Methods:Survey of all prior members of the AAO SRF GC.Results:The AAO-SRF has elected 52 GC members since its 2003 inception. Ten members are currently in training, and no data were obtained for 3. The remaining 38 prior GC members were analyzed. Each member served an average of 1.5 years (terms ranged 1 - 3 years). The mean time since completion of training to present is 4.1 years (range 0 - 10 years). A subspecialty fellowship was pursued in 86%, with 92% matching into their fellowship field of choice. Fifty-seven percent practice in an academic setting, with 3 members advancing to a subspecialty division director within their department. All prior GC members are current AAO members. Over half (59%) have served on an AAO committee, and most are frequent attendees of the annual meeting. ...

(1) To present data from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Section for Residents and Fellows-in-Training (SRF) annual survey from 2002 to 2011. (2) To compare and analyze trends in resident demographics, residency experiences, and post-training career choices.Review of cross-sectional survey data.Residents and Fellows registered as Members-in-Training through AAO-HNS.A review of data from surveys distributed between 2002 and 2011 was conducted. Respondent demographic data including age, postgraduate year, gender, and geographic distribution were analyzed. Responses about training experiences, fellowship selection, debt burden, and post-training practice choice were studied in order to elicit trends.Respondents have consistently rated otolaryngology, anesthesia, and trauma/critical care as the most important intern rotations for otolaryngology residents. Each year, approximately 70% of respondents have reported interest in pursuing a fellowship. Pediatric otolaryngology fellowship is now the most popular fellowship among respondents. There has been a recent increase in the percentage of respondents who are interested in pursuing a career in academics. Location, family, and lifestyle have consistently been the most important factors in determining choice of practice. Respondents have reported increasing levels of educational debt.The AAO-HNS SRF survey collects important data regarding resident/fellow training. Several factors limit the generalizability of these results. Despite its limitations, these unique data provide valuable information for continual evaluation and improvement of physician training in the specialty.

Evaluate the effects of continuous positive airway pressure (CPAP) on C-reactive protein (CRP) levels, reported either as a primary or secondary end point among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) based on a meta-analysis of published studies.English-language searches of PubMed, Ovid, and the Cochrane databases were completed. Reference sections of identified studies were also examined for additional relevant articles to review.Studies of adult patients with OSAHS who reported pre- and post-CPAP treatment CRP were reviewed and analyzed. Two independent reviewers extracted data from 10 peer-reviewed studies, which were combined using a random effects meta-analysis model.The CPAP treatment was found to lead to a significant reduction in CRP levels (17.8%, P = .002). This corresponds to an effect size of -0.485 (-0.731, -0.240). Sensitivity analysis was done to determine the impact of study design. Both case-control studies and case-series studies yielded a significant effect. Sensitivity analysis also yielded a significant effect for studies with average body mass index30, studies where CPAP was employed over automatic positive airway pressure, and studies treating patients ≤ 3 months. Analysis of publication bias, however, revealed a likelihood of "missing" studies.Although there is a significant lack of high-quality studies addressing this question, this analysis suggests that treatment with CPAP leads to a statistically significant reduction in CRP levels. However, the mean pre- and posttreatment CRP levels observed are considered "high risk" for cardiovascular morbidity. The clinical significance of this finding as it relates to cardiovascular risk reduction and the relationship between CRP and OSAHS requires further study.

To share our experiences treating patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) with titratable thermoplastic (TPD) and custom-made mandibular advancement devices (MAD) and to compare these devices in terms of objective improvement and cure and treatment success (improvement/cure plus adherence at 6 months).Case series with planned data collection.Tertiary care center.Patients with OSAHS who failed or refused both continuous positive airway pressure (CPAP) and surgery had a titratable oral appliance fitted. Patients were offered an office-fitted TPD or a custom-made dentist-fitted device. Assessment included pretreatment and appliance-titration polysomnography (PSG). Improvement was defined as ≥ 50% apnea-hypopnea index (AHI) reduction plus posttreatment AHI20, and cure was defined as AHI5. Patients were contacted at 1 and 6 months regarding treatment adherence.A total of 180 patients (123 TPD, 57 custom) with complete PSG data were reviewed. Improvement/cure were significantly better with the custom device overall (91.2%/71.9% vs 77.2%/52.0%, P = .024/.012). Adherence data at 1 and 6 months were obtained from 128/180 and 119/180 patients, respectively. Using an intention-to-treat analysis, those lost to follow-up were considered nonadherent. Adherence at 1/6 months was 64.9%/50.9% for custom versus 53.7%/32.5% for TPD (P = .156/.018), yielding treatment success rates (with initial improvement/cure) of 49.1%/40.4% for custom versus 27.6%/17.1% for TPD (P = .005/.001) at 6 months.Custom-fit devices achieve higher rates of objective improvement and cure of OSAHS than TPD at the time of titration-PSG. TPDs have a high acceptance rate, low cost, and reasonable initial improvement and cure rates of 77.2% and 52.0%, respectively, but significantly poorer 6-month compliance.

