Sleep Apnea Syndromes: Hörmann K

Verse T, de la Chaux R, Dreher A, Fischer Y, Grundmann T, Hecksteden K, Hörmann K, Hohenhorst W, Ilgen F, Kühnel T, Mahl N, Maurer JT, Pirsig W, Roth B, Siegert R, Stuck BA, Anonymous00280. · Klinik für HNO-Heilkunde, Asklepios Klinik Harburg, Hamburg. · Laryngorhinootologie. · Pubmed #17464894 No free full text.

This publication has no abstract.

Stuck BA, Maurer JT, Verse T, Hein G, Schiffmann B, Hörmann K. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Mannheim. · Otolaryngol Pol. · Pubmed #15101284 No free full text.

Abstract: Snoring is a widespread disorder, mostly affecting middle-aged men. Snoring is not harmful in itself, but may lead to social impairment. Therefore, snorers often seek for medical advice and effective treatment. Sleep studies are mandatory especially when surgical procedures are intended. Due to the lack of reliable objective snoring analysis, the evaluation by the bed partners is the most relevant criteria in estimating treatment success. Body weight and behaviour patterns are crucial in the treatment of snoring. Furthermore, oral appliances and other implements may be beneficial. Various kinds of surgical procedures are available, soft palate techniques being the most widespread. Minimally invasive procedures are safe and effective in the majority of patients. Temperature controlled radiofrequency tissue ablation offers much potential in the treatment of primary snoring. Furthermore, a system is currently being developed which is supposed to stabilise the soft palate with the help of implants.

Verse T, Pirsig W, Stuck BA, Hörmann K, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Am J Respir Med. · Pubmed #14720014 No free full text.

Abstract: Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary.In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%.Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort.

Hörmann K, Maurer JT, Hirth K. · Universitäts-HNO-Klinik, Mannheim. · Laryngorhinootologie. · Pubmed #10763178 No free full text.

Abstract: Snoring, excessive daytime sleepiness and nocturnal apnoea are among the leading symptoms of the obstructive sleep apnoea syndrome (OSAS). Primary snoring without upper airway obstruction is a more common and normal phenomenon in sleep and has to be distinguished from OSAS. Patients with primary snoring are often suffering and complain of great distress and social embarrassment and therefore request professional help. Therefore, the otorhinolaryngologist has to be aware of the different treatment options that are possible and sensible. Apart from behavioral changes and general measures (weight loss, reduction of alcohol consumption, sleep position training), there are different conservative and surgical treatment options. In this article, the pathophysiology, diagnosis and treatment of primary snoring will be discussed.

Hörmann K, Hirth K, Maurer JT. · Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Mannheim. · HNO. · Pubmed #10407727 No free full text.

Abstract: Before the invention of CPAP therapy, the only effective surgical treatment for obstructive sleep apnea syndrome was tracheotomy. Now, surgical approaches mainly focus on two anatomical sites. Each procedure influences either the retropalatal or retrolingual portion of the pharynx. They might be applied individually, synchronously with other procedures, or sequentially with other therapeutic devices. Common methods of velar surgery include uvulopalatopharyngoplasty (UPPP), Laser-assisted uvuloplasty (LAUP), radiofrequency or uvulaflap. These techniques are indicated mainly in patients with mild OSAS. Other procedures focus on the posterior airway space (PAS), including operations that reduce the volume of the tongue or base of tongue. In selected patients, an enlargement of the retrolingual airway is gained by osteosynthetic techniques. Improvement of the nasal airway passage is gained by performing a septoplasty and/or conchotomy. In this paper, the different methods and their indications for surgical therapy will be explained and the results are summarized.

Maurer JT, Huber K, Verse T, Hörmann K, Stuck B. · Sleep Disorders Center, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #17275545 No free full text.

