American Academy of Otolaryngology—Head and Neck Surgery 2002 Annual Meeting

American Academy of Otolaryngology—Head and Neck Surgery 2002 Annual Meeting – Conference News Update

San Diego

GENDER-BASED PREDICTORS OF SLEEP APNEA

Clinicians should consider potential gender differences when examining patients for obstructive sleep apnea syndrome (OSAS), reported Swedish researcher Johanna Dahlqvis, MB, from the University of Umea. Ms. Dahlqvis’ research shows that men and women differ in the physiologic predictors of the disorder.

Dahlqvis and colleagues’ study included 596 men and 205 women, all referred for suspected OSAS, to receive a standardized ear, nose, and throat examination. Researchers noted the size of patients’ tonsils and uvula, obstruction of the nose, the height and retroposition of the tongue, position of the mandible, distance between the uvula and the pharyngeal wall, and gag reflexes. To assess sleep apnea, a sleep study was conducted on each participant.

For both sexes, the propensity for OSAS was associated with elevated body mass index (BMI). Men with OSAS were more likely to have an obstruction in the nose, a larger uvula, a shorter distance between the uvula and the pharyngeal wall, and a high position of the tongue. For women, OSAS propensity was linked to retroposition of the mandible, a more sensitive gag reflex, and large tonsils.

WHAT’S NEW IN TONSILLECTOMY

Laser Technology Promising

Contact diode laser (CDL) will be prominent in the next phase of tonsillectomy, predicted pediatric otolaryngologist Riccardo D’Eredita, MD, of Vicenza Civil Hospital, Italy, and research scientist Roger R. Marsh, PhD, of the Children’s Hospital of Philadelphia.

These researchers conducted a prospective study of 58 pediatric patients (mean age, 5) undergoing tonsillectomy without adenoidectomy between January 2001 and January 2002. Patients were randomly assigned to undergo either monopolar cautery (MPC) or CDL.

For 10 days after surgery, families assessed the children’s pain levels using the WongBaker FACES pain scale. Parents recorded information on the children’s diet, medication, voice quality, and activity.

Compared with children in the cautery group, those in the laser group consistently reported lower mean pain scores. Furthermore, patients in the laser group required less pain medication and experienced fewer nights of multiple awakenings during the recovery period; most reported little or no pain after the third postoperative day.

Partial May Be Better

An old procedure, tonsillotomy, is being revisited as an effective alternative to total tonsillectomy. Now, however, the technique is being combined with contemporary technology.

Tonsillotomy involves using an endoscopic microdebrider to partially shave the tonsils. The procedure eliminates the obstructive portion of the tonsil while preserving the tonsillar capsule. Afterward, a natural biologic dressing is left in place over the pharyngeal muscles.

Peter J. Koltai, MD, and colleagues from the Children’s Hospital at the Cleveland Clinic Foundation enrolled 243 children with enlarged tonsils and associated obstructive sleep–disordered breathing. All underwent intracapsular (partial) tonsillectomy between October 1998 and June 2002. The comparison group consisted of 308 children who underwent a standard tonsillectomy.

The children’s postoperative recovery was assessed via telephone survey with their primary caregivers. Partial tonsillectomy was associated with less pain during recovery, less global pain, fewer days of analgesic use, and fewer days to resumption of normal activity and a normal diet. The incidence of delayed postoperative complications did not differ between the two techniques.

The researchers acknowledge that a partial tonsillectomy may eventually result in tonsillar regrowth and subsequent infection of the tonsillar remnant.

CT DETECTS SPREAD OF HEAD AND NECK CANCER

For patients who are newly diagnosed with head and neck cancer, CT scanning is a useful tool for diagnosing metastasis to the chest, announced P. S. Arunachalam, MD, of the Cumberland Infirmary in Carlisle, United Kingdom.

Dr. Arunachalam and colleagues studied 44 consecutive patients (30 men and 14 women) who were newly diagnosed with squamous cell carcinoma of the head and neck. Subjects’ mean age was 67. All underwent posteroanterior x-ray and CT chest scan at the same time as the CT scan of the primary lesion.

Five of the 44 patients had positive findings for cancer on the CT chest scan. Two had multiple metastases and died within six months, but one, who had a single lung lesion, was successfully treated via pneumonectomy. The other two patients are currently being followed, as repeat CT scans have shown no lesions or enlargements of nodules.

Chest x-ray results were abnormal in two cases, but in only one did CT scan confirm a lung tumor.

With up-to-date equipment, a CT scan of the chest involves only a small additional amount of radiologist and radiographic time. It can be performed at the same time as the primary CT scan, with minimal extra radiation, explained Dr. Arunachalam.

PALATE REDUCTION SURGERY SAFER THAN ASSUMED

A team of Brazilian otolaryngologists has found that palate reduction surgery for the treatment of primary snoring and OSAS has few serious complications.

Jose Antonio Pinto, MD, of the Center of Otolaryngology and Head and Neck Surgery of Sao Paulo, Brazil, summarized the results of a trial involving 785 patients and 945 procedures. The procedures included uvulopalatopharyngoplasties, uvulopalatopharyngo plasties with laser [CO.sub.2] and somnoplasties the palate.

Complications included hemorrhage (17 cases), hypoesthesia of the lower alveolar nerve (17 cases), and other problems in nine other patients. Tracheotomy was performed in 12 cases, and two patients required blood transfusions.

TINNITUS AND CHRONIC PAIN

More than half of patients with chronic pain experience tinnitus–a finding that requires further investigation, reported Jon E. Isaacson, MD, of Pennsylvania State University in Hershey. Between 16% and 35% of US adults experience tinnitus.

Dr. Isaacson and colleagues administered a survey to 72 new patients at a tertiary care pain clinic. Those who reported experiencing tinnitus were asked to qualify and quantify the condition.

Among the 29 women and 10 men who experienced both chronic pain and tinnitus, the most frequently cited primary pain site was the back. Patients reported their duration of pain as between six months and five years; the average report of duration of tinnitus was 13 years. Fifteen of these subjects reported that tinnitus started before the onset of pain and 13 said that it followed afterward; three subjects said that both occurred at the same time. Just four patients believed that their tinnitus was related to their chronic pain, and only eight reported that their tinnitus improved once they began pain treatment.

The patients did not perceive their tinnitus to be a significant handicap. Perhaps, the researchers speculate, their tendency to focus on their chronic pain may have made other symptoms seem secondary.

The 2002 Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery took place September 22 to 25, 2002.

COPYRIGHT 2002 Clinicians Publishing Group

COPYRIGHT 2002 Gale Group