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Background: ELOM‐080 is a phytomedicine approved for the treatment of acute and chronic inflammatory diseases of the respiratory tract, sinusitis, and bronchitis in particular. This prospective, randomized, placebo‐controlled, double‐blind clinical trial was conducted to assess efficacy and safety of ELOM‐080 in the treatment of acute viral rhinosinusitis (AVRS). Methods: Patients with AVRS received oral treatment (4 × 1 capsule per day) with either ELOM‐080 or matching placebo. Primary endpoints were the change in major symptom score (MSS) after 7 and 14 days of treatment assessed by the investigator (MSSINV). Secondary endpoints were changes in MSS assessed by the patients (MSSPAT), olfactory function (12‐item Sniffin' Sticks), 20‐Item Sino‐Nasal Outcome Test (SNOT‐20 GAV; German adapted version), influence of treatment on viral load, and safety. Results: Four hundred and sixty‐three patients were randomized. At day 4, subjective burden of disease (MSS) was significantly ameliorated compared to placebo (p = 0.012). During the first treatment week MSS scores improved about 1 day earlier, and 3 days earlier in the second week. Effect with ELOM‐080 on mean MSSINV was statistically significantly superior to placebo at visit 3 (p = 0.016) and visit 4 (p = 0.014). In chemosensory testing identification scores improved comparably in both treatments. The improvement of the SNOT‐20 GAV was more pronounced in ELOM‐080 patients. Treatment with ELOM‐080 indicated a potential for decreasing viral load. Both treatments were well tolerated. Conclusion: ELOM‐080 improves the burden of AVRS significantly in comparison to placebo, remission of symptoms occurred 3 days earlier. The results confirm the efficacy and safety of ELOM‐080 for treatment of AVRS. Level of Evidence: 1 Laryngoscope, 133:1576–1583, 2023 [ABSTRACT FROM AUTHOR]

Placebo effects substantially contribute to analgesic treatment outcomes and might be leveraged to enhance gold‐standard treatments. The taste of oral medications has been proposed to boost placebo effects. Here, we aimed at estimating how far the taste of an oral medication enhances placebo analgesia. We conducted a randomized, double‐blind, between‐group, single‐visit study, with pre‐treatment baseline. Over the course of three substudies, 318 healthy volunteers (297 included) were tested in a clinical trial setting. Participants were subjected to experimental tonic cold water pain (cold pressor test) before and after receiving taste‐neutral (water), or bitter (quinine), or sweet (saccharin), or no placebo drops. Pre‐ versus post‐treatment changes in area under the pain rating curve, the main outcome, indicated that placebo treatment showed a small analgesic effect versus no treatment. Added taste induced placebo enhancement in the very small effect size range, but accounted for a substantial portion of the overall placebo effect. No noteworthy advantage of sweet over bitter placebo was observed. An exploration of heart rate (HR) recordings indicated that placebo treatments were associated with an increase in peak HR‐response to cold water, but these were not associated with placebo analgesia at an individual level. Placebo treatments were associated with minimal side effects. These results indicate that added taste may be an easy‐to‐implement, cost‐effective, and safe way to optimize treatment outcomes and that taste‐neutral preparations may reduce placebo‐related outcome variance in clinical trials. Further studies are needed to test if these findings can be translated into clinical scenarios. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.Study Design: Prospective cohort study.Methods: Twenty-one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin' Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.Results: Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.Conclusions: Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.Level Of Evidence: 4. Laryngoscope, 128:E86-E90, 2018. [ABSTRACT FROM AUTHOR]