Abstract: OBJECTIVE: To prospectively evaluate the efficacy of the mandibular advancement device (MAD) Somnoguard in the treatment of OSA patients. STUDY DESIGN AND SETTING: Forty-four patients with OSA and noncompliant to continuous positive airway pressure were enrolled in this case series. Somnoguard is made of thermoplastic material. Direct intraoral fitting was done by an otorhinolaryngologist. Polysomnographic data concerning sleep and respiration were assessed at baseline and after familiarization with the MAD. RESULTS: Sleep efficiency and sleep stages distribution did not change significantly. The RDI could be reduced from 31.5+/-17.6 to 18.2+/-17.0 (P<0.05), the minimal oxygen saturation increased from 78+/-12.9 to 82+/-12.5% (P<0.05). According to standard criteria, 18 patients were cured, 12 were improved, 8 remained unchanged, and 6 worsened. Snoring time decreased from 223+/-132 to 183+/-134 minutes (P<0.05). CONCLUSION AND SIGNIFICANCE: With Somnoguard 68% of the enrolled OSA patients could be cured or substantially improved. It is a simple MAD for the otolaryngologist.

Baisch A, Hein G, Gössler U, Stuck BA, Maurer JT, Hörmann K. · Universitäts-HNO-Klinik Mannheim. · HNO. · Pubmed #16132876 No free full text.

Abstract: INTRODUCTION: Previous results showed the high effectiveness of our multi-level surgery concept based on the modified hyoid suspension for obstructive sleep apnea (OSA). This study was aimed at evaluating the discomforts and side-effects of this surgical concept. METHODS: Between November 2001 and June 2004, 102 patients with OSA and/or with laryngeal stenosis, who were all treated with a hyoid suspension in combination with surgery at the base of tongue, the soft palate or the nose, were included in the study. A questionnaire on discomfort and snoring was given to the patients. They were asked to answer the questions at the earliest 1 month after surgery. A reduction in snoring to a level which was tolerated by the bed-partner was regarded as success. RESULTS: Half of the patients needed analgesics until the 14th day after surgery, complained dysphagia until day 20 and had problems with their speech until day 30. However, 84% indicated that they would undergo surgery again; 94% reported a successful reduction in their snoring. CONCLUSION: Nearly all of the patients tolerated the discomforts and side-effects of our multi-level surgical concept. In combination with a reduction in snoring in 94% of all cases, this surgical concept was considered favorably by the patients.

Stuck BA, Köpke J, Hörmann K, Verse T, Eckert A, Bran G, Düber C, Maurer JT. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #15632924 No free full text.

Abstract: OBJECTIVES: Radiofrequency surgery is a minimally invasive technique for the treatment of the tongue base in sleep-disordered breathing. The aim of this study was to evaluate the changes in upper airway anatomy induced by radiofrequency surgery with MRI. STUDY DESIGN AND SETTING: 10 patients with sleep-disordered breathing were treated with radiofrequency surgery at tongue base. MRI measurements were performed before and after surgery with the help of a recently published protocol. RESULTS: The mean total number of energy delivered per patient was 4750 +/- 1641 Joule. Relevant changes could be observed neither for tongue volume or dimension nor for retrolingual space. CONCLUSIONS: Changes in upper airway anatomy could not be demonstrated. The effects of radiofrequency surgery of the tongue base may more likely be a result of changes in upper airway collapsibility. SIGNIFICANCE: Functional effects of surgical interventions in sleep-disordered breathing should be considered in addition to mechanistic concepts alone.

Hörmann K, Maurer JT, Baisch A. · Universitäts-HNO-Klinik Mannheim, 68135 Mannheim, Germany. · HNO. · Pubmed #15372171 No free full text.

Abstract: INTRODUCTION: Obstructive sleep apnea (OSA) is characterized by nocturnal collapsing of the upper airways. Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea syndrome (OSAS). Long-term compliance rates do not exceed more than 60 to 70%. Alternative multi-level surgeries are of interest, combining procedures at the level of the base of tongue and the soft palate in order to stabilize the airway. Preliminary results suggested the hyoid suspension as one part of the multi-level surgery concept to be of high effectiveness. Therefore this study investigated the outcome of the hyoid suspension and compared it with the CPAP therapy. METHODS: Between March 2001 and February 2003, 66 patients with OSA were treated with a hyoid suspension in combination with surgeries at the base of tongue, the soft palate or the nose (always performed by the same surgeon). All patients underwent a pre- and postoperative polysomnography in the sleep lab. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Mean age was 52,1 years, the mean body mass index (BMI) was 28,04 kg/m(2). RESULTS: The mean apnea-hypopnea-index (AHI) was 38,9121,10/h before operation and 19,25+/-19,64/h after operation (p<0,0001). More statistically significant changes were found for the arousal index, the oxygen saturation and the ESS (p<0,05). After surgery 57,6% of the subjects (38/66) were regarded as cured (reduction of AHI > or =50% and below 15/h). Another 21,2% (14/66) improved (reduction of AHI >20%). Altogether 78,8% of the patients were counted as responders. CONCLUSION: Multi-level surgeries based on the hyoid suspension show the effectiveness of this concept. This surgical strategy could be equal to the CPAP mask, especially in cases of CPAP intolerance.

