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When OSAHS surgery fails: Adjunctive treatment with MADs
respiratory depression, admission to hospital or intensive care) were recorded. Events were graded as major, minor, or absent. We compared the proportions of major and minor complications in both groups and their hospital stay. RESULTS: 49 obese children were identified (20 girls, 29 boys). There were no differences in mean ages (P⬎0.05) or types of surgical procedures (P⬎0.05) between the two groups. Seven obese patients and one control incurred major events (P⬍0.05). 47 obese children incurred minor complications versus 16 controls (P⫽0, OR 48.5). The mean hospital stay was also significantly longer for the obese group (18 vs 8 hours, P⫽0.03); boys in particular had a prolonged stay (22.6 vs 7.9 hours). CONCLUSIONS: Obesity in children significantly increases the risk of both major and minor respiratory complications following surgery for SDB compared with controls. This information impacts the risk benefit assessment of surgery for SDB in this population, especially since the benefit of surgery is limited, if not questionable. Safety of multilevel surgery in OSA: A review of 317 cases Kenny P Pang, FAMS, FRCS (presenter); Jin Keat Siow, MD OBJECTIVES: To review the safety of multilevel surgery in patients with OSA. METHODS: A retrospective review of 317 consecutive patients with OSA, and 898 surgical procedures from Jan 2006 to December 2008. Multilevel OSA surgery comprised of nasal surgery (endoscopic sinus surgery, septoplasty and inferior turbinate reduction), palate surgery (traditional UPPP, expansion sphincter pharyngoplasty and anterior palatoplasty), and tongue surgery (hyoid suspension, radiofrequency tongue base and tongue suspension suture). RESULTS: The overall complication rate was 3.8%, with no patients having any upper airway issues. Complications include (a) four patients had postoperative oxygen desaturation within three hours after extubation [these patients had severe OSA (AHI ⬎ 60 and LSAT ⬍ 80%)], (b) four patients had persistent hypertension (these patients had prior history of hypertension), (c) eleven patients had secondary hemorrhage (between seven to 12 days post-operative), (d) there were two cases of negative pressure pulmonary edema and (e) four patients with tongue edema (following tongue surgery). Patients who had tongue surgery were admitted to high dependency overnight. CONCLUSIONS: Routine postoperative admission to ICU for all OSA patients is unnecessary. Patients with OSA should be closely monitored in the post-anaesthesia care unit (PACU) area for at least 3 hours after surgery, and based on the outcome of this period, the patient can be observed overnight in either the high dependency unit or the general ward.
P123 Screening for OSAHS: Subjective and objective considerations Michael Friedman, MD (presenter); Tanya Pulver, MD; Meghan Wilson, MD OBJECTIVES: 1) Determine the sensitivity and specificity of the Berlin Questionnaire. 2) Determine the sensitivity and specificity of the OSAHS score based on physical findings. 3) Propose a novel screening system based on both objective and subjective factors to balance sensitivity and specificity of OSAHS screening. METHODS: A retrospective review of 300 patients with complete Berlin questionnaire, OSAHS score (Friedman Tongue Position ⫹ Tonsil size ⫹ BMI grade), Epworth Sleepiness Scale (ESS) and full polysomnography data was conducted. Data was analyzed to determine the sensitivity and specificity of the Berlin questionnaire or the OSAHS score in predicting an AHI of ⬎15. A screening system was also developed by combining subjective questionnaire data with objective physical findings to create a more accurate method of screening. RESULTS: The sensitivity and specificity of the Berlin questionnaire was determined to be 60.4% and 23% respectively in predicting an AHI of ⬎15. OSAHS score demonstrated a sensitivity and specificity of 61.1% and 70.3% in predicting an AHI of ⬎15. Accuracy in identifying OSAHS was improved using the