Background After tracheostomy, the airway lacks an essential mechanism for warming and humidifying the inspired air with the consequent functional impairment and discomfort. The purpose of this study was to compare airway hydration with cold-air nebulization versus heated high-flow humidification on medical interventions and tracheal ciliary beat frequency (CBF). Methods Newly tracheostomized patients (n = 20) were treated either with cold-air nebulization or heated humidification. The number of required tracheal suctioning procedures to clean the trachea and tracheal CBF were assessed. Results The number of required suctions per day was significantly lower in the heated humidification group with medians 3 versus 5 times per day. Mean CBF was significantly higher in the heated humidification group (6.36 ± 1.49 Hz) compared to the cold-air nebulization group (3.99 ± 1.39 Hz). Conclusion The data suggest that heated humidification enhanced mucociliary transport leading to a reduced number of required suctioning procedures in the trachea, which may improve postoperative patient care. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Treatment of hypopharyngeal collapse of upper airway is a surgical challenge in obstructive sleep apnea (OSA) patients who fail continuous positive airway pressure (CPAP). Study Design: A prospective, nonrandomized, multicentered, feasibility study. Methods: Nineteen OSA patients with an apnea-hypopnea index (AHI) between 15 and 50 with CPAP intolerance were included in the study. Baseline polysomnography (PSG) was measured, and 3- and 6-month postoperative PSGs were recorded. Preoperative and postoperative home sleep studies, cephalographs, and videoendoscopy were performed. Additionally, the subjects completed the Epworth Sleepiness Scale (ESS), Patient and Bed Partner Snoring Questionnaire, Functional Outcomes of Sleep Questionnaire, and Throat Questionnaire. Results: AHI dropped from 33.8 at baseline to 18.6 at 3-month follow-up and to 24.3 at 6-month follow-up, respectively. Overall surgical success was 38.9% as defined by a 50% drop in AHI to a score below 20 at 6 months. ESS decreased from 11.4 to 6.1 and 7.4 at 3 months and 6 months, respectively. Snoring intensity was reduced from 7% to 3.8% at 3 and 6 months, respectively. Quality of life was improved from 15.6 to 17.9 (14.3%) and 18.1 (15.6%) at 3 months and 6 months, respectively. Conclusions: The rates of surgical success, feasibility, and safety were satisfactory. Further technical device improvement is necessary and must be based on a new understanding of tongue forces. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Persistent taste disturbance is a rare complication after tonsillectomy and mainly documented by case reports or a few retrospective and prospective trials with a limited number of patients. None could clarify frequency, time course, or prognosis of long-lasting dysgeusia after tonsillectomy. The aim of the study was to provide a symptom-based follow-up after tonsillectomy to assess postoperative taste disorders. Study Design: Prospective clinical trial. Methods: From December 2007 to June 2009 adult patients undergoing tonsillectomy were asked to take part in the trial. Two hundred twenty-three patients (119 female, 104 male; mean age, 33 ± 13 years) were included. The day prior to surgery, and 2 weeks and 6 months after tonsillectomy a standardized questionnaire was completed by patients. The questionnaire focused on taste function, taste disorders, pain, foreign body sensation, and bleeding episodes after tonsillectomy. Results: One hundred eighty-eight (2 weeks) and 181 (6 months) patients returned the questionnaires. Thirty-two percent (n = 60) of patients reported taste disorders after tonsillectomy 2 weeks postoperatively and 15 patients (8%) at 6-month follow-up. Metallic and bitter parageusia were most frequently reported. The mean ratings of gustatory function were significantly lower 2 weeks after surgery (P < .001) and reached preoperative values 6 months after surgery. Almost 30% of patients reported postoperative bleeding, 10% long-lasting postoperative pain, and 20% foreign body sensation. Conclusions: Long-lasting taste disturbance (metallic and bitter parageusia) after tonsillectomy is more frequent than previously reported. Long-lasting pain and foreign body sensation seem to be common symptoms. With regard to these results, a thorough preoperative explanation is mandatory. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Research has shown that external stimuli presented during sleep can affect dream content, thus reflecting information processing of the sleeping brain. Olfactory stimuli should have a stronger effect on dream emotions because their processing is linked directly to the limbic system. Because selective olfactory stimulation does not increase arousal activity, intense olfactory stimulation is therefore a prime paradigm for studying information processing during sleep. Fifteen healthy, normosmic volunteers were studied by intranasal chemosensory stimulation during rapid eye movement sleep based on air-dilution olfactometry. For olfactory stimulation, hydrogen sulphide (smell of rotten eggs) and phenyl ethyl alcohol (smell of roses) was used and compared with a control condition without stimulation. The olfactory stimuli affected significantly the emotional content of dreams: the positively toned stimulus yielded more positively toned dreams, whereas the negative stimulus was followed by more negatively toned dreams. Direct incorporations, i.e. the dreamer is smelling something, were not found. The findings indicate that information processing of olfactory stimuli is present in sleep and that the emotional tone of dreams can be influenced significantly depending upon the hedonic characteristic of the stimulus used. It would be interesting to conduct learning experiments (associating specific odours with declarative material) to study whether this declarative material is incorporated into subsequent dreams if the corresponding odour cue is presented during sleep. It would also be interesting to study the effect of positively toned olfactory stimuli on nightmares. [ABSTRACT FROM AUTHOR]

