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Biomedical subjects

T Verse

Publications and source records attributed to T Verse.

At least 19 recordsLinked to original sources
PubMed2001

Unusual neck mass in an adolescent: benign basal cell adenoma of the minor salivary glands of the piriform sinus.

With an incidence of less than 3%, salivary gland tumors are rare in the head and neck. The percentage of basal cell adenomas within the group of salivary gland tumors is even less (0.2-2%). Salivary gland tumors occur very rarely in adolescents. The basal cell adenoma commonly affects older persons and occurs most frequently in the major salivary glands. We present the unusual case of a benign basal cell adenoma of the minor salivary glands of the piriform sinus in a 14 year old male patient. Unusual are the age of the patient, the histological type, size and localisation of the tumor.

Adenoma↗
PubMed2001

[Current aspects on diagnosis of sleep-related breathing disorders].

Various diagnostic procedures are available to diagnose sleep-related breathing disorders. The present review examines the amount of diagnostics necessary for daily routine. Concerning taking patients' history, the medical examination and nasal parameters, no new recommendations derive from this review. On the other hand,the detection of the site of pharyngeal obstruction seems to have become less important than it was a couple of years ago.Today, the upper airway is considered to be a complex, functional unit. The classification of the obstruction site into retropalatal and retrolingual seems to be oversimplified. A fully attended, complete polysomnography in the sleep laboratory no longer seems to be necessary in every case of suspected sleep-related breathing disorders. Under certain conditions, ambulatory recording units provide cost-effective alternatives.

Humans↗
PubMed2001

[Postoperative management following rhinosurgery interventions in severe obstructive sleep apnea. A pilot study].

BACKGROUND: Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy. PATIENTS AND METHOD: Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively. RESULTS: None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed. CONCLUSION: The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

Adult↗
PubMed2001

New developments in the therapy of obstructive sleep apnea.

This review of the literature summarizes new trends in the diagnosis and treatment of obstructive sleep apnea (OSA) over the last 3 years. A literature search in Medline on 5 March 2000 using the keywords "OSA" and "OSAS" identified 123 papers. Another 86 articles were added from the references of the first 123 papers. New trends were observed concerning measurements of quality of life. There are new developments regarding conservative treatment, for example, nasal continuous positive airway pressure (nCPAP) therapy and oral devices. With regard to surgical treatment of OSA new surgical procedures, the radiofrequency technique, and the concept of multilevel surgery are discussed. After more than 25 years of interdisciplinary sleep medicine there still are some new developments of interest for ears, nose, and throat surgeons, which indicate the need for the involvement of otorhinolaryngologists in modern sleep medicine.

Electric Stimulation Therapy↗
PubMed2001

Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo.

Scopolamine has been used successfully for treatment of motion sickness for almost a century and the nasal administration was first studied 50 years ago. However, there never appeared a nasal dosage form. Finally, after finding a stable and suitable formulation for scopolamine, a study to investigate efficacy, safety, and tolerability was conducted, with a randomised, double-blind, double-dummy, crossover, Latin square design including placebo control and a placebo/placebo control for internal validity at the German Air Force Institute of Aviation Medicine. To assess the efficacy of a new, stable and well-tolerated formulation of scopolamine nasal spray the reproducible induction of whole body vibrations by a rotating chair was chosen and a validated seasickness score (SKS). The reduction of SKS showed that scopolamine nasal spray at a concentration of 0.2% was statistically superior to both placebo and dimenhydrinate (P=0.003 and 0.004, respectively). There were no signs for a nasal or epipharyngeal irritation of the mucous membrane. Scopolamine nasal spray was found to be an effective and safe treatment in motion sickness, with a fast onset of action within 30 min after administration.

Administration, Inhalation↗
PubMed2001

[Modified hyoid suspension for therapy of sleep related breathing disorders. operative technique and complications].

