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Background and Objectives: We investigated the effects of using a BiZact™ device for tonsillectomy on operating time, intraoperative blood loss, postoperative bleeding rate, and pain through a meta-analysis of the relevant literature. Materials and Methods: We reviewed studies retrieved from the databases of PubMed, SCOPUS, Google Scholar, Embase, Web of Science, and Cochrane up to March 2024. The results were analyzed following PRISMA guidelines. Six studies that compared the outcomes of patients receiving perioperative BiZact™ tonsillectomy with those in control groups (cold steel dissection or bipolar tonsillectomy) were included for this analysis of the outcomes, which included intraoperative bleeding and time, postoperative pain, and frequency of postoperative bleeding. Results: The operative time (SMD −11.5985, 95%CI [−20.3326; −2.8644], I2 = 99.5%) in the treatment group was significantly reduced compared to the control group. However, BiZact™ showed no significant efficacy in reducing intraoperative bleeding when compared with the control group (SMD −0.0480, 95%CI [−1.8200; 1.7240], I2 = 98.6%). Postoperative pain on day 1 (SMD −0.0885, 95%CI [−0.4368; 0.2598], I2 = 98.9%), day 3 (SMD −0.2118, 95%CI [−0.6110; 0.1873], I2 = 99.5%), and later than day 7 (SMD 0.0924, 95%CI [−0.2491; 0.4338], I2 = 98.6%) in the treatment group was not significantly reduced relative to the control group. When compared to the control group, BiZact™ did not reduce the incidence of secondary postoperative bleeding control in the operation room (OR 0.5711, 95%CI [0.2476; 1.3173], I2 = 32.1%), primary bleeding (OR 0.4514, 95%CI [0.0568; 3.5894], I2 = 0.0%), or all postoperative bleeding events (OR 0.8117, 95%CI [0.5796; 1.1368], I2 = 26.3%). Conclusions: This study demonstrated that using the BiZact™ device for tonsillectomy significantly decreased the operative time but could not effectively reduce intraoperative bleeding or postoperative pain and bleeding. [ABSTRACT FROM AUTHOR]

Summary: Although understanding the physiological mechanisms of obstructive sleep apnea (OSA) is important for treating OSA, limited studies have examined OSA patients' sleep architecture at the epoch‐by‐epoch level and analysed the impact of sleep position and stage on OSA pathogenesis. The epoch‐labelled polysomnogram was analysed multidimensionally to investigate the effect of sleep position on the sleep architecture and risk factors of apnea in patients with OSA. This retrospective multicentric case–control study reviewed full‐night diagnostic polysomnography of 6983 participants. The difference in the proportion of time spent supine during non‐rapid eye movement (NREM) and REM stages, and the mean duration of respiratory events per body position were evaluated. The frequency of sleep stage transition per body position shift type was computed. Further subgroup analysis was performed based on OSA severity and positional dependency. Supine time in patients with OSA varied across sleep stages, with lower proportions in N3 and REM, and shorter durations with severity. Patients with OSA spent less time in supine positions during N3 and REM, and experienced longer apnea events in both positions compared to the control group. The frequency of all sleep stage transitions increased with OSA severity and was higher among non‐positional OSA than positional OSA and the control group, regardless of body position shift type. The sleep stage transition from N3 and REM to wakefulness was notably heightened during position shift. Understanding the sleep architecture of patients with OSA requires analysing various sleep characteristics including sleep position simultaneously, with future studies focusing on position detection to predict sleep stages and respiratory events. [ABSTRACT FROM AUTHOR]