Purpose To correlate pineal parenchyma volume (PP) to circadian melatonin profiles and to determine the 24-hour melatonin per volume of pineal tissue (MLPV). Furthermore, we compared melatonin profiles of cystic and solid glands. Methods In 15 healthy male subjects (20-27 years) the PP was determined using high-resolution magnetic resonance imaging (trueFISP, isotropic voxel: 0.8 mm3). Melatonin plasma concentrations (MC) were determined every 2 hours for 24 hours. Results Mean PP was 125 ± 54 mm3. PP correlated linearly to maximum MC and to 24-hour melatonin ( r = 0.61 and r = 0.64, P < 0.05) but not to minimum MC. The 24-hour melatonin was 653 ± 242.6 pg/mL, MLPV was 5.8 ± 2.3 pg/mL*ml−1. Nine pineal glands were solid and six were cystic. PP of solid glands showed higher linear correlations to maximum melatonin, to 24-hour melatonin, and to the slope of the melatonin increase of the curve ( P < 0.05). Conclusion PP correlates linearly to melatonin plasma concentrations in humans. MLPV displays similar interindividual differences as 24-hour melatonin. PP of solid glands show better correlation to melatonin profiles than cystic. J. Magn. Reson. Imaging 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The efficacy of combined radiofrequency (RF) surgery of the soft palate (RF-assisted uvulopalatoplasty [RF-UPP]) was demonstrated in a prospective study. Nevertheless, the data is based on short-term follow-up only, as it is the case with the majority of clinical studies regarding surgical treatment of snoring. Long-term follow-up is of particular importance in this context, as snoring relapses in a significant number of patients. The aim of this study was to assess the long-term efficacy of RF-UPP in the treatment of snoring. Study Design: Prospective clinical trial. Methods: Twenty-one patients with primary snoring (apnea/hypopnea index <15, body mass index [BMI] <32) were going through the initial trial. Patients had received two sessions of RF-UPP at the soft palate as previously described. For the present trial, all patients were contacted after approximately 18 months and asked to complete an additional follow-up questionnaire assessing current BMI, snoring (visual analogue scale), and the overall satisfaction with the procedure. Results: From the 21 initial patients, 19 (90%) answered the questionnaire. Mean follow-up was 19.8 ± 4.9 months. The postoperative snoring scores showed an increase from 2.0 ± 2.1 to 5.1 ± 3.3 ( P < .05) at long-term follow-up. Seven (37%) patients demonstrated long-term success (1.7 ± 0.5), whereas seven patients experienced a relapse in snoring (8.1 ± 1.4). BMI remained unchanged. Age, sex, BMI, or the length of follow-up did not influence long-term outcome. Conclusions: After RF-UPP of the soft palate, a relapse in snoring has to be expected at long-term follow-up in a subgroup of patients. At present, there are no prospective parameters which would predict long-term benefit. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]

