Updated Nasal Surgery for Obstructive Sleep Apnea.
Authors: Johnson DM, Soose RJ
Abstract
Numerous studies report that difficulty breathing through the nose is associated with reduced sleep quality, increased daytime dysfunction, and increased risk of snoring and obstructive sleep apnea (OSA). Additionally, chronic nasal obstruction often complicates and limits successful medical device therapy for OSA, particularly with continuous positive airway pressure (CPAP). When medical evaluation and management of the nose is inadequate, surgical therapy to lower nasal resistance has been shown to substantially improve sleep and breathing outcome measures. Although...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Advanced Concepts in the Pathophysiology of Obstructive Sleep Apnea.
Authors: White DP
Abstract
The primary pathological event in the disorder obstructive sleep apnea (OSA) is the partial or complete closure of the pharyngeal airway during sleep in an individual with a widely patent airway during wakefulness. This yields an apnea or hypopnea with resulting hypoxia and hypercapnia, and most often requires an arousal to terminate the event. These events occur in a repetitive manner during sleep, yielding intermittent hypoxia and sleep fragmentation with their associated adverse effects on the health and quality of life of the afflicted individual. Here, we focus on the events...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Updated Friedman Staging System for Obstructive Sleep Apnea.
Authors: Friedman M, Salapatas AM, Bonzelaar LB
Abstract
In the practice of sleep medicine, the first step is identification of those patients at high risk for sleep apnea. Nearly every physician and every hospital has preferred methods of screening. Many patient questionnaires or surveys as well as some objective physical measurements have been suggested to predict the presence of sleep apnea. Screening is well established, and laboratory and home testing are widely available. An early assessment with a physical examination can help direct treatment planning. The Friedman tongue position, lingual tonsil h...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Updated Palate Surgery for Obstructive Sleep Apnea.
Authors: Li HY
Abstract
Initially described in 1981, uvulopalatopharyngoplasty was the first surgical procedure specially designed at the palatal level for snoring and obstructive sleep apnea (OSA). To date, palatal surgery remains the most commonly used surgery for OSA. The advancement of this surgery over the past 30 years has been a process of evolution in concepts, examination, and technique to increase safety and effectiveness in the treatment of OSA. Concept changes have emerged in the disease etiology, purpose of surgery, treatment priorities, staging of operations, integration therapy, and surgical...
Source: Advances in Oto-Rhino-Laryngology - July 26, 2017 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Differential Diagnosis of Chronic Rhinosinusitis with Nasal Polyps.
Authors: London NR, Reh DD
Abstract
Nasal polyps are semi-translucent mucosal outgrowths of the paranasal sinuses which typically arise in the setting of chronic rhinosinusitis (CRS). Nasal polyps are also associated with asthma, aspirin sensitivity, cystic fibrosis and allergic fungal rhinosinusitis (AFS). The majority of nasal polyps are bilateral and characterized by tissue edema and eosinophil infiltration. Patients with nasal polyps often present with complaints including nasal obstruction, congestion, rhinorrhea or altered sense of smell. The differential diagnosis ranges from benign masses such as s...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Allergic Fungal Rhinosinusitis: The Latest in Diagnosis and Management.
Authors: Loftus PA, Wise SK
Abstract
Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinusitis in the United States. Its pathophysiological basis is associated with a predisposed person's type I IgE-mediated allergic response to inhaled mold spores that are ubiquitous in the environment. AFRS is a well-recognized type of chronic, recurrent, and non-invasive hypertrophic sinus disease that affects immunocompetent hosts, most commonly young African American males. There are 5 main criteria used for the diagnosis of AFRS, one being the presence of nasal polyposis. A review of the curre...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Aspirin Exacerbated Respiratory Disease.
This article summarizes the current knowledge about the pathophysiology, focuses on modern diagnostic approaches of AERD and discusses various aspirin desensitization protocols with respect to efficacy as well as to undesirable side effects.
PMID: 27466843 [PubMed - as supplied by publisher] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Cystic Fibrosis Sinusitis.
Authors: Le C, McCrary HC, Chang E
Abstract
Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the CF transmembrane conductance regulator gene(CFTR) resulting in impaired ion transport. Nearly all people with CF will develop chronic rhino-sinusitis (CRS) and present with the characteristic viscous mucus, impaired mucociliary clearance and chronic inflammation/infection of the sinonasal cavity. While some individuals with CF can appear relatively asymptomatic in terms of their sinus disease, commonly reported symptoms include anosmia, headache, facial pain, nasal obstruct...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Influence of P-Glycoprotein Function on Chronic Rhinosinusitis/Nasal Polyps Pathophysiology.