Background: We investigated the role of perioperative intraoral glossopharyngeal nerve block to minimize postoperative pain in patients undergoing tonsillectomy through a meta‐analysis of the relevant literature. Methods: We retrieved eight studies from PubMed, Scopus, Embase, Web of Science, and Cochrane databases up to August 2023. We compared perioperative glossopharyngeal nerve block with a control group, in order to examine postoperative pain, analgesic use, and other postoperative morbidities. Results: Postoperative pain was significantly reduced at 1–4 h (SMD −1.26, 95% CI [−2.35; −0.17], I2 = 94.7%, P = 0.02) and 5–8 hours (SMD −1.40, 95% CI [−2.47; −0.34], I2 = 96.1%, p = 0.01) in the treatment groups compared to the control group. However, glossopharyngeal nerve block showed no efficacy in reducing pain or use of analgesic drugs after 12 h compared to the control group. The incidences of postoperative bleeding (OR 0.95, 95% CI [0.35; 2.52], I2 = 0.0%), local agent toxicity (OR 4.14, 95% CI [0.44; 38.63], I2 = 0.0%), nasal problems (OR 1.25, 95% CI [0.60; 2.61], I2 = 0.0%), postoperative nausea and vomiting (OR 1.35, 95% CI [0.78; 2.33], I2 = 0.0%), swallowing difficulty (OR 1.61, 95% CI [0.76; 3.42], I2 = 56.0%), and voice change (OR 3.11, 95% CI [0.31; 30.80], I2 = 0.0%) were not significantly different between the treatment and control groups. The treatment group showed higher prevalence of respiratory problems and dry mouth compared to control without statistical significance, but a significant increase in throat discomfort (p = 0.02). Conclusion: Intraoral glossopharyngeal nerve block for tonsillectomy did not significantly impact postoperative pain management and was associated with some adverse effects with increases in respiratory problems, dry mouth, and throat discomfort compared to controls. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the impact of cryoablation of the posterior nasal nerve on symptoms of rhinitis in individuals with allergic rhinitis (AR) and non‐allergic rhinitis (NAR). Data Sources: PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases for studies published up to June 2023. Review Methods: Studies that evaluated the quality of life and rhinitis‐related symptom scores before and after cryotherapy treatment, as well as sham‐controlled studies, were included. Results: In total, 368 patients from seven studies were analyzed. Patients who underwent cryoablation showed a significant improvement in rhinitis‐related symptoms in both NAR and AR. In particular, the most significant improvement was observed in symptoms of rhinorrhea and congestion. Furthermore, cryoablation improved the disease‐specific quality of life evaluated using the Rhinoconjunctivitis Quality of Life Questionnaire. The rate of clinical improvement in the total nasal symptom score (total nasal symptom score [TNSS]; >30% reduction from baseline) after cryotherapy was 74%. The change in TNSS score significantly increased over time in NAR patients (p = 0.0041). Therefore, changes in the TNSS score after 12 months of cryotherapy treatment were greater in the NAR group than in the AR group (p = 0.0020), indicating that cryoablation is effective for both types of rhinitis and has better long‐term efficacy in NAR than in AR. Conclusions: Subjective symptom scores related to rhinitis, particularly for rhinorrhea and congestion, decrease after cryoablation of the posterior nasal nerve. Furthermore, the symptom improvement was greater in NAR than AR. Laryngoscope, 134:2502–2512, 2024 [ABSTRACT FROM AUTHOR]

Simple Summary: We compared the diagnostic accuracy of conventional smears and liquid-based preparations for detecting thyroid lesions using fine-needle aspiration cytology. We reviewed 15,861 samples from 17 studies. There was no significant difference between conventional smears and liquid-based preparations in terms of diagnostic accuracy or the proportion of inadequate smears. SurePath outperformed ThinPrep in terms of diagnostic accuracy among the liquid-based preparations. Recommendations for one method over another should take cost, feasibility, and accuracy into account, necessitating additional research. Background: To compare conventional smears (CSs) and liquid-based preparations (LBPs) for diagnosing thyroid malignant or suspicious lesions. Methods: Studies in the PubMed, SCOPUS, Embase, Web of Science, and Cochrane database published up to December 2023. We reviewed 17 studies, including 15,861 samples. Results: The diagnostic odds ratio (DOR) for CS was 23.6674. The area under the summary receiver operating characteristic curve (AUC) was 0.879, with sensitivity, specificity, negative predictive value, and positive predictive value of 0.8266, 0.8668, 0.8969, and 0.7841, respectively. The rate of inadequate specimens was 0.1280. For LBP, the DOR was 25.3587, with an AUC of 0.865. The sensitivity, specificity, negative predictive value, and positive predictive value were 0.8190, 0.8833, 0.8515, and 0.8562. The rate of inadequate specimens was 0.1729. For CS plus LBP, the AUC was 0.813, with a lower DOR of 9.4557 compared to individual methods. Diagnostic accuracy did not significantly differ among CS, LBP, and CS plus LBP. Subgroup analysis was used to compare ThinPrep and SurePath. The DORs were 29.1494 and 19.7734. SurePath had a significantly higher AUC. Conclusions: There was no significant difference in diagnostic accuracy or proportion of inadequate smears between CS and LBP. SurePath demonstrated higher diagnostic accuracy than ThinPrep. Recommendations for fine-needle aspiration cytology should consider cost, feasibility, and accuracy. [ABSTRACT FROM AUTHOR]

