SM14: Advances in Otolaryngology Improve Surgical Techniques, Treatment of Common Disorders

The STAR trial (N Engl J Med. 2014;370:139-149) involved patients with moderate to severe sleep apnea who either couldn’t tolerate or didn’t adhere to use of continuous positive airway pressure (CPAP). Also, their BMI had to be 32 or lower.

The 126 patients enrolled saw a 68% reduction in apnea-hypopnea index from baseline to 12 months and a 70% drop in oxygen desaturation index over the same time frame. The study patients also reported significant improvements in daytime alertness and quality of life measures.

Patients who responded were randomized after 12 months to have the device kept on or turned off. Researchers found a relapse in those in whom the device was turned off but continued successful management in those who maintained use of the device.

“We have data that the vast majority of patients liked it, and that’s in stark contrast to the CPAP,” Dr. Soose said. “This is by no means a fix-all for every sleep apnea patient. This is a nice tool in the toolbox to have, a nice alternative to be able to provide for patients who are unable to achieve benefit with CPAP.”

Advances in Facial Nerve Paralysis

Kofi Boahene, MD, associate professor of facial plastic and reconstructive surgery and otolaryngology-head and neck surgery at The Johns Hopkins University School of Medicine in Baltimore, emphasized the importance of timeliness in procedures to treat facial nerve paralysis. “The longer you wait, the less your results will be,” he said.

He described a reliable method, called the subzygomatic triangle, to find the elusive masseteric nerve, a small but valuable nerve in facial nerve

paralysis cases. A triangle is formed by the zygomatic arch, the temporomandibular joint, and the frontal branch of the facial nerve, and it’s a valuable tool, Dr. Boahene said. This eliminates the need for extensive dissection. “Always the masseter nerve is there,” Dr. Boahene said. “Within 10 minutes, using this triangle, you can find the nerve.”

He also described a method of “supercharging” a facial nerve without risking the loss of partial recovery the patient may have already experienced. The method, called the “epineural window end-to-side anastomosis,” involves creating a window to make more nerve connections without cutting the main facial nerve.

Personalized Treatment of Sinusitis

Joseph Han, MD, director of rhinology and endoscopic sinus surgery at Eastern Virginia Medical School in Norfolk, underscored the importance of treating sinusitis according to its category.

Allergy and asthma have a role in differentiating types of sinusitis with polyps, he said. “There’s no new medical treatment for chronic sinusitis that has been written, but what is new is how you personalize treatment for sinusitis.”