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Curr Opin Otolaryngol Head Neck Surg 2018 Dec;26(6):356-366

Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago.

Purpose Of Review: The purpose of this manuscript is to highlight the latest advances in diagnosis and management of velopharyngeal incompetence (VPI) as it pertains to swallowing deficits in children. This is timely and relevant as otolaryngologists are often amongst the first to diagnose and treat VPI. Although nasal regurgitation of a bolus is frequently transient, persistent problems can be associated with other swallowing problems and other significant medical problems. Read More

Orphanet J Rare Dis 2018 Apr 23;13(1):63. Epub 2018 Apr 23.

Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.

Background: Infants and children with syndromic craniosynostosis (SCS), such as Apert-, Crouzon- or Pfeiffer syndrome, are prone to sleep disordered breathing (SDB) including obstructive sleep apnea and upper airway resistance syndrome (OSAS, UARS), potentially leading to tracheostomy. We modified the Tübingen Palatal Plate (TPP), an oral appliance with a velar extension effectively treating airway obstruction in Robin sequence, by attaching a tube to its velar extension to bridge the narrow pharyngeal airway in SCS patients. Here, we evaluated this treatment concept. Read More

Int J Pediatr Otorhinolaryngol 2018 Jan 31;104:51-53. Epub 2017 Oct 31.

Department of Pathology, Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, 34093, Turkey.

We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. Read More

Am J Case Rep 2017 Nov 30;18:1266-1270. Epub 2017 Nov 30.

Department of Otorhinolaryngology, Celal Bayar University , Uncubozkoy, Manisa, Turkey.

BACKGROUND Pleomorphic adenoma is the most common benign tumor arising in the salivary gland. The signs and symptoms of pleomorphic adenoma of the minor salivary glands vary, depending on the anatomical site involved. A rare case of pleomorphic adenoma of the posterior surface of the soft palate is reported that caused sleep disturbance, which was resolved with endoscopic surgical treatment. Read More

Otol Neurotol 2017 09;38(8):1133-1139

*Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon †Reuth Rehabilitation Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv ‡Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin, Israel.

Background: The Eustachian tube (ET) has a major role in the middle ear (ME) pressure homeostasis. ET dysfunction is the accepted paradigm for pressure-related ME disorders. We studied the ME status in patients with severely diminished ET opening abilities, and anticipated to find ME disorders in most of them. Read More

Head Face Med 2017 Mar 30;13(1). Epub 2017 Mar 30.

Interdisciplinary Centre for Craniofacial Malformations, Tuebingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany.

Background: Infants with Robin sequence (RS) suffer from upper airway obstruction (UAO) and feeding problems. We developed an oral appliance with a velar extension in combination with functional treatment and appropriate feeding techniques, which was proven effective in isolated RS. As the above problems are particularly challenging in syndromic RS, we set out to evaluate our treatment concept also in these patients. Read More

Eur Arch Otorhinolaryngol 2017 Jun 12;274(6):2513-2519. Epub 2017 Mar 12.

Department of Otolaryngology, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95, Wen-Chang Road, Shih-Lin District, Taipei, Taiwan.

The objective of this retrospective review is to evaluate the ability of the Murray secretion scale to predict aspiration as determined by fiberoptic endoscopic evaluation of swallowing. Patients with dysphagia undergoing a fiberoptic endoscopic evaluation of swallowing study between January 2013 and November 2015 from a single, tertiary care institution were retrospectively reviewed. The Murray secretion scale and penetration aspiration scale on fiberoptic endoscopic evaluation of swallowing examination were determined. Read More

JAMA Otolaryngol Head Neck Surg 2016 10;142(10):994-1001

Second Department of Propedeutic Surgery, School of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.

Importance: Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection.

Objective: To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy. Read More

J Clin Anesth 2016 Nov 3;34:336-8. Epub 2016 Jun 3.

The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address:

A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. Read More

Otolaryngol Head Neck Surg 2016 10 28;155(4):710-3. Epub 2016 Jun 28.

Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.