Stuck BA, Starzak K, Hein G, Verse T, Hörmann K, Maurer JT. · Department of Otorhinolaryngology--Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, Mannheim, Germany. · Acta Otolaryngol. · Pubmed #15370568 No free full text.

Abstract: OBJECTIVE: To investigate the safety and efficacy of combined temperature-controlled radiofrequency volumetric tissue reduction of the tongue base and soft palate in obstructive sleep apnoea. MATERIAL AND METHODS: A total of 20 patients with obstructive sleep apnoea and combined palatal and retrolingual obstruction were included in a non-randomized clinical trial and 51 combined treatments were performed under local anaesthesia. Postoperative pain was assessed using visual analogue scales. Functional parameters, daytime sleepiness and quality of life were assessed using questionnaires (Epworth Sleepiness Scale, Short Form-36) before and 12 weeks after the last treatment session. Concurrently, polysomnography was performed on two consecutive nights. Results The mean postoperative pain score dropped from 5.6 at Day 1 to 0.6 at Day 7. Painkillers were taken for a mean of 3.3 days. There were no postoperative complications or changes in functional parameters. Daytime sleepiness improved significantly (p<0.05). The mean respiratory disturbance index was reduced from 25.3+/-11.4 to 16.7+/-15.3 (p<0.05). Six out of 18 (33%) patients were cured after a mean of 2.7 treatment sessions. CONCLUSION: Combined radiofrequency volumetric tissue reduction of the tongue base and soft palate is a safe and effective treatment for obstructive sleep apnoea.

Stuck BA, Köpke J, Maurer JT, Verse T, Eckert A, Düber C, Hörmann K. · Universitäts-HNO-Klinik Mannheim. · HNO. · Pubmed #12955249 No free full text.

Abstract: BACKGROUND: Due to its minimally invasive character, radiofrequency surgery has become a topic of increasing attention, especially with respect to the surgical treatment of sleep-related breathing disorders. Temperature-controlled radiofrequency volumetric tissue reduction is the most common technique employed in these cases. However, despite the increasingly widespread use of this technique, there is little data available on the induced effects in vivo. The aim of the present study was to investigate whether magnetic resonance imaging could be used in the evaluation of the in vivo effects of radiofrequency surgery at the base of the tongue. PATIENTS AND METHODS: Six patients were treated at the base of tongue with radiofrequency surgery. At 4-6, 8-10 and 24 h after surgery, magnetic resonance imaging was performed using an inversion recovery technique (TIRM) and the lesions created were evaluated. RESULTS: The lesions could be visualised at all postoperative measurement times. They appeared as oval hypointense structures encircled by a hyperintense area. Lesion size diminished slightly over time. DISCUSSION: Lesions induced by radiofrequency surgery can be clearly visualised with magnetic resonance imaging. Lesion size may be assessed in relation to energy application. In the future, the treatment of sleep-related breathing disorders may be further optimised with the help of this technique.

Baisch A, Afshar S, Hörmann K, Maurer JT. · Universitäts-HNO-Klinik Mannheim, Theodor-Kutzer-Ufer, 68135, Mannheim. · HNO. · Pubmed #17149630 No free full text.

Abstract: About 2-4% of adults suffer from obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder (SRBD). Repetitive obstructions of the upper airway mean that it is associated with hypertension and an elevated cardio- and cerebrovascular morbidity, which can be lowered by means of effective therapy. These patients cannot be treated correctly unless they are identified early in the course of the condition. Therefore, this study evaluated the use of the microMESAM screening device (known up to December 2005 as the "ApneaLink") in 61 patients in whom SRBD was suspected. The device proved reliable and practical in application.