BACKGROUND: : Concerning the therapy of obstructive sleep apnea (OSA) the discrimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address both anatomical areas. Minimal invasive surgical techniques treating the soft palate have recently been developed while there is still an ongoing development concerning the base of tongue. METHODS: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disorders. Between October 2000 and March 2001, 14 patients underwent modified hyoid suspension within a multi-level surgery concept. The operative technique manages with only one wire-suture and does not include myotomies and intersection of the ligamenta stylohyoidea. RESULTS: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysis. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedure was well tolerated. Neither increased postoperative pain nor increased requirement of analgetics was observed. Substantial side-effects were one case of seroma and 9 cases of transitory dysphagia. The retrolingual airway space increased significantly after surgery. CONCLUSIONS: These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.

Adult↗
PubMed2000

[Obstructive sleep apnea in older patients after the closure of a tracheostoma].

BACKGROUND AND OBJECTIVE: The closure of tracheostomies may postoperatively induce an obstructive sleep apnea (OSA) even in patients who never complained about sleep related breathing disorders before they underwent tracheotomy. The present study was designed to evaluate, whether OSA appears after the tracheostomy has been airtightly blocked and if so, whether there are typically illnesses predictive for OSA after operative closure of tracheostomies. PATIENTS AND METHODS: Twelve consecutive patients (3 male; 9 female; mean age 66 years), who addressed our clinic for operative closure of their tracheostomies were enrolled in this study over a period of 18 months. On basis of patient's history and clinical findings the patients were divided into two groups. Group A included 7 patients with laryngeal pathologies and group B included 5 patients with normal larynges. All patients underwent a 12-channel polysomnography (PSG) with airtightly blocked tracheostomies preoperatively. RESULTS: In 5 patients a mild OSA and in one patient a severe OSA was diagnosed by PSG. The patients of group A with laryngeal pathologies were older, had a lower Body Mass Index (BMI) and a higher Apnea-Hypopnea Index than patients of group B (p < 0.05). CONCLUSION: Laryngeal pathologies in the elderly might facilitate the development of OSA after operative closure of tracheostomies. Based on the results postoperative reevaluation is recommended for all elderly patients with laryngeal abnormalities after operative closure of the tracheostomy.

Aged↗
PubMed2000

Long-term results in the treatment of obstructive sleep apnea.

No recent update is available on long-term results of the various types of treatment of obstructive sleep apnea (OSA) which can help the physician in evaluating the individually tailored treatment for patients with OSA in the long term. We arbitrarily defined "long-term" results as those after at least 3 years and reviewed the literature from the past 25 years for reports on conservative, apparative, and surgical therapy of OSA in children and adults. Another inclusion criterion was that the diagnosis was also confirmed by polysomnography before treatment and at follow-up. Only relatively few long-term studies meeting the criteria of 'evidence based medicine' were found, comparing the findings of these was difficult or impossible due to varying criteria for success. Long-term data were available about the effect of weight reduction, nasal ventilation therapy, oral devices, tonsillectomy, uvulopalatopharyngoplasty, maxillomandibular advancement osteotomies, and tracheotomy. After approx. 25 years many treatment modalities in sleep medicine are still experimental concerning the long-term use for the individual. In particular, randomized controlled trials in surgery are lacking. Late results show that at least 50% of patients with OSA can be treated effectively by one or a combination of treatments. Nasal continuous positive airway pressure, tracheotomy, maxillomandibular advancement osteotomy, and tonsillectomy are the most effective treatments of OSA.

Combined Modality Therapy↗
PubMed2000

[Meta-analysis of laser-assisted uvulopalatopharyngoplasty. What is clinically relevant up to now?].