Fishers linear classification equation. In the validation study, this equation was applied casewise to 223 patients and correctly predicted 85% of cases by result. CONCLUSIONS: This study finds strictly subjective or objective screening systems fail in either being sensitive but not specific or specific but not sensitive. An approach to screening that accounts for both patient symptoms as well as physical findings vastly improves the ability to accurately identify patients at risk for OSAHS. When OSAHS surgery fails: Adjunctive treatment with MADs Michael Friedman, MD (presenter); Tanya Pulver, MD; Meghan Wilson, MD OBJECTIVES: 1) Share our experience with the use of newly available, ENT office-made thermoplastic, tritratable and nontitratable mandibular advancement devices (MADs). 2) Study compliance and ease of molding and fitting of these devices. 3) Study the efficacy of these devices, specifically in patients who have failed obstructive sleep apnea/hypopnea syndrome (OSAHS) surgery and are unwilling to use CPAP. 4) Compare the efficacy and tolerability of three available devices. METHODS: A prospective, non-randomized cohort study in a tertiary care center. Patients who tried and failed both CPAP and surgical therapy were enrolled in the study and chose one of three MADs: Non-titratable Snore Guard (n⫽40), nontitratable SomnoGuard 2.0 (n⫽20), or titratable SomnoGuard AP (n⫽25). Pre- and post-treatment assessment included: (1)
ORALS
Program Oral Presentations
P124
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
Epworth Sleepiness Scale, (2) Quality of life survey, (3) Polysomnogram, (4) Bed partner assessment of snoring level, (5) Three month compliance questionnaire. RESULTS: Acceptance of the MADs was ⬎80%. At three months, 73% of patients were using the device, comparing favorably with reported compliance of dental devices. Patients with mild, moderate and severe disease benefited with an overall mean reduction of AHI from 37.6 26.2 to 15.3 13.5 (p⫽0.001). Classic cure was obtained in 56% of patients with severe disease and 56% of patients with mild/moderate disease. On initial analysis, there was no significant difference in compliance or efficacy between the three MADs. CONCLUSIONS: In this group of patients who failed OSAHS surgery, the use of ENT office-made, thermoplastic MADs resulted in classic cure rate of 56% with excellent compliance.
Socio-Economic Six years later: Satisfaction and gender in otolaryngology training Rhoda Wynn, MD (presenter); Siri Cheng, MD OBJECTIVES: To determine if differences exist in the perception of otolaryngology residency training by gender with regard to operative experience and career guidance, and to
reassess the residency experience six years after the initial survey and compare results. METHODS: Otolaryngology residents were surveyed anonymously by an electronic questionnaire. A 22-item survey was scored using a 5-point ordinal Likert scale. Responses were analyzed with regard to gender and PGY level. The data obtained was compared to that collected from an anonymous mail survey six years ago. RESULTS: Complete surveys were returned by 184 residents (27% female). Age and post-graduate year level distribution did not differ between genders. Similar to the previous study, women were less likely to agree that their surgical abilities were appropriate for training level (p⫽0.02) and adequate for post-residency practice (p⫽0.04). In contrast to the prior study, however, there are no longer demonstrated differences in the perceptions of being more likely to be encouraged to enter private practice (p⫽0.13), having a solid career network (p⫽0.14), and confidence about being ready to run their own practice (p⫽0.30). CONCLUSIONS: Women now comprise a larger segment of otolaryngology residents. Since the last study, several significant changes are observed compared to the prior study. Items pertaining to career guidance no longer differ by gender, but differences on two items on perceptions of surgical confidence persist.
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.