Flexible fiberoptic nasopharyngolaryngoscope (FN) examinations are important to the practice of otolaryngology (ENT). We sought to assess whether a portable recording adaptor for the FN can enhance resident learning and improve patient management. The adaptor was used prospectively on consultations by first- and second-year ENT residents, and changes in diagnosis and management were recorded in the patient care workflow. Read More

Kulak Burun Bogaz Ihtis Derg 2016 May-Jun;26(3):129-34

Department of Otolaryngology, Medipol University, 34214 Bağcılar, İstanbul, Turkey.

Objectives: This study aims to investigate the effects of adenotonsillar hypertrophy on general development, as well as fine and gross motor capabilities, social communication, and language development in children with adenotonsillar hypertrophy by applying the Denver Developmental Screening Test-II.

Patients And Methods: The study included 30 patients (12 boys, 18 girls; mean age 53.3±12. Read More

Int J Pediatr Otorhinolaryngol 2015 Aug 11;79(8):1330-2. Epub 2015 Jun 11.

Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.

Objective: The aim of this study was to evaluate the effects of flexible and rigid endoscopes using a visual analog scale and reveal which one is better tolerated by children.

Material And Methods: The pediatric patients with voice disorders examined between July 2012 and October 2014 were included the study. Patients to whom endoscopic visualization had been applied several times were recalled for information about their preference of scope. Read More

Endocrine 2016 Feb 21;51(2):308-16. Epub 2015 Jun 21.

Medicina Generale e Malattie Aterotrombotiche e Degenerative, Department of Medicine, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134, Verona, Italy.

Pathogenesis and long-term outcome of obstructive sleep apnea syndrome (OSAS) in acromegalic patients are still under debate. The aim of the study was to assess the prevalence and long-term follow-up of a series of acromegalic patients with OSAS and to investigate site, degree, and possible causes of upper airway obstruction by morphological study. Cross-sectional and longitudinal study was conducted in 58 acromegalic patients (33 active, 25 controlled) with polysomnography in all subjects, repeated in 25 patients with OSAS, and echocardiography. Read More

J Voice 2015 Jul 19;29(4):484-9. Epub 2015 Feb 19.

Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.

Introduction: Inhaled steroids are widely used for persistent cough treatment. Although the side effects of long-term inhaled steroids have been well described in the literature, their laryngeal side effects after short-term use have not yet been defined. The aim of this study was to evaluate the effect of 1 month application of inhaled steroid treatment on voice parameters in patients with subacute or chronic cough. Read More

Eur Arch Otorhinolaryngol 2015 Jul 9;272(7):1793-9. Epub 2015 Jan 9.

Otolaryngology Section, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy,

The aim of the present study was to investigate if any of the three awake procedures [fiberoptic nasopharyngoscopy with modified Müller Maneuver (FNMM), nasal snoring endoscopy (NSE), or oral snoring endoscopy (OSE)] could efficiently predict the grade or pattern of upper airway (UA) collapse found with drug-induced sleep endoscopy (DISE), which is considered by many authors as the current gold standard in optimizing obstructive sleep apnea syndrome (OSAS) patient selection for UA surgery. Twenty consecutive patients (simple snorers and OSAS patients) were studied with FNMM, NSE, OSE, and DISE. The inter-test agreement was evaluated with Cohen's kappa coefficient (κ). Read More

Sleep Breath 2015 May 5;19(2):661-7. Epub 2014 Nov 5.

Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuai Fu Yuan, Dongcheng District, 100730, Beijing, China.

Purpose: This study aimed to compare fiberoptic nasopharyngoscopy during Mueller's maneuver (FNMM) with fiberoptic nasopharyngoscopy with simulation of snoring (FNSS) for upper airway (UA) assessment in patients with obstructive sleep apnea and hypopnea syndrome. We also investigated the relationship between daytime endoscopic examinations and nocturnal pressure measurements.

Methods: We conducted a prospective, case-series study at Peking Union Medical College Hospital. Read More

Laryngoscope 2015 Feb 14;125(2):286-90. Epub 2014 Aug 14.

Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A.

Objectives/hypothesis: To determine whether findings on fiberoptic nasolaryngoscopy beyond the nasal cavity can aid in diagnosis of atopy.

Study Design: Case control analysis of patients undergoing fiberoptic nasolaryngoscopy and allergy testing at a single academic institution.

