The SF-36 and RQLQ are good for discriminating rhinitis patients from controls, but the former is poor for detecting changes in QOL. Both are inappropriate for mildly symptomatic patients. Each instrument measures non-overlapping halves of the measurable HRQL. For an assessment of the HRQL in persistent AR that is complete and responsive both instruments should be employed together.

Dysphagia after a high vagal nerve injury may be associated with a patulous hypopharynx that serves as a reservoir for pharyngeal secretions, contributing to primary or secondary aspiration. We describe a new hypopharyngeal pharyngoplasty procedure for the paralyzed pharynx to improve swallow. The paralyzed pyriform sinus is resected to remove insensate and redundant mucosa. The inferior constrictor muscle is then advanced anterior to the oblique line of the thyroid cartilage to improve pharyngeal tone and prevent pharyngeal dilatation. The surgery is performed in conjunction with medialization laryngoplasty and arytenoid adduction. The utility of this procedure is reviewed retrospectively in 8 patients. They were evaluated by clinical evaluation, fiberoptic endoscopic evaluation of swallow, and modified barium swallow study. All had significant preoperative dysphagia. Three patients were gastrostomy tube-dependent. After operation, all patients had subjective and objective improvements in swallow and progressed to peroral feeding. There were no operative complications. We conclude that hypopharyngeal pharyngoplasty diminishes pyriform sinus pooling and improves pharyngeal transit. Dysphagia patients with unilateral pharyngeal paralysis secondary to cranial nerve palsies may benefit from this new procedure.

Poster Presentations P201 POSTERSMethod: Viscoelastic shear properties of false fold specimens were quantified as functions of frequency, with measurements of elastic shear modulus (G′) and dynamic viscosity (h′) at up to 250 Hz using a simple-shear rheometer. Ventricular fold phonation of three subjects was analyzed by HSDI (high speed digital imaging) through kymography and laryngotopography.

Objective To review multilevel surgery involving the Expansion SphincterPlasty (ESP) with tongue base surgery in the treatment of severe OSA. Methods Prospective non-randomized collection of 39 consecutive patients with severe OSA. Patients were >18 years old, type II Fujita with lateral pharyngeal wall collapse, small tonsils, BMI <30. Mean follow-up was 9.3 months. Results All 39 patients were male, with mean age of 44.1 years (range of 26 to 49 years), mean BMI was 25.7 (range of 21.1 to 29.1). 22 patients had ESP/Hyoid/RF Tongue Base procedure, while 17 patients had the ESP/Hyoid/Tongue Suspension procedure. The mean pre-operative AHI for the entire group improved from 56.3 ± 18.1 to 19.2 ± 14.0 postoperatively. There was a greater AHI improvement in the ESP/Hyoid/TS group than the ESP/Hyoid/RFBOT group. The 17 patients in the ESP/Hyoid/TS group had a mean pre-operative AHI that improved from 52.2 ± 18.7 to 18.0 ± 12.8 (p<0.05), compared to the ESP/Hyoid/RFBOT group, where AHI improved from 48.1 ± 17.9 to 25.6 ± 17.1 (p<0.05). Oxygen saturations also improved in both groups. When using the success criteria of a reduction in 50% of the pre-operative AHI and an AHI <20, the overall success rate for both groups was 71.2%. The success rate for the ESP/Hyoid/TS group was 74.8%, while the success rate for the ESP/Hyoid/RFBOT group was 67.5%. Conclusions The use of the ESP with tongue surgery is effective in the management of patients with severe OSA.

Objective: To determine if awake clinical evaluation methods like Friedman’s Tongue Position (FTP), endoscopic assessment of the hypopharynx using Mueller maneuver (MM), and during end expiration (EEPBOT) to assess tongue-base obstruction correlate well with tongue-base obstruction seen during drug-induced sleep endoscopy (DISE). Method: Pilot prospective study of 16 patients with moderate to severe OSA recruited over 1 year at a tertiary care center. These patients were evaluated in the clinic with the flexible nasendoscope and subsequently underwent full PSG and DISE with midazolam. Results: The 16 patients studied had a mean AHI of 65 (range, 18.8 to 129). Fifteen out of 16 patients (93.7%) were found to have multi segment obstruction on DISE according to the original grading proposed by Pringle and Croft. Comparing the various awake dynamic maneuvers against DISE as a gold standard, MM was found to have sensitivity of 53%, FTP had a sensitivity of 80%, and EEPBOT had a sensitivity of 93%. Because of the skewed nature of the results (only 1 out of 16 patients [6.3%] was classified as not having obstruction), specificity results had no statistical value. Conclusion: This small pilot study showed a good correlation between EEPBOT, FTP, and DISE. A poorer correlation between MM and DISE is seen. Our results suggest that EEPBOT and FPP are superior to MM in evaluating tongue-base obstruction in OSA; however, further research is required to support these findings.