Effects of Uvulopalatopharyngoplasty With or Without Radiofrequency Tongue Base Reduction on Voice in Patients With Obstructive Sleep Apnea
|
|
- Dortha Nicholson
- 5 years ago
- Views:
Transcription
1 The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Effects of Uvulopalatopharyngoplasty With or Without Radiofrequency Tongue Base Reduction on Voice in Patients With Obstructive Sleep Apnea Young Gyu Eun, MD, PhD; Seung Youp Shin, MD, PhD; Sung Wan Kim, MD, PhD Objectives/Hypothesis: To investigate voice change as a complication after uvulopalatopharyngoplasty (UPPP) with or without radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea. Study Design: Before and after study. Methods: Twenty-two patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngoplasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 8 weeks after surgery. Acoustic measures included mean fundamental frequency (mf0), maximal phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR), hypernasality test, and the first three formant frequencies (F1, F2, F3) for sustained vowels. Voice handicap index (VHI) was used to determine subjective voice change. Results: values for mf0, MPT, jitter, shimmer, NHR, hypernasality test, and F1 did not significantly change in either group following surgery. There were the significant decreases at the F2 of /u/ and the F3 of /o/ in the UPPP group, and at the F2 of /o/ and the F3 of /a/, /i/, and /o/ in the RTBR group. VHI score was increased only in the RTBR group. Conclusions: UPPP and UPPP with RTBR have an impact on formant frequencies of vowels. Despite a relatively small number of patients, it is apparent that UPPP with RTBR influences VHI. Patients, especially professional voice users, should be advised of this before considering the surgery. Key Words: Obstructive sleep apnea, voice, formant, radiofrequency, tongue base. Level of Evidence: 4 Laryngoscope, 123: , 2013 From the Department of Otolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, South Korea. Editor s Note: This Manuscript was accepted for publication May 3, This work was supported by the Kyung Hee University Research Fund in 2009 (KHU ). The authors have no other funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Sung Wan Kim, MD, Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University Medical Center, #1 Hoegi-dong, Dongdaemun-gu, Seoul, South Korea drkimsw@hanmail.net DOI: /lary INTRODUCTION Obstructive sleep apnea (OSA) is very common and increasingly recognized as a major health problem. 1 Although a variety of surgical techniques have been described to manage OSA, multilevel pharyngeal surgery is required to overcome collapse at multiple levels of the pharyngeal airway. Because the surgical procedure to treat OSA may change the nasal cavity, oral cavity, and pharynx, there is concern over the effects of the surgery on speech quality and swallowing. Many studies have examined the potential changes in perceptual and acoustic characteristics of vocal quality after upper airway operations Most of these studies were concerned with surgery for the palate. In general, minimal or no change was found. Among the currently available tongue base procedures that alleviate lower pharynx obstruction, radiofrequency tongue base reduction (RTBR) is widely used due to its minimal invasiveness and simplicity RTBR is safe and is not associated with major side effects. 21 However, RTBR can cause scarring of the submucosal tissue, resulting in reduced tissue volume, which may affect vocal quality by altering the resonant characteristics of the vocal tract. These resonances, termed formants, 22 are defined by the size and shape of the acoustic spaces of the vocal tract (i.e., oral, nasal, and pharyngeal cavities) and the coupling between those spaces. In speech, formant frequencies are manipulated by creating varying degrees of constriction of the airflow using the lips, mandible, tongue, velopharyngeal port, and pharyngeal walls. The formant frequencies define the vowels produced and significantly contribute to overall vocal quality. 22 The purpose of the study was to investigate voice change as a complication after uvulopalatopharyngoplasty (UPPP) with or without RTBR in patients with OSA. MATERIALS AND METHODS Subjects This was a prospective controlled study of 47 OSA patients treated with surgery at Kyung Hee University Medical Center.
2 All patients were preoperatively evaluated through historytaking, physical examination, cephalometry, fiberoptic nasopharyngoscopy with Mueller s maneuver, and an overnight polysomnography. Patients with an apnea-hypopnea index (AHI) <5, age <18 years, speech or voice dysfunction history, previous surgical history such as microlaryngoscopy or OSA surgery, and head and neck cancer history were excluded. Surgical procedures were chosen based on the presence of velopharyngeal airway or retrolingual airway narrowing of the tongue base on cephalometry, and fiberoptic nasopharyngoscopy during Mueller s maneuver. Patients with only velopharyngeal collapse underwent UPPP and constituted the UPPP group. Patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP and RTBR and constituted the RTBR group. To exclude the effect of UPPP, we chose patients who underwent UPPP combined with RTBR as the subject group and patients who underwent only UPPP as the control group. Informed consent was obtained from the patients. This study was approved by the institutional review board of Kyung Hee University Hospital. Surgery In the UPPP procedure, tonsillectomy was performed first with electrocautery and then the oral soft palate mucosa and submucosa were debrided, preserving as much of the palatopharyngeus, palatoglossus, and uvula muscles as possible. The uvular tip was trimmed prior to reflecting the palate anteriorly and superiorly. The denuded flap was made by cold knife dissection, and imbricated and sutured to the residual mucosa of the soft palate. The approximation of posterior and anterior pillars was achieved by sutures with maximal lateralization for creating more retropalatal airway space. RTBR was performed using a CelonProSleep (Celon AG Medical Instruments, Berlin, Germany) to accomplish stiffening and volume reduction of the tongue base. 14 A total of nine lesions were selected for treatment. Three of these lesions were at the midline of the circumvallate papillae, and were 1 cm anterior and posterior to the middle of the circumvallate papillae. The next six lesions were 1 cm right or left of the first three lesions. The setting