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The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were... more
The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and surgical outcome of relocation pharyngoplasty in patients with obstructive sleep apnea. Case series with planned data collection. Tertiary referral center. A total of 45 obstructive sleep apnea patients were included who underwent conservative treatment (n = 13) or relocation pharyngoplasty (n = 32), and their baseline and postoperative polysomnographies and awake nasopharyngoscopies with Müller's maneuver were reviewed. Shape ratio (transverse diameter [TD] / longitudinal diameter [LD]) in the stationary and Müller's phases and collapsibility (ColTD and ColLD) of the airway at the level of the uvular base were measured with a picture archiving and communication system. Intra- and interrater reliabilities were assessed. Associations among nasopharyngoscopic measurements, AHI, positional dependency, and surgical success (defined as a reduction of AHI ≥50% and a postoperative AHI ≤20/h) were statistically analyzed. Reliability tests indicated substantial agreements of all nasopharyngoscopic measurements between raters and within raters. A higher baseline ColTD was significantly associated with an elevated AHI (r = 0.49, P = .001), whereas a lower postoperative ColTD was significantly related to surgical success (r = -0.38, P = .034). Nasopharyngoscopic findings were not statistically significantly correlated with positional dependency. Transverse retropalatal collapsibility measured by awake nasopharyngoscopy with Müller's maneuver helps to predict individuals with moderate to severe sleep apnea and surgical outcome.
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BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity... more
BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequently, the participants each performed a focused H&P with a real outpatient. Two raters used the Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) questionnaires to assess the participants’ performance blindly. The Cognitive Load Component questionnaire and a portable electrocardiogram monitor were used to measure cognitive load and HRV, respectively. RESULTS All participants completed the study (mean age=24.2 years, standard deviation=0.9 years; 44 [69%] males and 20 [31%] females). The physical examination and student’s satisfaction scores (Mini-CEX), total DOPS score, total and intrinsic cognitive load scores, and standard deviation of normal to normal R-R intervals in the 360° VR video group were significantly higher than those in the 2D video group (effect size=0.63, 0.56, 0.72, 0.53, 0.67, and 0.52, respectively). Differences in the other aspects of the Mini-CEX and cognitive loads of both groups were not statistically significant. CONCLUSIONS This study provides a high level of evidence to confirm that 360° VR video review can help undergraduate medical students to perform fundamental H&P skills as effectively as traditional 2D video review. Furthermore, a 360° VR video review could be used to more efficiently examine the body of a real patient with higher learner’s satisfaction. These findings may inspire the design of 360° VR video-based training protocols to enhance competencies other than history taking. CLINICALTRIAL Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)
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<p>SI: snoring index. Imax: maximal sound intensity. Imean: mean sound intensity. Fpeak: peak frequency. Fmean: mean frequency. B1: the band between 40 Hz and 300 Hz. B2: the band between 301 Hz and 850 Hz. B3: the band between 851... more
<p>SI: snoring index. Imax: maximal sound intensity. Imean: mean sound intensity. Fpeak: peak frequency. Fmean: mean frequency. B1: the band between 40 Hz and 300 Hz. B2: the band between 301 Hz and 850 Hz. B3: the band between 851 Hz and 2000 Hz.</p>†<p>Significance was assessed by a Kruskal Wallis test.</p>‡<p>Significance was tested using a 2-sided Mann-Whitney <i>U</i> test.</p>*<p>A value of <i>P</i><0.05 was considered significant.</p
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Objectives/HypothesisDirect suspension laryngoscopic biopsy performed under general anesthesia is the conventional management for obtaining pathological diagnosis for neoplasms of the larynx, oropharynx, and hypopharynx. Since the... more
