The Impact of Cardiovascular Risk Factors on the Incidence, Severity, and Prognosis of Sudden Sensorineural Hearing Loss (SSHL): A Systematic Review

Sudden sensorineural hearing loss (SSHL) is believed to be mainly idiopathic since the cause is not usually identified. Several recent studies have examined the role of cardiovascular risk factors in this disease. The aim of this systematic literature review is to investigate the possible association between acquired and inherited cardiovascular risk factors and the incidence, severity, and prognosis of SSHL. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the PubMed database for the period between February 2010 and January 2023 was performed in order to retrieve eligible articles. The analytic cohort included 24 studies. Overall, this systematic review includes a total of 61,060 patients that were encompassed in these studies. According to most studies, the prevalence of dyslipidaemia, diabetes, and ultrasound indices of atherosclerosis was significantly higher in SSHL patients compared to controls. On the other hand, obesity, hypertension, and smoking did not seem to influence the risk of SSHL. Most studies suggest the presence of a correlation between a high cardiovascular risk profile and the risk of developing SSHL. The theory of microvascular impairment in the development of SSHL is indirectly supported by the findings of this review.

Pterygoid Hamulus: Morphological Analysis and Clinical Implications

INTRODUCTION

 The pterygoid hamulus (PH), as a small and curved projection of the sphenoid bone, occupies a unique position at the skull base. Given its functional relation with the surrounding anatomical structures, the study of this rather underrepresented structure in the literature assumes paramount importance.

MATERIALS AND METHODS

We examined a total of 87 pterygoid hamuli (50 right-sided and 37 left-sided) out of a sample of 114 dry skulls. We measured the length, width, and angle of each PH and the interpterygoid distance in skulls with both pterygoid hamuli intact, and we calculated the mean, maximum, and minimum values.

RESULTS

Our statistical analysis revealed the mean length (0.9 cm), width (0.3 cm), and angle (47.8°) of the PH, as well as the mean interpterygoid distance (3.31 cm). We recorded the longest-ever documented PH (1.64 cm). The obtained length values were higher than those provided by radiological studies. We also investigated possible associations between anatomy and pathological conditions related to the PH morphology, including pterygoid hamular elongation syndrome, hamular fracture, middle ear disorders, and obstructive sleep apnea syndrome.

CONCLUSION

Our study uses precise measurement techniques to detail the anatomy of the PH in dry skulls. This research can be a valuable resource for future studies, advancing our understanding of the PH's structure and its clinical significance.

The role of telephone clinics in ENT

OBJECTIVE

This quality improvement project assessed the outcomes of telephone consultations for ENT patients in order to identify areas where telephone consultations may be useful in the long term.

METHOD

New ENT patient appointments in May 2019 and May 2020 were reviewed. Total outcomes as well as subspecialty-specific and presentation-specific outcomes were compared for telephone versus face-to-face consultations.

RESULTS

There were 638 consultations in total (465 in 2019 and 173 in 2020). Following telephone consultations, more patients were followed up and fewer patients were listed for surgery or discharged. Overall outcomes for subspecialties followed the general trend, albeit with a few variations.

CONCLUSION

Lack of clinical examination in telephone consultations likely affects confidence in making a diagnosis and therefore discharging or listing patients for surgery. Nevertheless, looking at specialty-specific and presentation-specific data, there may be a role for telephone consultations in selected patients.

A Rare Case of a Giant Sialolith Within Wharton’s Duct

Sialolithiasis is a common disease characterized by the formation of calculi within the salivary glands or their ducts. Although many cases of large stones located within the submandibular gland have previously been reported, the presence of a giant stone within Wharton's duct is extremely rare. We report the case of a patient who presented with an unusually large stone measuring about 6 cm in the greatest dimension located within Wharton's duct and causing local swelling and pain. The sialolith was successfully removed intraorally indicating that a minor procedure under local anesthesia can be a successful treatment modality even in the case of a giant sialolith.

