Literature Review: A Roundup of Important Recent Studies

Study design: Retrospective chart review with prospective patient-reported symptoms.

Setting: Department of Otolaryngology-Head and Neck Surgery, University of Adelaide, Adelaide, Australia.

Synopsis: A total of 109 patients who underwent primary frontal sinus endoscopic surgery were evaluated from January 2003 through December 2009. The overall patency rate was 92 percent. Complete resolution of symptoms occurred in 85 patients (78 percent). Clinically significant post-operative stenosis correlated well with return or persistence of symptoms, infection or polyp recurrence, along with actual size of the frontal ostia. Other factors such as asthma, smoking and fungal mucin polyposis in general did not provide a significant correlation.

Bottom line: Primary frontal sinus endoscopic surgery in experienced hands is successful in relieving frontal sinus symptoms in at least 75 percent of patients. Even though a frontal ostia is patent post-operatively (92 percent), some patients still have symptoms or infection requiring revision surgery (9 percent of cases or higher). Surgeons must exercise great care in order to avoide mucosal injury leading to stenosis, which can occur even in experienced hands.

Reference: Naidoo Y, Wen D, Bassiouni A, Keen M, Wormald PJ. Long-term results after primary frontal sinus surgery. Int Forum Allergy Rhinol. 2012;2(3):185-190.

—Reviewed by James A. Stankiewicz, MD

Success Following Surgery to Correct Obstructive Sleep Apnea Dependent Upon Scoring Measures

Are the success rates of surgical treatments for obstructive sleep apnea (OSA) dependent upon the polysomnographic (PSG) scoring system and metrics used?

Background: OSA diagnosis is confirmed by an elevated apnea-hypopnea index (AHI), and surgery can be considered a second-line treatment when continuous positive airway pressure (CPAP) therapy is inadequate or is not tolerated by the patient. Different criteria for cure or improvement are frequently used to determine success thresholds, and some metrics can emphasize statistical over clinical outcomes.

Study design: Retrospective case series with reanalysis of PSG data.

Setting: None specified.

Synopsis: Forty patients (32 males, eight females) with moderate to severe OSA undergoing multi-level pharyngeal surgery were given a preoperative questionnaire, along with pre-operative and post-operative PSGs; post-operative PSGs were scored for both the AHIChicago and AHIRec apnea/hypopnea indices. Surgery was classified as successful in patients with a post-operative

AHIRec ≤ 20 with a 50 percent reduction in AHI from baseline. Thirty-one of the patients had a complete PSG data set; using AHI < 20, 83.3 percent of the cohort had a successful outcome. However, success rates ranged from 38.9 percent to 91.7 percent as criteria and metrics changed (AHI < 30, AHI < 20; AHI reduced by 50 percent; AHI < 20 and reduced by 50 percent) and varied according to the AHI scoring system used.