Objectives/HypothesisDirect suspension laryngoscopic biopsy performed under general anesthesia is the conventional management for obtaining pathological diagnosis for neoplasms of the larynx, oropharynx, and hypopharynx. Since the development of distal chip laryngoscopy and digital imaging systems, transnasal flexible laryngoscopy tissue sampling has gained popularity as an office‐based procedure. Additional assessment with narrow‐band imaging (NBI) can help to increase the diagnostic yield. The aim of the study was to evaluate the accuracy, sensitivity, and specificity of a novel diagnostic tool: office‐based NBI (OB‐NBI) flexible laryngoscopic tissue sampling.Study DesignRetrospective chart review performed in a tertiary referral medical center in Taiwan.MethodsFrom January 2010 to February 2013, 90 consecutive patients received OB‐NBI biopsies. The accuracies of the OB‐NBI biopsies were compared among locations, tumor sizes, head and neck cancer histories, and other factors.ResultsAll patients had completed the procedure without life‐threatening complications. The overall sensitivity and specificity were 97.2% and 100%, respectively, with a diagnostic accuracy of 98.9%. Accuracy was not affected by tumor size, location, learning curves, or previous head and neck cancer history.ConclusionsWe present an integrated technique that merges the safety and versatility of flexible laryngoscopy with the diagnostic power of NBI to produce a promising method of high accuracy and minimal morbidity.Level of Evidence4 Laryngoscope, 126:2764–2769, 2016
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BACKGROUND Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position,... more
BACKGROUND Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position, the mechanism of voice dysfunction induced by dysfunction of CT muscle in UVFP patients remains controversial. This study compares aerodynamics between UVFP patients with and without CT muscle involvement. METHODS This cross-sectional study recruited patients with UVFP manifesting dysphonia, and UVFP was confirmed with videolaryngoscopy and laryngeal electromyography (LEMG). Voice analysis and aerodynamic tests were further performed. Patients with (CT+ group) and without (CT- group) CT muscle involvement were compared. RESULT A total of 175 patients (40 in the CT+ group and 135 in the CT- group) with UVFP were analyzed. The CT+ group showed lower maximal sound pressure level (SPL) (P=0.039), mean SPL (P=0.042), peak air pressure (P<0.001), mean peak air pressure (P<0.001) and aerodynamic power (P=0.004) than the CT- group. CONCLUSION The decrease in SPL, peak air pressure, and aerodynamic power in UVFP patients with CT muscle dysfunction suggests that the effect of CT muscle dysfunction is mediated by a change in aerodynamics.
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BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive... more
BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequen...
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Objectives/HypothesisDirect suspension laryngoscopic biopsy performed under general anesthesia is the conventional management for obtaining pathological diagnosis for neoplasms of the larynx, oropharynx, and hypopharynx. Since the... more
Objectives/HypothesisDirect suspension laryngoscopic biopsy performed under general anesthesia is the conventional management for obtaining pathological diagnosis for neoplasms of the larynx, oropharynx, and hypopharynx. Since the development of distal chip laryngoscopy and digital imaging systems, transnasal flexible laryngoscopy tissue sampling has gained popularity as an office‐based procedure. Additional assessment with narrow‐band imaging (NBI) can help to increase the diagnostic yield. The aim of the study was to evaluate the accuracy, sensitivity, and specificity of a novel diagnostic tool: office‐based NBI (OB‐NBI) flexible laryngoscopic tissue sampling.Study DesignRetrospective chart review performed in a tertiary referral medical center in Taiwan.MethodsFrom January 2010 to February 2013, 90 consecutive patients received OB‐NBI biopsies. The accuracies of the OB‐NBI biopsies were compared among locations, tumor sizes, head and neck cancer histories, and other factors.Resul...
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The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and... more
The aim of this study was to investigate whether the retropalatal airway shape and collapsibility defined by awake nasopharyngoscopy with Müller's maneuver were associated with apnea-hypopnea index (AHI), positional dependency, and surgical outcome of relocation pharyngoplasty in patients with obstructive sleep apnea. Case series with planned data collection. Tertiary referral center. A total of 45 obstructive sleep apnea patients were included who underwent conservative treatment (n = 13) or relocation pharyngoplasty (n = 32), and their baseline and postoperative polysomnographies and awake nasopharyngoscopies with Müller's maneuver were reviewed. Shape ratio (transverse diameter [TD] / longitudinal diameter [LD]) in the stationary and Müller's phases and collapsibility (ColTD and ColLD) of the airway at the level of the uvular base were measured with a picture archiving and communication system. Intra- and interrater reliabilities were assessed. Associations among naso...
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To evaluate the effect of sedation depth on drug-induced sleep endoscopy (DISE). Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at... more
To evaluate the effect of sedation depth on drug-induced sleep endoscopy (DISE). Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65-75 (light sedation) and 50-60 (deep sedation). For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confidence interval); 14.3 (4.7-43.4), 11.7 (4.2-32.9), and 13.2 (2.8-62.3), respectively). A good agreement ...
