Drug-induced Sleep Endoscopy:Are there Predictors for Failure of Oral Appliance Treatment?

Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or  50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI < 30 events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI < 30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p < 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT

The impact of injury of the chorda tympani nerve during primary stapes surgery or cochlear implantation on taste function, quality of life and food preferences:A study protocol for a double-blind prospective prognostic association study

BACKGROUND: The chorda tympani nerve (CTN) is a mixed nerve, which carries sensory and parasympathetic fibres. The sensory component supplies the taste sensation of the anterior two-thirds of the ipsilateral side of the tongue. During middle ear surgery the CTN is exposed and frequently stretched or sacrificed, because it lacks a bony covering as it passes through the middle ear. Injury may cause hypogeusia, ageusia or altered taste sensation of the ipsilateral side of the tongue. To date, there is no consensus regarding which type of CTN injury (sacrificing or stretching), during middle ear surgery, leads to the least burden for the patient.METHODS: A double-blind prospective prognostic association study was designed in a single medical centre in the Netherlands to determine the effect of CTN injury on postoperative taste disturbance and quality of life. 154 patients, who will undergo primary stapes surgery or cochlear implantation will be included. The taste sensation, food preferences and quality of life of these patients will be evaluated preoperatively and at one week, six weeks and six months postoperatively using the Taste Strip Test, Electrogustometry, supplementary questionnaire on taste disturbance, Macronutrient and Taste Preference Ranking Task, Appetite, Hunger and Sensory Perception questionnaire and Questionnaire of Olfactory Disorders to assess the association of these outcomes with CTN injury. Evaluation of olfactory function will only take place preoperatively and at one week postoperatively using the Sniffin' Sticks. The patient and outcome assessor are blinded to the presence or absence of CTN injury.DISCUSSION: This study is the first to validate and quantify the effect of chorda tympani nerve injury on taste function. The findings of this study may lead to evidence-based proof of the effect of chorda tympani injury on taste function with consequences for surgical strategies.TRIAL REGISTRATION: Netherlands Trial Register NL9791. Registered on 10 October 2021.</p

The Vestibular Implant: Quo Vadis?

Objective: To assess the progress of the development of the vestibular implant (VI) and its feasibility short-term. Data sources: A search was performed in Pubmed, Medline, and Embase. Key words used were “vestibular prosth*” and “VI.” The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation. Study selection: All studies about the VI and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the VI. Data extraction and synthesis: Data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies. Conclusion: To use a basic VI in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation), complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt

Endoscopic vs. microscopic stapes surgery:An anatomical feasibility study

OBJECTIVES: To investigate the feasibility of the endoscopic approach vs. microscopic approach during stapes surgery, focusing on the visualization of the important anatomical structures of the middle ear, the volume of the resected scutum and chorda tympani (CT) injury. METHODS: Fresh frozen human cadaveric heads underwent two stapes surgeries using an operating microscope on one ear and an endoscope on the other ear. The surgeon documented the visualization of critical landmarks, as well as exposure and injury of the CT. The volume of resected scutum was evaluated using cone beam computed tomography scanning and three-dimensional imaging. RESULTS: We performed endoscopic stapes surgery in 10 ears and microscopic stapes surgery in 11 ears. A stapes prosthesis was placed in all ears. The volume of bony scutum resection was significantly lower in the endoscopic group (median = 2.20 mm 3, IQR = 4.17) than in the microscopic group (median 13.25 mm 3, IQR = 8.71). No scutum was removed in two endoscopic ears, while scutum was removed in all microscopic ears. The endoscopic and microscopic group had similar CT injury. CONCLUSIONS: This study showed that the endoscopic stapes surgery procedure is feasible and might be less invasive than microscopic stapes surgery. Future clinical prospective and functional studies will be needed to support our findings