Objective: To prospectively evaluate the efficacy of the mandibular advancement device (MAD) Somnoguard in the treatment of OSA patients. Study design and setting: Forty-four patients with OSA and noncompliant to continuous positive airway pressure were enrolled in this case series. Somnoguard is made of thermoplastic material. Direct intraoral fitting was done by an otorhinolaryngologist. Polysomnographic data concerning sleep and respiration were assessed at baseline and after familiarization with the MAD. Results: Sleep efficiency and sleep stages distribution did not change significantly. The RDI could be reduced from 31.5 ± 17.6 to 18.2 ± 17.0 (P < 0.05), the minimal oxygen saturation increased from 78 ± 12.9 to 82 ± 12.5% (P < 0.05). According to standard criteria, 18 patients were cured, 12 were improved, 8 remained unchanged, and 6 worsened. Snoring time decreased from 223 ± 132 to 183 ± 134 minutes (P < 0.05). Conclusion and significance: With Somnoguard 68% of the enrolled OSA patients could be cured or substantially improved. It is a simple MAD for the otolaryngologist. [Copyright &y& Elsevier]

Objective: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). Study design and setting: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. Results: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 ± 20.0 vs 20.7 ± 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. Conclusion: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful. EBM rating: B-2b [Copyright &y& Elsevier]

Objective: To determine the safety and efficacy of the Pillar Palatal Implant System over a 1-year follow-up period. Study design and setting: In this prospective study, 40 healthy adult patients with primary snoring due to palatal flutter were treated after clinical, polysomnographic, and endoscopic examination. Under local anesthesia 3 implants were placed into the soft palate. Postoperative morbidity and functional parameters were assessed. Snoring and daytime sleepiness were assessed before and 90, 180, and 360 days after surgery. Objective data were obtained by polysomnography and SNAP-recording before and 90 days after treatment. Results: All implants were placed without complications. A total of 13 implants partially extruded uneventfully in 10 patients. Functional parameters remained unchanged. After 1 year, snoring was reduced from 7.1 ± 1.9 to 4.8 ± 2.5 (Visual-Analogue-Scale, P < 0.05) and daytime sleepiness from 6.1 ± 3.2 to 4.9 ± 3.1 (Epworth-Sleepiness-Scale, P < 0.05). SNAP data and polysomnography parameters showed clinically irrelevant changes. Conclusion: Our data demonstrate a significant decrease in snoring and daytime sleepiness over a period of one year. [Copyright &y& Elsevier]

Objective: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. Study design and setting: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. Results: Mean respiratory disturbance index was reduced from 35.2 ± 19.1 to 27.4 ± 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. Conclusions: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. Significance: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway. [Copyright &y& Elsevier]

Objectives: Radiofrequency surgery is a minimally invasive technique for the treatment of the tongue base in sleep-disordered breathing. The aim of this study was to evaluate the changes in upper airway anatomy induced by radiofrequency surgery with MRI. Study design and setting: 10 patients with sleep-disordered breathing were treated with radiofrequency surgery at tongue base. MRI measurements were performed before and after surgery with the help of a recently published protocol. Results: The mean total number of energy delivered per patient was 4750 ± 1641 Joule. Relevant changes could be observed neither for tongue volume or dimension nor for retrolingual space. Conclusions: Changes in upper airway anatomy could not be demonstrated. The effects of radiofrequency surgery of the tongue base may more likely be a result of changes in upper airway collapsibility. Significance: Functional effects of surgical interventions in sleep-disordered breathing should be considered in addition to mechanistic concepts alone. [Copyright &y& Elsevier]