Objective: Internal nasal valve dysfunction is a prevalent cause of nasal obstruction. This systematic review, along with a Meta‐analysis, evaluated the efficacy of temperature‐controlled radiofrequency device (RFD) treatment in alleviating nasal obstruction by rectifying nasal valve collapse. Data Sources: A comprehensive review of studies retrieved from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases (up to December 2022) was conducted. Review Methods: We included studies that evaluated the quality of life and nasal obstruction scores before and after RFD treatment. In addition, sham‐controlled studies were analyzed. Results: In total, 451 patients across 8 studies were included in the analysis. Patients who underwent RFD treatment reported a significantly enhanced quality of life 24 months after treatment compared to pretreatment scores. The rates of clinically improved states and positive responses regarding quality of life after treatment were 82% and 91%, respectively. Moreover, the disease‐specific quality of life, as assessed by the Nasal Obstruction Symptom Evaluation score, significantly improved. Conclusion: RFD may help improve nasal obstruction symptoms. Further randomized clinical studies on larger cohorts are essential to substantiate its efficacy in enhancing nasal valve function. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of topically applied tramadol in peritonsillar area for pain control and induction of perioperative morbidity in children undergoing adenotonsillectomy. Methods: Two authors independently searched the databases (MEDLINE, SCOPUS, and Cochrane databases) up to April 2022 for randomized controlled trials comparing the efficacy of an intraoperative peritonsillar administered tramadol with placebo or other agents only in pediatric patients. The outcomes were postoperative pain scores, time to take the first pain reducing drugs, and postoperative nausea/vomiting. Results: Our analysis was based on 17 trials. Peritonsillar administered tramadol significantly reduced postoperative pain at less than 20 minutes (SMD −1.5852, 95% CI [−2.3900; −0.7804]), 1 hour (SMD −1.5811, 95% CI [−2.3400; −0.8222]), 8 hours (SMD −1.0258, 95% CI [−1.8792; −0.1724]), 16 hours (SMD −0.8397, 95% CI [−1.4266; −0.2529]), and 1 day (SMD −1.0110, 95% CI [−1.5213; −0.5007]) and the time to take the first analgesic drug (SMD 1.6565, 95% CI [0.2838; 3.0293]) compared with the placebo. However, tramadol showed no significant difference on postoperative pain relief effects and the time to take the first analgesic drug compared to the other topical agents (bupivacaine, lidocaine, ketamine, and dexamethasone). Tramadol did not cause significant postoperative nausea and vomiting. Conclusions: This study demonstrated that intraoperatively applied topical tramadol could control postoperative pain and reduce the analgesic uptake compared with a control. However, the efficacy of tramadol in pain control was similar to other agents in pediatric adenotonsillectomy. [ABSTRACT FROM AUTHOR]