Methods: Patients who underwent flexible nasolaryngoscopy for either laryngeal or nasal symptoms and allergy testing by in vitro methods were divided into an atopic group and a nonatopic control group based on results of allergy testing. Read More

Ear Nose Throat J 2012 Nov;91(11):E1-3

Department of Pulmonary Medicine, Konya Education and Research Hospital, Meram, Konya, Turkey 42100.

We describe 2 cases of obstructive sleep apnea syndrome (OSAS) that were found to be caused by the presence of laryngeal masses. Both patients presented with a long-standing history of snoring, gasping for air while sleeping, excessive daytime sleepiness, and morning headaches. In both patients, the lesions were discovered by fiberoptic nasopharyngoscopy. Read More

Otolaryngol Head Neck Surg 2010 Jul;143(1):85-9

Otolaryngology, Head & Neck Surgery Department, Athens Medical Center, Marousi, Athens, Greece.

Objective: To analyze computer-assisted quantitative measurements of endoscopic images taken during fiberoptic nasopharyngoscopy with Müller's maneuver that were processed with the use of fractal geometry and correlate them with the apnea-hypopnea index of patients with obstructive sleep apnea syndrome as well as habitual snorers.

Study Design: Diagnostic test assessment for the analysis of images acquired through fiberoptic nasopharyngoscopy with Müller's maneuver and processed with the use of fractal geometry.

Setting: Sleep laboratory in a tertiary care private hospital in Athens, Greece. Read More

Kulak Burun Bogaz Ihtis Derg 2009 Sep-Oct;19(5):246-52

Department of Otolaryngology, Keçiören Training and Research Hospital, Ankara, Turkey.

Objectives: The aim of this study was to compare nasopharyngeal examination findings with those of polysomnography, which is considered to be the gold standard, in positional and nonpositional obstructive sleep apnea syndrome (OSAS) patients.

Patients And Methods: The study included 374 patients (215 males, 159 females; mean age 44.9 years; range 11 to 77 years) presenting with OSAS or simple snoring. Read More

Braz J Otorhinolaryngol 2009 May-Jun;75(3):463-6

EPM, UNIFESP.

Unlabelled: Sleep apnea-hypopnea syndrome was described twenty years ago, and since then there have been doubts and controversies regarding it. Fiberoptic nasopharyngoscopy with Muller's maneuver, first described by Borowieck and Sassin (1983), is among them.

Aim: Careful literature review on Muller's maneuver, regarding whether it can predict the sucess of uvulopalatopharyngoplasty, location of upper airway obstruction and severity of the disorder. Read More

Otolaryngol Head Neck Surg 2008 Mar;138(3):289-93

Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: The aim of this study was to examine the correlation between the degree or shape of pharyngeal narrowing as observed during the Muller maneuver and the severity of sleep-disordered breathing (SDB).

Subjects And Methods: We enrolled 33 patients with SDB, and they underwent polysomnography (PSG). The degree of pharyngeal narrowing (grade I-IV) according to fiberoptic nasopharyngoscopy with the Muller maneuver (FNMM) and the shape of pharyngeal narrowing were evaluated at different anatomical levels. Read More

Otolaryngol Clin North Am 2007 Aug;40(4):845-53

Stanford Sleep Disorders Clinic and Research Center, 401 Quarry Road, Stanford, CA 94305, USA.

Obstructive sleep apnea (OSA) is the result of upper airway obstruction during sleep. Hypopharyngeal airway obstruction can be caused by the prominence or relaxation of the base of the tongue, lateral pharyngeal wall, and occasionally, the aryepiglottic folds or epiglottis. Although nasal continuous positive airway pressure (CPAP) is considered as the first treatment for obstructive sleep apnea, surgery has been shown to be a viable option for patients who are intolerant of positive pressure therapy. Read More

Laryngoscope 2007 Jun;117(6):1102-6

Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Korea University, Seoul, South Korea.

Objectives/hypothesis: Open-mouth breathing during sleep may increase the severity of obstructive sleep apnea (OSA) and complicate nasal continuous positive airway pressure (CPAP) therapy in patients with OSA. The aim of this study was to assess the effect of open-mouth breathing on upper airway anatomy using lateral cephalometry and fiberoptic nasopharyngoscopy.

Study Design: This was a cross-sectional study. Read More

Laryngoscope 2006 Jul;116(7):1223-7

ENT Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.

