The objective of the study is to assess the correlation between outpatient department (OPD) assessment and sleep nasendoscopy (SNE) in treatment planning for sleep related breathing disorders. The study design includes a blinded, cohort study comparing the treatment prediction based on OPD clinical evaluation with SNE in consecutive, adult patients by a single clinician with a specialist interest in snoring related disorders. Patients with moderate to severe obstructive sleep apnoea and those who had undergone previous treatment were excluded. The study was conducted in Royal National Throat, Nose and Ear Hospital, London and Queen's Hospital, Romford. Ninety-four patients were recruited as participants for the study. The main outcome measures include site of obstruction and treatment planning. The results show no significant correlation between the two groups with SNE recommending less surgical intervention and a choice of surgical and non-surgical management in greater number of patients. In conclusion, even in experienced hands, clinical prediction is significantly modified by SNE findings. The addition of SNE to the diagnostic pathway, to assess the three-dimensional dynamic anatomy of the upper airway, provides a valuable adjunct to the OPD assessment of upper airway collapse. This affords the clinician a greater accuracy of diagnosis and the patient a more focussed management strategy with increased choice of modality of treatment.

ApneaGraph relies on measuring pressure and airXow simultaneously at diVerent levels in the pharynx identifying the segment of airway obstruction and providing baseline respiratory parameters. This study aims to evaluate ApneaGraph and correlate results with both sleep nasendoscopy and polysomnography. This was a prospective study of 49 patients with snoring and/or obstructive sleep apnoea. Thirty of the these patients underwent a PSG and an ApneaGraph study simultaneously in the Sleep Lab. Nineteen patients attended the day surgery unit and had a sleep nasendoscopy with a 10-min ApneaGraph analysis. Polysomnography was used to validate the ApneaGraph system. There are no signiWcant diVerences (independent t test, P > 0.15) between ApneaGraph compared to Polysomnography based on the apnoea-hypopnoea index, total number of apnoeic events, average oxygen saturations and maximum desaturation. This suggests that the ApneaGraph can be used to assess OSA. Statistically, there is poor correlation between the two groups (Spearman's 0.29). In the cases of discordance, ApneaGraph places greater emphasis on a lower pharyngeal contribution. This unique study analyses the ApneaGraph system in the diagnosis of obstructive sleep apnoea and snoring. It demonstrates the beneWts of this new system and highlights certain limitations in localizing the site and level of pharyngeal obstruction in patients with sleep disorders.

IntroductionSuperior semicircular canal dehiscence represents a manageable cause of sound and pressure induced vertigo. This case highlights its presentation and investigation, including a review of the literature, and the authors' surgical technique used in its successful treatment.Case presentationA 45-year-old Caucasian man presented with vertigo induced by sound or pressure. Subsequent investigation revealed dehiscence of the superior semicircular canal and the patient underwent a surgical repair.ConclusionSurgery to repair or resurface the dehiscence represents an effective treatment modality, offering a resolution of symptoms with no detrimental effect on hearing or long-term sequelae. A five-layer composite repair consisting of temporalis fascia – bone pate – conchal cartilage – bone pate – temporalis fascia has been found to be safe and effective.

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