Objective: Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the usefulness of DISE compared with that of traditional awake examination for surgical decision making in patients with obstructive sleep apnea (OSA).Data Sources: Scopus, PubMed, and Cochrane Library databases were searched. Review Methods: Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision making in patients with OSA were selected. The included studies directly compared awake examination data with DISE outcome data in terms of possible influences on surgical decision making and operation success.Results: A total of eight studies with 535 patients were included in this review. Overall, the surgical treatment changed after DISE in 50.24% (standard deviation 8.4) cases. These changes were more frequently associated with structures contributing to hypopharyngeal or laryngeal obstruction. However, these differences do not automatically indicate a higher success rate.Conclusion: This review emphasized the direct impact of DISE compared with that of awake examination on surgical decision making in OSA patients. However, it is also clear that the available published studies lack evidence on the association between this impact and surgical outcomes.

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Objective: Evaluation of the audiological patient performance with an upgrade of the firmware from the fixed feedback canceller (FFC) to the adaptive feedback canceller (AFC) on an active middle ear implant. Study Design: Retrospective observational nonrandomized group study. Setting: Private hospital. Patients/Intervention(s): From March 2018 to September 2019, 15 patients implanted with an active middle ear implant, with 6 or more months of experience with a FFC system, were upgraded to an AFC algorithm. Main Outcome Measure(s): Functional gain, speech perception in silence and in noise, and sound localization capacities were examined. Feedback reduction was also analyzed. Results: Thirteen patients were analyzed. Pure tone audiometric evaluation with FFC (mean value of 48.02 dB) compared with AFC at 1 (mean value of 49.12 dB) and 6 months (mean value of 42.75 dB) revealed no statistically significant differences (p = 0.889 and p = 0.358 respectively). In speech discrimination in silence, clinically relevant improvements were observed with AFC at 1 and 6 months, with a mean value of 41.5 and 38.3 dB, respectively (p = 0.03 and p = 0.021 correspondingly). In speech discrimination in noisy environments, we observed an improvement of the different conditions tested. No differences were found in localization capacities between FFC and AFC at the two different moments of evaluation. Conclusions: AFC is more effective than FFC in cancelling feedback and improving sound quality, allowing for better speech understanding in silence and in noise.

Objective:The aim of this study was to evaluate the effect of a totally implantable active middle ear implant in quality of life of the implanted patients taking into account their hearing performance. Methods:Retrospective observational nonrandomized group study. Settings: Private hospital. From March 2018 and September 2019, all the participant with minimum 6 months' experience with the Carina system were evaluated. The evaluation was performed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire.Results: Nine patients complete the entire questionnaire. A reduction of difficulties was seen in quiet environments/ease of communication (32.8% vs 54.3%), in background noise environments (42.8% vs 62.3%) and in environments with reverberation (38.7% vs 63.9%) in the patient with the active middle ear implant when compared to the unaided condition. In what concerned the trouble caused by unpleasant sounds/Aversiveness, an increased discomfort was described with de middle ear implant compared to the unaided condition (50.3% vs 32.8%). Conclusion:Active middle ear implants seem to improve auditory perception in daily activities, even in difficult conditions like background noise or reverberation environments, although statistically significant conclusions cannot be achieved due to the small sample size. APHAB demonstrated to be a potential useful tool in this evaluation.