Reference: Paul BC, Chen S, Sridharan S, Fang Y, Amin MR, Branski RC. Diagnostic accuracy of history, laryngoscopy, and stroboscopy. Laryngoscope. 2013;123:215-219.
Explore This IssueJanuary 2013
—Reviewed by Sue Pondrom
Pillar Implant Improves Snoring and Some OSA
What is the efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea?
Background: Various treatment modalities have been introduced and evaluated for patients with snoring or obstructive sleep apnea (OSA). Although positive airway pressure therapy has repeatedly proven successful, there is low adherence. Various surgical procedures have been attempted. Laser-assisted uvulopalatoplasty failed to show any clinical efficacy and is no longer recommended. Uvulopalatopharyngoplasty does not reliably normalize the apnea-hypopnea index (AHI). Maxillomandibular advancement is considered to be the only surgical procedure, with the exception of tracheotomy, to reduce AHI. There has not been a meta-analysis of the Pillar implant.
Study design: Meta-analysis.
Setting: Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University; Department of Obstetrics and Gynecology, Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konkuk University, Seoul, Republic of Korea.
Synopsis: Seven studies, all conducted between January 2002 and March 2011, were analyzed for snoring and mild-to-moderate OSA. The Pillar implant reduced snoring sound significantly and, for mild-to-moderate OSA patients, significantly reduced the Epworth Sleepiness Scale and AHI. The mean extrusion rate was 9.3 percent. The authors noted that there have been significant complications with other types of surgery, including pain, dryness and foreign-body sensation. Therefore, the Pillar implant is a new alternative, with effects that are long lasting due to its biologically compatible structure. Study limitations included the relevant studies not being placebo controlled, the short follow-up period and the co-existing OSA, because polysomnography was not mandatory for diagnosis of snoring in the studies.
Bottom line: The Pillar implant has a moderate effect on snoring and mild-to-moderate OSA.
Reference: Choi JH, Kim SN, Cho JH. Efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis. Laryngoscope. 2013;123:269-276.
—Reviewed by Sue Pondrom
Role of Frontal Sinus Surgery in Nasal Polyp Recurrence
What are the patterns of polyp recurrence and the effect of frontal sinus surgery on polyp recurrence?
Background: One of the most important causes of surgical failure in chronic rhinosinusitis with nasal polyposis (CRSwNP) is polyp recurrence. The rate can be as high as 60 percent. There is some contradictory evidence for higher recurrence rates reported in asthmatic patients, and the role of bacteria and/or fungus is still not clearly elucidated.