Oxford guidelines for adult day-case tonsillectomy

Oxford guidelines were developed after critically reviewing the existing literature and aim to assist anaesthetists, surgeons and allied healthcare staff in providing optimal care for patients undergoing tonsillectomy as a day-case procedure. Appropriate patient selection, provision of robust analgesia, antiemesis, perioperative warming and hydration are key factors to ensure patient comfort and allow same-day discharge. Patients can be discharged home after a minimum observation of 6h as this is the period with the greatest risk of primary haemorrhage. All patients must have a clear and safe understanding of which complications may occur and know how to seek help. A team effort and close collaboration between the anaesthetic, surgical, theatre and ward teams are essential to achieve optimum outcomes and reduce the rate of failed discharges.

Association between Patient- and Partner-Reported Sleepiness Using the Epworth Sleepiness Scale in Patients with Obstructive Sleep Apnoea

Excessive daytime sleepiness in obstructive sleep apnoea (OSA) is often measured differently by patients and their partners. This study investigated the association between patient- and partner-completed Epworth Sleepiness Scale (ESS) scores and a potential correlation with OSA severity. One hundred two participants, 51 patients and 51 partners, completed the ESS before and three months after initiating CPAP treatment. There was no significant difference when comparing patients’ and partners’ ESS scores at baseline (10.75 ± 5.29 vs. 11.47 ± 4.96, respectively) and at follow-up (6.04 ± 4.49 vs. 6.41 ± 4.60, respectively). There was a strong correlation between patients’ and partners’ ESS scores on both (baseline and follow-up) assessments (p < 0.001). There was significant improvement in patients’ and partners’ ESS scores after CPAP therapy (p < 0.001). There was no significant difference in patients’ or partners’ ESS scores between patients with mild, moderate or severe OSA. There was no significant correlation between oxygen desaturation index (ODI) and ESS score reported either by patient or by partner. In conclusion, our study revealed a strong correlation between patient- and partner-reported ESS scores. However, neither patient- nor partner-completed ESS scores were associated with OSA severity.

A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature

BACKGROUND

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes.

METHODOLOGY

Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020.

RESULTS

Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks.

CONCLUSIONS

In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review

PURPOSE

This systematic review was conducted to answer the following 3 questions: 'Does nasal pathology affect CPAP use?', 'What is the effect of CPAP on the nose?' and 'Does treatment of nasal pathology affect CPAP use?'.

METHODS

Pubmed and Scopus databases were searched for articles relevant to the study questions up to October 2020.

RESULTS

Sixty-three articles were selected, of which a majority were observational studies. Most studies identified a correlation between larger nasal cross-sectional area or lower nasal resistance and higher CPAP compliance or lower CPAP pressures; however, nasal symptoms at baseline did not appear to affect CPAP use. The effect of CPAP on the nose remains uncertain: while most studies suggested increased mucosal inflammation with CPAP, those investigating symptoms presented contradictory results, with some reporting an increase and others an improvement in nasal symptoms. Evidence is clearer for nasal surgery leading to an increase in CPAP compliance and a decrease in CPAP pressures, whereas there is little evidence available for the use of topical nasal steroids.

CONCLUSION

There appears to be a link between nasal volumes or nasal resistance and CPAP compliance, an increase in nasal inflammation caused by CPAP and a beneficial effect of nasal surgery on CPAP usage, but no significant effect of CPAP on nasal patency or effect of topical steroids on CPAP compliance. Results are more mitigated with regard to the effect of nasal symptoms on CPAP use and vice versa, and further research in this area would help identify patients who may benefit from additional support or treatment alongside CPAP.

Effect of oral steroids on olfactory function in chronic rhinosinusitis with nasal polyps

AIMS

The present study aimed to investigate the effects of oral steroids on olfactory disturbances in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).

MATERIAL AND METHODS

This is a prospective randomized non-blinded study. Selected CRSwNP patients (n=140), with hyposmia, were devided into two groups; group A received a 7-day course of oral steroids with a 12-weeks course of nasal steroids and douching; group B received a 12-weeks course of nasal steroids and douching. Assessment included Sniffin' Sticks scores, visual analogue scale score for olfaction and discomfort (VASsmell, VASdis), the Sinonasal Outcome Test-22, Greek-version (SNOT22-Gr) and the endoscopic appearance (EAS).