on the power control unit was 10 W. Application time varied from 4 to 6 seconds per puncture and was terminated by the acoustic end-indication, which is an auto-stop mechanism facilitated by a thermistor. Tissue impedance was measured using the probe tip. The delivery energy at this power setting was approximately 60 J per punctum. All surgical procedures were performed by a single surgeon (S.W.K.). Voice Analysis Subjects had their voice measured prior to and 8 weeks after surgical treatment. To minimize subjectivity, a single certified speech-language pathologist in the voice clinic at the Kyung Hee Medical Center performed all voice evaluations. The recordings of the speech samples were performed in a sound-isolated room with a high-quality condenser microphone (C 1000 S; AKG, Vienna, Austria) positioned 20 cm away from the mouth at a 45 angle, which was attached to a TASCAM US-122L digital audio tape recorder (Teac Corp., Tokyo, Japan). For the standardization and comparability of the voice samples, the patients were instructed to sustain the vowels at a comfortable pitch and level of loudness three times before recording to obtain maximum steady phonation during recording. Voice signals were recorded as sustained vowels (/a/e/i/o/u/) for 10 seconds and trimmed to 5-second midportions before analysis. Sustained vowel recordings were analyzed with the Multi- Dimensional Voice Program, model 5105, version (Kay Pentax, Lincoln Park, NJ). The mean fundamental frequency (mf0) and the first three formant frequencies (F1, F2, F3) of these sustained vowels were determined. Linear predictive coding analysis was used to obtain formant frequencies. Additionally, jitter, shimmer, noise-to-harmonics ratio (NHR), and maximum phonation time (MPT) were measured. For testing nasality, the Glatzel mirror-fogging test and Gutzmann test were performed. In the mirror-fogging test, nasalization was assessed by evaluating the degree of condensation (0 4; 0 no condensation; 4 severe condensation) on a cold mirror held 0.5 cm under the nose during phonation (subjects were asked to sustain the vowels /a/ and /i/, and the consonant / m/). 23 In the Gutzmann test, subjects were asked to produce a series of /a/ and /i/ sounds alternately with the nares held open and closed (a change in vowel quality when the subject produced the vowels with the nares closed was indicative of hypernasality, in which case a score of 1 was assigned; absence of change was assigned a score of 0). 23 Patient self-assessment of voice was obtained in the Voice Handicap Index (VHI). The VHI is a validated questionnaire measuring psychosocial handicapping effects of voice disorders. 24 The VHI is a 30-item dysphonia-specific quality-of-life questionnaire with good content validity and reliability. It provides a numerical score that reflects the patient s perception of the degree to which the voice is a physical, social, or functional handicap in daily life. Scores can range from 0 (no handicap) to 120 (maximum handicap). 25 Statistical Analyses Data are expressed as mean 6 standard deviation for normally distributed data and median 6 interquartile range for not normally distributed data. All statistical analyses were performed using SPSS for Windows version 11.5 (IBM, Armonk, NY). Differences before and after surgical treatment were assessed by paired t test if data were normally distributed, or by Wilcoxon signed rank test if data were not normally distributed. Statistical significance was defined as P <.05. RESULTS There were 22 males (mean age, years) in the UPPP group and 25 males (mean age, years) in the RTBR group. The two groups were similar in terms of age (P ¼.110). The mean values of AI, HI, AHI, and RDI were 9.74, 8.45, 18.19, and in the UPPP group, respectively, and 9.81, 9.06, 19.02, and in the RTBR group, respectively. There were no significant differences of polysomnographic data between the groups. No statistical significance was found between preoperative and postoperative jitter, shimmer, NHR, MPT, and mf0 in the groups (Table I). There were significant changes at the F2 value of sustained vowel /u/ and the F3 value of sustained vowel /o/ after the surgical treatment in the UPPP group (Table II). There were the significant changes at the F2 value of sustained vowel / o/ and the F3 values of sustained vowels /a/, /i/, and /o/ after surgical treatment in the RTBR group (Table III). The mirror fogging test and the Gutzmann test showed no differences between the preoperative and postoperative data in both groups (Table IV). VHI score was , and postoperative VHI score was in the UPPP group. No statistical significance was found between preoperative and postoperative VHI scores in the UPPP group (P ¼.407). 1807
3 TABLE I. Change of Vocal Parameters After Surgical Treatment. Data Data UPPP group Jitter (%) Shimmer (%) NHR MPT (s) mf0 (Hz) RTBR group Jitter (%) Shimmer (%) NHR MPT (s) mf0 (Hz) UPPP ¼ uvulopalatopharyngoplasty; NHR ¼ noise-to-harmonic ratio; MPT ¼ maximal phonation time; mf0 ¼ mean fundamental frequency; RTBR ¼ radiofrequency tongue base reduction. VHI score was and postoperative VHI score was in the RTBR group. There was a significant change after surgical treatment in the RTBR group (P ¼.022). A change over 15 points was found in one of 22 (4.5%) patients in the UPPP group and two of 25 (8%) patients in the RTBR group. DISCUSSION The aim of the present study was to evaluate the potential effects of the RTBR on speech and voice. To exclude the effect of UPPP, we chose patients who underwent UPPP combined with RTBR as the subject group and patients who underwent only UPPP as the control group. The primary findings of this study were a TABLE II. Change of Formants After Surgical Treatment in the Uvulopalatopharyngoplasty Group. Sustained Vowel F1 /a/ /e/ /i/ /o/ /u/ F2 /a/ /e/ /i/ /o/ /u/ F3 /a/ /e/ /i/ /o/ /u/ TABLE III. Change of Formants After Surgical Treatment in the Radiofrequency Tongue Base Reduction Group. Sustained Vowel F1 /a/ /e/ /i/ /o/ /u/ F2 /a/ /e/ /i/ /o/ /u/ F3 /a/ /e/ /i/ /o/ /u/ significant decrease of F2 and F3 in the UPPP group and the RTBR group, and increased postoperative VHI score in the RTBR group but not in the UPPP group. The surgical procedures used for treatment of snoring and OSA syndrome commonly alter the structures of the upper airway and so have the potential to affect vocal quality. 26 Previous studies considering this issue have mainly investigated the effects of palatal surgeries such as UPPP, palatal implants, and radiofrequency palatal volumetric reduction. 2,23,26 28 To our knowledge, this is the first study to evaluate the effects of RTBR on voice and speech. RTBR causes submucosal tissue scarring, resulting in tissue volume reduction and increased TABLE IV. Change of Nasality Parameters After Surgical Treatment in the Uvulopalatopharyngoplasty Group and the Radiofrequency Tongue Base Reduction Group. UPPP group RTBR group Mirror-fogging test Data Data /a/ /i/ /m/ Gutzmann test Mirror-fogging test /a/ /i/ /m/ Gutzmann test UPPP ¼ uvulopalatopharyngoplasty; RTBR ¼ radiofrequency tongue base reduction. 1808