Baisch A, Maurer JT, Hörmann K. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #16647548 No free full text.

Abstract: OBJECTIVE: This study investigated the outcome of the hyoid suspension as a part of a multilevel surgery protocol. STUDY DESIGN AND SETTING: Eighty-three patients with obstructive sleep apnea (OSA) underwent a multilevel surgical treatment because of continuous positive-airway pressure intolerance, 67 with the hyoid suspension and 16 without the hyoid suspension. All patients underwent a pre- and postoperative polysomnography in the sleep laboratory. RESULTS: The mean preoperative apnea hypopnea index (AHI) was 36.4+/-21.2 and 19.4+/-19.7 postoperatively for all patients (P<0.0001). Further statistically significant changes were found for the arousal index, the oxygen saturation, and the daytime sleepiness. No statistically significant change was found for body mass index. In the group of patients treated without the hyoid suspension, the AHI did not decrease statistically significant. After surgery, 59.7% of the subjects with the hyoid suspension were regarded as cured. CONCLUSION: Multilevel surgery including the hyoid suspension is an effective treatment in subgroup of OSA patients. EBM rating: C-4.

Verse T, Baisch A, Maurer JT, Stuck BA, Hörmann K. · Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #16564374 No free full text.

Abstract: OBJECTIVE: To determine the efficacy of a new multilevel surgical protocol for obstructive sleep apnea (OSA). STUDY DESIGN AND SETTING: Sixty patients with moderate to severe OSA because of multilevel pharyngeal obstruction were enrolled into this prospective, controlled clinical trial after clinical examination, endoscopy, and polysomnography. Surgery included uvulaflap, tonsillectomy, hyoid suspension, and radiofrequency treatment of the tongue base (group A). A second group did not receive hyoid suspension (group B). In both groups, nasal surgery was performed if necessary. Polysomnography and Epworth Sleepines Scale (ESS) were recorded at baseline and 2 to 15 months after surgery. RESULTS: In group A, the mean apnea-hypopnea index (AHI) decreased significantly after surgery (38.9 +/- 20.0 vs 20.7 +/- 20.6, P < 0.0001), whereas in group B the AHI did not. All secondary variables (minimal oxygen saturation, mean oxygen saturation, arousal index), and the ESS significantly improved in group A with only changes in arousal index and ESS reaching levels of significance in group B. CONCLUSION: The presented protocol including the hyoid suspension proved to be effective in the treatment of OSA, whereas surgery without hyoid suspension was less successful. EBM rating: B-2b.

Baisch A, Hein G, Gössler U, Maurer JT, Hörmann K. · Universitäts-HNO-Klinik, Mannheim. · Laryngorhinootologie. · Pubmed #16358191 No free full text.

Abstract: Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). For patients with CPAP-intolerance and for those tolerating the CPAP-mask but without success, surgical strategies are of growing interest. There are several surgical concepts which combine different surgical procedures on both the velopharyngeal and the retro-lingual section of the upper airway. The case presented here describes the failed CPAP-therapy in an OSAS-patient who tolerates the CPAP-mask. The apneas and hypopnoes could not be reduced by using the CPAP-mask, even more they increased under CPAP-ventilation. Performing a video-documented sleep-endoscopy of the upper airway (under physiological sleep patterns) the location of the obstruction could be identified. After performing a hyoid suspension in combination with a radiofrequency therapy of the base of tongue the apneas and hypopneas decreased. Only by using the sleep endoscopy the reason for the failed CPAP-therapy could be identified and therefore the surgical protocol succeed. To what extend the sleep video endoscopy becomes a standardized procedure in sleep labs warrants further investigations.

Stuck BA, Neff W, Hörmann K, Verse T, Bran G, Baisch A, Düber C, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Otolaryngol Head Neck Surg. · Pubmed #16143189 No free full text.

