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Miniseminar: Sleep-disordered breathing (SDB) in children: A clinical update
Scientific Sessions—Tuesday
10:30 AM to 11:50 AM Room JJCC 1A10 •
Miniseminar: Sleep-Disordered Breathing (SDB) in Children: A Clinical Update
Norman R Friedman, MD (presenter); Michael Friedman, David Gozal; Ron B Mitchell, MD Denver CO; Chicago IL; Louisville KY; Richmond VA
MD;
SDB is a spectrum of disorders ranging from primary snoring through upper airway resistance syndrome to obstructive sleep apnea (OSA). The Academy of Pediatrics recently published guidelines on the management of childhood OSA leading to an increase in awareness of the prevalence and potential morbidity of SDB. Consequently, more children are referred to otolaryngologists for evaluation of suspected SDB. Studies have shown that history and physical examination findings are poor predictors of SDB’s severity. However, the identification and correction of SDB is important since cognitve, behavioral, cardiovascular, and metabolic abnormalities are much higher in this group of children. Intervention can reverse these changes. Multiple dilemmas exist for otolaryngologists who evaluate children with SDB: (A) when does a snoring child have SDB? (B) who needs surgery? (C) when should you request a sleep study? (D) what does the sleep report mean? (E) what happens if nothing is done? And (F) do simple instruments exist to help predict which children will benefit from intervention? Our invited speaker is Dr David Gozal who is well known in the field of sleep medicine. His research interests include investigating the morbid consequences of SDB in children and the mechanisms underlying
10:30 AM to 11:50 AM Room JJCC 1A06 •
Medical Devices and Drugs Committee: Powered Instrumentation and ESS Complications
James A Duncavage, MD (moderator); Berrylin J Ferguson, MD; Serge A Martinez, MD JD; Scott M Graham, MD; Michael G Stewart, MD MPH; Roy R Casiano, MD Nashville TN; Pittsburgh PA; Louisville KY; Iowa City IA; Houston TX; Miami FL Powered Instrumentation and ESS Complications will have an interactive format with panelists presentation and audience participation. The introduction of powered instru-
such morbidities. He is interested in answering the questions that all otoloaryngologists have: “Can we identify when we need to intervene, and how quickly, to prevent the long-term consequences we have demonstrated.” The other aspects of the symposium will cover: evaluation tools for SDB, the physical examination, and sleep study interpretation. The evaluation tools for SDB emphasize either diagnosis or quality of life (QOL). Those instruments that attempt to diagnose SDB and its severity aim to substitute clinical criteria for polysomnography. General QOL instruments and those specific to SDB will be discussed. An evaluation of the predictive value for each instrument will be presented. The emphasis will be their practical application in a busy clinical practice. The physical examination component of the symposium will provide a pictorial analysis of the anatomical sites contributing to SDB. Adenotonsillar hypertrophy is not the sole etiology for SDB. A systematic approach to the evaluation will be emphasized so that no aspect of the examination is overlooked. A variety of overnight studies exist. They range from a home oximetry study to full-night polysomnography. The reports can range from a 1-page summary to an extensive 10-page report. Otolaryngologists will become familiar with the necessary terminology to understand the report. Examples of sleep recordings and video clips will illustrate the definitions. Participants will learn how to critically analyze the report. The final aspect of the symposium will concentrate on the consequences of SDB. The morbidity of SDB is divided into categories: neurobehavioral, cardiovascular, and somatic growth. Dr Gozal will present current research on these consequences of SDB.
mention for ESS has revolutionized the techniques of endoscopic sinus surgeons. The ability of the powered instrument called a shaver or microdebrider to remove nasal and sinus tissue efficiently is undisputed. This efficient removal of tissue during ESS is a dynamic event. The introduction of ESS in the 1980s relied on standard tissue biting forceps or a static process of tissue removal. The static method of tissue removal had associated with it certain safety precautions now well known to ESS surgeons. The dynamic removal of tissue has made the static safety precautions less likely to prevent surgical entry into the orbit or brain. This miniseminar will examine the dynamic removal of tissue and the associated issues of static safety precautions, complications, consent issues, and directions for the future.