4 tension in the tongue base. UPPP with RTBR is one of the most commonly used multilevel surgeries worldwide, particularly for mild-to-moderate cases. Success rates of 50%, 41%, and about 54% have been previously reported for this technique. 14,29,30 Previous studies investigating the effects of palatal surgeries on voice have produced equivocal results. 2,4,9 11,31 ly, mf0 has been reported to decline, 31 increase up to 10 Hz, 2 or to be unchanged after UPPP. 4,9 11 Presently, no statistically significant difference was detected for mf0, jitter, shimmer, NHR, and MPT before and after surgery in the UPPP group and RTBR group. Although these data were predictable and not primarily required because the laryngeal level and vocal folds are not involved with UPPP or RTBR, they were included in the study for the purpose of being proven objectively. The results of mirror fogging test or Gutzmann test did not reveal any significant differences between the presurgical and postsurgical conditions. Regarding nasality in terms of hypernasality, the results after UPPP only or UPPP with RTBR in this study support the findings of previous studies of no significant change of nasality after UPPP. 11,13,32 Although vocal output is the function of laryngeal level, the transfer process in the supraglottic level affects voice quality and precision. Resonance of the vocal tract leads to formants. Formants are determined by size, shape, and interaction between the nasal, oral, and pharyngeal cavities of the vocal tract. 26 The F1 is associated with closure of the oropharyngeal cavity and is used as a measure of velopharyngeal function or activity. 9,26 The F1 frequencies of five vowels after surgery were found to be unchanged in the UPPP and RTBR groups. This result might reflect the lack of effect of UPPP or UPPP with RTBR on velopharyngeal function or activity. The F2 and F3 are associated with advancement of the tongue and demonstrate tongue-palate coordination. The F2 frequency of /u/ in both groups and the F3 frequencies of /o/ in the UPPP group and /a/i/o/ in the RTBR group were decreased after surgery. The formant frequencies change with respect to the upper airways anatomy. The calculations by Titze and Story suggest that a narrowing of the epilaryngeal region tends to raise the three lowest formants of the vocal tract. 33 Inversely, a widening of the epilaryngeal area lowers these formants. These results might be interpreted as the widening of the pharynx after UPPP or UPPP with RTBR. Patient s perception of voice is an important treatment outcome measure, especially in the case of benign disease where the greatest impact is on quality of life. The VHI shows that the relationship between selfassessment of voice quality and scores is clear and statistically significant (the worse the self-assessment of the voice, the lower the VHI score). 34 There is no criterion level defining presence or absence of perceived vocal handicap. The usefulness of the VHI as an outcome measure is not in the absolute value of the score, but rather in the change in score after treatment. A change of 15 points is generally considered clinically relevant. 35,36 Even though there was a small portion of patients in the present study, VHI change was found after UPPP with RTBR. This would be important for patients with concerns about postoperative vocal quality, such as singers or professional speakers. CONCLUSION Our results indicate that UPPP only and UPPP with RTBR have an impact on formant frequencies of vowels. Despite the relatively small number of patients, it was found that UPPP with RTBR influences VHI. These findings are important for patients with concerns about postoperative vocal quality, such as singers and professional speakers. Therefore, patients should be advised of this before considering the surgery. BIBLIOGRAPHY 1. Flemons WW. Clinical practice. Obstructive sleep apnea. N Engl J Med 2002;347: Brosch S, Matthes C, Pirsig W, Verse T. Uvulopalatopharyngoplasty changes fundamental frequency of the voice a prospective study. J Laryngol Otol 2000;114: Chen MY, Metson R. Effects of sinus surgery on speech. Arch Otolaryngol Head Neck Surg 1997;123: Coleman RF, Sly DE. and postoperative voice analysis of uvulopalatopharyngoplasty patients. Arch Otolaryngol Head Neck Surg 1991;117: Hong KH, Kwon SH, Jung SS. The assessment of nasality with a nasometer and sound spectrography in patients with nasal polyposis. Otolaryngol Head Neck Surg 1997;117: Hori Y, Koike Y, Ohyama G, Otsu SY, Abe K. Effects of tonsillectomy on articulation. Acta Otolaryngol Suppl 1996;523: Hosemann W, Gode U, Dunker JE, Eysholdt U. Influence of endoscopic sinus surgery on voice quality. Eur Arch Otorhinolaryngol 1998;255: Lin P-T, Gould WJ, Fukazawa T, El-Assuooty A. Acoustic analysis of voice in tonsillectomy. J Voice 1989;3: Murry T, Bone RC. Acoustic characteristics of speech following uvulopalatopharyngoplasty. Laryngoscope 1989;99: Nakai K, Sakakura A, Takahashi H, Sadaoka T, Kakitsuba N. Articulation after uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol 1996;253: Rihkanen H, Soini I. Changes in voice characteristics after uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol 1992;249: Saida H, Hirose H. Acoustic changes in voice after tonsillectomy. Acta Otolaryngol Suppl 1996;523: Salas-Provance MB, Kuehn DP. Speech status following uvulopalatopharyngoplasty. Chest 1990;97: Eun YG, Kim SW, Kwon KH, Byun JY, Lee KH. Single-session radiofrequency tongue base reduction combined with uvulopalatopharyngoplasty for obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 2008; 265: Eun YG, Kwon KH, Shin SY, Lee KH, Byun JY, Kim SW. Multilevel surgery in patients with rapid eye movement-related obstructive sleep apnea. Otolaryngol Head Neck Surg 2009;140: Fischer Y, Khan M, Mann WJ. Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea. Laryngoscope 2003;113: Friedman M, Ibrahim H, Joseph NJ. Staging of obstructive sleep apnea/ hypopnea syndrome: a guide to appropriate treatment. Laryngoscope 2004;114: Powell NB, Riley RW, Guilleminault C. Radiofrequency tongue base reduction in sleep-disordered breathing: a pilot study. Otolaryngol Head Neck Surg 1999;120: Steward DL. Effectiveness of multilevel (tongue and palate) radiofrequency tissue ablation for patients with obstructive sleep apnea syndrome. Laryngoscope 2004;114: Stuck BA, Starzak K, Verse T, Hormann K, Maurer JT. Complications of temperature-controlled radiofrequency volumetric tissue reduction for sleep-disordered breathing. Acta Otolaryngol 2003;123: Boudewyns A, Van De Heyning P. Temperature-controlled radiofrequency tissue volume reduction of the soft palate (somnoplasty) in the treatment of habitual snoring: results of a European multicenter trial. Acta Otolaryngol 2000;120: Borden GJ, Harris KS, Raphael LJ. Speech Science Primer: Physiology, Acoustics, and Perception of Speech. Baltimore, MD: Williams & Wilkins;
5 23. Van Lierde KM, Van Borsel J, Moerman M, Van Cauwenberge P. Nasalance, nasality, voice, and articulation after uvulopalatopharyngoplasty. Laryngoscope 2002;112: Schindler A, Capaccio P, Maruzzi P, Ginocchio D, Bottero A, Otraviani F. Preliminary considerations on the application of the voice handicap index to paediatric dysphonia. Acta Otorhinolaryngol Ital 2007;27: Maertens K, de Jong FI. The voice handicap index as a tool for assessment of the biopsychosocial impact of voice problems. B-ENT 2007;3: Behrman A, Shikowitz MJ, Dailey S. The effect of upper airway surgery on voice. Otolaryngol Head Neck Surg 2002;127: Akpinar ME, Kocak I, Gurpinar B, Esen HE. Effects of soft palate implants on acoustic characteristics of voice and articulation. J Voice 2011;25: Birkent H, Soken H, Akcam T, Karahatay S, Gerek M. The effect of radiofrequency volumetric tissue reduction of soft palate on voice. Eur Arch Otorhinolaryngol 2008;265: Friedman M, Ibrahim H, Lee G, Joseph NJ. Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 2003;129: Nelson LM. Combined temperature-controlled radiofrequency tongue reduction and UPPP in apnea surgery. Ear Nose Throat J 2001;80: Tewary AK, Cable HR. Speech changes following uvulopalatopharyngoplasty. Clin Otolaryngol Allied Sci 1993;18: Gislason T, Lindholm CE, Almqvist M, et al. Uvulopalatopharyngoplasty in the sleep apnea syndrome. Predictors of results. Arch Otolaryngol Head Neck Surg 1988;114: Titze IR, Story BH. Acoustic interactions of the voice source with the lower vocal tract. J Acoust Soc Am 1997;101: Behlau M, Hogikyan ND, Gasparini G. Quality of life and voice: study of a Brazilian population using the voice-related quality of life measure. Folia Phoniatr Logop 2007;59: Jacobson B, Johnson A, Grywalksi C. The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol 1997;6: Rosen CA, Murry T, Zinn A, Zullo T, Sonbolian M. Voice handicap index change following treatment of voice disorders. J Voice 2000;14:
Medicare C/D Medical Coverage Policy
Medicare C/D Medical Coverage Policy Surgical Treatment of Obstructive Sleep Apnea Origination: June 26, 2000 Review Date: January 18, 2017 Next Review January, 2019 DESCRIPTION OF PROCEDURE OR SERVICE
More informationSnoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6
Snoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 6 MINIMALLY INVASIVE TREATMENTS OF SNORING AND SLEEP APNEA OVERVIEW The past decade has seen the rise of effective,
More informationObstructive Sleep Apnea- Hypopnea Syndrome and Snoring: Surgical Options
Obstructive Sleep Apnea- Hypopnea Syndrome and Snoring: Surgical Options Joshua L. Kessler, MD, FACS Boston ENT Associates Clinical Instructor, Otology and Laryngology Harvard Medical School Why Consider
More informationComparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty: A Single University Experience
771395AORXXX10.1177/0003489418771395Annals of Otology, Rhinology & LaryngologyHuntley et al research-article2018 Original Article Comparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty:
More informationSurgical Options for the Successful Treatment of Obstructive Sleep Apnea
Surgical Options for the Successful Treatment of Obstructive Sleep Apnea Benjamin J. Teitelbaum, MD, FACS Otolaryngology Head and Neck Surgery Saint Agnes Medical Center Fresno, California Terms Apnea
More informationModified Uvulopalatopharyngoplasty: The Extended Uvulopalatal Flap
Modified Uvulopalatopharyngoplasty: The Extended Uvulopalatal Flap Hseuh-Yu Li, MD,* Kasey K. Li, MD, DDS, Ning-Hung Chen, MD, and Pa-Chun Wang, MD Objective: To investigate the surgical outcomes of a
More information부비동내시경수술후비음도변화. Effects of Endoscopic Sinus Surgery on Nasality 동헌종 김선일 권중근 윤영선 강수미 추광철
KISEP Rhinology Korean J Otolaryngol 1999;42:871-5 부비동내시경수술후비음도변화 동헌종 김선일 권중근 윤영선 강수미 추광철 Effects of Endoscopic Sinus Surgery on Nasality Hun-Jong Dhong, MD, Sun-Il Kim, MD, Joong-Keun Kwon, MD, Young-Sun
More informationORIGINAL ARTICLE. First-Choice Treatment in Mild to Moderate Obstructive Sleep Apnea
ORIGINAL ARTICLE First-Choice Treatment in Mild to Moderate Obstructive Sleep Apnea Single-Stage, Multilevel, Temperature-Controlled Radiofrequency Tissue Volume Reduction or Nasal Continuous Positive
More informationHyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome
266 Original Research THIEME Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome Abd Alzaher Tantawy 1 Sherif Mohammad Askar 1 Hazem Saeed Amer 1 Ali Awad 1 Mohammad
More informationORIGINAL ARTICLE. Effect of Uvulopalatopharyngoplasty on Positional Dependency in Obstructive Sleep Apnea
ORIGINAL ARTICLE Effect of Uvulopalatopharyngoplasty on Positional Dependency in Obstructive Sleep Apnea Chul Hee Lee, MD; Sang-Wook Kim, MD; Kyuhee Han, MD; Jae-Min Shin, MD; Sung-Lyong Hong, MD; Ji-Eun
More informationJae Wook Kim, Jae Hong Park, Ki Nam Park, and Seung Won Lee. Correspondence should be addressed to Seung Won Lee;
e Scientific World Journal, Article ID 327928, 4 pages http://dx.doi.org/10.1155/2014/327928 Clinical Study Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in
More informationRoles of Surgery in OSA MASM Annual Fall Conference 2017 October 14, 2017 Kathleen Yaremchuk, MD, MSA Chair, Department of Otolaryngology/Head and
Roles of Surgery in OSA MASM Annual Fall Conference 2017 October 14, 2017 Kathleen Yaremchuk, MD, MSA Chair, Department of Otolaryngology/Head and Neck Surgery Senior Staff Sleep Medicine Henry Ford Hospital
More informationStep (2) Looked for correlations between baseline surrogates and postoperative AHI.