OBJECTIVES

The main objective was to compare the olfactory effect of the different therapy in group A and group B, at 2, 12 and 24 weeks. Accessory objectives included the comparison of EAS, VASdis and SNOT22-Gr between groups, the evaluation of the therapeutic outcome duration, and, the investigation of potential correlation between the evaluated parameters.

RESULTS

The 2-weeks evaluation showed a significant statistical difference (P<0.001) for all parameters except VASdis. Olfactory outcomes (Sniffin' Sticks and VASsmell scale scores) were found significantly better in group A at the 24-weeks evaluation (P<0.001). Within groups, the therapeutic result remained stable between the 12-weeks and 24-weeks evaluation (P>0.05). Sniffin' Sticks score was strongly correlated at 12-weeks evaluation with EAS (rho=0.58, P<0.001).

CONCLUSION

Our results suggest that a combination treatment of oral and nasal steroids in well-selected patients with CRSwNP may result in early olfaction restoration with a possible long-term effect.

Assessing the need for adenotonsillectomy for sleep-disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study

OBJECTIVE

To assess whether children with sleep-disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention.

METHODS

Children with snoring and tonsillar hypertrophy (4 to 10-years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3-month follow-up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep-related breathing disorder scale (PSQ-SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ-SRBD <0.33 (low-risk for apnea-hypopnea index ≥5/h) if they had score ≥0.33 at baseline.

RESULTS

Sixty-eight children were assigned to the AT and 72 to the control group and two-thirds of them had PSQ-SRBD ≥0.33. The AT group experienced significantly larger improvement between follow-up and baseline than controls (between-group difference [95% CI] for PSQ-SRBD: -0.31 [-0.35 to -0.27]; and mESS: -2.76 [-3.63 to -1.90]; P < .001 for both). Children with baseline PSQ-SRBD ≥0.33 in the AT group had an eight-times higher probability of achieving PSQ-SRBD <0.33 at follow-up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92-17.54]; P < .001).

CONCLUSION

Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ-SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Use of Oximetry to Determine Need for Adenotonsillectomy for Sleep-Disordered Breathing

: media-1vid110.1542/5802711151001PEDS-VA_2017-3382Video Abstract OBJECTIVES: We evaluated the efficacy of adenotonsillectomy (T/A) in children with sleep-disordered breathing (SDB) in a controlled study using oximetry. We hypothesized that children with SDB and abnormal nocturnal oximetry in a community setting will have improved hypoxemia indices after T/A.

METHODS

Children with snoring and tonsillar hypertrophy (4-10 years old) who were candidates for T/A were randomly assigned to 2 oximetry sequences (baseline and 3-month follow-up): (1) oximetry immediately before T/A and at the 3-month follow-up, which occurred postoperatively (T/A group); or (2) oximetry at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (1) proportion of subjects with McGill oximetry score (MOS) >1 at baseline acquiring MOS of 1 at follow-up and (2) proportion of subjects achieving oxygen desaturation (≥3%) of hemoglobin index (ODI3) <2 episodes per hour at follow-up if they had ODI3 ≥3.5 episodes per hour at baseline.

RESULTS

One hundred and forty children had quality oximetry tracings. Twelve of 17 (70.6%) children with MOS >1 in the T/A group and 10 of 21 (47.6%) children with MOS >1 in the control group had MOS of 1 at follow-up (P = .14). More subjects in the T/A than in the control group achieved ODI3 <2 episodes per hour at follow-up (14 of 32 [43.8%] vs 2 of 38 [5.3%]; P < .001). Three children with elevated ODI3 were treated to prevent persistently abnormal ODI3 in 1 child at follow-up.

CONCLUSIONS

An ODI3 ≥3.5 episodes per hour in nocturnal oximetry is related to increased resolution rate of nocturnal hypoxemia after T/A for SDB compared with no intervention.