Objectives/hypothesis: To evaluate the usefulness of tongue-base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS).

Study Design: Long-term prospective case series.

Setting: University tertiary care medical center. Read More

Semin Respir Crit Care Med 2005 Feb;26(1):80-8

Stanford Sleep Disorders Clinic and Research Center, Stanford University, 1900 University Avenue #105, Palo Alto, CA 94303, USA.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review presents the current state of the art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiography, formulation of a surgical plan with selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes. Read More

Arch Otolaryngol Head Neck Surg 2005 Jul;131(7):626-9

Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, 78229-3900, USA.

Objective: To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region.

Design And Setting: Prospective case series at an academic medical center.

Patients: Twenty-six patients with an open excisional biopsy or a fine-needle aspiration biopsy finding that confirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. Read More

Sleep Med Rev 2005 Jun 9;9(3):201-9. Epub 2005 Apr 9.

Stanford Sleep Disorders Clinic and Research Center, 1900 University Avenue, Suite 105, East Palo Alto, CA 94303, USA.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes. Read More

Chest 2004 Apr;125(4):1265-9

Department of Pediatrics, University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, MA 01655, USA.

Study Objective: To evaluate the practice of using nasopharyngoscopy without routine fiberoptic bronchoscopy for children presenting to a pediatric pulmonary practice with nonspecific noisy breathing.

Design: Retrospective chart review. Records of patients who underwent nasopharyngoscopy between January 1, 1990, and December 31, 1999, were reviewed. Read More

Arch Otolaryngol Head Neck Surg 2003 Mar;129(3):305-9

Division of Pediatric Otolaryngology, Department of Otolaryngology, Columbus Children's Hospital, The Ohio State University College of Medicine and Public Health, USA.

Objective: To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor.

Design: Prospective study comparing direct laryngoscopy and bronchoscopy with nasopharyngoscopy, airway fluoroscopy, and plain films. Children with stridor or partial airway obstruction were evaluated by the Department of Otolaryngology at Columbus Children's Hospital, Columbus, Ohio. Read More

Am J Otolaryngol 2002 Nov-Dec;23(6):378-81

Department of Otolaryngology, Sleep Center, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kueishan, Taoyuan, Taiwan.

Obstructive sleep apnea is rarely caused by laryngomalacia in adult patients. To our knowledge, laryngomalacia secondary to osteogenesis imperfecta inducing obstructive sleep apnea has not been reported. We present an adult osteogenesis imperfecta patient with obstructive sleep apnea. Read More

J Oral Maxillofac Surg 2002 May;60(5):526-30; discussion 531

Stanford University Sleep Disorders and Research Center, Stanford, CA, USA.

Purpose: The study aim was to evaluate the resultant changes in the upper airway after maxillomandibular advancement (MMA) for obstructive sleep apnea.

Methods: Twelve patients were evaluated before and after MMA using fiberoptic nasopharyngoscopy (NPG) with Müller maneuver. An inspiratory force meter was used to ensure the consistency of the inspiratory efforts between the 2 examinations. Read More

Arch Otolaryngol Head Neck Surg 2002 Apr;128(4):435-40

Otorhinolaryngology Service, Hospital Clínic de Barcelona, C/ Villarroel 170, Barcelona 08036, Spain.

Objective: To evaluate the usefulness of uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea syndrome (OSAS).

Design: Prospective study of 20 consecutive patients with OSAS.

Setting: University medical center. Read More

J Oral Maxillofac Surg 2002 Mar;60(3):252-60; discussion 260-1

Oral and Maxillofacial Surgery, Charlotte, NC, USA.

Purpose: The purpose of the present study was to evaluate a clinically practical classification system for tongue-base narrowing and to assess intrarater and interrater reliability of the proposed system.

Patients And Methods: A population of 248 consecutive patients with polysomnographically proven upper airway obstructive pathology were evaluated (using the hypotonic method) for evidence of upper airway narrowing with the commonly available techniques of fiberoptic nasopharyngoscopy, clinical examination and lateral cephalometric analysis.

Results: Four basic patterns of tongue-base narrowing have been discerned to occur in awake adult patients with diagnosed obstructive upper airway pathology. Read More

Laryngoscope 2000 Dec;110(12):2016-9

Department of Otolaryngology, Long Island College Hospital, Brooklyn, New York, USA.