Development of the PSG PLUS PHYIOLOGY model Step (1) Picked possible surrogates of the physiological traits (See Table 1 in the main text). Step (2) Looked for correlations between baseline surrogates
More informationThe effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance
DOI 10.1007/s11325-014-1092-8 ORIGINAL ARTICLE The effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance Doğan Atan & Kürşat Murat Özcan & Aykut
More informationThe Preliminary Assessment for the Feasibility of CO2 Laserassisted Phonomicrosurgery Using Computer-guided Scanner in Broad-based Vocal Polyps
OA() Med Laser 2013;2(1):19-23 pissn 2287-8300ㆍeISSN 2288-0224 The Preliminary Assessment for the Feasibility of CO2 Laserassisted Phonomicrosurgery Using Computer-guided Scanner in Broad-based Vocal Polyps
More informationEffects of Radiofrequency Versus Sham Surgery of the Soft Palate on Daytime Sleepiness
The Laryngoscope VC 2014 The American Laryngological, Rhinological and Otological Society, Inc. Effects of Radiofrequency Versus Sham Surgery of the Soft Palate on Daytime Sleepiness Thorbjorn Holmlund,
More informationNasal Mass Presenting as Obstructive Sleep Apnea Syndrome
ORIGINAL ARTICLE pissn 2093-9175 / eissn 2233-8853 http://dx.doi.org/10.17241/smr.2015.6.2.54 Nasal Mass Presenting as Obstructive Sleep Apnea Syndrome Seung Hoon Lee, MD, PhD, In Sik Song, MD, Jae Woo
More informationThe Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep Apnea on Globus Sense and Positional Dependency
Clinical and Experimental Otorhinolaryngology Vol. 3, No. 3: 141-146, September 2010 DOI 10.3342/ceo.2010.3.3.141 Original Article The Effect of Uvula-Preserving Palatopharyngoplasty in Obstructive Sleep
More informationORIGINAL ARTICLE. for mild to moderate obstructive
ORIGINAL ARTICLE An Investigation of Upper Airway Changes Associated With Mandibular Advancement Device Using Sleep Videofluoroscopy in Patients With Obstructive Sleep Apnea Chul Hee Lee, MD, PhD; Jeong-Whun
More informationTranssubmental tongue-base suspension in treating patients with severe obstructive sleep apnoea after failed uvulopalatopharyngoplasty:
CORRESPONDENCE: OUR EXPERIENCE Transsubmental tongue-base suspension in treating patients with severe obstructive sleep apnoea after failed uvulopalatopharyngoplasty: Our Experience Huang, T.-W.,* Su,
More informationSnoring. Forty-five percent of normal adults snore at least occasionally and 25
Snoring Insight into sleeping disorders and sleep apnea Forty-five percent of normal adults snore at least occasionally and 25 percent are habitual snorers. Problem snoring is more frequent in males and
More informationSKUP 3 : 6 and 24 Months Follow-up of Changes in Respiration and Sleepiness After Modified UPPP
The Laryngoscope VC 2017 The American Laryngological, Rhinological and Otological Society, Inc. SKUP 3 : 6 and 24 Months Follow-up of Changes in Respiration and Sleepiness After Modified UPPP Nanna Browaldh,
More informationAdult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality
Original Paper Published online: November 1, 2014 Differences Affect Postoperative Transient Hypernasality Olaf Zagólski a Paweł Stręk b Mariusz Gajda c a ENT Day Surgery Department, St. John Grande s
More informationA Reversible Uvulopalatal Flap for Snoring and Sleep Apnea Syndrome
Sleep, 19(7):593-599 1996 American Sleep Disorders Association and Sleep Research Society Short Report: Surgical Technique A Reversible Uvulopalatal Flap for Snoring and Sleep Apnea Syndrome Nelson Powell,
More informationSURGERY FOR SNORING AND MILD OBSTRUCTIVE SLEEP APNOEA
SURGERY FOR SNORING AND MILD OBSTRUCTIVE SLEEP APNOEA INTRODUCTION Snoring with or without excessive daytime somnolence, restless sleep and periods of apnoea are all manifestations of sleep disordered
More informationCleft Palate Speech-Components and Assessment Voice and Resonance Disorders-ASLS-563. Key Components of Cleft Palate Speech.
Cleft Palate Speech-Components and Assessment Voice and Resonance Disorders-ASLS-563 Key Components of Cleft Palate Speech Disorder Type of Disorder/ Causes Hypernasality Resonance Disorder insufficiency
More informationLong-term Complications after Multilevel Surgery for Sleep-related Breathing Disorders
6 The Open Sleep Journal, 2012, 5, 6-11 Open Access Long-term Complications after Multilevel Surgery for Sleep-related Breathing Disorders N. S. Gebhardt* and K. P. Tschopp ENT Clinic, Cantonal Hospital
More informationRadiofrequency Uvulopalatoplasty for Primary Snoring
ORIGINAL REPORT Radiofrequency Uvulopalatoplasty for Primary Snoring Seyed Hadi Samimi Ardestani 1, Mohammad Hossein Dadgarnia, Mohammad Hossein Baradaranfar, Mona Mazidi, Mahtab Rabbani, Nasim Behniafard
More informationSoft tissue hypopharyngeal surgery for obstructive sleep apnea syndrome
Oral Maxillofacial Surg Clin N Am 14 (2002) 371 376 Soft tissue hypopharyngeal surgery for obstructive sleep apnea syndrome B. Tucker Woodson, MD, FACS, ABSM Department of Otolaryngology and Human Communication,
More informationNasal Evaluation & Non-surgical Nasal Therapy in SDB
Nasal Evaluation & Non-surgical Nasal Therapy in SDB Edward M. Weaver, MD, MPH Seattle VA Medical Center University of Washington Harborview Medical Center Acknowledgments This material is the result of
More informationTongue Coblation via the Ventral Approach for Obstructive Sleep Apnea Hypopnea Syndrome Surgery
The Laryngoscope VC 2012 The American Laryngological, Rhinological and Otological Society, Inc. Tongue Coblation via the Ventral Approach for Obstructive Sleep Apnea Hypopnea Syndrome Surgery Tiening Hou,
More informationUvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS
B-ENT, 2009, 5, 245-250 Uvulopalatopharyngoplasty with tonsillectomy in the treatment of severe OSAS S. Gallina*, F. Dispenza**, G. Kulamarva***, A. Ballacchino**** and Riccardo Speciale**** *Dipartimento
More informationTongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions
SLEEP AND BREATHING VOL. 4, NO. 4, 2000 Tongue Base Reduction with Radiofrequency Tissue Ablation: Preliminary Results after Two Treatment Sessions BORIS A. STUCK, M.D., JOACHIM T. MAURER, M.D., and KARL
More informationAssociation of Palatine Tonsil Size and Obstructive Sleep Apnea in Adults
The Laryngoscope VC 2017 The American Laryngological, Rhinological and Otological Society, Inc. Association of Palatine Tonsil Size and Obstructive Sleep Apnea in Adults Sebastian M. Jara, MD ; Edward
More informationTolerance of Positive Airway Pressure following Site-Specific Surgery of Upper Airway
34 The Open Sleep Journal, 2008, 1, 34-39 Open Access Tolerance of Positive Airway Pressure following Site-Specific Surgery of Upper Airway Ho-Sheng Lin *,#,1,2, Roger Toma #,2, Cara Glavin 2, Mark Toma
More informationTransoral robotic surgery for treatment of obstructive sleep apnea: factors predicting surgical response.