Objective: To determine the safety and efficacy of a new soft palate implant procedure for the reduction of snoring. Study design and setting: Fifteen healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination and polysomnography. The average age of the patients was 41.2 ± 8.6 years with a body mass index of 26.2 ± 2.5 kg/m2. The Anti-Snoring Device consists of a delivery tool with a cylindrical implant of braided polyester filaments. Under local anesthesia, three implants intended for permanent implantation were placed into the soft palate. Snoring-related symptoms were assessed by visual analogue scales (VAS), polysomnography, and the SNAP system at baseline and 90 days postoperatively. Results: All implants were placed without complications. Only minor discomfort was reported in four cases within the first three days postprocedure. At the 90-day follow-up snoring was reduced from 7.3 ± 1.6 to 2.5 ± 2.1 (VAS, P < 0.01) and from 347 ± 239 to 264 ± 168 snoring sounds/hour (SNAP, P > 0.05). Polysomnography did not show any deterioration of sleep or breathing. Speech, swallowing, and taste were unchanged. Conclusion: The Anti-Snoring Device is a new surgical tool offering a simple and minimally invasive procedure. Our data demonstrate that the treatment is safe and effective with good patient acceptance. Further patient follow-ups are needed to evaluate the long-term results. [Copyright &y& Elsevier]

Objectives/Hypothesis Magnetic resonance imaging (MRI) potentially offers various advantages in assessing the upper airway. The aims of the presented study were 1) to evaluate which anatomical parameters of upper airway soft tissue morphology (distances, areas, volumes) could be defined using MRI scans, 2) to examine the stability or variability of these parameters over time and between different investigators, and 3) to develop a standardized protocol for MRI measurements of the upper airway. Study Design Prospective clinical trial. Methods Twenty-four scans were performed on six healthy subjects over a period of 4 weeks. Various parameters such as tongue dimensions, volumes and spaces, posterior airway spaces, and soft palate dimensions were established, and their variation over time between different investigators and with repeated analysis was assessed. Results All the parameters were of high stability and reproducibility. The time of day had no significant influence on the results. An abbreviated method for the evaluation of the tongue volume was developed. Four-millimeter slices with a conventional MRI scan generate pictures of high quality in a maintainable acquisition time. Conclusions We were able to evaluate which anatomical parameters of upper airway could be defined using MRI scans. The variability of these parameters over time and between different investigators was assessed. We developed a standardized protocol for MRI measurements of the upper airway. Standardized protocols are mandatory, and the variability of the measurements must be taken into account if results of different clinical centers must be compared or if changes after therapeutic interventions are to be investigated. [ABSTRACT FROM AUTHOR]

The article offers information on treatment options for obstructive sleep apnea (OSA). It informs that the treatment of OSA with continuous positive airway pressure (CPAP) is regarded as successful if a reduction in the apnea-hypopnea index (AHI) below five is achieved while using devices. It mentions that the effectiveness of conservative treatment regarding the reduction of AHI depends both on its impact on airway obstruction and compliance.

In a former study, taste disturbances after tonsillectomy seemed to be more frequent than expected. Eight percent of patients reported subjective taste disorders 6 months after tonsillectomy. Fifteen patients from the initial trial, who reported taste disorders after tonsillectomy, were contacted again for this long-term follow-up. A telephone interview using the same questionnaire addressing the current self-estimate of taste function was performed. At 32 ± 10 months following surgery, two (0.9%) patients still reported suffering from taste disturbance. This long-term follow-up study shows that dysgeusia following tonsillectomy occurs in approximately 1% of patients. These data should be considered when patients are informed about complications after tonsillectomy. [ABSTRACT FROM AUTHOR]

Problem: In obstructive sleep apnea (OSA) surgical treatment is discussed controversially. Minimal invasive treatments are favored by the patients. Having shown the efficacy of Pillar Palatal Implant Systems (made of polyethylentherephthalate) in the treatment of primary snoring, the aim of our study was to assess their effectiveness in the treatment of mild to moderate OSA.Methods: Overweight patients (n = 10; BMI 26.5 ± 2.2 kg/m2; age, 49 ± 8.6 years) with mild to moderate OSA were included in our prospective study. Objective (polysomnography) and subjective (daytime sleepiness, snoring, pain, taste, and speech) data were assessed pre- and postoperatively. Three implants were inserted into the soft palate under local anesthesia. The postoperative exam was performed after 3 months.Results: There were no complications during surgery. Snoring was reduced in the Visual Analogue Scale from 8.5 ± 1.8 to 3.8 ± 2.3 (P < 0.01), the Apnea-Hypopnea-Index went down from 18.4/h ± 4.4 to 11.1/h ± 13.0 (P > 0.05). Speech, swallowing, and taste remained unchanged.Conclusion: The new Pillar Palatal Implant System is a safe and secure method to reduce snoring. Short time results show no significant changes in the Apnea-Hypopnea-Index. Detailed analysis of long-term results remains to be carried out.Significance: The Pillar Palatal Implant System is a simple procedure with impact on snoring. We hope that long-term results might show a decrease in the Apnea-Hypopnea-Index.Support: None reported. [Copyright &y& Elsevier]