BACKGROUND: Laser-assisted uvulopalatoplasty (LAUP) was not recommended by the American Sleep Disorders Association for the treatment of snoring and obstructive sleep apnea (OSA) because of data lacking in 1994. In the meantime numerous new papers concerning this subject have been published in peer reviewed journals. A new evaluation of the value of LAUP is presented. METHODS: In a world-wide literature search (Medline) from 1980 until March 1999, seventy articles were identified. The papers were analyzed concerning the subtopics "operative techniques", "LAUP and OSA", "LAUP and snoring", "pain", "side-effects", "indications" and "predictive criteria". RESULTS: On the basis of the collected data, it is possible to put definitive values on the subtopics "operative techniques", "LAUP and snoring" and "side-effects". In contrast, objective long-term results concerning "LAUP and OSA" are still missing. Short-term results are promising. CONCLUSION: Nevertheless, LAUP and its related procedures presently should not be recommended for the treatment of any severity of OSA.

Adult↗
PubMed2000

Tonsillectomy as a treatment of obstructive sleep apnea in adults with tonsillar hypertrophy.

OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Adult↗
PubMed2000

Uvulopalatopharyngoplasty changes fundamental frequency of the voice--a prospective study.

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.

Adult↗
PubMed2000

Validation of the POLY-MESAM seven-channel ambulatory recording unit.

STUDY OBJECTIVES: To determine the recording capabilities of the POLY-MESAM (PM) unit (MAP; Martinsried, Germany), an American Sleep Disorders Association level III system, and to compare it with simultaneous 12-channel polysomnography in the sleep laboratory. MEASUREMENTS AND RESULTS: Fifty-three patients (49 men and 4 women) with obstructive sleep-related breathing disorders of varying severity were included. The apnea-hypopnea indexes (AHIs) obtained using the two methods differed significantly from each other, although the correlation was close. The PM unit produced false-negative results in patients with mild to moderate obstructive sleep apnea (OSA). The sensitivity of the PM unit in detecting patients with an AHI > 10 was 92%, while the specificity was 96.3%. CONCLUSIONS: The correlation of AHIs obtained with polysomnography and with the PM unit is close. However, in some cases, the PM may underestimate OSA parameters. The PM unit produces false-negative results in patients with mild to moderate OSA. While inpatient polysomnography remains the "gold standard," the PM unit may provide an inexpensive alternative in some special cases.

Adult↗
PubMed1999

Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy.

At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position. At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8. Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep. This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.

Aged↗
PubMed1999

[What are the side-effects of nocturnal continuous positive pressure ventilation (nCPAP) in patients with sleep apnea for the head-neck region?].

BACKGROUND: Nasal continuous positive airway pressure ventilation therapy is the present gold standard in the treatment of obstructive sleep apnea. Depending on the definitions used, about 60% of the patients tolerate nCPAP therapy. The reason for this limited tolerance is a varying number of side effects. The aim of the present retrospective study was to analyze the incidence and intensity of otorhinolaryngological side effects of nCPAP therapy. METHOD: Questionnaires inquiring about the frequency of using nCPAP and objective and subjective complaints were sent to 92 patients who were treated with nCPAP in our department within the last years. Six of 92 patients also used a heated humidifier. A telephone interview was added to complete the questionnaires as correctly as possible. RESULTS: Eighty questionnaires were sent back completely answered. The mean frequency of using nCPAP (+/- standard deviation) was 6.8 +/- 1.6 hours per night and 6.5 +/- 1.4 nights per week. The mean duration of nCPAP therapy was 28.0 +/- 21.0 months; the mean pressure used was 6.8 +/- 1.2 cm H2O. The following side effects were specified most frequently: disturbance of sleep during the night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure marks by the mask (41.3%), crusts within the nasal cavity (38.8%), and hearing loss (26.3%). Dryness within the nose and mouth was considered the most irritating side effects. CONCLUSIONS: NCPAP therapy has a number of different side effects in the head and neck. These side effects are seen frequently. Prospective analysis must show whether there are correlations between the intensity and frequency of side effects and the duration of therapy, and whether technical improvements (quality of masks, noise reduction, humidifiers) are able to reduce the frequency of side effects.

Adult↗