EXT-DCR, when compared with EESC-DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.

Severe obstructive sleep apnea (OSAS) is most often accompanied by metabolic syndrome, obesity, diabetes and coronary disease. In its most severe form, it is a life-threatening condition, requiring active and immediate help. Nasal continuous positive airway pressure (CPAP) is the most efficient nonsurgical treatment for patients with OSAS. However, for anatomical, disease-related and subjective reasons, many patients cannot accept this treatment. A permanent tracheostomy may be one alternative in such patients who, in addition, often suffer from extreme obesity and severe heart disease. In this paper, we describe the long-term follow-up results of 7 patients suffering from OSAS and treated with permanent tracheostomy. All the patients (5 men, 2 women) were diagnosed using the static charge sensitive bed method and night-time oximetry for sleep analysis. The mean body mass index (BMI) of the patients ranged from 34 to 60 and the age from 41 to 64 years. All the patients had severe OSAS and long periods of low oxygen saturation (SaO₂) levels. Six patients had a CPAP trial before tracheostomy. Only 2 patients tolerated the trial but, despite the continuous use of CPAP, they were nonresponders. Permanent tracheostomy was done according to normal routine in each patient. After primary healing of 2 days, they used silver cannulae, which also allowed them to speak. The patients were evaluated every year after the tracheostomy. After some practical difficulties including proper maintenance of the cannula, all the patients quickly learned the correct management. In postoperative sleep studies, nadir SaO₂ levels had improved significantly, obstructive apneas had disappeared and the subjective quality of life had improved. No marked changes in BMI were found.

No abstract

Functional endoscopic endonasal sinus surgery (FESS) is at present the surgical method of choice for many clinicians treating chronic sinusitis and nasal polyposis. Postoperatively, patients have felt that patency of the nasal airway is improved, although all previous studies have failed to objectively measure changes produced. By using anterior active rhinomanometry, decreased unilateral and total nasal resistance was measured. Although improvement in total resistance was not statistically significant, reduction in unilateral resistance was. All patients demonstrated subjective improvements in unilateral and total nasal patencies. The reduction in nasal resistance was more pronounced in baseline resistance values than after decongestion, indicating that FESS had a positive effect on mucosal edema but did not alter the structural anatomy of the main nasal passages.

This study addressed the question of whether there are any differences in the size and collapsibility of the upper airway measured by digital fluoroscopy, between snorers and controls whilst they were awake and breathing normally; and whether there are any correlations between these measurements and other clinical data.The dynamic changes of the upper airway size were evaluated using digital fluoroscopy in 33 patients and 16 normal controls. The measurements were compared with findings in an overnight sleep study, including a static-charge-sensitive bed (SCSB) and oximeter recordings.The minimum anteroposterior dimension at the velopharyngeal level was smaller in patients with partial upper airway obstruction than in controls (p<0.005); patients with complete obstruction did not differ from the controls. The velopharyngeal airways were also more collapsible in patients with severe partial obstruction (p<0.01) than in controls. At the oropharyngeal and hypopharyngeal levels, the dimensions and the collapsibilities were similar in patients and controls. The velopharyngeal collapsibility correlated with body mass index (p<0.001), whereas the airway size did not. The velopharyngeal collapsibility was more pronounced in patients with frequent episodes of arterial oxyhaemoglobin desaturation during sleep.Velopharyngeal collapsibility associated with high body mass index was the important determinant of nocturnal breathing disturbances. Digital fluoroscopy displays the dynamic changes of the upper airways throughout the respiratory cycle.