Objectives This study aims to determine the anatomical changes occurring in the nasal septal body (NSB) among patients with sinonasal disease and compares the measurements obtained from patients without sinonasal disease.Methods This was a retrospective study involving review of 405 (93 without and 212 with sinonasal disease) plain paranasal sinus computed tomography (PNS CT) on coronal view at a tertiary training hospital, which was done consecutively from January 2014 to December 2015. NSB measurements from 3 areas were done: anterior part (A), located anterior and superior to inferior turbinate; middle or widest (M) part, located anterior to middle turbinate and superior to inferior turbinate and posterior (P) part, located within the anterior 1/3 of middle turbinate not going beyond the crista galli. Posterior part of septum (sP) was measured at the area of horizontal attachment of middle turbinate to the lateral nasal wall and superior turbinate to represent the less vasoactive part of the septum. Demographic data and NSB diameters were also analyzed.Results The mean NSB diameter measurements were significantly larger among the diseased group (disease vs. control; A: 6.88 mm vs. 5.92 mm, P=0.001; M: 12.74 mm vs. 10.47 mm, P=0.001; P: 8.35 mm vs. 6.79 mm, P=0.001). A similar observation in sP part (3.35 mm vs. 2.54 mm, P=0.014) was noted. When grouped by age, among the control group, older subjects had considerable decrease in NSB size in all points of measurements except for sP (P>0.05). Such reduction in size is noticeable for those in their 4th, 5th, 6th, and 7th decades of life. For the diseased group, a trend of increasing NSB and sP size was noted as the subjects are getting older. However, only the anterior part (A) of NSB reached statistical significance (P=0.016).Conclusion With aging we expect nasal mucosal atrophy among normal subjects. However, patients with chronic sinonasal disease showed thickened nasal mucosa. Further study for the reversibility of thickened mucosa is needed.

ObjectiveTo identify adequate criteria to determine the success or failure of mandibular advancement device (MAD) treatment for obstructive sleep apnoea (OSA) based on long-term symptoms and new-onset hypertension.DesignObservational cohort study.SettingA tertiary care hospital setting in South Korea.ParticipantsPatients (age >18 years) who were diagnosed with OSA by a polysomnography (PSG) or Watch peripheral arterial tonometry (PAT), and who had been treated with MAD between January 2007 and December 2014 were enrolled.Primary and secondary outcome measuresPatients underwent PSG or Watch PAT twice; before and 3 months after the application of MAD. The patients were categorised into success and failure groups using seven different criteria. MAD compliance, witnessed apnoea and snoring, Epworth Sleepiness Scale score and occurrence of new-onset hypertension were surveyed via telephonic interview to determine the criteria that could identify success and failure of MAD.ResultsA total of 97 patients were included. The mean follow-up duration was 60.5 months, and the mean apnoea–hypopnoea index (AHI) was 35.5/hour. Two of the seven criteria could significantly differentiate the success and failure groups based on long-term symptoms, including (1) AHI<10/hour with MAD and (2) AHI<10/hour and AHI reduction of >50% with MAD. Kaplan-Meier survival analysis showed that one criterion of AHI<15/hour with MAD could differentiate the success and failure groups based on new-onset hypertension (p=0.035). The receiver operating characteristic curve analysis indicated that the cut-off AHI for new-onset hypertension was 16.8/hour (71.4% sensitivity and 75.0% specificity).ConclusionOur long-term follow-up survey for symptoms and new-onset hypertension suggested that some of the polysomnographic success criteria, that is, AHI<10/hour with MAD, AHI<10/hour and AHI reduction of >50% with MAD and AHI<15/hour with MAD may be useful in distinguishing the success group from failure one. Further prospective longitudinal studies are warranted to validate these criteria.