Simple Summary: This meta-analysis determined the optimal cut-off value for differentiating benign and malignant thyroid nodules in two risk stratification systems (ACR and Kwak TI-RADS) and compared their diagnostic performance. Both systems showed good diagnostic performance. TR4 and 4B were estimated as optimal cut-off values for ACR and Kwak TI-RADS, respectively, but the cut-off values can be adjusted in consideration of changes in sensitivity and specificity. (1) Background: To determine the optimal cut-off values of two risk stratification systems to discriminate malignant thyroid nodules and to compare the diagnostic performance; (2) Methods: True and false positive and negative data were collected, and methodological quality was assessed for forty-six studies involving 39,085 patients; (3) Results: The highest area under the receiver operating characteristic (ROC) curve (AUC) of ACR and Kwak TI-RADS were 0.875 and 0.884. Based on the optimal sensitivity and specificity, the highest accuracy values of ROC curves or diagnostic odds ratios (DOR) were taken as the cut-off values for TR4 (moderate suspicious) and 4B. The sensitivity, specificity, DOR, and AUC by ACR (TR4) and Kwak TI-RADS (4B) for malignancy risk stratification of thyroid nodules were 94.3% and 96.4%; 52.2% and 53.7%; 17.5185 and 31.8051; 0.786 and 0.884, respectively. There were no significant differences in diagnostic accuracy in any of the direction comparisons of the two systems; (4) Conclusions: ACR and Kwak TI-RADS had good diagnostic performances (AUCs > 85%). Although we determined the best cut-off values in individual risk stratification systems based on statistical assessment, clinicians can adjust the optimal cut-off value according to the clinical purpose of the ultrasonography because raising or lowering cut-points leads to reciprocal changes in sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Frontal Mucocele grows gradually and unnoticed as a benign lesion but, as the frontal mucocele expands to and compresses surrounding organs like brain, orbit, etc., it can cause diverse symptoms and signs. Although the surgical approaches of mucocele include open, endoscopic and combined approach, endoscopic marsupialization has been commonly used because endoscopic marsupialization was reported with high success rates, low complication rates and better operative vision. However, recently we experienced rare complication of endoscopic marsupialization of huge frontal mucocele, large amount of intracerebral hemorrhage, immediately after successful surgery and report this rare case with short review. [ABSTRACT FROM AUTHOR]

Background and Objectives: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. Materials and Methods: The Onodi cell and intersphenoid sinus septation based on preoperative paranasal sinus computed tomography (PNS CT) and the surgical records of 877 patients who underwent the endoscopic endonasal transsphenoidal approach (EETSA) were retrospectively reviewed. Results: An intersphenoid sinus septum (ISS) blocking the clivus was defined as a pseudoclivus. Complete and incomplete pseudoclivuses were found in 2.97% and 10.5% of patients, respectively. Intraoperative and PNS CT ISS findings differed in 17.1% of patients. Misconceptions regarding a ridge or vertical ISS and confusion between an incomplete pseudoclivus and a vertical ISS were common. Conclusions: Because intraoperative and PNS CT findings may differ, anatomical variation in the paraclival area should be evaluated carefully. A pseudoclivus mimicking the clivus is important to attain a fully exposed EETSA surgical view. [ABSTRACT FROM AUTHOR]

Simple Summary: This systemic review and meta-analysis compared and analyzed the safety and effectiveness of transoral robotic thyroidectomy on the thyroid tumor with other thyroid approaches. Transoral robotic thyroidectomy showed similar results to other robotic-assisted thyroid surgeries. Compared to a conventional open thyroidectomy, transoral robotic thyroidectomy had longer operational times and hospitalization days, and worse postoperative pain, but a higher cosmetic satiation score. However, more randomized controlled studies need to be included and analyzed. Background: To assess the safety and effectiveness of transoral robotic thyroidectomy (TORT) in thyroid tumor. Methods: PubMed, Embase, Web of Science, SCOPUS, Cochrane database, and Google Scholar up to June 2022. Studies comparing outcomes and complications between TORT and control groups (robotic bilateral axillo-breast, trans-axillary, postauricular approach, conventional open thyroidectomy (OT), and transoral endoscopic approach) were analyzed. Results: Ten studies of 1420 individuals. The operative time (SMD 1.15, 95%CI [0.48; 1.89]) was significantly longer and the number of retrieved lymph nodes (LNs) (SMD −0.27, 95%CI [−0.39; −0.16]) was fewer in TORT than in the control group. The postoperative cosmetic satisfaction score (SMD 0.60, 95%CI [0.28; 0.92]) was statistically higher in TORT than in the control group. In subgroup analysis, there was no significant difference between robotic surgeries. However, TORT had significantly longer operative times (SMD 2.08, 95%CI [0.95; 3.20]) and fewer retrieved LNs (SMD −0.32, 95%CI [−0.46; −0.17]) than OT. TORT satisfied significantly more patients in cosmetic view. However, it increased hospitalization days and postoperative pain on the operation day and first day compared to OT. Conclusions: TORT is not inferior to other robotic-assisted approaches. Its operation time and hospitalization days are longer and postoperative pain is greater than OT, although its cosmetic satisfaction is high. [ABSTRACT FROM AUTHOR]

