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BACKGROUND: This international study aimed at determining current routine palate surgeries and surgical methods adopted by otolaryngologists who practice surgical management of obstructive sleep apnea (OSA). METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current routines in palatal procedures. The surgeons were asked 33 multiple-choice questions. RESULTS: A total of 141 sleep surgeons answered the questionnaire, of whom 27% were from Africa, 30% from Asia, 24% from Centre-South America, and 19% from Europe. According to otolaryngology surgical specialties, 51% were sleep surgeons, 31% general ENTs, 8% Rhinologists, 7% Head & Neck surgeons, 2% otologists, and 1% maxillofacial surgeons. Of the 141 respondents, 51% answered they were sleep specialists, whereas 49% were non-sleep specialists. According to specific medical degree, 38% were specialists, 33% were consultants, 25% were professors, and 4% were residents or trainees. CONCLUSION: This study gives an overview of the current surgical practice in OSA management in otolaryngology in different countries.

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

Upper respiratory infections are widespread in clinical practice. Antibiotics are frequently used in the management of patients with airways infection. However, antibiotics can induce intestinal and respiratory dysbiosis that, in turn, worsens respiratory symptoms. Moreover, respiratory infections per se can cause dysbiosis. Consequently, probiotics may counterbalance the disturbed microbiota. The current clinical experience evaluated the efficacy and safety of an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii subspecies delbrueckii LDD01 (200 million living cells), in 2928 outpatients with an upper respiratory infection and treated with antibiotics. Patients took one stick/daily for four weeks. Simultaneously, 2877 patients with an upper respiratory infection and treated with antibiotics were recruited as control. This probiotic mixture significantly diminished the presence and the severity of respiratory symptoms at the end of the probiotic course and, more evidently, after a 3-month follow-up. In conclusion, the current clinical experience suggested that this probiotic mixture may be considered an effective and safe therapeutic option in managing patients with an upper respiratory infection and treated with antibiotics.

Otitis media (OM) affects the middle ear and is typically characterized by earache. OM may be classified as acute (AOM) or chronic (COM), based on symptom duration. OM may be clinically suspected, but the diagnosis is usually confirmed by the otoscopy. Antibiotic therapy is frequently used in clinical practice. However, antibiotics often induce intestinal and respiratory dysbiosis associated with some clinical problems. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).

Rhinosinusitis (RS) affects the nose and the paranasal sinus and is characterized by nasal and systemic symptoms. It may be classified as acute or chronic, based on duration. Rhinosinusitis may be clinically suspected, but the diagnosis is usually based on the endoscopy. Antibiotic therapy is frequently used for RS patients in clinical practice. However, antibiotics often induce intestinal dysbiosis associated with some clinical problems and respiratory microbiota impairment. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).

Objective: Does nasal surgery affect multilevel surgical success outcome. Methods: Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results: There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 +/- 11.4, no nose group 44.2 +/- 11.8. Mean preoperative BMI for nose group 27.5 +/- 3.6, no nose group 27.5 +/- 4.1, mean postoperative BMI nose group 26.3 +/- 3.7, no nose group 27.1 +/- 3.8 (P= .006). Mean preoperative AHI nose group 32.7 +/- 19.4, no nose group 34.3 +/- 25.0 (P = .377); and mean postoperative AHI nose group 13.5 +/- 10.2, no nose group 17.1 +/- 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 +/- 4.7, no nose group was 10.4 +/- 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 +/- 3.2, no nose group was 6.7 +/- 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P < .001). Change in BMI did not affect AHI nor ESS change (Cohen effect 0.03 and 0.14, respectively). AHI change in both groups were also statistically significant in the mild OSA (P = .008) and the severe OSA (P = .01). Success rate of surgery for the nose group 68.2%, while the no nose group 55.0% (P = .002). Conclusion: Combining nose surgery in multilevel surgery improves surgical success.

Objective Does nasal surgery affect multilevel surgical success outcome. Methods Prospective eight country nonrandomized trial of 735 obstructive sleep apnea (OSA) patients, who had multilevel palate and/or tongue surgery, divided into two groups, with or without nose surgery. Results There were 575 patients in nose group, 160 patients in no nose group. The mean age for nose group 44.6 ± 11.4, no nose group 44.2 ± 11.8. Mean preoperative BMI for nose group 27.5 ± 3.6, no nose group 27.5 ± 4.1, mean postoperative BMI nose group 26.3 ± 3.7, no nose group 27.1 ± 3.8 (P = .006). Mean preoperative AHI nose group 32.7 ± 19.4, no nose group 34.3 ± 25.0 (P = .377); and mean postoperative AHI nose group 13.5 ± 10.2, no nose group 17.1 ± 16.0 (P = .001). Mean preoperative ESS nose group was 11.3 ± 4.7, no nose group was 10.4 ± 5.4 (P = .051); and mean postoperative ESS nose group was 5.3 ± 3.2, no nose group was 6.7 ± 2.8 (P = .001). The nose group had higher percentage change (adjusted for age, gender, BMI) in AHI (33.7%, 95% CI 14% to 53.5%) compared to the no nose group (P = .001); the nose group also had more percentage change in ESS (37%, 95% CI 23.6% to 50.3%) compared to the no nose group (P

The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer recording, and endoscopic evaluation. Drug-induced sleep endoscopy (DISE) is a diagnostic tool that allows the dynamic, three-dimensional evaluation of the patterns of vibration and collapse of the upper airway of SDB patients. DISE may change the initial surgical planning in a high percentage of cases. A universally accepted and methodologically standardized DISE could provide significant insight into its role to improve surgical outcomes. However, up to now the ideal DISE protocol remains an open question.

La sindrome OSAS è un disturbo frequente caratterizzato dall’insorgere di apnee durante il sonno. Questa ricerca ipotizza che tali pazienti presentino livelli elevati di sonnolenza diurna, di percezione dello stress, di depressione e un’alterazione del comportamento di malattia rispetto ai controlli. Il campione studiato è composto da 96 soggetti (32 pazienti ospedalizzati con diagnosi OSAS; 32 soggetti ricoverati nello stesso reparto per un disturbo differente e 32 soggetti sani). Gli strumenti utilizzati sono: l’ESS per misurare la sonnolenza diurna; l’IBQ per il comportamento di malattia; il CES-D per la depressione, il PSQ per lo stress percepito e un Questionario Clinico appositamente approntato per la ricerca. I pazienti OSAS hanno presentato livelli significativamente elevati di sonnolenza diurna e stress percepito rispetto ad entrambi gli altri gruppi e maggiori sintomi depressivi rispetto al solo gruppo dei pazienti ricoverati. All’IBQ i pazienti OSAS hanno mostrato, rispetto a quelli ospedalizzati, punteggi significativamente elevati alle scale di Irritabilità, Affermazione di Malattia e Funzione Discriminante, e si sono differenziati dai soggetti sani rispetto alla Convinzione di Malattia. Il questionario clinico ha evidenziato che questi pazienti lamentano, con l’insorgere del disturbo, un calo delle capacità di attenzione, concentrazione e abilità manuale, difficoltà in ambito lavorativo, sociale, familiare e sessuale e un incremento nell’uso di sostanze eccitanti.