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Objectives: Analyze the frequency of and techniques used in performing tracheostomies. Understand the prevailing contraindications used in the decision between open versus percutaneous method. Evaluate outcomes among the 2 modes of tracheostomy procedures. Methods: Case-series review of all patients who underwent a tracheostomy spanning 4 years within a tertiary metropolitan hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related emergency department (ED) visits, and other complications. Results: A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open versus 881 (66%) via the percutaneous dilatational technique (PDT). There was no difference in short-term complications between the 2 groups. The primary long-term complication, tracheal stenosis, occurred most commonly in the PDT group. The contraindications practiced in decision for open versus PDT are not uniform among the various services performing tracheostomies. Approximately 26% of all discharged patients presented to the ED with respiratory or tracheostomy-related complaint within 90 days of discharge. Conclusions: We present the largest tracheostomy case-series containing a majority performed via the percutaneous technique. Tracheal stenosis is the most common long-term complication seen primarily among PDT group, indicating that factors such technique may lead to such outcomes. Institutional adoption of absolute contraindications may be necessary to avoid long-term complications. The development of an institutional common pathway for care and follow-up may help avoid related ED visits.

Objectives: (1) Assess the effectiveness of multilevel surgery in the treatment of obstructive sleep apnea (OSA). (2) Analyze outcomes based on reduction of apnea hypopnea index (AHI) and positive airway treatment pressures. Methods: Case-series review in a tertiary referral center. A total of 44 patients underwent multilevel OSA surgery between November 2009 and September 2013. Depending on the preoperative examination and OSA severity based on sleep study, patients underwent multilevel surgery including nasal, oropharyngeal, transoral robotic, tongue base, hyoid, and/or orthognathic surgery. Follow-up sleep studies at 4 months were obtained and compared with preoperative data. Results: Overall AHI was significantly reduced from a mean of 44.5 to 19.9 ( P = .0008), 78.9 to 35.8 ( P = .0001) in the severe OSA group, 21.4 to 7.0 ( P = .0001) in the moderate group, and 8.7 to 4.5 ( P = .0004) in the mild group. AHI reduced from mean of 98.1 to 31.7 ( P = .0013) in those who underwent orthognathic surgery and 36.1 to 18.1 ( P = .011) in those who had soft tissue procedures without orthognathic surgery. Overall continuous positive airway pressure (CPAP) improved from mean of 10.9 to 4.7 cmH20 ( P = .0001). Body mass index was significantly higher in the severe OSA group than the mild and moderate groups. No significant difference was noted in neck circumference between the 3 groups. Conclusions: Targeted multilevel OSA surgery in this cohort was successful in an overall reduction of AHI and CPAP pressures. The maximum improvement in AHI was seen in patients with moderate OSA and in those who had an orthognathic procedure.

Oral Presentations P129 Smell Decline as a Good Predictor of Sinonasal Polyposis Recurrence after Endoscopic SurgeryMehdi Bakhshaee, MD (presenter); Masoud Naseri, MD; Fereshteh Esmatinia, MD Objectives: Evaluate the most sensitive symptom that predicts recurrence of nasal polyposis.Methods: In this prospective study, we evaluated 62 patients with diffuse nasal polyposis. All patients underwent functional endoscopic sinus surgery. Sino-Nasal Outcome Test (SNOT-22) was answered by patients at preoperative visit and 1, 3, 6, 12, and 24 months after surgery. All of the patients were on maintenance therapy with nasal corticosteroid and saline irrigation postoperatively for 6 months. Patients were followed up with serial endoscopic examination, and computed tomography (CT) scan was performed if indicated.Results: All 62 patients (37 male, 25 female) completed the study. The mean age was 41.24 ± 12.47 years. Allergic rhinitis and asthma existed in 45% and 43.5% of cases respectively. Seven patients (11.3%) underwent revision surgery during the 2-year follow-up period. Fifty-two patients had a smell problem preoperatively, but 98.1% of them regained satisfactory olfaction after the surgery. The severity of symptoms gradually increased in patients with recurrence of polyposis but at a different point of time (P value = .008). Sense of smell was the first symptom that became worse in patients with relapse (mean 6 months) followed by nasal secretion (12 months) and obstruction (24 months). Patients with asthma and allergic rhinitis showed the symptoms of recurrence sooner than other patients (P < .05).Conclusions: The most sensitive symptom for the recurrence of nasal polyposis is decrease in sense of smell. Recurrence of nasal obstruction was noticed in the late stage of relapse when frank polyposis formation was established. SNOT-22 in a Control PopulationSally Erskine, MBChB (presenter); Carl M. Philpott, MBChBObjectives: This analysis uses data from the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim of CRES is to determine factors which influence the onset and severity of chronic rhinosinusitis (CRS). Sino-Nasal Outcome Test (SNOT-22) is a widely used score for nasal symptoms in many ENT clinics internationally, although there are few data characterizing SNOT-22 scores for a normal population. The aim of this analysis is to establish a dataset of normal values for SNOT-22 in a British population.Methods: Study-specific questionnaires including demographic and socioeconomic factors and past medical history as well as SNOT-22 and SF-36 were distributed to patients with CRS attending ENT clinics and to a control population across several centers in the United Kingdom. This analysis considered just the control population. Controls had no self-reported nasal problems in the past, no chronic conditions undergoing active treatment, and no hospital admissions in the preceding 12 months.Results: A total of 1529 participants were recruited; 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with na...

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