Background: Angioneurotic edema of the upper aerodigestive tract (AEUAT) often challenges the otolaryngologist with the decision of surgical intervention versus observation.

Objective: To develop a logical approach to the evaluation and management of the airway in patients with AEUAT, emphasizing fiberoptic examination (FOE) findings.

Methods: A computer-based retrospective review of all patients diagnosed with AEUAT was performed. Read More

Acta Otorrinolaringol Esp 2000 Jan-Feb;51(1):40-5

Servicio de ORL, Hospital Miguel Servet, Zaragoza, España.

Dynamic changes in the upper airway during sleep have been identified in patients with obstructive sleep apnea syndrome (OSAS). Fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM) has been advocated as a practical, clinically useful, preoperative dynamic diagnostic method for assessing the site of collapse. The value of FNMM in predicting response to uvulopalatopharyngoplasty (UPPP) was assessed in patients with obstructive sleep apnea syndrome. Read More

J Oral Maxillofac Surg 1999 Apr;57(4):382-5

Medical College of Virginia/Virginia Commonwealth University, Richmond, USA.

Purpose: The purpose of this study was to investigate the success of a staged surgical reconstruction of the upper airway for treatment of obstructive sleep apnea syndrome.

Patients And Methods: Thirty-five patients with obstructive sleep apnea syndrome documented by nocturnal polysomnography were treated surgically with a staged protocol for reconstruction of the upper airway. All patients were evaluated preoperatively by a history and physical examination, including fiberoptic nasopharyngoscopy, oropharyngoscopy, and hypopharyngoscopy; cephalometric analysis; and laboratory polysomnography. Read More

Otolaryngol Clin North Am 1998 Dec;31(6):979-1012

Stanford Sleep Disorders Clinic, Center of Excellence, Stanford University School of Medicine, Stanford, California, USA.

The etiology of sleep disordered breathing is collapse or obstruction of the upper airway during sleep. This obstruction may be localized to one or two areas or may encompass the entire upper airway passages to include the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The presurgical evaluation, which includes polysomnography, a comprehensive head and neck physical examination, fiberoptic nasopharyngoscopy, and lateral cephalometric analysis is essential in directing surgical therapy in a site specific approach. Read More

Radiology 1996 Nov;201(2):393-8

Department of Radiology, Tottori University School of Medicine, Yonago, Japan.

Purpose: To compare magnetic resonance (MR) imaging of the oropharynx in patients with sleep apnea syndrome with fiberoptic nasopharyngoscopy, and oropharyngeal pressure and apnea index values.

Materials And Methods: After sleep induction, 24 patients with sleep apnea syndrome and nine patients with non-sleep-apnea snoring underwent MR imaging and fiberoptic nasopharyngoscopy combined with subsequent measurement of oropharyngeal pressure. Patients were previously classified with apnea index values obtained at polysomnography. Read More

Radiologe 1996 Mar;36(3):245-53

Institut für Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universität München.

Functional imaging of the pharynx used to be the domain of cineradiography, CT and ultrafast CT. The development of modern MRI techniques led to new access to functional disorders of the pharynx. The aim of this study was to implement a new MRI technique to examine oropharyngeal obstructive mechanisms in patients with obstructive sleep apnea (OSA). Read More

Laryngoscope 1995 Mar;105(3 Pt 1):311-4

Thomas Jefferson University, Philadelphia, Pa. 19107.

The objective of this study was to assess the value of preoperative fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM) and cephalometric radiography in predicting response to uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome. Fifty-three such patients having significant obstruction at the soft palatal level and variable degrees of obstruction at the base-of-tongue level underwent both diagnostic procedures before UPPP. Outcome was assessed by the apnea-plus-hypopnea index (AHI) as determined by polysomnography, which was performed before and after surgery. Read More

J Fam Pract 1994 May;38(5):479-85

Riverside University Family Practice, Minneapolis, MN.

Background: Although office procedures that involve special training and office equipment are often performed by a specialist in an urban setting, they are increasingly being performed by family physicians in rural settings. This study documents the prevalence of four such procedures in rural family practice: flexible sigmoidoscopy, cardiac stress testing, colposcopy, and nasopharyngoscopy. Individual and community characteristics of physicians who perform each of the procedures are compared with those of physicians who do not. Read More

Diagn Ther Endosc 1994 ;1(2):63-8

Vanderbilt University Medical Center S-2100 Medical Center North Nashville Tennessee USA.