Objective: We explored the clinical significances of the relationships among sphenoid sinus aeration, intersphenoid sinus septum (ISS), and internal carotid artery (ICA). Methods: We retrospectively reviewed the preoperative paranasal sinus computed tomography scans and the medical charts of 490 patients who were treated by the endoscopic endonasal transsphenoidal approach. We analyzed sphenoid sinus pneumatization, number of ISS, and positional relationships between the ICA and ISS (including ICA prominence and the thickness of surrounding bone). Results: ISS were often present in the ICAs of patients with presellar pneumatization (36.2%; p = 0.042). Sphenoid sinus pneumatization status significantly differed according to number of ISS (p < 0.001), ICA prominence (p < 0.001), ISS insertion into the ICA (p = 0.042), and distance from ISS to ICA (p = 0.004). When sphenoid sinus aeration was poor, the ICA was not prominent, and the ISS were attached to or lay close to the paraclival ICA. Conclusions: Patients with presellar pneumatization exhibited less prominent ICAs, and more ISS attached to or near the paraclival ICA, than did other patients. Therefore, particular caution is required when using the endoscopic endonasal transsphenoidal approach to treat patients with poor sphenoid sinus aeration. [ABSTRACT FROM AUTHOR]

Importance: The newly emerged coronavirus disease 19 (COVID-19), is threatening the world. Olfactory or gustatory dysfunction is reported as one of the symptoms worldwide. As reported so far, different clinical features have been reported according to outbreak sites and gender; most of the patients, who complained of anosmia or hyposmia, were Europeans. We had a fast review for novel articles about COVID-19 infection and olfactory function.Observations: Rapid reviews for COVID-19 or other viral infection and olfactory and/or gustatory dysfunctions were done in this review. Up to date, a lot of reports have shown that olfactory dysfunction is related to viral infections but no exact mechanism, clinical course, and definite treatment have been discovered, which is also same in COVID-19. In general, intranasal steroid (INS) and oral steroid for short time help improve the recovery of the olfactory function in case of olfactory dysfunction after virus infection. Considering severe respiratory complications and immunocompromised state of COVID-19, the use of steroid should be limited and cautious because we do not have enough data to support the usage of steroid to treat olfactory dysfunction in the clinical course of COVID-19.Conclusions and Relevance: In the days of pandemic COVID-19, we should keep in mind that olfactory dysfunctions, even without other upper respiratory infection or otolaryngologic symptoms, might be the early signs of COVID-19. [ABSTRACT FROM AUTHOR]

Summary This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position‐dependent obstructive sleep apnea, and of sleep position on rapid eye movement‐dependent obstructive sleep apnea. We analysed epoch‐labelled polysomnographic readouts of 3843 patients, and calculated the apnea–hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position‐dependent obstructive sleep apnea patients changed during rapid eye movement and non‐rapid eye movement sleep, and whether that of rapid eye movement‐dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea–hypopnea index was highest in the rapid eye movement‐supine position (50.7 ± 22.6 events per hr), followed by non‐rapid eye movement‐supine, rapid eye movement‐lateral and non‐rapid eye movement‐lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position‐dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement‐dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position‐dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position‐dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement‐dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical features of invagination of the sphenoid sinus mucosa (ISM) and compare them with other similar cases using a visual analog scale (VAS) to assess the various nasal symptoms and to discuss its clinical significance and means of prevention. Study Design: Retrospective chart review at a tertiary referral center. Methods: Between 2010 and 2015, 8 patients who had undergone EETSA surgery displayed postoperative ISM. The comparison group consisted of 147 patients who underwent the same surgical procedures and were diagnosed with the same diseases. Pre- or postoperative paranasal sinus computed tomography (PNS CT) and VAS were performed and subsequently analyzed. Results: The clinical features of ISM of the sphenoid sinus showed sellar floor invagination and regenerated inverted ingrowing sphenoid mucosa on endoscopic imaging. PNS CT also showed a bony defect and invaginated air densities at the sellar turcica. Pre- and postoperative VAS scores revealed that the ISM group had much less of an improvement in headaches after surgery than that of the comparison group (p = 0.049). Conclusion: ISM may occur because of a change in pressure, sphenoid mucosal status, or arachnoid membrane status. Moreover, ISM is related to improvements in headaches. Therefore, EETSA patients should avoid activities that cause rapid pressure changes during the healing process. In addition, sellar reconstruction that is resistant to physical pressure changes should be mandated despite the absence of an intraoperative CSF leak. [ABSTRACT FROM AUTHOR]