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To investigate the neurologic and functional effect of intracordal hyaluronate injections in acute unilateral vocal fold paralysis (UVFP) in a randomized controlled trial. In this open-label, randomized controlled study, 29 patients with... more
To investigate the neurologic and functional effect of intracordal hyaluronate injections in acute unilateral vocal fold paralysis (UVFP) in a randomized controlled trial. In this open-label, randomized controlled study, 29 patients with UVFP were recruited within 6 months of their first outpatient visit and were randomized to receive either single hyaluronate injection (HI group) or conservative management (CM group). Quantitative laryngeal electromyography, videolaryngostroboscopy, UVFP-related quality of life (Voice Outcomes Survey, VOS), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1, 3 and 6 months post-injection in the HI group, and at baseline and 6 months in the CM group. Improvements in most quality of life domains and other assessments were comparable between the HI and CM groups; however, the HI group had a greater improvement in the mental health domain of quality of life at the end of follow-up. Early hyalurona...
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OBJECTIVE Tracheal granulation is one of the common long term complications in patients after tracheostomy. Hypertrophic tracheal granulation may cause airway obstruction and further operation may be required to recreate an airway. Distal... more
OBJECTIVE Tracheal granulation is one of the common long term complications in patients after tracheostomy. Hypertrophic tracheal granulation may cause airway obstruction and further operation may be required to recreate an airway. Distal tracheal granulation is clinically challenging because of its position and surgical field limitation. This retrospective case review study evaluated the outcomes of PEAK PlasmaBlade-assisted tracheal surgery in patients with distal tracheal granulation. METHODS This study retrospectively reviewed patients with distal tracheal granulation following long-term tracheostomy. All patients received PEAK PlasmaBlade assistance tracheal surgery (PATS) between February 2013 and December 2019. The surgery was performed using the PEAK PlasmaBlade with TnA type tip, powered by a PULSAR Generator, and guided by a 45 ° rigid endoscope. Patients were regularly followed up for a minimum of 12 months. RESULTS A total 21 patients had completed PATS. None of the patients experience immediate life-threatening complications during or after the procedure. All the 21 patients were free of recurrent obstructive granulation within 12 months after operation. CONCLUSION PATS is practical, effective, and safe for distal tracheal granulation and can be performed by single surgeon. Furthermore, it is technically less demanding than other surgical approaches and it has a rapid learning curve.
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Though trauma related to direct laryngoscopy may occur anywhere from the lips to the glottis, damage to the epiglottis during intubation is a rare complication. Although large hematoma formation in the epiglottis after intubation is... more
Though trauma related to direct laryngoscopy may occur anywhere from the lips to the glottis, damage to the epiglottis during intubation is a rare complication. Although large hematoma formation in the epiglottis after intubation is uncommon, its nature is potentially lethal. We report a case of epiglottic hematoma secondary to endotracheal intubation.
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ObjectiveTo investigate the quality‐of‐life status of Taiwanese adult patients with sleep‐disordered breathing (SDB).Study Design and SettingA prospective, quality of life survey in a tertiary referral sleep center on 94 consecutive adult... more
ObjectiveTo investigate the quality‐of‐life status of Taiwanese adult patients with sleep‐disordered breathing (SDB).Study Design and SettingA prospective, quality of life survey in a tertiary referral sleep center on 94 consecutive adult SDB patients. Patients were evaluated with polysomnogram, Medical Outcome Study SF‐36 Health Survey, Snore Outcome Survey (SOS), and Epworth Sleepiness Scale (ESS).ResultsSDB patients have significantly lower scores in all 8 SF‐36 subscales (P &lt; 0.05) than do normative Taiwan adult population. Apnea patients have lower SOS (34.5 ± 7.5 vs 40.1 ± 10.3, P = 0.005) and higher ESS scores than do simple snorers (8.8 ± 5.1 vs 11.7 ± 5.2, P = 0.03). Patients with a higher degree of sleepiness show worse performance in all dimensions of their general health status (P values 0.0005 to 0.01). Deep sleep (stage 3 + 4) is predictive of SF‐36 role: physical (β = 1.63, P = 0.04), bodily pain (β = 1.22, P = 0.01), vitality (β = 1.05, P = 0.01), subscales scores (adjusted R2 0.005 to 0.1).ConclusionSDB has considerable impact on a patient's global health status.SignificanceDaytime sleepiness, rather than apnea, is a major quality‐of‐life determinant. EBM rating: B‐2b
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A neurofibroma of the larynx is a rare disease that usually involves the arytenoids and the aryepiglottic fold. Pediatric patients with a laryngeal neurofibroma often present with progressive dyspnea. A definitive diagnosis of a laryngeal... more
A neurofibroma of the larynx is a rare disease that usually involves the arytenoids and the aryepiglottic fold. Pediatric patients with a laryngeal neurofibroma often present with progressive dyspnea. A definitive diagnosis of a laryngeal neurofibroma is based on the histopathologic demonstration of the characteristic spindle cells, and a positive result in immunohistochemical staining for S-100 protein. Tumor excision of laryngeal neurofibromas by an external approach was formerly common. We present a case of a solitary laryngeal neurofibroma in a 4-year-old child that was completely excised using direct laryngoscopy and a CO2 laser. There has been no recurrence after a follow-up of 4 years. For pediatric patients with an isolated laryngeal neurofibroma, endoscopic surgery provides an alternative approach due to its safety, effectiveness, and minimal invasiveness.