Granular cell (Abrikossoff) tumor in the head and neck: A series of 5 cases

We evaluated a series of 5 patients-3 men and 2 women, aged 39 to 70 years (mean: 54.4)-with a granular cell tumor (GCT) of the head and neck in an effort to better define the clinical presentation, imaging characteristics, and surgical management of this type of tumor. In all cases, the diagnosis was established by pathologic analysis. There were 2 cases of laryngeal GCT and 1 case each of GCT arising in the nostril, hypopharynx, and the tongue base. The clinical findings were variable, depending on the location and extent of each lesion. Four of these patients underwent endoscopic examination, and in 2 cases computed tomography was performed. Treatment included wide surgical excision of the lesion in all cases. Otolaryngologists should be familiar with this unusual tumor. Although an accurate preoperative diagnosis is extremely difficult to make, appropriate therapeutic intervention is associated with a cure rate that is quite high.

Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment

PURPOSE

Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance).

METHODS

Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life.

RESULTS

Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred.

CONCLUSIONS

TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.

Long-term prospective evaluation comparing robotic parathyroidectomy with minimally invasive open parathyroidectomy for primary hyperparathyroidism

BACKGROUND

Targeted parathyroidectomy is a popular technique for localized pathology. No single technique is established as superior. The purpose of this study was to compare robotic-assisted parathyroidectomy (RAP) with the most common approach.

METHODS

This was a prospective, nonrandomized study. Fifteen consecutive patients who underwent RAP were compared to 15 matched controls undergoing focused lateral parathyroidectomy (FLP).

RESULTS

Biochemical cure occurred in 29 of 30 patients (97%). No major complications occurred, although there was 1 robotic conversion. RAP demonstrated a significant time reduction (R(2)  = 0.436; p = .01) but took much longer to perform than FLP (119 minutes vs 34 minutes; p = .001). RAP was associated with less initial postoperative pain (p = .036) and higher satisfaction with scar cosmesis (p = .002) until 6 months. Quality of life (QOL) improved in both groups (p = .007).

CONCLUSION

RAP provides superior early cosmesis with equivalent global health improvement compared to FLP. The high cost and learning curve may preclude widespread adoption. Further evaluation is necessary to establish its clinical efficacy regarding scar cosmesis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E300-E7, 2016.

Variants in C-reactive protein and IL-6 genes and susceptibility to obstructive sleep apnea in children: a candidate-gene association study in European American and Southeast European populations

BACKGROUND

Preliminary evidence indicates that variants of the C-reactive protein (CRP) and IL-6 genes might be associated with the presence of obstructive sleep apnea (OSA) in childhood. Thus a candidate-gene association study was conducted to investigate the association of four variants of the CRP gene (1444C/T, -717T/C, 1861C/T, and 1919A/T) and two variants of the IL-6 gene (-174G/C and 597G/A) with OSA in a cohort of European American and Greek children.

METHODS

The genetic risk effects were estimated based on the odds ratio (OR) of the allele contrast and the generalized odds ratio (ORG), which is a model-free approach. The mode of inheritance was assessed using the degree of dominance index. The impact of haplotypes was also examined.

RESULTS

In the American population, the allele contrast and the model-free approach produced significant ORs for the CRP 1444C/T variant (OR, 3.82 [95% confidence interval {CI}, 1.91-7.63] and ORG, 4.37 [95% CI, 1.96-9.76]), respectively, and the mode of inheritance was recessiveness of allele T. Significance was also shown for the CRP 1919A/T variant (OR, 2.45 [95% CI, 1.23-4.85] and ORG, 2.76 [95% CI, 1.26-6.03]) with the mode of inheritance being nondominance of allele T. For the IL-6-174G/C variant, there was an indication of recessiveness of allele C. Finally, the IL-6-174C/IL-6 597A haplotype was associated with OSA. In the Greek population, no association was detected for any variant or haplotype.

CONCLUSIONS

Genetic variation in the IL-6/CRP pathway was associated with increased risk for OSA in European American children and may account for the higher CRP levels in the context of pediatric OSA compared to Greek children.