Abstract: OBJECTIVE: To assess the effects of isolated hyoid suspension on subjective and objective parameters of obstructive sleep apnea and to evaluate changes in upper airway anatomy with the help of standardized magnetic resonance imaging. STUDY DESIGN AND SETTING: Fifteen patients received isolated hyoid suspension. Changes in respiratory disturbance index were assessed with polysomnography, and anatomical changes with standardized magnetic resonance imaging. Snoring, daytime sleepiness, and functional parameters were assessed with questionnaires. Lateral x-ray cephalometry was performed preoperatively. RESULTS: Mean respiratory disturbance index was reduced from 35.2 +/- 19.1 to 27.4 +/- 26.2. Forty percent of the patients were classified as responders. Daytime sleepiness improved significantly. Relevant changes in upper airway anatomy could not be detected. There were no remarkable differences between responders and nonresponders in regard to imaging. CONCLUSIONS: Hyoid suspension is effective only in a subgroup of patients and does not lead to relevant changes in airway diameters in the awake patient. Magnetic resonance imaging and x-ray cephalometry do not add additional information for patient selection. SIGNIFICANCE: The reported clinical effects of hyoid suspension are more likely due to functional changes in airway collapsibility than to an enlargement of the upper airway.

Huber K, Sadick H, Maurer JT, Hörmann K, Hammerschmitt N. · Universitäts-HNO-Klinik Mannheim. · Laryngorhinootologie. · Pubmed #16142622 No free full text.

Abstract: BACKGROUND: Primary management of tonsillar hyperplasia in children is tonsillectomy. Recent data from clinical case-series are clearly in support of the hypothesis that tonsillotomy with the CO2-laser seems to be effective and is noted to have less postoperative bleeding and less pain as compared to tonsillectomy. For the first time we used a monopolar argon-supported needle for tonsillotomy in the following study. METHODS: Fifty patients (age: 4.58 years; SD +/- 2.33) with benign tonsillar hyperplasia were recruited. For tonsillotomy we used the monopolar argon-supported needle. The outcome measures were postoperative pain, capability of oral intake, consumption of analgesics and postoperative bleeding. RESULTS: No postoperative bleeding occurred. Post-operative pain hardly occurred and could easily be controlled. The third postoperative day analgesics intake was under one portion per day (mean: 0.91; SD +/- 1.26). Capability of oral intake and swallowing was normal on the seventh postoperative day. CONCLUSION: It was concluded that tonsillotomy, using the monopolar argon-supported needle, is a valid treatment for benign tonsillar hyperplasia in children, which can be performed with slight post-operative pain and a low risk for postoperative bleeding. It offers good dissection and haemostasis abilities. Compared to the CO2-laser the monopolar argon-supported needle does not require any laser safety precautions.

Hörmann K, Baisch A. · University Hospital Mannheim, Department of Otolaryngology, Head and Neck Surgery, Mannheim, Germany. · Laryngoscope. · Pubmed #15475804 No free full text.

This publication has no abstract.

Verse T, Baisch A, Hörmann K. · Universitäts-HNO-Klinik, Mannheim. · Laryngorhinootologie. · Pubmed #15316892 No free full text.

Abstract: BACKGROUND: Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea (OSA). Unfortunately nCPAP does not exceed long-term compliance rates of much more than 60 percent. Therefore, surgical strategies are of growing interest in this field. Today, so called multi-level surgeries are favored which combine at least one surgical procedure on both the velopharyngeal and the retrolingual section of the upper airway. The Mannheim concept combines at least one surgical procedure to the soft palate (UPPP or Uvulaflap) inclusive tonsillectomy and a hyoid suspension and/or a radiofrequency procedure on the base of tongue. METHODS: In between July 2000 and February 2003, 139 patients with OSA were included in the protocol. By now 46 patients finished the follow-up. Mean age was 51.9 years, the mean body mass index was 28.5 kg m (- 2). All patients underwent as well preoperatively as postoperatively a fully attended polysomnography in the sleep lab using standard criteria. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). RESULTS: Before surgery the mean apnea-hypopnea-index (AHI) was 36.5 +/- 22.2, the mean ESS score was 10.4. Postoperatively the mean AHI decreased to 24.9 +/- 21.6 (p < 0.01) and the mean ESS score to 7.1 (p < 0.05). After surgery 39.1 % of the subjects were regarded as cured (reduction of AHI > or = 50 % and below 15). Another 30.4 % were substantially improved (reduction of AHI > 20 %). Altogether 69.6 % of the patients were counted as responders. Cure rates decreased with increasing AHI and BMI. The hyoid suspension showed a positive effect on the treatment success. CONCLUSIONS: The presented concept shows inferior success rates than other more invasive concepts. This might be due to the abandonment of the mandibular osteotomy with genioglossus advancement.

