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Objective To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis. Data Sources MEDLINE, Embase, The Cochrane Library, CINAHL/EBASCO, and Scopus. Review Methods The protocol was registered in PROSPERO in March 2018. Following PRISMA guidelines, 2 independent researchers conducted a search from their inception through July 2018. Polysomnography (PSG) data were collected for sleep stages, apnea-hypopnea index (AHI), respiratory disturbance index, and/or lowest oxygen saturation (LSAT). Data concerning the frequency and severity of snoring intensity and sleep architecture were also collected. Only studies with PSG data were evaluated, with exclusion of studies with home sleep testing data. A multivariate regression and pooled analysis with forest plot was performed. Results A total of 1266 manuscripts were screened, and 13 manuscripts with 279 patients met inclusion criteria. Pooled analysis of AHI for control versus alcohol consumption revealed a mean difference (MD) of 3.98 events per hour (95% CI, 3.27 to 4.68; P < .001). Pooled analysis of LSAT for control versus alcohol consumption revealed an MD of −2.72% (95% CI, −3.69 to −1.76; Z score, 5.53; P < .00001). Conclusion Alcohol consumption is associated with worsening severity of snoring, altered sleep architecture, AHI, as well as lowest oxygen saturation among patients susceptible to snoring and obstructive sleep apnea.

Objectives/Hypothesis Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments. Study Design Retrospective chart review. Methods A review of upper aerodigestive tract procedures, some of which penetrated mucosa, was performed by analyzing 100 patient records during the unpackaged period and 100 during the packaged period. A comparison of infections, deaths, and length of stay in the hospital was included in the analysis. Additionally, a timed simulation to setup a simple group of instruments for an emergency airway situation from both the unpackaged and packaged airway carts was performed using a total of 11 surgical technologists and nurses. Results Each group had a total of four airway infections and neither had any deaths. The average length of hospital stay was 0.36 days for the unpackaged period and 0.44 days from the packaged period. None of these variables reached statistical significance. The average time to find and set out the correct instruments for the two groups was 46.6 and 95.5 seconds for the unpackaged and packaged airway carts, respectively (P = .004). Conclusions This study suggests individually packaging of instruments used for emergency airway cases may put lives at risk when time matters and fails to decrease the risk of infection. Level of Evidence 3 Laryngoscope, 129:715–719, 2019

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Herein, we present a unique case of Sjögren’s syndrome (SS) first presenting as facial palsy, as well as a literature review of case reports describing SS-associated facial paralysis. A PubMed search for papers containing the keywords Sjögren’s syndrome or Sjögren’s disease, as well as facial paralysis, facial paresis, facial palsy, or Bell’s palsy, was performed. Articles not in English and cases of SS not involving facial paralysis were excluded. Appropriate articles were reviewed for patient demographics and symptoms of SS, including laterality of facial paralysis, cranial nerve involvement, and comorbid diseases. House–Brackmann grades were annotated based on either assignment by individual case reports or the authors’ descriptions when sufficient details were present. Of 43 peer-reviewed articles found, 14 were both in the English language and provided adequate information on a total of 16 patients with facial paralysis and SS diagnosis. Ultimately, SS and other systemic autoimmune disorders should be considered in the differential diagnosis of patients presenting with insidious onset facial paralysis.