Laryngoscope. 05 Apr;5(4):03-0. doi: 0.00/lary.4970. Epub 04 Oct 4. Transoral robotic surgery for treatment of obstructive sleep apnea: factors predicting surgical response. Lin HS, Rowley JA, Folbe AJ,
More informationComparative study of four radiofrequency generators for the treatment of snoring
Otolaryngology Head and Neck Surgery (2008) 138, 294-299 ORIGINAL RESEARCH SLEEP MEDICINE Comparative study of four radiofrequency generators for the treatment of snoring Marc B. Blumen, MD, Frédéric Chalumeau,
More informationDoes the dimple point represent the margin of soft palate musculature?
Asian Biomedicine Vol. 2 No. 5 October 2008;397-401 Brief Communication Does the dimple point represent the margin of soft palate musculature? Department of Otolaryngology, Faculty of Medicine, Chulalongkorn
More informationTreating OSA? Don't Forget the Tongue
From: ENT Today, January 2008 Treating OSA? Don't Forget the Tongue by Pippa Wysong Although otolaryngologic surgeons commonly focus on the palate when treating patients with obstructive sleep apnea (OSA),
More informationof the Literature REVIEW
REVIEW Radiofrequency Surgery of the Soft Palate in the Treatment of Snoring: a Review of the Literature Boris A. Stuck, MD; Joachim T. Maurer, MD; Gerhard Hein, MD; Karl Hörmann, MD; Thomas Verse, MD
More informationUpdated Friedman Staging System for Obstructive Sleep Apnea
Updated Friedman Staging System for Obstructive Sleep Apnea Michael Friedman a, b Anna M. Salapatas b Lauren B. Bonzelaar c a Section of Sleep Surgery, Rush University Medical Center, and b Section of
More information피대근절개에따른갑상선절제술후의음성변화. Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy 김영모 1 조정일 1 김철호 1 박정선 1 최호순 3 하현령 2
KISEP Head and Neck Korean J Otolaryngol 2000;43:985-91 피대근절개에따른갑상선절제술후의음성변화 김영모 1 조정일 1 김철호 1 박정선 1 최호순 3 하현령 2 Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy
More informationOutcomes of Upper Airway Surgery in Obstructive Sleep Apnea
Original Research Outcomes of Upper Airway Surgery in Obstructive Sleep Apnea Hadiseh Hosseiny 1, Nafiseh Naeimabadi 1, Arezu Najafi 1 *, Reihaneh Heidari 1, Khosro Sadeghniiat-Haghighi 1 1. Occupational
More informationContemporary Snoring Management
Contemporary Snoring Management Eric J. Kezirian, MD, MPH Director, Division of Sleep Surgery Otolaryngology Head and Neck Surgery University of California, San Francisco ekezirian@ohns.ucsf.edu Sleepsurgery.ucsf.edu
More informationCorporate Medical Policy
Corporate Medical Policy PALATOPHARYNGOPLASTY/UVULOPALATOPHARYGOPLASTY Description of Procedure or Service Palatopharyngoplasty refers to several surgical approaches for management of the upper airway,
More informationThe Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery
432 Original Research THIEME The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery Francesco Lorusso 1 Francesco Dispenza 1 Domenico Michele Modica
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Effective Date: January 15, 2018 Related Policies: 2.01.18 Diagnosis and Medical Management of Obstructive Sleep Apnea Surgical Treatment of Snoring and Obstructive Sleep Apnea
More informationThe Mandibular Advancement Device and Patient Selection in the Treatment of Obstructive Sleep Apnea
ORIGINAL ARTICLE The Mandibular Advancement Device and Patient Selection in the Treatment of Obstructive Sleep Apnea Chul Hee Lee, MD; Ji-Hun Mo, MD; Ik-Joon Choi, MD; Hyun Jong Lee, MD; Beom Seok Seo,
More informationSnoring: What Works?
Snoring: What Works? Eric J. Kezirian, MD, MPH Director, Division of Sleep Surgery Otolaryngology Head and Neck Surgery University of California, San Francisco ekezirian@ohns.ucsf.edu Sleepsurgery.ucsf.edu
More informationMEDICAL POLICY SUBJECT: SURGICAL MANAGEMENT OF SLEEP DISORDERS
MEDICAL POLICY PAGE: 1 OF: 9 If the member's subscriber contract excludes coverage for a specific service, it is not covered under that contract. In such cases, medical policy criteria are not applied.
More informationLINGUISTICS 130 LECTURE #4 ARTICULATORS IN THE ORAL CAVITY
LINGUISTICS 130 LECTURE #4 ARTICULATORS IN THE ORAL CAVITY LIPS (Latin labia ) labial sounds bilabial labiodental e.g. bee, my e.g. fly, veal TEETH (Latin dentes) dental sounds e.g. think, they ALVEOLAR
More informationDifferences of the Voice Parameters Between the Population of Different Hearing Tresholds: Findings by Using the Multi-Dimensional Voice Program
Original Article Clinical and Experimental Otorhinolaryngology Vol. 10, No. 3: 278-282, September 2017 http://dx.doi.org/10.21053/ceo.2015.01900 pissn 1976-8710 eissn 2005-0720 Differences of the Voice
More informationPang-Rotenberg Sign Snoring Surgery Prognosticator: A Prospective Clinical Trial of 153 Patients
The Laryngoscope VC 2015 The American Laryngological, Rhinological and Otological Society, Inc. Pang-Rotenberg Sign Snoring Surgery Prognosticator: A Prospective Clinical Trial of 153 Patients Kenny P.
