Nasopharyngeal actinomycosis: a rare cause
of nasal airway obstruction.
Daamen N, Johnson JT.
Department of Otolaryngology--Head and Neck Surgery, University of
Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Nasopharyngeal
actinomycosis is a rare clinical disease. It can occur after nasal
trauma or surgical manipulation. It is also reported to occur without
prior trauma, making diagnosis difficult. We report a case of
nasopharyngeal actinomycosis that presented as nasal airway obstruction
causing snoring and mimicking nasopharyngeal carcinoma. To our
knowledge, only a few other cases of nasopharyngeal actinomycosis have
previously been published, most coming after mucosal trauma. Diagnosis
is made by observing the bacteria or its associated sulfur granules in
the biopsy specimen. This anaerobic organism is difficult to culture.
Treatment consists of wide debridement and prolonged antibiotic
therapy, with good prognosis.
Snoring Adult Products
[Treatment of snoring and sleep apnea.
Maxillo-mandibular advancement osteotomy]
[Article in Dutch]
de Lange J, de Graaf J, Veldhuijzen van Zanten L, Waalkens HA.
Afdeling Mondziekten en Kaakchirurgie, Isala Klinieken, Zwolle.
kaakchirurgie@isala.nl
In
this article, a patient is presented who was treated by a
maxillo-mandibular advancement osteotomy, in order to increase the
volume of the oropharynx as a final treatment of the obstructive sleep
apnea syndrome. This syndrome is a common affliction, characterized by
excessive daytime sleepiness and unintentionally falling asleep. It can
be diagnosed by patient history and polysomnography. Nasal-continuous
positive airway pressure is the golden standard of treatment. However,
in mild to moderate cases of the syndrome, treatment with a mandibular
reposition appliance is also an option. The extraoral device of the
first treatment option as well as the intraoral appliance of the second
treatment option are demanding patients' compliance. Therefore,
research into other treatments is necessary. The initial results of the
advancement osteotomy among six patients were very good and in
accordance with other literature reports. These results justify further
research to clarify the importance of this treatment option of the
obstructive sleep apnea syndrome.
Snoring Adult Solution
Managing disturbing snoring with palatal
implants: a pilot study.
Ho WK, Wei WI, Chung KF.
Division
of Otorhinolaryngology-Head & Neck Surgery, Department of Surgery,
University of Hong Kong Medical Centre, Hong Kong SAR.
OBJECTIVE:
To evaluate the safety and efficacy of polyethylene terephthalate
implants in the soft palate to modify disturbing snoring. DESIGN:
Interventional study, before-after trial. SETTING: Referral center,
institutional practice, hospitalized care. PATIENTS: Twelve consecutive
patients with disturbing snoring and an apnea-hypopnea index less than
15 per hour and a body mass index of 30 or less were recruited. One
patient with no adverse effects was lost to follow-up. Extrusion of
implants occurred in 2 patients. Complete data in 9 patients were
available for analysis. INTERVENTION: Polyethylene terephthalate
implants were inserted in the soft palate. MAIN OUTCOME MEASURES:
Safety of the procedure and evaluation of the loudness of snoring by
bed partners using a visual analog scale. RESULTS: There were no
complications of infection or bleeding. Extrusion of implants occurred
in 2 patients with no clinical sequelae. The mean (SD) loudness of
snoring at baseline, as assessed by bed partners using a visual analog
scale of 0 to 100, was 79 (17.2). This significantly decreased to 48
(20.4) at 3 months (Wilcoxon signed rank test, P =.008). Daytime
sleepiness as measured with the Epworth Sleepiness Scale also decreased
from an average score of 8.9 at baseline to 5.7 at 3 months (P =.007).
There were no significant changes in the apnea-hypopnea index and body
mass index from baseline to 3 months' follow-up. CONCLUSIONS:
Polyethylene terephthalate implants in the soft palate are safe.
Snoring decreased significantly at 3 months after surgery. Polyethylene
terephthalate implants in the soft palate should be further explored as
a treatment for snoring.
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