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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]

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]

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]

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]

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.