Low morning serum cortisol levels in children with tonsillar hypertrophy and moderate-to-severe OSA

BACKGROUND

Hypertrophic tonsillar tissue in children with obstructive sleep apnea (OSA) has enhanced expression of glucocorticoid receptors, which may reflect low endogenous cortisol levels. We have evaluated the effect of the interaction between tonsillar hypertrophy and OSA severity on morning serum cortisol levels.

METHODS

Children with and without snoring underwent polysomnography, tonsillar size grading, and measurement of morning serum cortisol.

RESULTS

Seventy children (2-13 years old) were recruited: 30 with moderate-to-severe OSA (apnea-hypopnea index [AHI] > 5 episodes/h), 26 with mild OSA (AHI > 1 and ≤ 5), and 14 controls (no snoring; AHI ≤ 1). Tonsillar hypertrophy was present in 56.7%, 53.8%, and 42.9% of participants in each group, respectively. Application of a general linear model demonstrated a significant effect of the interaction between severity of OSA and tonsillar hypertrophy on cortisol levels (P = 0.04), after adjustment for obesity, gender, and age. Among children with tonsillar hypertrophy, subjects with moderate-to-severe OSA (n = 17; AHI 14.7 ± 10.6), mild OSA (n = 14; AHI 2.3 ± 1.2), and control participants (n = 6; AHI 0.7 ± 0.2) were significantly different regarding cortisol levels (P = 0.02). Subjects with moderate-to-severe OSA had lower cortisol (16.9 ± 8.7 mcg/dL) than those with mild OSA (23.3 ± 4.2; P = 0.01) and those without OSA (controls) (23.6 ± 5.3 mcg/dL; P = 0.04). In contrast, children with normal-size tonsils and moderate-to-severe OSA, mild OSA, and controls did not differ in cortisol levels.

CONCLUSIONS

Children with moderate-to-severe obstructive sleep apnea and the phenotype of hypertrophic tonsils have reduced morning serum cortisol levels and potentially decreased glucocorticoid inhibitory effects on tonsillar growth.

Huge mastoid congenital cholesteatoma in a 52-year-old patient

Congenital cholesteatoma may arise in various locations within the temporal bone. The rarest site of origin is the mastoid process. We report an unusual case of a 52-year-old man with mastoid congenital cholesteatoma that manifested as a persistent ear discharge. The preoperative suspicion was based on the imaging findings and the patient's history. A simple mastoidectomy was conducted and the cholesteatoma was completely removed while using facial nerve monitoring. Although rare, mastoid congenital cholesteatoma can be considered as an alternative in the differential diagnosis of persistent otorrhea.

Basaloid squamous cell carcinoma of the tonsil

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma that mainly arises in the upper aerodigestive tract. The tonsil is a rare site of BSCC development and only fourteen cases have been reported in the international literature. We report here on the case of a 56-year-old man who presented with mild dysphagia. Computed tomography and examination of the oropharynx revealed a suspicious-looking, bulky mass on the right tonsil. Histopathological examination confirmed the presence of BSCC. The patient had cervical lymph node metastases and pulmonary metastases and was treated with chemotherapy and concurrent radiation. Despite the metastases the patient is still alive 3 years after the initial diagnosis.

Urine concentrations of cysteinyl leukotrienes in children with obstructive sleep-disordered breathing

BACKGROUND

Adenotonsillar tissue of children with obstructive sleep-disordered breathing (SDB) has increased content of cysteinyl leukotrienes (CysLTs) and expression of CysLTs receptors. Furthermore, CysLTs concentrations in the nasal exhaled breath condensate of children with sleep apnea are elevated.

OBJECTIVE

To investigate the relationship between urine levels of CysLTs and severity of SDB in children.

METHODS

Morning urine concentrations of CysLTs were measured in children with symptoms of SDB and in control subjects with recurrent tonsillitis and without snoring who underwent polysomnography and were expressed in pg/mL per mg/dL of urine creatinine.