More informationThe Ear, Nose and Throat in MPS
The Ear, Nose and Throat in MPS Annerose Keilmann Voice Care Center Bad Rappenau, Germany Preciptorship program on MPS Wiesbaden, November 2 nd 2015 Alterations of the outer and middle ear in MPS I narrowing
More information(1) TONSILS & ADENOIDS
(1) TONSILS & ADENOIDS (2) Your child has been referred to have his tonsils and adenoids removed. This operation is commonly called an adenotonsillectomy and is one of the most common major operations
More informationPlace and Manner of Articulation Sounds in English. Dr. Bushra Ni ma
Place and Manner of Articulation Sounds in English Dr. Bushra Ni ma Organs of Speech Respiratory System Phonatory System Articulatory System Lungs Muscles of the chest Trachea Larynx Pharynx Lips Teeth
More informationTaste Disturbance Following Tongue Base Resection for OSA
The Laryngoscope VC 2015 The American Laryngological, Rhinological and Otological Society, Inc. Taste Disturbance Following Tongue Base Resection for OSA Hsin-Ching Lin, MD, FACS; Michelle S. Hwang, BS;
More informationOriginal Article. Clinical Archives of Communication Disorders / Vol. 2, No. 1:15-22 / April 2017 INTRODUCTION
Original Article http://e-cacd.org/ eissn: 2287-903X Clinical Archives of Communication Disorders / Vol. 2, No. 1:15-22 / April 2017 https://doi.org/10.21849/cacd.2017.00024 Open Access Aerodynamic Parameters
More informationOBSTRUCTIVE SLEEP APNEA and WORK Treatment Update
OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update David Claman, MD Professor of Medicine Director, UCSF Sleep Disorders Center 415-885-7886 Disclosures: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)
More informationBipolar radiofrequency induced thermotherapy of the tongue base: its complications, acceptance and evectiveness under local anesthesia
Eur Arch Otorhinolaryngol (006) 63:03 040 DOI 0.007/s00405-006-05-x MISCELLANEOUS Bipolar radiofrequency induced thermotherapy of the tongue base: its complications, acceptance and evectiveness under local
More informationORIGINAL ARTICLE. Hsueh-Yu Li, MD; Ning-Hung Chen, MD; Yu-Hsiang Shu, MSc; Pa-Chun Wang, MD, MSc
ORIGINAL ARTICLE Changes in Quality of Life and Respiratory Disturbance After Extended Uvulopalatal Flap Surgery in Patients With Obstructive Sleep Apnea Hsueh-Yu Li, MD; Ning-Hung Chen, MD; Yu-Hsiang
More informationAlexandria Workshop on
Alexandria Workshop on 1 Snoring & OSA Surgery Course Director: Yassin Bahgat MD Claudio Vicini MD Course Board: Filippo Montevecchi MD Pietro Canzi MD Snoring & Obstructive ti Sleep Apnea The basic information
More informationEffect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea
European Journal of Orthodontics 20 (1998) 293 297 1998 European Orthodontic Society Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea J. Lamont*, D. R. Baldwin**,
More informationSnoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 2
Snoring and Obstructive Sleep Apnea: Patient s Guide to Minimally Invasive Treatments Chapter 2 CAUSES OF SNORING AND SLEEP APNEA We inhale air through our nose and mouth. From the nostrils, air flows
More informationVoice Low Tone to High Tone Ratio - A New Index for Nasal Airway Assessment
Chinese Journal of Physiology 46(3): 123-127, 2003 123 Voice Low Tone to High Tone Ratio - A New Index for Nasal Airway Assessment Guoshe Lee 1,4, Cheryl C. H. Yang 2 and Terry B. J. Kuo 3 1 Department
More informationCHALLENGES IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA. Amy S. Whigham, MD Assistant Professor
CHALLENGES IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA Amy S. Whigham, MD Assistant Professor Disclosures I have nothing to disclose. Outline Epidemiology Diagnosis Adenotonsillectomy Failure Treatment of Refractory
More informationTemperature controlled radiofrequency ablation for OSA
Temperature controlled radiofrequency ablation for OSA Ridhwan Y. Baba, M.B.B.S. *1, V.V.S. Ramesh Metta, M.B.B.S. 1, Arjun Mohan, M.B.B.S. 2, M. Jeffery Mador, M.D. 2 1 Department of Internal Medicine,
More informationHead and Neck Physical Examination: Comparison Between Nonapneic and Obstructive Sleep Apnea Patients
The Laryngoscope Lippincott Williams & Wilkins, Inc. 2005 The American Laryngological, Rhinological and Otological Society, Inc. Head and Neck Physical Examination: Comparison Between Nonapneic and Obstructive
More informationClinical Predictors of Effective Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea/Hypopnea Syndrome
The Laryngoscope VC 2015 The American Laryngological, Rhinological and Otological Society, Inc. Clinical Predictors of Effective Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea/Hypopnea
More informationOriginal Policy Date
MP 7.01.42 Laser-Assisted Tonsillectomy Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return to Medical Policy
More informationThe Throat. Image source:
The Throat Anatomy Image source: http://anatomyforlayla.blogspot.co.za/2007/04/blog-post.html The Throat consists of three parts: 1. The Nasopharynx is the upper part of the throat and it is situated behind
More informationNIH Public Access Author Manuscript Otolaryngol Head Neck Surg. Author manuscript; available in PMC 2010 May 1.
NIH Public Access Author Manuscript Published in final edited form as: Otolaryngol Head Neck Surg. 2009 May ; 140(5): 646 651. doi:10.1016/j.otohns.2009.01.012. Test-retest reliability of drug-induced
More information11/19/2012 ก! " Varies 5-86% in men 2-57% in women. Thailand 26.4% (Neruntarut et al, Sleep Breath (2011) 15: )
Snoring ก Respiratory sound generated in the upper airway during sleep that typically occurs during inspiration but may occur during expiration ICSD-2, 2005..... ก ก! Prevalence of snoring Varies 5-86%
More informationClinical Policy Title: Uvulopalatopharyngoplasty
Clinical Policy Title: Uvulopalatopharyngoplasty Clinical Policy Number: 10.03.05 Effective Date: October 1, 2015 Initial Review Date: June 17, 2015 Most Recent Review Date: July 20, 2017 Next Review Date:
More informationLinköping University Post Print. Long-term effects of radiofrequency ablation of the soft palate on snoring.
Linköping University Post Print Long-term effects of radiofrequency ablation of the soft palate on snoring. Elisabeth Hultcrantz, Lena Harder, Helena Loord, Lars-Göran Käll, Kjell Ydreborg, Staffan Wallberg
More informationResonance Disorders & Velopharyngeal Dysfunction
Resonance Disorders & Velopharyngeal Dysfunction Cincinnati Children s Normal Velopharyngeal Function Structures Active in Velopharyngeal Closure Velum (soft palate) - The velum moves in a superior and
More informationTitle: Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires in the Greek language.