P123 Screening for OSAHS: Subjective and objective considerations Michael Friedman, MD (presenter); Tanya Pulver, MD; Meghan Wilson, MD OBJECTIVES: 1) Determine the sensitivity and specificity of the Berlin Questionnaire. 2) Determine the sensitivity and specificity of the OSAHS score based on physical findings. 3) Propose a novel screening system based on both objective and subjective factors to balance sensitivity and specificity of OSAHS screening. METHODS: A retrospective review of 300 patients with complete Berlin questionnaire, OSAHS score (Friedman Tongue Position ⫹ Tonsil size ⫹ BMI grade), Epworth Sleepiness Scale (ESS) and full polysomnography data was conducted. Data was analyzed to determine the sensitivity and specificity of the Berlin questionnaire or the OSAHS score in predicting an AHI of ⬎15. A screening system was also developed by combining subjective questionnaire data with objective physical findings to create a more accurate method of screening. RESULTS: The sensitivity and specificity of the Berlin questionnaire was determined to be 60.4% and 23% respectively in predicting an AHI of ⬎15. OSAHS score demonstrated a sensitivity and specificity of 61.1% and 70.3% in predicting an AHI of ⬎15. Accuracy in identifying OSAHS was improved using the Fishers linear classification equation. In the validation study, this equation was applied casewise to 223 patients and correctly predicted 85% of cases by result. CONCLUSIONS: This study finds strictly subjective or objective screening systems fail in either being sensitive but not specific or specific but not sensitive. An approach to screening that accounts for both patient symptoms as well as physical findings vastly improves the ability to accurately identify patients at risk for OSAHS. When OSAHS surgery fails: Adjunctive treatment with MADs Michael Friedman, MD (presenter); Tanya Pulver, MD; Meghan Wilson, MD OBJECTIVES: 1) Share our experience with the use of newly available, ENT office-made thermoplastic, tritratable and nontitratable mandibular advancement devices (MADs). 2) Study compliance and ease of molding and fitting of these devices. 3) Study the efficacy of these devices, specifically in patients who have failed obstructive sleep apnea/hypopnea syndrome (OSAHS) surgery and are unwilling to use CPAP. 4) Compare the efficacy and tolerability of three available devices. METHODS: A prospective, non-randomized cohort study in a tertiary care center. Patients who tried and failed both CPAP and surgical therapy were enrolled in the study and chose one of three MADs: Non-titratable Snore Guard (n⫽40), nontitratable SomnoGuard 2.0 (n⫽20), or titratable SomnoGuard AP (n⫽25). Pre- and post-treatment assessment included: (1)
ORALS
Program Oral Presentations
P124
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
Epworth Sleepiness Scale, (2) Quality of life survey, (3) Polysomnogram, (4) Bed partner assessment of snoring level, (5) Three month compliance questionnaire. RESULTS: Acceptance of the MADs was ⬎80%. At three months, 73% of patients were using the device, comparing favorably with reported compliance of dental devices. Patients with mild, moderate and severe disease benefited with an overall mean reduction of AHI from 37.6 26.2 to 15.3 13.5 (p⫽0.001). Classic cure was obtained in 56% of patients with severe disease and 56% of patients with mild/moderate disease. On initial analysis, there was no significant difference in compliance or efficacy between the three MADs. CONCLUSIONS: In this group of patients who failed OSAHS surgery, the use of ENT office-made, thermoplastic MADs resulted in classic cure rate of 56% with excellent compliance.
Socio-Economic Six years later: Satisfaction and gender in otolaryngology training Rhoda Wynn, MD (presenter); Siri Cheng, MD OBJECTIVES: To determine if differences exist in the perception of otolaryngology residency training by gender with regard to operative experience and career guidance, and to
reassess the residency experience six years after the initial survey and compare results. METHODS: Otolaryngology residents were surveyed anonymously by an electronic questionnaire. A 22-item survey was scored using a 5-point ordinal Likert scale. Responses were analyzed with regard to gender and PGY level. The data obtained was compared to that collected from an anonymous mail survey six years ago. RESULTS: Complete surveys were returned by 184 residents (27% female). Age and post-graduate year level distribution did not differ between genders. Similar to the previous study, women were less likely to agree that their surgical abilities were appropriate for training level (p⫽0.02) and adequate for post-residency practice (p⫽0.04). In contrast to the prior study, however, there are no longer demonstrated differences in the perceptions of being more likely to be encouraged to enter private practice (p⫽0.13), having a solid career network (p⫽0.14), and confidence about being ready to run their own practice (p⫽0.30). CONCLUSIONS: Women now comprise a larger segment of otolaryngology residents. Since the last study, several significant changes are observed compared to the prior study. Items pertaining to career guidance no longer differ by gender, but differences on two items on perceptions of surgical confidence persist.
Words and degrees that may be missing from abstracts in this program are due to limitations in the submission process. Continuing improvements in that database are still in process, and a serious attempt has been made to correct missing content. For the latest information about the annual meeting, and to access the new Itinerary Planner for your visit, please go to: www.entnet.org/annual_meeting.