RESULTS

Nineteen children with moderate-to-severe SDB (mean [+/- SD] age, 5.4 +/- 1.6 years; obstructive apnea-hypopnea index [OAHI]: 14.4 +/- 9.6 episodes/h), 29 subjects with mild SDB (5.1 +/- 1.5 years; OAHI: 2.9 +/- 0.8 episodes/h), 26 children with primary snoring (PS) [7 +/- 2.6 years; OAHI: 1.1 +/- 0.3 episodes/h], and 18 control subjects (6.4 +/- 2.5 years; OAHI: 0.7 +/- 0.3 episodes/h) were studied. Children with moderate-to severe SDB had higher log-transformed urine CysLTs levels than those with mild SDB, PS, or control subjects (2.39 +/- 0.51 vs 2.06 +/- 0.26 vs 2.11 +/- 0.25 vs 1.86 +/- 0.28; p < 0.05). Log-transformed CysLTs concentration, tonsillar size, and body mass index z score were significant predictors of log-transformed OAHI (p < 0.01).

CONCLUSIONS

Urine excretion of CysLTs is related to SDB severity in children. This finding indicates that 5-lipoxygenase pathway products participate in the pathogenesis of obstructive sleep apnea in childhood or alternatively that SDB promotes CysLTs biosynthesis.

Urine levels of catecholamines in Greek children with obstructive sleep-disordered breathing

INTRODUCTION

Adults with obstructive sleep apnea have increased sympathetic activity. It was hypothesized that in children with symptoms of obstructive sleep-disordered breathing (SDB), morning urine levels of catecholamines correlate with severity of nocturnal hypoxemia.

METHODS

Children with snoring referred for polysomnography and controls without snoring were recruited. Morning urine norepinephrine, epinephrine, normetanephrine, and metanephrine levels were measured (ng/mg urine creatinine).

RESULTS

Twelve children (age 5.2 +/- 2.3 years) with severe hypoxemia (oxygen saturation of hemoglobin-SpO2 nadir < or =86%), 20 subjects (age 6.1 +/- 2.1 years) with moderate hypoxemia (SpO2 nadir < or =90% and >86%), 22 children (age 6.6 +/- 1.5 years) with mild nocturnal hypoxemia (SpO2 nadir >90%), and 10 controls (age 7.1 +/- 2.8 years) were studied. Children with severe hypoxemia had significantly higher log-transformed norepinephrine levels (1.63 +/- 0.29) compared to those with moderate hypoxemia (1.43 +/- 0.22; P < 0.05) or compared to controls (1.39 +/- 0.31; P < 0.05). In subjects with SDB, log-transformed oxygen desaturation of hemoglobin index or SpO2 nadir predicted log-transformed norepinephrine levels after adjustment by age, gender and body mass index (r2 = 0.24; and r2 = 0.24, respectively; P < 0.01).

CONCLUSIONS

Severity of nocturnal hypoxemia in children with intermittent upper airway obstruction during sleep correlates with morning urine levels of norepinephrine suggesting increased sympathetic tone.

Obesity and persisting sleep apnea after adenotonsillectomy in Greek children

BACKGROUND

The relative importance of obesity and adenotonsillar hypertrophy in the pathogenesis of obstructive sleep-disordered breathing (SDB) in childhood is unclear. Adenotonsillectomy (AT) for SDB is not always curative, and obese children are at increased risk for residual disease postoperatively.

OBJECTIVE

The aim of this investigation was to assess the efficacy of AT as treatment for SDB in obese and nonobese children.

METHODS

Children with adenoidal and/or tonsillar hypertrophy who underwent AT for the treatment of SDB underwent polysomnography preoperatively and postoperatively. A body mass index (BMI) z score of > 1.645 was used to define obesity. The achievement of a postoperative obstructive apnea-hypopnea index (OAHI) of less than one episode per hour (ie, the cure of SDB) was the primary outcome measure.

RESULTS

Twenty-two obese children (mean [+/- SD] age, 5.8 +/- 1.8 years; mean BMI z score, 2.6 +/- 0.8; mean OAHI, 9.5 +/- 9.7 episodes per hour) and 48 nonobese children (mean age, 6.9 +/- 2.6 years; mean BMI z score, 0.09 +/- 1.1; OAHI, 6 +/- 5.4 episodes per hour) were recruited. After surgery, obese and nonobese subjects did not differ in the efficacy of AT (postoperative OAHI of less than one episode per hour, 22.7% vs 25% of subjects, respectively; p > 0.05). The presence of obesity, adenoidal or tonsillar hypertrophy, gender, and postoperative BMI change were not significant predictors of SDB cure.