Nasopharyngeal cancer (NPC) is a unique disease with increasing interest for many physicians due to its unusual etiology, histology, and epidemiology. The recent era of fiberoptic endoscopy now provides the clinician with better tools for the screening, diagnosis, staging, and follow-up of NPC. The use of high resolution flexible and rigid nasopharyngoscopy gives the physician an opportunity for a more sensitive examination in a higher proportion of patients. Read More

Chest 1994 Jan;105(1):278-83

Seattle Sleep Disorders Center, Swedish Medical Center 98107-1507.

We prospectively studied nine patients with the obstructive sleep apnea (OSA) syndrome with polysomnography before and after combined (seven simultaneous and two sequential) uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement as treatment for OSA. All patients had failed to tolerate nasal continuous positive airway pressure and had a respiratory disturbance index (RDI) > or = 20. All patients were found to have disproportionate pharyngeal anatomy with airway narrowing by cephalometrograms and/or fiberoptic nasopharyngoscopy. Read More

Acta Otolaryngol 1993 Mar;113(2):206-9

Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway.

The site of obstruction in the upper aerodigestive tract in 20 snorers and/or patients with obstructive sleep apnea syndrome was determined by two methods: fiberoptic nasopharyngoscopy with the Müller manoeuvre and continuous, nocturnal pressure measurements in the upper aerodigestive tract supplemented with recording of O2 saturation and oro-nasal air-flow. Identical results were obtained by both methods in only 5 (25%) of the patients, whilst in 11 (55%) obstruction was recorded in the pharynx by the pressure method which could not be demonstrated by the Müller manoeuvre. The latter method is not sufficiently accurate and should no longer be used in the pre-treatment assessment of this group of patients. Read More

South Med J 1992 Jul;85(7):779-81

Department of Otolaryngology and Maxillofacial Surgery, University of Tennessee, Memphis 38163.

We have presented a case of laryngomalacia in an 18-year-old mentally retarded woman treated with epiglottoplasty. The preoperative and postoperative appearance of the larynx during aspiration was documented using video and still photography. Diagnosis was made by fiberoptic nasopharyngoscopy and laryngoscopy. Read More

Am Fam Physician 1992 May;45(5):2190-9

Harvard Community Health Plan of New England, Providence, Rhode Island.

An accurate history is essential to the diagnosis of chronic sinusitis. Patients classically present with several weeks of daily facial pain or pressure between the eyes, headache, nasal congestion, postnasal drip, ear pain or blockage, and fatigue. The headache in chronic sinusitis is usually worse in the morning and following head movement. Read More

Ann Otol Rhinol Laryngol 1992 May;101(5):417-22

Division of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia 30322.

Otitis media is almost universal in cleft palate patients, at least during infancy. A lesser cleft manifestation, the occult submucous cleft palate, is identifiable in living patients by surgical dissection or flexible fiberoptic nasopharyngoscopy. We addressed the hypothesis that an even more subtle form of submucous cleft palate, involving both an abnormal musculus levator veli palatini and an abnormal musculus uvulae, is associated with otitis media. Read More

Cleft Palate Craniofac J 1991 Oct;28(4):413-7; discussion 417-8

Department of Logopedics and Phoniatrics, Karolinska Institutet, Stockholm, Sweden.

The videofluoroscopic and nasopharyngoscopic observations of velopharyngeal movements during speech were compared in 80 subjects with hypernasal speech. An endviewing flexible fiberoptic endoscope was used for nasopharyngoscopic examination. This failed to demonstrate movements of the lateral pharyngeal walls that were videofluoroscopically documented in one third of the patients. Read More

Cancer 1991 Jan;67(2):434-9

Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital.

Five hundred sixty-four nasopharyngeal carcinomas (NPC), mostly of undifferentiated histologic type, were studied for survival, distant metastasis, and local recurrence. All had computerized tomography of the nasopharynx and skull base (CT-NP) and fiberoptic nasopharyngoscopy for evaluation of the primary tumor. Regional disease was assessed by palpation. Read More