Study Objectives: The use of sleep tracking devices is increasing as people become more aware of the importance of sleep and interested in monitoring their patterns. With many devices on the market, we conducted a meta-analysis comparing sleep-scoring data from consumer wrist-worn sleep tracking devices with polysomnography to validate the accuracy of devices., Methods: We retrieved studies from the databases of SCOPUS, EMBASE, Cochrane Library, PubMed, Web of Science, and KoreaMed, and OVID Medline up to March 2024. We compared personal data about participants and information on objective sleep parameters., Results: From 24 studies, data of 798 patient using Fitbit, Jawbone, myCadian watch, WHOOP strap, Garmin, Basis B1, Zulu Watch, Huami Arc, E4 wristband, Fatigue Science Readiband, Apple Watch, or Xiaomi Mi Band 5 were analyzed. There were significant differences in total sleep time {mean difference (MD) -16.854, 95% confidence interval (CI) [-26.332; -7.375]}, sleep efficiency (MD -4.691, 95% CI [-7.079; -2.302]), sleep latency (MD 2.574, 95% CI [0.606; 4.542]), and wake after sleep onset (MD 13.255, 95% CI [4.522; 21.988]) between all consumer sleep tracking devices and polysomnography. In subgroup analysis, there was no significant difference of wake after sleep onset between Fitbit and polysomnography. There was also no significant difference sleep latency between other devices and polysomnography. Fitbit measured sleep latency longer than other devices, and other devices measured wake after sleep onset longer. Based on Begg and Egger's test, there was no publication bias in total sleep time and sleep efficiency., Conclusions: Wrist-worn sleep tracking devices, while popular, are not as reliable as polysomnography in measuring key sleep parameters like total sleep time, sleep efficiency, and sleep latency. Physicians and consumers should be aware of their limitations and interpret results carefully, though they can still be useful for tracking general sleep patterns. Further improvements and clinical studies are needed to enhance their accuracy., (© 2024 American Academy of Sleep Medicine.)

Objectives: The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms., Methods: We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA., Results: The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065-2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303-1.030) and moderate (OR, 1.822; 95% CI, 0.995-3.339) groups., Conclusion: Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.

Objectives: Multiple minimally invasive techniques for chronic rhinitis treatment focus on posterior nasal nerve ablation. We conducted a systematic review and meta-analysis to evaluate the efficacy of cryotherapy and radiofrequency ablation for alleviating symptoms in patients with allergic and nonallergic rhinitis., Methods: We retrieved studies from PubMed, Scopus, Embase, Web of Science, and Cochrane Database up to July 2023. Data on the impact of cryotherapy and radiofrequency ablation on quality of life and symptom ratings of rhinitis were extracted and evaluated., Results: An analysis of 12 studies involving 788 patients demonstrated significant improvements in quality of life and rhinitis-related symptoms (nasal obstruction, itching, rhinorrhea, and sneezing) in patients treated with cryotherapy or radiofrequency ablation (symptom score at 24 months and quality of life score at 3 months). However, radiofrequency ablation had a more positive effect on nasal symptoms after 3 months than cryotherapy. Nonallergic rhinitis patients responded more favorably to posterior nerve ablation than patients with allergic rhinitis. Both techniques enhanced disease-specific quality of life during the initial 3 months of treatment (cryotherapy, 84.6%; radiofrequency, 81.6%; P=0.564). After 3 months of treatment, a clinical improvement in all nasal symptoms (minimal clinically important difference in the total nasal symptom score: >1.0 points) was seen in 81.8% and 91.9% of patients who underwent cryotherapy and radiofrequency ablation, respectively (P=0.005), suggesting that radiofrequency is more likely to lead to clinical improvement., Conclusion: Rhinitis-associated subjective symptom scores and quality of life may be improved by both cryotherapy and radiofrequency ablation. Ablation was more efficacious than cryotherapy for nasal symptoms in patients with nonallergic rhinitis. To corroborate these findings, further randomized controlled studies directly comparing these two techniques are warranted.