Objective: 1) Compare the efficacy of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone in the treatment of pediatric OSAHS. 2) Compare the morbidity of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone.Method: Randomized single-blind controlled study of 60 pediatric patients treated between January 2009 to January 2010 at a tertiary care center. Patients were randomized into 2 groups: adenotonsillectomy alone (group I) and adenotonsillectomy with pharyngoplasty (group II). Endpoints included: pre- and postsurgical AHI, number of cures, pain levels, and change in OSA-18.Results: Sixty patients were enrolled and 52 patients completed the study (group I n = 27, group II n = 25). The mean age, BMI, and baseline AHI did not differ significantly between the two groups. The change in AHI from pre- to postsurgery was not found to be significant between the 2 groups (P = .337). No significant differences were found in the number of cures (P = .709). There was no significant diffe...

Objective: 1) Report the accuracy of subjective Reflux Symptom Index scores (RSI) and objective Reflux Finding Scores (RFS) in identifying patients with laryngopharyngeal reflux (LPR) using ambulatory pH monitoring as confirmation. 2) Present clinical recommendations for the use of subjective and objective tools in the diagnosis of LPR.Method: Retrospective chart review of 300 adult outpatients from January 3, 2009 to December 30, 2010 in a tertiary care setting. Patients with a diagnosis of LPR based on abnormal RSI and positive findings on laryngeal endoscopic examination using RFS were tested for confirmation with a 24-hour oropharyngeal pH study using the Restech Dx-pH system.Results: Among 300 consecutive patients with an RSI score >5, 58.6% were confirmed to have reflux after undergoing 24-hour oropharyngeal pH-monitoring. Of these 300 patients, 146 had an RFS score >5. Among patients with a RSI >5 and a RFS 5 and RFS>5 the positive predictive value (PPV) increased to 71.9% (105 of 146). Therefore, ...

Objective: 1) Report our experience with custom-made and thermoplastic mandibular advancement devices (MADs). 2) Compare the cost, efficacy, and compliance of thermoplastic mandibular advancement devices vs custom made MADs.Method: Retrospective review of 287 consecutive adult outpatients treated between July 2009 and August 2010. Compliance was assessed using chart review and phone interviews after 1 and 6 months. Endpoints included: 1. Efficacy measured by post-MAD AHI.Results: The percentage of patients achieving AHI reduction criteria for efficacy was 70.3% and 72.2% for thermoplastic vs custom-made devices (P = .204). Compliance more than 4 hours a night for 70% of nights within the first month after receiving MAD was 88.2% for thermoplastic vs 64.3% for custom-made (P < .001). At 6 months compliance was 47.4% for thermoplastic devices vs 61.1% for custom devices (P = .01). The average cost for the thermoplastic devices was $150 vs $1450 for the custom-made devices.Conclusion: Thermoplastic devices r...

Objective: 1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base-of-tongue (RFBOT) MG.Method: Retrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications.Results: Twenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for (P...

Objective: 1) Determine the effect of continuous positive airway pressure (CPAP) on C-reactive protein (CRP) levels in patients with obstructive sleep apnea (OSA). 2) Demonstrate the effect of CPAP on general health status using CRP as a marker for cardiovascular health.Method: A computerized search was conducted using PubMed, Ovid, and the Cochrane database. A systematic review was preformed to identify studies that included CRP levels in adult patients (age >18 years) with OSA pre- and post-CPAP treatment.Results: Initial search results identified 136 articles of which 64 articles then underwent second-stage review. Ten studies met the inclusion criteria and a meta-analysis was performed to determine the overall change in CRP levels. Meta-analysis included 325 subjects (mean sample size of 32.5 patients) with mean BMI of 33.12. The mean CRP level in patients with OSA decreased from 0.43 ± 0.39 mg/dL to 0.35 ± 0.346 mg/dL following CPAP treatment (p = 0.002).Conclusion: In patients with OSA, CRP levels s...

Growing evidence suggests that changes in the ion buffering capacity of glial cells can give rise to neuropathic pain. In the CNS, potassium ion (K+) buffering is dependent on the glia-specific inward rectifying K+channel Kir4.1. We recently reported that the satellite glial cells that surround primary sensory neurons located in sensory ganglia of the peripheral nervous system also express Kir4.1, whereas the neurons do not. In the present study, we show that, in the rat trigeminal ganglion, the location of the primary sensory neurons for face sensation, specific silencing of Kir4.1 using RNA interference leads to spontaneous and evoked facial pain-like behavior in freely moving rats. We also show that Kir4.1 in the trigeminal ganglion is reduced after chronic constriction injury of the infraorbital nerve. These findings suggests that neuropathic pain can result from a change in expression of a single K+channel in peripheral glial cells, raising the possibility of targeting Kir4.1 to treat pain in general and particularly neuropathic pain that occurs in the absence of nerve injury.