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To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment. Case series with chart review in a tertiary care medical center in Taiwan. Forty-two consecutive patients who... more
To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment. Case series with chart review in a tertiary care medical center in Taiwan. Forty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements. Twenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation. Male patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT.
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Research Interests: Quality of life, Speech Acoustics, Medicine, Voice, Humans, and 15 moreFemale, Male, PARALYSIS, Electromyography, Clinical Sciences, Aged, Middle Aged, Adult, Retrospective Studies, Laryngeal Paralysis, Vocal Fold Paralysis, Postoperative Complications, Surveys and Questionnaires, Vocal cords, and Vocal cord paralysis
Background & objectives: several studies have shown a close relationship between obstructive sleep apnoea (OSA) and dyslipidaemia. This study was designed to clarify the relationship of metabolic dysfunctions in sleep related-breathing... more
Background & objectives: several studies have shown a close relationship between obstructive sleep apnoea (OSA) and dyslipidaemia. This study was designed to clarify the relationship of metabolic dysfunctions in sleep related-breathing disorders (SRBD), including OSA and simple snoring. The end point was to determine the prevalence of hyperlipidaemia and hyperuricaemia in SRBD. Factors contributing to hyperlipidaemia and hyperuricaemia in SRBD were also evaluated. Methods: Outpatients >20 yr old with complaint of habitual snoring were prospectively enrolled. All patients underwent an overnight polysomnography (PSG) in a sleep laboratory and blood assay after overnight fasting. The factors of gender, age, body mass index (BMI), apnoea-hypopnoea index (AHI), and desaturation index (DI) were recorded in the PsG report. A logistic regression analysis was conducted to investigate the relationship between metabolic dysfunctions and these factors. Results: Of the 275 patients (88.4% male), 236 (85.8%) were diagnosed with OSA (AHI>5/h). The mean (+/- SD) of age, BMI, AHI, and DI were 44.2 +/- 11.4 yr, 27.4 +/- 4.0 kg/m(2), 37.9 +/- 30.6/h, and 21.2 +/- 23.2/h, respectively. The overall prevalence of hypercholesterolaemia, hypertriglyceridaemia, and hyperuricaemia in this study was 61.1, 55.3, and 25.8 per cent, respectively. Logistic regression analysis revealed that DI was a significant independent factors contributing to hypercholesterolaemia [odds ratio (OR)=1.016, P=0.010, 95% confidence interval (CI)=1.004-1.028] and hypertriglyceridaemia (OR=1.021, P=0.002, 95% CI=1.008-1.034). Interpretation & conclusions: The data of the present study support a high prevalence of hyperlipidaemia in SRBD. DI may be a determining factor contributing to hyperlipidaemia in SRDB. Underdiagnosis of hyperlipidaemia in SRBD is a critical problem.
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An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor... more
An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor and foreign body sensation when swallowing for 6 weeks. A hot potato voice and biphasic stridor were remarkable upon physical examination. Indirect mirror and fibroscopic examination revealed a huge epiglottic cyst. The neck lateral X-ray and computed tomography scan demonstrated a huge cystic mass over the epiglottis. A 2.5 x 3.0 cm cystic mass was removed with endoscopic CO2 laser after needle decompression. The patient was discharged on the third day after surgery without complications. An epiglottic cyst in an adult seldom causes upper airway obstruction and is easily ignored by clinicians. We emphasize that complete airway evaluation including routine check-up of the larynx is mandatory for patients with intractable obstructive airway disease. Endoscopic laser surgery is effective in the surgical removal of an epiglottic cyst.