Elsevier Editorial System(tm) for Journal of Voice Manuscript Draft Manuscript Number: JVOICE-D--000R1 Title: Evaluating the outcome of phonosurgery: comparing the role of VHI and VoiSS questionnaires
More informationOverview. Goal of Evaluation. DISE: Identifying the Sites of Obstruction in OSA. Characterize disorder to guide effective treatment.
DISE: Identifying the Sites of Obstruction in OSA Eric J. Kezirian, MD, MPH Director, Division of Sleep Surgery Otolaryngology Head and Neck Surgery University of California, San Francisco ekezirian@ohns.ucsf.edu
More informationSnoring, obstructive sleep apnea (OSA), and upper. impact of basic research on tomorrow. Snoring Imaging* Could Bernoulli Explain It All?
impact of basic research on tomorrow Snoring Imaging* Could Bernoulli Explain It All? Igor Fajdiga, MD, PhD Study objectives: To identify upper airway changes in snoring using CT scanning, to clarify the
More informationCritical Review: Are laryngeal manual therapies effective in improving voice outcomes of patients with muscle tension dysphonia?
Critical Review: Are laryngeal manual therapies effective in improving voice outcomes of patients with muscle tension dysphonia? María López M.Cl.Sc (SLP) Candidate University of Western Ontario: School
More informationTHE RISE AND FALL(?) OF UPPP FOR SLEEP APNEA COPYRIGHT NOTICE
THE RISE AND FALL(?) OF UPPP FOR SLEEP APNEA COPYRIGHT NOTICE Washington University grants permission to use and reproduce the The Rise and Fall(?) of UPPP for Sleep Apnea as it appears in the PDF available
More informationGoal of Evaluation. Overview. Characterize disorder to guide effective treatment 1/10/2018. Disclosures
to Identify Sites of Obstruction in Patients with OSA Eric J. Kezirian, MD, MPH Professor, Otolaryngology Head & Neck Surgery President, International Surgical Sleep Society Sleep-Doctor.com Eric.Kezirian@med.usc.edu
More informationDownloaded from tumj.tums.ac.ir at 17:29 IRDT on Friday March 22nd 2019
8-22 387 2 66 8 :.... (radiofrequency palatoplasty) :.. non randomized prospective quasi-experimental.( ) 2 :.. 2 BMI. %57. 25-65 (SD=/7) 47. %7/4.(SD=4/5)...(p=/5).(p
More informationSpeech (Sound) Processing
7 Speech (Sound) Processing Acoustic Human communication is achieved when thought is transformed through language into speech. The sounds of speech are initiated by activity in the central nervous system,
More informationFEP Medical Policy Manual
FEP Medical Policy Manual Last Review: December 2016 Effective Date: January 15, 2017 Related Policies 2.01.18 Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome Surgical Treatment of
More informationIEHP considers the treatment of obstructive sleep apnea (OSA) medically necessary according to the criteria outlined below:
: Positive Airway Pressure, Oral Appliances, and Surgical Interventions Policy: Obstructive sleep apnea (OSA) is characterized by an interruption of breathing during sleep most commonly due to extra or
More informationTonsilloplasty Versus Tonsillectomy in Children With Sleep-Disordered Breathing: Short- and Long-Term Outcomes
The Laryngoscope VC 2012 The American Laryngological, Rhinological and Otological Society, Inc. Tonsilloplasty Versus Tonsillectomy in Children With Sleep-Disordered Breathing: Short- and Long-Term Outcomes
More informationPrimary Snoring Evaluation and Treatment
Primary Snoring Evaluation and Treatment Andrew N. Goldberg, MD, MSCE Professor Department of Otolaryngology-Head and Neck Surgery University of California-San Francisco Disclosures Apnicure Stock holder
More informationLateral Pharyngoplasty Reduces Nocturnal Blood Pressure in Patients With Obstructive Sleep Apnea
The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Lateral Pharyngoplasty Reduces Nocturnal Blood Pressure in Patients With Obstructive Sleep Apnea Carolina
More informationObstructive Sleep Apnea Syndrome
SMGr up Obstructive Sleep Apnea Syndrome Alper Dilci, Handan Koyuncu and Vural Fidan* Otorhinolaryngology Department, Yunus Emre Government Hospital, Turkey *Corresponding author: Vural Fidan, Otorhinolaryngology
More informationSurgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome. Original Policy Date
MP 7.01.81 Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature
More informationA Clicking Larynx: Diagnostic and Therapeutic Challenges
The Laryngoscope VC 2017 The American Laryngological, Rhinological and Otological Society, Inc. Case Report A Clicking Larynx: Diagnostic and Therapeutic Challenges Derrek A. Heuveling, MD, PhD ; Maarten
More informationSurgical Treatment of OSA. Han-Soo Bae, MD Monroe Ear Nose and Throat Associates May 5, 2017
Surgical Treatment of OSA Han-Soo Bae, MD Monroe Ear Nose and Throat Associates May 5, 2017 Disclosure None Treatment of OSA PAP Oral appliance Surgery OSA and Mortality Surgical Treatment of OSA Surgery
More informationCoblation-assisted Lewis and MacKay operation (CobLAMO): new technique for tongue reduction in sleep apnoea surgery
University of Wollongong Research Online Faculty of Science, Medicine and Health - Papers Faculty of Science, Medicine and Health 2013 Coblation-assisted Lewis and MacKay operation (CobLAMO): new technique
More informationCelonENT. RFITT Bipolar Radiofrequency Induced Thermotherapy. A minimally invasive procedure for daily practice in ENT.
CelonENT RFITT Bipolar Radiofrequency Induced Thermotherapy. A minimally invasive procedure for daily practice in ENT. 2 CELON AG, A MEMBER OF THE OLYMPUS MEDICAL SYSTEMS GROUP, DEVELOPS AND MANUFACTURES
More informationSelected surgical managements in snoring and obstructive sleep apnoea patients
Selected surgical managements in snoring and obstructive sleep apnoea patients Olszewska E., Rutkowska J., Czajkowska A., Rogowski M. Abstract Obstructive sleep apnea syndrome (OSAS) may contribute to
More informationAll the Essential Elements You Deserve in a Doctor EXPERIENCE
All the Essential Elements You Deserve in a Doctor EXPERIENCE S K I LL D E D I C AT I O N WA R MT H C O M PA S S I O N are right here at Providence ENT If you or your children suffer from sinus problems,
More information