TUESDAY
P140
Otolaryngology– Head and Neck Surgery August 2004
10:30 AM to 11:50 AM Room JJCC 1A10 •
Miniseminar: Sleep-Disordered Breathing (SDB) in Children: A Clinical Update
Norman R Friedman, MD (presenter); Michael Friedman, David Gozal; Ron B Mitchell, MD Denver CO; Chicago IL; Louisville KY; Richmond VA
MD;
SDB is a spectrum of disorders ranging from primary snoring through upper airway resistance syndrome to obstructive sleep apnea (OSA). The Academy of Pediatrics recently published guidelines on the management of childhood OSA leading to an increase in awareness of the prevalence and potential morbidity of SDB. Consequently, more children are referred to otolaryngologists for evaluation of suspected SDB. Studies have shown that history and physical examination findings are poor predictors of SDB’s severity. However, the identification and correction of SDB is important since cognitve, behavioral, cardiovascular, and metabolic abnormalities are much higher in this group of children. Intervention can reverse these changes. Multiple dilemmas exist for otolaryngologists who evaluate children with SDB: (A) when does a snoring child have SDB? (B) who needs surgery? (C) when should you request a sleep study? (D) what does the sleep report mean? (E) what happens if nothing is done? And (F) do simple instruments exist to help predict which children will benefit from intervention? Our invited speaker is Dr David Gozal who is well known in the field of sleep medicine. His research interests include investigating the morbid consequences of SDB in children and the mechanisms underlying
10:30 AM to 11:50 AM Room JJCC 1A06 •
Medical Devices and Drugs Committee: Powered Instrumentation and ESS Complications
James A Duncavage, MD (moderator); Berrylin J Ferguson, MD; Serge A Martinez, MD JD; Scott M Graham, MD; Michael G Stewart, MD MPH; Roy R Casiano, MD Nashville TN; Pittsburgh PA; Louisville KY; Iowa City IA; Houston TX; Miami FL Powered Instrumentation and ESS Complications will have an interactive format with panelists presentation and audience participation. The introduction of powered instru-
such morbidities. He is interested in answering the questions that all otoloaryngologists have: “Can we identify when we need to intervene, and how quickly, to prevent the long-term consequences we have demonstrated.” The other aspects of the symposium will cover: evaluation tools for SDB, the physical examination, and sleep study interpretation. The evaluation tools for SDB emphasize either diagnosis or quality of life (QOL). Those instruments that attempt to diagnose SDB and its severity aim to substitute clinical criteria for polysomnography. General QOL instruments and those specific to SDB will be discussed. An evaluation of the predictive value for each instrument will be presented. The emphasis will be their practical application in a busy clinical practice. The physical examination component of the symposium will provide a pictorial analysis of the anatomical sites contributing to SDB. Adenotonsillar hypertrophy is not the sole etiology for SDB. A systematic approach to the evaluation will be emphasized so that no aspect of the examination is overlooked. A variety of overnight studies exist. They range from a home oximetry study to full-night polysomnography. The reports can range from a 1-page summary to an extensive 10-page report. Otolaryngologists will become familiar with the necessary terminology to understand the report. Examples of sleep recordings and video clips will illustrate the definitions. Participants will learn how to critically analyze the report. The final aspect of the symposium will concentrate on the consequences of SDB. The morbidity of SDB is divided into categories: neurobehavioral, cardiovascular, and somatic growth. Dr Gozal will present current research on these consequences of SDB.
mention for ESS has revolutionized the techniques of endoscopic sinus surgeons. The ability of the powered instrument called a shaver or microdebrider to remove nasal and sinus tissue efficiently is undisputed. This efficient removal of tissue during ESS is a dynamic event. The introduction of ESS in the 1980s relied on standard tissue biting forceps or a static process of tissue removal. The static method of tissue removal had associated with it certain safety precautions now well known to ESS surgeons. The dynamic removal of tissue has made the static safety precautions less likely to prevent surgical entry into the orbit or brain. This miniseminar will examine the dynamic removal of tissue and the associated issues of static safety precautions, complications, consent issues, and directions for the future.
TUESDAY
P140
Otolaryngology– Head and Neck Surgery August 2004