Verse T, Schwalb J, Hörmann K, Stuck BA, Maurer JT. · Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Mannheim. · HNO. · Pubmed #14647925 No free full text.

Abstract: BACKGROUND: Transcutaneous electrical stimulation while asleep has been used to treat obstructive sleep apnea (OSA), although without convincing results. Modern strategies consist of electrical muscle training for a number of weeks during wakefulness rather than stimulation during sleep. OBJECTIVE: The purpose of this study was to assess the practicability, safety, and efficacy of a new device, SilentOne (Imperpuls, Chemnitz, Germany). PATIENTS AND METHODS: Fifteen patients with various degrees of OSA used transcutaneous submental electrical stimulation therapy for 4-5 weeks every day, day and night. A patient's diary recorded practicability and potential adverse events. Respiratory parameters were recorded by fully attended polysomnography in the sleep lab. Daytime sleepiness and snoring were assessed by questionnaires. RESULTS: The apnea-hypopnea-index decreased from 29.2 before to 21.2 after therapy (P<0.05). Daytime sleepiness improved significantly (P<0.01) as did snoring (P<0.005). CONCLUSIONS. Transcutaneous electrical stimulation therapy using SilentOne proved to be safe, easy to use, and potent. However, therapy showed a limited cure rate.

Stuck BA, Köpke J, Maurer JT, Verse T, Eckert A, Bran G, Düber C, Hörmann K. · Department of Otolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Laryngoscope. · Pubmed #12972936 No free full text.

Abstract: OBJECTIVES: Temperature controlled radiofrequency volumetric tissue reduction (RFVTR) of the tongue base is a minimally invasive technique for the treatment of obstructive sleep apnea. But despite its widespread use, little is yet known about in vivo effects in humans. Such knowledge would be essential for evidence-based criteria in the selection of energy application. METHODS: In a preparatory in vitro study, porcine tongues were preserved in growing medium. Lesions with different amounts of energy were applied, and maximum diameters were assessed. In the in vivo study, 11 patients were treated with RFVTR at the tongue base by employing different energy levels (800, 600, 400, or 200 J) on two application sites. Magnetic resonance imagery scans were performed 4 to 6, 8 to 10, and 24 hours after surgery. An inversion recovery technique was used to visualize the lesions. RESULTS: RFVTR created lesions at the porcine tongue from 50 J and higher. Maximum lesion sizes were achieved with 400 J. In vivo, all the lesions were clearly visible in the postoperative scans. Lesion size increased with the amount of energy applied. Maximum diameters were created from 600 J and higher. Higher amounts of energy only resulted in a slight increase in lesion length. CONCLUSIONS: The application of 600 J at 85 degrees C leads to optimal lesion sizes. Higher amounts of energy will not lead to a relevant increase in tissue necrosis. With regard to the time needed for application, 600 J appears to be the ideal adjustment for energy delivery in the treatment of the human tongue.

Stuck BA, Starzak K, Verse T, Hörmann K, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Acta Otolaryngol. · Pubmed #12797590 No free full text.

