To develop and validate an objective method for calculating the annoyance caused by snoring sounds. 53 subjects assessed 50 different snoring and breath sounds on a visual analog scale for level of annoyance. A linear regression analysis was used to correlate these subjective assessments with objectively calculated psychoacoustic parameters (loudness, roughness, sharpness, and fluctuation strength, calculating the maximum, mean, and 5th percentile in each case). The quality of the resulting formula was checked, and additional validation was performed using subjective assessments of 60 new snoring and breath sounds by 52 new subjects. Receiver operating characteristic (ROC) analysis was used to scale the annoyance ranges obtained with the formula. A score consisting of the 5th percentile of loudness and the mean of roughness was developed. The formula displays high goodness of fit (R = 0.91) and quality. In the validation phase, a highly significant correlation (r = 0.95; p < 0.01) was obtained between the scores calculated with the formula and the subjective assessments. ROC analysis was able to define the annoyance ranges with a discriminatory power between 52 and 73 % (optimum sensitivity/specificity). The subjective assessments made by the participants were distinctly scaled and were reflected in a psychophysical algorithm. In the setting of polygraphy and polysomnography, this means that a reliable annoyance score that is not dependent on the bed partner can be obtained to establish the indication for anti-snoring treatments and to review their utility.

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The aim of this study is to investigate whether snoring sounds can be reliably, i.e. reproducibly and comparably, assessed by the listener. This is an absolute prerequisite if an objective method is to provide a valid representation of subjective assessments of snoring sounds. Fifty-three subjects, both men and women, from different age categories assessed snoring sequences in terms of their annoyance level. This was done using a paired comparison model with ten sequences, once at original volume and once at adjusted peak level. In addition, assessments of 50 sequences were made using a visual analog scale (VAS). In the first paired comparison the assessments displayed very high consistency (K = 0.94) and high concordance (W = 0.83). The results showed very good agreement between the sexes (r s = 0.98), between different levels of snoring-related experience (r s = 0.99) and between different ages (r s = 0.98). At adjusted peak level there was also very high consistency (K = 0.91) although concordance was clearly lower (W = 0.50). The rankings in the two paired comparisons showed a high degree of correlation (r s = 0.81). The assessments on the VAS revealed good inter-rater reliability (α = 0.73) and a high degree of correlation with the result of the first paired comparison (r s = 0.93). Snoring sounds can be assessed in a reproducible and comparable manner in terms of their annoyance level. There are no gender-specific differences, and age-specific and experience-specific differences also appear to be negligible. While volume plays a dominant role, other characteristics of the sounds are also sufficient to permit an assessment.

Purpose It is not easy to assess how severe and annoying a patient's snoring is. Solid parameters are lacking; snorers cannot deliver a reliable self-assessment and it is uncertain whether bed partners' statements can be relied upon. The purpose of the present study was therefore to investigate whether and how well snoring assessment based on acoustic parameters and bed partners' reporting agree. Methods In a double-blind, placebo-controlled study on snoring treatment, several acoustic parameters [snoring index (SI), percentage snoring time (ST), sound pressure level, sound energy, loudness, psychoacoustic annoyance and psychoacoustic snore score (PSS)] were measured in 18 subjects during 24 polysomnographies. Bed partners also assessed snoring annoyance and loudness as well as treatment outcome. Results No correlation was found between the subjective annoyance caused by snoring and the acoustic parameters. Regarding perceived loudness, there was a moderate, significant correlation with loudness (N 5) and PSS over the hour with the highest SI. SI, ST, LAeq and maximum sound pressure level dB(A) max showed no significant correlation. After the intervention only mean sound energy LAeq over the entire night showed a significant correlation (r s = 0.782; p = 0.022) with bed partners' assessments. However, this result was not confirmed in the second control night. Conclusions The non-existent or only weak correlation between bed partners' ratings and objective parameters indicate that snoring severity should be evaluated with caution. Neither acoustic parameters, at least for one measurement over just one night, nor bed partners' ratings should be used as the sole basis for snoring assessment.

Background Extended endoscopic endonasal operations of the sinuses and the frontal skull base require a bimanual action of the surgeon in many cases. Thus, typically an assistant guides the endoscope and centers the field of view. In this study, we investigate in which cases an endoscope holding arm can be used alternatively. Materials and methods The electromagnetic system ENDOFIXexo was used in different surgical interventions of the paranasal sinuses and beyond questioning ergonomics and geometrical limitations. The realized degrees of freedom were documented, and a topography of possible applications compiled. Results The presented system is limited by the anatomy of the anterior ethmoid and dynamic working conditions in the sagittal direction. Especially in extended interventions in the posterior ethmoid, in which parts of the nasal septum have been resected and a static position of the endoscope is desired the surgeon can greatly benefit from the robotic arm. Moreover, through the high flexibility of the endoscopic arm surgeries of the pharynx and larynx were performed, questioning the current gold standard of microscope-assisted surgical procedures. Conclusion Under the impression of an urging staff shortage and due to its unlimited patience, the ENDOFIXexo arm seems promising. Taking into account the complex anatomy and the limited access, we especially see a favorable field of application in the surgery of the pituitary gland and skull base tumors.