Positive airway pressure (PAP) therapy is known to be an effective treatment for obstructive sleep apnea (OSA) that does not generally have serious complications. However, pneumothorax following lung barotrauma with the use of PAP has rarely been reported. We recently experienced the case of a 72-year old male patient with chronic obstructive pulmonary disease who developed pneumothorax after the use of automatic PAP (APAP). After 4 months of APAP use with a pressure of 4-8 cm H 2 O, he complained of sudden severe dyspnea at midnight. He eventually underwent surgical repair for pneumothorax. After 4 months, continuous PAP with low pressure of 5 cm H 2 O was applied without any complications. In summary, we emphasize the risk of barotrauma when PAP is used by OSA patients with lung disease., Competing Interests: Conflicts of Interest Yun Jin Kang who is on the editorial board of the Journal of Rhinology was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest., (Copyright © 2023 by The Korean Rhinologic Society.)

Background: Patients with sleep disturbances have gastrointestinal symptoms. Breath hydrogen (H 2 ) and methane (CH 4 ) indicating small intestinal bacterial overgrowth (SIBO) might be related with these symptoms. The study was conducted to assess the link between breath profiles and untreated obstructive sleep apnea (OSA)., Methods: : This prospective study enrolled consecutive patients with OSA using polysomnography. Heart rate variability (HRV) was used as a measurement for the balance of autonomic nervous system during polysomnography. Glucose breath test (GBT) to evaluate breath H 2 and CH 4 and bowel symptom questionnaire to investigate associated intestinal symptoms were performed., Results: Among 52 patients with OSA, 16 (30.8%) showed positivity to GBT. Although no significant difference was shown in GBT positivity between patients with healthy controls and patients with OSA (13.3% vs 30.8%, P = 0.109), breath H 2 and CH 4 levels in the OSA group were significantly higher than those in controls (P < 0.05). Flatulence was significantly common in OSA groups with GBT positivity than those without GBT positivity. Multivariate analysis demonstrated that waist-to-hip ratio (odds ratio = 12.889; 95% confidence interval (CI): 1.257-132.200; P = 0.031) and low-to-high-frequency ratio of HRV (odds ratio = 1.476; 95% CI: 1.013-2.151, P = 0.042) are independently related to GBT positivity in patients with OSA., Conclusion: : Elevated breath H 2 or CH 4 after glucose load might not be an uncommon finding in patients with untreated OSA. Abdominal obesity and autonomic imbalance dysfunction are significantly associated with GBT positivity in OSA patients. SIBO could be considered as target for therapeutic management in OSA patients., Competing Interests: None

Study Objectives: Because air leakage from masks is known as a common cause of low adherence to continuous positive airway pressure therapy, we analyzed the risk factors for air leakage related to parameters associated with auto-titrating positive airway pressure, polysomnography, InBody Test, and rhinomanometry., Methods: Usage data and medical records of 120 auto-titrating positive airway pressure users were reviewed retrospectively. All patients used a nasal or pillow mask and were carefully monitored at scheduled follow-ups., Results: Use of a pillow mask, sex (male), age, and abdominal fat percentage were significantly associated with high average air leakage. The higher the auto-titrating positive airway pressure average and mean pressure, the more likely patients exhibited high rates of air leakage. The percentage of patients with high average air leakage increased over time (up to 6 months of follow-up)., Conclusions: Older male patients using a pillow mask and those with a high abdominal fat percentage and high auto-titrating positive airway pressure may require close follow-up and continuous monitoring for air leakage. Because air leakage from a mask can change over time, mask-sealing capacity should be reassessed and masks should be changed regularly., Citation: Kang YJ, Cho J-H, Park C-S. Analysis of risk factors for air leakage in auto-titrating positive airway pressure users: a single-center study. J Clin Sleep Med . 2022;18(1):75-88., (© 2022 American Academy of Sleep Medicine.)