CONCLUSIONS

Obesity does not necessarily predict an unfavorable outcome of AT as treatment for SDB.

Absence of blood pressure, metabolic, and inflammatory marker changes after adenotonsillectomy for sleep apnea in Greek children

AIM

Pediatric studies revealed associations of obstructive sleep-disordered breathing (SDB) with inflammation, metabolic dysfunction, and elevated blood pressure. Evidence about effects of adenotonsillectomy on these abnormalities is scarce. Aim of this investigation was to assess changes in C-reactive protein (CRP), circulating intercellular adhesion molecule-1 (cICAM-1), insulin and blood pressure levels after adenotonsillectomy for SDB in Greek children.

METHODS

Polysomnography was performed pre- and postoperatively in children with SDB and controls undergoing adenotonsillectomy for recurrent tonsillitis or otitis. Outcome measures were changes in serum markers and blood pressure.

RESULTS

Fifty-eight patients (6.2 +/- 2.5 years old) and 17 controls (6.5 +/- 2) were studied. After surgery, apnea-hypopnea index (AHI) decreased (mean: -5.9 episodes/hr; 95% confidence interval: -7.8 to -4) in patients. Patients and controls were similar regarding outcomes: CRP (-0.11 mg/dl [-0.25 to 0.02] vs. 0.13 [-0.19 to 0.46]; P = 0.11), cICAM-1 (-11.6 ng/ml [-38.6 to 15.4] vs. -46.6 [-101.7 to 8.6]; P = 0.23), insulin (2.49 mU/L [0.32-4.67] vs. -0.16 [-2.47 to 2.16]; P = 0.21), systolic blood pressure index (5.2% [2.1-8.3] vs. 10.8 [3.6-17.9]; P = 0.1) and diastolic blood pressure index (-3.2% [-7.2 to 0.8] vs. 2.8 [-5.5 to 11.2]; P = 0.16). Patients with CRP > 0.3 mg/dl had reduced values after AT (P = 0.003) and those with postoperative AHI < or = 1 had a decrease in diastolic blood pressure (P = 0.02).

CONCLUSIONS

Although adenotonsillectomy improves SDB, it has variable effects on inflammatory and metabolic markers or blood pressure.

Adiposity in relation to age as predictor of severity of sleep apnea in children with snoring

Correlation between obesity and obstructive sleep apnea has been documented in both adults and children. This investigation evaluated importance of body mass index (BMI) in relation to age as predictor of severity of obstructive sleep-disordered breathing (SDB). Children with habitual snoring referred for polysomnography were recruited. BMI Z score (> or =1.036 vs <1.036, i.e. at risk for overweight or overweight vs normal) was assessed as predictor of severity of SDB (apnea-hypopnea index [AHI] >five vs < or =five episodes per hour) at different ages (< or =6 vs >6 years). Two hundered eighty-four participants were recruited: 75 young children (4.6 +/- 1 years) with high BMI (1.9 +/- 0.7); 95 young subjects (4.5 +/- 1.1 years) with low BMI (-0.2 +/- 1.3); 55 older children (9.2 +/- 1.8 years) with high BMI (1.8 +/- 0.5); and 59 older participants (9.7 +/- 2.2 years) with low BMI (-0.2 +/- 1.1). Odds ratios for AHI >5 in young/high BMI children, young/low BMI subjects, and older/high BMI subjects relative to older/low BMI participants were: 6.5 (95% confidence interval 2.1-19.9), 7.3 (2.4-22) and 2 (0.6-7.3), respectively. Large tonsil size was associated with young age (odds ratio 1.97; 1.2-3.3). Among children with habitual snoring, adiposity does not predict severity of obstructive SDB in early childhood probably due to the prominent role of adenotonsillar hypertrophy. However, it may have a more important contribution to severity of SDB in older children.