Authors: Cheng YS, Bleier BS
Abstract
Permeability glycoprotein (P-gp) is an active efflux membrane transporter that has been researched extensively due to its ability to confer multidrug resistance in a wide range of cancers. P-gp has an impressively broad substrate specificity and is known to interact with hundreds of compounds, including drugs and toxins. This substrate promiscuity is the key to its physiological role, and P-gp is thought to be responsible for extruding xenobiotics and cellular metabolites, as well as maintaining tissue barriers at the blood-brain interface and gastrointestinal epitheli...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
B-Cells and Antibody-Mediated Pathogenesis in Chronic Rhinosinusitis with Nasal Polyps.
Authors: Min JY, Hulse KE, Tan BK
Abstract
The sinonasal mucosa forms a dynamic immune barrier where epithelial cells and the immune system interact with the inhaled environment and nasal microbiome. Recent studies suggest that B-cells, plasma cells and antibody production are highly activated locally within the nasal mucosa of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Findings additionally suggest that polyp tissue contains elevated levels of cytokines, chemokines and complement that may drive this profound B-cell response. Currently, the data are conflicting on whether the B-cell r...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Innate Lymphoid Cells: The Innate Counterpart to T Helper Cells.
Authors: Padro Dietz C, Luong A
Abstract
Innate lymphoid cells (ILCs) are a recently discovered subset of innate immune cells that are capable of secreting great amounts of cytokines that have been found to influence effector cell activity. Chronic rhinosinusitis (CRS) in the absence (CRSsNP) or presence (CRSwNP) of nasal polyps has been characterized as type 1- and type 2-skewed, respectively, based on the presence of cytokines characteristic of type 1 and 2 immune responses. Based on the ability of type 1 ILCs to secrete interferon-x03B3;, a type 1 cytokine found elevated in CRSsNP and type 2 ILCs to sec...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
The Role of Innate Immunity and Aeroallergens in Chronic Rhinosinusitis.
Authors: London NR, Tharakan A, Ramanathan M
Abstract
Allergy has been inferred to contribute to the pathophysiology of chronic rhinosinusitis (CRS) although this role is controversial and the mechanism is debated. Furthermore, the role of aeroallergens in CRS is poorly defined and has been postulated to contribute to CRS through direct penetration in the sinuses or downstream systemic consequences. Common aeroallergens implicated in chronic rhinosinusitis include air pollution/second hand smoke, dust mite and pollen [<citeref rid="ref1">1</citeref>,<citeref rid="ref2">2</citeref>,&...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Acquired Cystic Fibrosis Transmembrane Conductance Regulator Deficiency.
Authors: Cho DY, Woodworth BA
Abstract
In the genetic airway disease cystic fibrosis (CF), deficiency or dysfunction of the cystic fibrosis membrane conductance regulator (CFTR) alters anion transport in respiratory epithelium and consequently disrupts mucociliary clearance. An enriched understanding of the role of CFTR in the maintenance of normal epithelial function has revealed that mild and variable CFTR mutations play a causative role in a number of diseases not classically associated with CF. Furthermore, recent evidence indicates that acquired defects in wild-type CFTR protein processing, endocytic ...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Role of Vitamin D in Pathogenesis of Chronic Sinusitis with Nasal Polyposis.
Authors: Shahangian A, Schlosser RJ
Abstract
Vitamin D3 (VD3) is a potent immunomodulatory steroid hormone involved in the regulation of numerous host immune cells. Additionally, it may have an important role in host immunity against chronic bacterial infections, as well as in chronic rhinosinusitis. Many factors modulate expression of various enzymes important for production of VD3, local concentration of which may be important for its complex and diverse functions. Here, we explore some of the contributions of VD3 to chronic rhinosinusitis with nasal polyposis and its role as a disease-modifying agent.
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Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Taste Receptors in Upper Airway Immunity.
Authors: Carey RM, Lee RJ, Cohen NA
Abstract
Taste receptors are well known for their role in communicating information from the tongue to the brain about nutritional value or potential toxicity of ingested substances. More recently, it has been shown that taste receptors are expressed in other locations throughout the body, including the airway, gastrointestinal tract, brain and pancreas. The roles of some 'extraoral' taste receptors are largely unknown, but emerging research suggests that bitter and sweet taste receptors in the airway are capable of sensing bacteria and modulating innate immunity. This c...
Source: Advances in Oto-Rhino-Laryngology - July 29, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