Problem: Sleep-disordered breathing is one of the most widespread diseases in industrialized countries. Unfortunately, even in severe cases, sleep apnea patients often do not follow the treatments suggested. The aim of this study was to investigate (1) the primary acceptance rates in relation to the kind of treatment suggested and (2) whether there are characteristic differences between patients who accept and those who do not accept the treatments recommended.Methods: In our study, 503 patients with sleep-disordered breathing underwent complete fully attended polysomnography in the sleep lab. With regard to the nature and severity of their sleep disorder and the individual clinical findings, 171 patients were recommended to undergo nCPAP, 42 to use a mandibular advancement device (MAD), and for 244 patients a surgical treatment was suggested. In 21 cases there was no need for any kind of treatment, and in the other 25 cases only weight loss was suggested.Results: In total, 234 patients accepted the treatment suggested (46.5%). In detail, the recommendations were accepted as follows: nCPAP 54%, surgery 42%, MAD 40.5%, and weight loss 4%. Gender did not have any affect on the acceptance rate. The youngest and the oldest patients showed higher acceptance rates (<24 years 100%, >65 years 62%). In general patients with more severe disease tended to accept treatment more frequently (acceptance rate of 40% for primary snorers vs 85% for patients with severe sleep apnea; P < 0.05).Conclusion: The acceptance rate of treatment suggestions for sleep-disordered breathing is dependent on the severity of the disease. This may be due to the more pronounced clinical symptoms going along with increasing severity of the disease. The kind of treatment suggested (apart from weight loss) and the age of the patients seem to have only minor influence on the primary acceptance of treatment suggestions, while gender seems to have no effect at all.Significance: In mild sleep apnea, the consequences of the disease have to be accounted very carefully to the patient in order to achieve the patient’s compliance for any kind of treatment.Support: No comments. [Copyright &y& Elsevier]

Objectives: Hyoid suspension is frequently used in surgical approaches for obstructive sleep apnea, usually combined with genioglossus or maxillomandibular advancement. An enlargement of the retrolingual space is thought to be the underlying mechanism for treatment efficacy. A systematic evaluation of the effects on upper airway anatomy has not yet been performed.Methods: Ten patients with obstructive sleep apnea were included in this prospective trial. All subjects underwent an isolated hyoid suspension using 4 sutures for permanent fixation of the hyoid bone to the thyroid cartilage and a dissection of the stylohyoid ligaments. Subjects underwent an evaluation of their upper airway soft tissue following a standardized MRI protocol before as well as 1 and 6–10 weeks after surgery.Results: So far, 5 patients completed the protocol. Relevant changes in upper airway soft tissue anatomy (eg, retrolingual space, posterior airway spaces [PAS]) could not be detected. For retrolingual space preoperative volume was 7.9 ± 1.7 ccm compared to 7.4 ± 1.0 ccm postoperatively. Changes for PAS were as follows: nasal plane 1.7 ± 0.3 cm to 1.7 ± 0.3 cm; occlusal plane 0.6 ± 0.6 cm to 0.5 ± 0.3 cm and mandibular plane 1.0 ± 0.4 cm to 1.0 ± 0.2 cm.Conclusions: In contrast to the assumption that hyoid suspension enlarges the upper airway, no changes in soft tissue parameters could be detected. The beneficial effects demonstrated for hyoid suspension seem to be linked to functional effects and/or a stabilization of soft tissue due to the fixation of the hyoid bone preventing upper airway collapse rather than to simple changes in airway diameters. [Copyright &y& Elsevier]

