The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients

Vicini, Claudio; Vito, Andrea De; Benazzo, Marco; Frassineti, Sabrina; Campanini, Aldo; Frasconi, Piercarlo; Mira, E

doi:10.1007/s00405-012-1965-z

Cited by 130 publications

(83 citation statements)

References 7 publications

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“…[12,16] because it was considered subjective and dependent on the patient's effort. [17] However, the Müller maneuver may be easy to perform, provide a thorough assessment of the upper airway, enable exclusion of other lesions, and be valid when marked collapse is present (Müller grade 3 or 4).…”

Section: Discussionmentioning

confidence: 99%

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Avci¹,

Lakadamyalı²,

Büyüklü³

et al. 2017

Kulak Burun Bogaz Ihtis Derg

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Objectives: This study aims to evaluate anatomic abnormalities that may be associated with obesity and may cause sleep apnea in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) by physical examination and Müller maneuver. Patients and Methods:This single center, prospective, cross-sectional study included 330 OSAHS patients (274 males, 56 females; mean age 47±11 years; range 17 to 79 years) who were performed polysomnography. Patients' clinical history as well as otolaryngology examination findings including pharyngeal soft tissues, anterior rhinoscopy and Müller maneuver were recorded. Results:Mean body mass index (BMI) was 32±5 kg/m 2 (range 21.9 to 48.4 kg/m 2 ) and apnea-hypopnea index (AHI) was 27±24 episodes per hour (range 0 to 106 episodes/hour). The AHI and BMI were statistically significantly correlated with minimum oxygen saturation, neck circumference, waist circumference, Epworth Sleepiness Scale score, retropalatal and retroglossal grades, tonsil size, and modified Mallampati score. Patients with higher AHI or BMI had statistically significantly higher retropalatal, retroglossal, and combined retropalatal and retroglossal grades (p≤0.001). Conclusion:Obesity affects the retropalatal and retroglossal grades and modified Mallampati scores of patients with OSAHS. High scores of those variables with low BMI may be attributed to upper airway soft tissue or craniofacial bony abnormalities. The retropalatal airway may narrow earlier than the retroglossal airway when fat accumulation starts in the lateral pharyngeal walls and tongue.Keywords: Müller maneuver; obesity; obstructive sleep apnea. ) ve apne-hipopne indeksi saatte 27±24 epizod (dağılım 0-106 epizod/saat) idi. Apne-hipopne indeksi ve VKİ; minimum oksijen satürasyonu, boyun çevresi, karın çevresi, Epworth Uykululuk Skalası skoru, retropalatal ve retroglossal evre, tonsil büyüklüğü ve modifiye Mallampati skoru ile istatistiksel olarak anlamlı şekilde ilişkiliydi. Apne-hipopne indeksi veya VKİ'si daha yüksek olan hastalar istatistiksel olarak daha yüksek retropalatal, retroglossal ve kombine retropalatal ve retroglossal evreye sahipti (p≤0.001).Sonuç: Obezite, OUAHS'li hastaların retropalatal ve retroglossal evrelerini ve modifiye Malampati skorlarını etkiler. Bu değişkenlere ait skorların yüksek, VKİ'nin düşük olması, üst solunum yolu yumuşak doku veya kraniyofasiyal kemik anormalliklerine bağlanabilir. Lateral farengeal duvarlarda ve dilde yağ birikimi başladığında retropalatal hava yolu, retroglossal hava yolundan önce daralabilir.Anahtar Sözcükler: Müller manevrası; obezite; obstrüktif uyku apnesi.

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Section: Discussionmentioning

confidence: 99%

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Avci¹,

Lakadamyalı²,

Büyüklü³

et al. 2017

Kulak Burun Bogaz Ihtis Derg

View full text Add to dashboard Cite

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“…Vicini C et al [17] were the first to describe and use this classification system for precise dynamic description for the upper airway collapse in sleep disordered patients during sleep.…”

Section: Discussionmentioning

confidence: 99%

“…V) Müller maneuver: Endoscopic evaluation of the upper airways through the nose, with the patient in the supine position, during which a modified Muller maneuver (forced inspiratory suction with mouth and nose closed) [17].…”

Section: Iii) Ent Examinationmentioning

confidence: 99%

Morphological Characteristics of Osa Patients Using Drug Induced Sleep Endoscopy

Tabbakh¹

2017

JOENTR

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To evaluate the reliability of drug induced sleep endoscopy (DISE) in identifying levels and degrees of severity of obstruction in sleep disordered breathing (SDB) patients. Patients with obstructive sleep apnea syndrome (OSAS) and habitual snoring diagnosed by polysomnography assessed by history and Epworth Sleepiness Scale (ESS), modified Malampatti index, Friedman staging system, Assessment of the Body mass index (BMI), neck circumference (NC), Müller maneuver (MM) and DISE using the NOHL (nose, oropharynx, hypopharynx and larynx) classification system. Our results revealed 66 patients, 34 males and 32 females with ages ranging from 23 to 58 years. BMI showed that 86.4 % of cases were obese with mean BMI (35.1 ± 5.6) ranging from (24 -50 kg/m 2 ). NC showed large NC (> 37cm) in 100 % of females while it was large (> 43 cm) in only 29.4 % of males. The mean apnea/hypopnea index was 10.7 ± (11.8/h). Obstruction at oropharyngeal level was 82% of the patients with grades ranging from 50 to 100%followed by obstruction at the level of hypopharynx in 68%. Only 13.6% showed supraglottic obstruction due to flappy epiglottis. Almost all patients showed multilevel obstruction with different grades. We found no correlation between the results of DISE, MM and classic ENT evaluation techniques. DISE treatment recommendations was different in 82% of patients at the oropharyngeal level and in 39% at the hypopharyngeal level than those of MM, but was nearly the same regarding supraglottic obstruction.Conclusion: DISE is a reliable tool of upper airway collapse assessment leading to better treatment recommendations for SDB patients.

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“…Vicini et al [40] introduced the nose, oropharynx, hypopharynx and larynx (NOHL) classification and have been using this system since 1996. It is an extensive classification system, grading the degree of obstruction as (1) (0-25 % obstruction), (2) (25-50 %), (3) (50-75 %) or (4) (75-100 %) and defining the pattern of collapse as transversal, anterior-posterior or concentric.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Sleep Endoscopy in Adults with Obstructive Sleep Apnea: A Review of the Literature

Maanen

Ravesloot

Safiruddin

et al. 2013

Curr Otorhinolaryngol Rep

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Since history and physical examination alone cannot reliably diagnose obstructive sleep apnea (OSA), the gold standard for the diagnosis of OSA is polysomnography. When an oral device or surgery is considered, it is of utmost importance to examine an individual's pattern, degree and site(s) of upper airway obstruction. This article tries to evaluate recent literature published on the use of (drug-induced) sleep endoscopy in evaluating the individually tailored treatment. Different techniques, interrater reliability, test-retest reliability and currently available data on the relationship with treatment outcome are reviewed.

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The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients

Cited by 130 publications

References 7 publications

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Effect of obesity on upper airway physical examination in obstructive sleep apnea-hypopnea syndrome

Morphological Characteristics of Osa Patients Using Drug Induced Sleep Endoscopy

The Utility of Sleep Endoscopy in Adults with Obstructive Sleep Apnea: A Review of the Literature

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