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Children with sleep-disordered breathing (SDB) can manifest a continuum from simple snoring and upper airway resistance syndrome to obstructive sleep apnea (OSA) with secondary growth impairment, neurocognitive deficits, and less often... more
Children with sleep-disordered breathing (SDB) can manifest a continuum from simple snoring and upper airway resistance syndrome to obstructive sleep apnea (OSA) with secondary growth impairment, neurocognitive deficits, and less often cardiovascular sequelae. Most children who present with SDB are four to eight years old with variable clinical symptoms at different ages. In general, infants often present with noisy breathing and disturbed nocturnal sleep, toddlers and preschool-aged children with snoring and mouth breathing, and school-aged children with behavioral and dental problems. The pathogenesis of SDB in children remains incompletely understood. Adenotonsillar hypertrophy is the leading cause of OSA. Other risk factors include allergic rhinitis, craniofacial anomalies, cleft palate following pharyngeal flap surgery, neuromuscular diseases, laryngomalacia, and obesity. Polysomnography (PSG) is the gold standard diagnostic tool. However, great variation exists in the interpretation of PSG and criteria for the definition of pediatric OSA, even though consensus statements have been used to standardize the scoring of summary indices for the disorders. Adenotonsillectomy is the cardinal treatment for pediatric SDB. Rapid maxillary expansion is a useful approach in upper jaw contraction. Distraction osteogenesis has become an acceptable procedure in the treatment of severe maxillomandibular deficiency. Continuous positive airway pressure has been successful in treating intractable or severe OSA in children with other underlying medical disorders and has modified the indications for tracheotomy in pediatric patients with craniofacial anomalies and OSA. Follow-up in children treated for OSA reveals that underlying structural or neuromuscular abnormalities can decrease the response to treatment and obesity may lead to recurrence of OSA later during adolescence.
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OBJECTIVE The overnight rostral fluid shift from the lower limbs is one of the causes of obstructive sleep apnea (OSA). Compression stockings (CS) prevent lower limb fluid retention and have been reported to decrease nighttime fluid... more
OBJECTIVE The overnight rostral fluid shift from the lower limbs is one of the causes of obstructive sleep apnea (OSA). Compression stockings (CS) prevent lower limb fluid retention and have been reported to decrease nighttime fluid shift. The aim of this study is to evaluate the effect of CS on fluid shift and the severity of OSA. METHODS A systematic literature search was performed in the PubMed, EMBASE and Cochrane Library databases. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Studies evaluating the effect of CS on the overnight fluid shift and OSA severity were included in the analysis. RESULTS A total of 4 studies were included in this meta-analysis. The pooled analysis showed that the apnea-hypopnea index (AHI) of the overall study group was significantly lower after using CS (SMD, -1.08; 95% CI, -1.49 to -0.67). Decreases in the AHI were also observed in the normal fluid status (SMD, -1.05; 95% CI, -1.73 to -0.37) and fluid overload status (SMD, -1.17; 95% CI, -1.76 to -0.58) populations. The overall study group had significant decreases in overnight changes in neck circumference (SMD, -1.05; 95% CI, -2.06 to -0.03) and leg fluid volume (SMD, -1.14; 95% CI, -1.88 to -0.41) after using CS. However, no significant differences in overnight changes in neck circumference and leg fluid volume were observed in normal fluid status patients. CONCLUSION CS may help decrease overnight fluid shift and could be a treatment option for OSA.
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Background and Purpose: The aim of our study is to evaluate the effect of botulinum toxin in patients of adductor spasmodic dysphonia (SD) with and without voice tremor. Methods: We used botulinum toxin A (BTX-A, Botox®) in treating 10... more
Background and Purpose: The aim of our study is to evaluate the effect of botulinum toxin in patients of adductor spasmodic dysphonia (SD) with and without voice tremor. Methods: We used botulinum toxin A (BTX-A, Botox®) in treating 10 patients with adductor SD. Among them, 6 patients were presenting simple adductor SD, 4 patients were presenting adductor SD and prominent voice tremor. The features of their voices were evaluated blindly by another neurologist, by a speech pathologist, and by an otolarygologist with direct videoendoscopic observation before and after treatment. Guided with EMG, a dose of 15 to 20 units of BTX-A was injected into the unilateral thyroarytenoid muscle. Results: We obtained a significant improvement of voice quality in 5 out of 6 simple adductor SD patients. The benefits commenced at a mean of 5 days (range; 4-6 days). The median duration of peak effects was 4 weeks (range: 3-6 weeks). The remaining 1 patient had only mild effects. The videoendoscopic parameters also showed a significant improvement in correlation with the clinical effect. Four adductor SD patients associated with dominant voice tremor did not improve, especially in the tremor component. Conclusion: We have proved that BTX-A is an effective treatment for simple adductor SD, but not for adductor SD with prominent voice tremor. We suggest that a videoendoscopic evaluation is valuable for selecting the patients with adductor SD, particularly complicated with voice tremor.