Abstract: OBJECTIVE: Temperature-controlled radiofrequency volumetric tissue reduction (RFVTR) is a minimally invasive technique used in the treatment of the tongue base, soft palate and turbinates. Complications seem to be rare, but the scope of previous studies was often limited by the small number of patients included. The aim of this study was to evaluate postoperative complications in a large series of patients. MATERIAL AND METHODS: In this retrospective study, temperature-controlled radiofrequency procedures (Somnoplasty) performed between May 1998 and March 2002 were considered. The charts of the patients were analyzed with regard to intra- or postoperative complications. RESULTS: In total, 322 patients received 497 treatment sessions; 239 of these treatments were isolated and the remaining 258 were combined procedures. Mean follow-up was 122.8 +/- 145.5 days. Concerning radiofrequency surgery, nine postoperative complications were observed (2.0%) as follows: ulcerations of the tongue base or soft palate; dysphagia necessitating hospital admission; temporary palsy of the hypoglossal nerve; and an abscess of the base of the tongue. CONCLUSIONS: Complications occurring after RFVTR are infrequent and mostly mild. Overall, temperature-controlled RFVTR is a safe procedure when used both in isolation and as part of a combined approach.

Maurer JT, Stuck BA, Hein G, Verse T, Hörmann K. · Schlafmedizinisches Zentrum, Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Mannheim. · Dtsch Med Wochenschr. · Pubmed #12529835 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Prevention of the supine position has for decades been a well known treatment option in positional obstructive sleep apnea. It was the aim of this study to test the efficacy of a recently patented commercially available supine position preventing vest. PATIENTS AND METHODS: The vest is made of linen tissue with a half cylindrical piece of hard foam in its dorsal part. 12 male patients slightly overweight (body mass index 26.5 +/- 2.6 kg/m(2)) and 55.8 +/- 11.6 years old were investigated polysomnographically prospectively. RESULTS: The pretherapeutical respiratory-disturbance index (RDI) was 26.7+/-11.9/h increasing to 39.3+/-16.1/h in the supine position. When using the vest, patients no longer slept on their back and the RDI dropped to 7.6 +/- 5.1/h (p < 0.005). Total sleep time at an oxygen saturation below 90 % was reduced from 11.7 +/- 11.3 % to 1.5 +/- 2.1 %. 9 patients (75 %) were cured (RDI < 10/h and RDI reduction > 50 %), 2 patients (17 %) improved (RDI reduction > 50 %) and only the oldest patient (76 years old) remained unchanged. Even though snoring decreased from 180 +/- 125 minutes to 110 +/- 52 minutes, an increase was observed in 30 % of the patients. Sleep quality and structure did not change considerably. CONCLUSION: The supine position prevention vest is a safe and simple treatment alternative of high efficacy in positional sleep apnea. As a complete remission cannot be predicted, polygraphic or polysomnographic controls are necessary.

Stuck BA, Maurer JT, Verse T, Hörmann K. · Sleep Disorders Center, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany. · Acta Otolaryngol. · Pubmed #12206264 No free full text.

Abstract: In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of > or = 50% and a postoperative RDI of < 15/h) and ten (55%) showed an improvement of > 20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.

Hörmann K, Hirth K, Erhardt T, Maurer JT, Verse T. · Universitäts-HNO-Klinik, Mannheim, Germany. karl.hö · Laryngorhinootologie. · Pubmed #11555783 No free full text.

Abstract: BACKGROUND:: Concerning the therapy of obstructive sleep apnea (OSA) the discrimination between either retropalatal or retrolingual site of obstruction seems to be an oversimplification. Thus modern surgical concepts address both anatomical areas. Minimal invasive surgical techniques treating the soft palate have recently been developed while there is still an ongoing development concerning the base of tongue. Methods: A less invasive modification of the hyoid suspension to the thyroid cartilage, originally described by Riley, is presented as treatment modality for sleep related breathing disorders. Between October 2000 and March 2001, 14 patients underwent modified hyoid suspension within a multi-level surgery concept. The operative technique manages with only one wire-suture and does not include myotomies and intersection of the ligamenta stylohyoidea. Results: All together 10 male and 4 female subjects with a mean age of 50.9 years were included in the analysis. Preoperatively the mean apnea hypopnea index (AHI) was 18.4. The procedure was well tolerated. Neither increased postoperative pain nor increased requirement of analgetics was observed. Substantial side-effects were one case of seroma and 9 cases of transitory dysphagia. The retrolingual airway space increased significantly after surgery. Conclusions: These preliminary results are promising. The presented modified hyoid suspension is time-effective and shows less postoperative morbidity. Therefore it might become a suitable treatment modality within the multi-level surgery concept for sleep related breathing disorders.