Objectives: Three-month results could demonstrate the safety and efficacy of the Pillar® Palatal Implant System in the treatment of primary snoring in a limited number of patients. The aim of this study was to determine the results over a 1-year follow-up period in an extended patient group.Methods: Forty-one healthy patients with primary snoring due to palatal flutter were enrolled into this prospective study after clinical and endoscopic examination (42.3 ± 9.0 years, body-mass-index 25.3 ± 2.6 kg/m2, apnea-hypopnea-index 3.4 ± 2.3). Under local anesthesia, 3 implants intended for permanent implantation were placed into the soft palate as close to the midline as possible. Snoring (evaluated by the bedpartner), postoperative morbidity, and daytime sleepiness (evaluated by the patient) were assessed by visual analog scale (VAS) before and 90, 180, and 360 days after surgery.Results: All implants could be placed without any complications or remarcable postoperative pain. During the first year, 12 implants were partially extruded in 10 patients without any airway compromise. Four patients had them reimplanted as they realized an increase of their snoring after the implant removal. Speech, swallowing, and taste remained unchanged. Snoring was reduced from 7.1 ± 1.9 to 4.2 ± 2.7 and finally 4.0 ± 2.6 (VAS, P < 0.001). Daytime sleepiness dropped significantly from 2.8 ± 2.6 to finally 1.2 ± 1.2 (VAS, P < 0.001).Conclusions: The Pillar® Palatal Implant System is a new surgical tool for the reduction of snoring. Our subjective data demonstrated its safety and efficacy as well as good patients’ acceptance over a period of 1 year. [Copyright &y& Elsevier]

Objective: Currently no data exist on what distance from facial nerve (FN) it is safe to perform bipolar cautery (BC) in parotid surgery, although frequently performed., Methods: The degree of damage was measured using continuous intraoperative neuromonitoring (cIONM, NIM™ 3, Medtronic) in 16 Wistar rats. Amplitude drop of at least 50% (A 50 ) or a loss of signal (LOS) in the cIONM was defined as harmful; BC was performed in power range 20-60 W., Results: BC ≤30 W did not cause LOS (0/14 nerves). When applying 35 W, A 50 occurred at 4 mm from FN and LOS was noted in 1 of 5 nerves. BC at a power of 40 to 60 W demonstrated LOS in all nerves (12/12) at a 5 mm distance., Conclusion: BC up to 30 W can be safely applied up to 3 mm distance from FN. 40 to 60 W should be avoided and used only at a distance of over 6 mm from FN., Level of Evidence: NA/animal study. Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Temperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence-based criteria in the selection of energy application., Methods: In a preparatory in vitro study, porcine tongues were preserved in growing medium. Lesions with different amounts of energy were applied, and maximum diameters were assessed. In the in vivo study, 11 patients were treated with RFVTR at the tongue base by employing different energy levels (800, 600, 400, or 200 J) on two application sites. Magnetic resonance imagery scans were performed 4 to 6, 8 to 10, and 24 hours after surgery. An inversion recovery technique was used to visualize the lesions., Results: RFVTR created lesions at the porcine tongue from 50 J and higher. Maximum lesion sizes were achieved with 400 J. In vivo, all the lesions were clearly visible in the postoperative scans. Lesion size increased with the amount of energy applied. Maximum diameters were created from 600 J and higher. Higher amounts of energy only resulted in a slight increase in lesion length., Conclusions: The application of 600 J at 85 degrees C leads to optimal lesion sizes. Higher amounts of energy will not lead to a relevant increase in tissue necrosis. With regard to the time needed for application, 600 J appears to be the ideal adjustment for energy delivery in the treatment of the human tongue.