Microbiome on the Bone-Anchored Hearing System: A Prospective Study

The bone-anchored hearing system (BAHS) has evolved to a common treatment option for various types of hearing revalidation. The BAHS consists of an implant in the skull that breeches the skin. Soft tissue reactions are a common complication associated with BAHS and are generally poorly understood. This study aims to investigate the influence of BAHS and associated skin reactions around the implant. A total of 45 patients were prospectively followed from implantation up to at least 1 year. Swabs were obtained at baseline, 12 weeks follow-up and during cases of inflammation (Holgers score ≥2). The microbiota was assessed using IS-proTM, a bacterial profiling method based on the interspace region between the 16S–23S rRNA genes. Detection of operational taxonomic units, the Shannon Diversity Index, sample similarity analyses and Partial Least Squares Discriminant Analysis (PLS-DA) were employed. Staphylococcus epidermidis, Streptococcus pneumoniae/mitis, Propionibacterium acnes, Staphylococcus capitis, Staphylococcus hominis, Bifidobacterium longum, Haemophilus parainfluenzae, Lactobacillus rhamnosus, Bordetella spp., Streptococcus sanguinis, Peptostreptococcus anaerobius, Staphylococcus aureus, Lactococcus lactis, Enterobacter cloacae, and Citrobacter koseri were the most commonly found bacterial species. S. pneumoniae/mitis was significantly more often observed after implantation, whereas P. acnes was significantly less observed after implantation compared with baseline. The relative abundance of S. epidermidis (17%) and S. aureus (19.4%) was the highest for the group of patients with inflammation. The Shannon Diversity Index was significantly increased after implantation compared with pre-surgical swabs for Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia (FAFV), but not for other phyla. When combining all phyla, there was no significant increase in the Shannon Diversity Index. The diversity index was similar post-surgically for patients experiencing inflammation and for patients without inflammation. With a supervised classifier (PLS-DA), patients prone to inflammation could be identified at baseline with an accuracy of 91.7%. In addition, PLS-DA could classify post-surgical abutments as non-inflamed or inflamed with an accuracy of 97.7%. This study shows the potential of using IS-proTM to describe and quantify the microbiota associated with the percutaneous BAHS. Furthermore, the results indicate the possibility of an early identification of patients susceptible to adverse skin reaction following implantation. Both S. aureus and S. epidermidis should be considered as relevant bacteria for BAHS-associated inflammation

Prediction of obstructive sleep apnea:comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index

PURPOSE: To evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI). METHODS: Data from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables. RESULTS: The NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort. CONCLUSION: This is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11325-020-02219-6) contains supplementary material, which is available to authorized users

Tinnitus:Pathophysiology, diagnosis and treatment

Tinnitus is a common and heterogeneous condition, characterised by experiencing sound in the absence of an external source. Various treatment options are available in the Netherlands for patients with tinnitus, but these have limited support from methodologically sound studies. Diagnosis and treatment of tinnitus demands a standardized and multidisciplinary approach. Ideally, there should be a stepwise approach to diagnosis and treatment of tinnitus, with a gradual increase in intensity of treatment. This increase should depend upon the patient's requirements and degree of distress. Current scientific evidence suggests that intensive treatment of tinnitus based on cognitive behavioural therapy (CBT) is indicated for patients with severe tinnitus.</p

Analysis of a cochlear implant database : changes in tinnitus prevalence and distress after cochlear implantation

The aim of this study was to estimate the prevalence and distress of tinnitus pre- and post-cochlear implantation in patients with bilateral severe to profound hearing loss. In this retrospective study, we included patients from a cochlear implant clinic in Perth, Western Australia. Pre- and post-cochlear implantation data from 300 implant recipients were collected on self-reported presence of tinnitus, tinnitus distress using the Tinnitus Reaction Questionnaire (TRQ), hearing-related quality of life using the Abbreviated Profile of Hearing Aid Benefit (APHAB), and consonant-nucleus vowel-consonant (CNC) word recognition test scores. Retrospectively, patients were grouped into those with or without tinnitus, and the grade of tinnitus distress. The potential factors associated with post-implantation changes in the presence of tinnitus and its distress were evaluated. Tinnitus prevalence was 55.8% pre-operatively and 44.3% post-implantation with a median TRQ score respectively of 12.0 (IQR: 1.0–28.0) and 3.5 (IQR: 0.0–16.2) points. Among the 96 patients experiencing tinnitus pre-implantation, 14.6% patients experienced moderate to catastrophic tinnitus distress pre-implantation compared to 6.3% post-implantation. To conclude, the pre- and post-implantation median TRQ score for the cohort population showed that tinnitus was a “slight” handicap. Tinnitus prevalence and its associated tinnitus distress decreased post-implantation. Patients with tinnitus post-implantation were significantly younger and had less severe pre-implantation hearing loss in the non-implanted ear than patients without tinnitus. Further research is needed to understand the factors influencing changes in tinnitus.https://journals.sagepub.com/home/tiahj2023Speech-Language Pathology and Audiolog