Explore the vast range of titles available.

Oral appliances (OAs) are commonly used as an alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea (OSA). However, OAs have variable success at reducing the apnea-hypopnea index (AHI), and predicting responders is challenging. Understanding this variability may lie with the recognition that OSA is a multifactorial disorder and that OAs may affect more than just upper-airway anatomy/collapsibility. The objectives of this study were to determine how OA alters AHI and four phenotypic traits (upper-airway anatomy/collapsibility and muscle function, loop gain, and arousal threshold), and baseline predictors of which patients gain the greatest benefit from therapy. In a randomized crossover study, 14 patients with OSA attended two sleep studies with and without their OA. Under each condition, AHI and the phenotypic traits were assessed. Multiple linear regression was used to determine independent predictors of the reduction in AHI. OA therapy reduced the AHI (30 ± 5 vs. 11 ± 2 events/h; P < 0.05), which was driven by improvements in upper-airway anatomy/collapsibility under passive (1.9 ± 0.7 vs. 4.7 ± 0.6 L/min; P < 0.005) and active conditions (2.4 ± 0.9 vs. 6.2 ± 0.4 L/min; P < 0.001). No changes were seen in muscle function, loop gain, or the arousal threshold. Using multivariate analysis, baseline passive upper-airway collapsibility and loop gain were independent predictors of the reduction in AHI (r  = 0.70; P = 0.001). Our findings suggest that OA therapy improves the upper-airway collapsibility under passive and active conditions. Importantly, a greater response to therapy occurred in those patients with a mild anatomic compromise and a lower loop gain.

Abstract Study Objectives Recent findings indicate that noradrenergic and antimuscarinic processes are crucial for sleep-related reductions in pharyngeal muscle activity. However, there are few human studies. Accordingly, this study aimed to determine if a combined noradrenergic and antimuscarinic intervention increases pharyngeal dilator muscle activity and improves airway function in sleeping humans. Methods Genioglossus (GG) and tensor palatini electromyography (EMG), pharyngeal pressure, upper airway resistance, and breathing parameters were acquired in 10 healthy adults (5 female) during two overnight sleep studies after 4 mg of reboxetine (REB) plus 20 mg of hyoscine butylbromide (HBB) or placebo using a double-blind, placebo-controlled, randomized, cross-over design. Results Compared with placebo, peak and tonic GG EMG were lower (Mean ± SD: 83 ± 73 vs. 130 ± 75, p = 0.021 and 102 ± 102 vs. 147 ± 123 % wakefulness, p = 0.021, respectively) but the sleep-related reduction in tensor palatini was less (Median [25th, 75th centiles]: 53[45, 62] vs. 34[28, 38] % wakefulness, p = 0.008) with the drug combination during nonrapid eye movement (non-REM) sleep. These changes were accompanied by improved upper airway function including reduced pharyngeal pressure swings, airway resistance, respiratory load compensation, and increased breathing frequency during N2. REB and HBB significantly reduced rapid eye movement sleep compared with placebo (0.6 ± 1.1 vs. 14.5 ± 6.8 % total sleep time, p < 0.001). Conclusions Contrary to our hypothesis, GG muscle activity (% wakefulness) during non-REM sleep was lower with REB and HBB. However, sleep-related reductions in tensor palatini activity were less and upper airway function improved. These findings provide mechanistic insight into the role of noradrenergic and antimuscarinic processes on upper airway function in humans and have therapeutic potential for obstructive sleep apnea. Clinical Trial Registration Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au, trial ID: ACTRN12616000469415.

The assessment of pharyngeal residues during fiberoptic endoscopic evaluation of swallowing (FEES) is based on visual-perceptual scales that involve clinical subjectivity. Training might be helpful to increase agreement among clinicians. This paper aims to assess the efficacy of training for the assessment of pharyngeal residue in FEES frames and videos through the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Twenty-nine clinicians (Phoniatricians, Otorhinolaryngologists, Speech and Language Pathologists) and 47 students in Speech and Language Pathology participated in this study. Fourteen clinicians were randomly allocated to the training group, whilst the remaining 15 served as a control group; all the students participated in the training. Participants scored 30 pairs of videos and frames using the YPRSRS twice, before and after the training for the training groups and at least two weeks apart for the control group. Construct validity, defined as the agreement between each rater and the experts’ scores, and inter-rater reliability were compared among the groups and between the first and the second assessments to verify the efficacy of the training. Construct validity significantly improved at the second assessment in the training group for the pyriform sinuses videos (baseline 0.71 ± 0.04, post-training 0.82 ± 0.05, p  = .049) and in the students’ group for the valleculae (baseline 0.64 ± 0.02, post-training 0.84 ± 0.02, p  < .001) and pyriform sinuses videos (baseline 0.55 ± 0.03, post-training 0.77 ± 0.02, p  < .05). No significant differences were found in the inter-rater reliability in any group. In conclusion, the training seems to improve participants’ agreement with experts in scoring the YPRSRS in FEES videos.

Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized cone beam computed tomography (CIBT) for a three-dimensional (3D) analysis of airway changes, comparing the results with those of a control group consisting of untreated skeletal Class III patients. Materials and Methods: The study included 60 participants (34 boys, 26 girls) aged 9 to 14 years, all diagnosed with skeletal Class III malocclusion due to maxillary underdevelopment. The participants were divided into four treatment groups, each consisting of 15 individuals: Group 1—RME; Group 2—RME/FM; Group 3—FM; Group 4—Control group. The pharyngeal airway measurements were evaluated using CBCT and analyzed with Dolphin 3D software (version 11.9). Volumetric parameters and minimal axial area (MAA) were measured in the nasopharyngeal, retropalatal, retroglossal, and total airway regions. The collected data were statistically analyzed using SPSS 20.0 software. Results: The results indicated significant changes in pharyngeal airway volumes across all treatment groups compared to the control group. A statistically significant increase in nasopharyngeal, retropalatal, and total airway volume were observed in all treatment groups. Only the RME group demonstrated a significant increase in retroglossal volume. Significant increases in MAA were found in the RME/FM and FM groups in the nasopharyngeal and retropalatal regions. However, minimal changes were observed in the retroglossal region across all treatment groups. The control group showed no significant changes in any of the measured parameters, underscoring the effects of the treatments. Conclusions: The findings of this study suggest that both RME and/or FM treatments result in significant positive changes in the pharyngeal airways, particularly in the nasopharyngeal and retropalatal regions. The retroglossal region showed more limited response to the treatments. The combined RME/FM therapy was found to be particularly effective in improving airway dimensions in the anterior and mid-pharyngeal regions. These results highlight that early orthodontic interventions, such as RME and FM, can improve both airway patency and overall respiratory function, in addition to addressing skeletal Class III malocclusion.

To investigate whether uvulopalatopharyngoplasty (UPPP) improves sleep quality in patients with obstructive sleep apnea (OSA) using the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Karolinska Sleep Questionnaire (KSQ). Randomized controlled trial used to compare modified UPPP with controls at baseline and after 6 months. The controls received delayed surgery and a 6-month postoperative follow-up. All operated patients were offered a 24-month follow-up. At each follow-up, patients underwent polysomnography and vigilance testing and completed questionnaires. Nine scales were evaluated: five subscales and the total score in the FOSQ and three subscales in the KSQ. Sixty-five patients, mean 42.3 years (SD 11.5), Friedman stage I and II, body mass index < 36 kg/m2, and moderate-to-severe OSA, were randomized to intervention (n = 32) or control (n = 33). In the FOSQ and in the KSQ, the mean rate of missing values was 6.2% (range 0%-19%) and 20.5% (3%-38%), respectively. In 8 of 9 scales, significant differences were observed between the groups in favor of UPPP. There were significant correlations between results from the questionnaires and objective measures from polysomnography and the vigilance test. At the 6- and 24-month postoperative follow-ups, eight of nine scales were significantly improved compared with baseline. In selected patients with OSA, subjective sleep quality was significantly improved 6 months after UPPP compared with controls, with stable improvements 24 months postoperatively. The correlations between subjective and objective outcomes and the long-term stability suggest a beneficial effect from surgery, although a placebo effect cannot be excluded. NCT01659671. http://www.clinicaltrials.gov.

Objective: To evaluate the safety of fiberoptic endoscopic evaluation of swallowing (FEES) and the reliability of both FEES and a videofluoroscopic swallowing study (VFSS) in identifying laryngeal penetration and tracheal aspiration in infants under 3 months old in the neonatal intensive care unit (NICU). Study Design: Twenty-five infants at least 37 weeks postmenstrual age suspected of aspirating were assessed with FEES and VFSS. Complications, autonomic instability and vital signs before endoscope insertion and following FEES were documented. Blinded video recordings were coded by two reviewers to determine reliability. Results: We found no major complications or significant differences between FEES prefeeding and postfeeding vital signs, including respiratory rate, heart rate or oxygen saturation. FEES interrater reliability was 80% for both penetration and aspiration, compared with 87 and 90%, respectively, for VFSS. Conclusion: FEES is safe and reliable in assessing laryngeal penetration and tracheal aspiration in NICU infants.

Purpose: This article investigated the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. Method: A within-subject experimental design was used with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. Results: Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. Conclusions: The results of this study suggest that use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore, therapeutic activities used to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical effect on swallow function for individuals with head and neck cancer.

This article describes a retrospective analysis of functional outcome, time in therapy, and cost per unit of functional change in patients who received therapy for pharyngeal dysphagia. Twenty-five patients presenting dysphagia following stroke and 20 patients with dysphagia following treatment for head/neck cancer completed a systematic therapy program supplemented with surface electromyographic (sEMG) biofeedback. Eighty-seven percent (39/45) of all patients increased their functional oral intake of food/liquid including 92% of stroke patients and 80% of head/neck cancer patients. Patients with dysphagia following stroke demonstrated greater improvement than those in the head/neck cancer group. Patients in the stroke group completed more therapy sessions thus increasing the total cost of therapy, but they made more functional progress resulting in lower costs per unit of functional change than patients in the head/neck cancer group. Limitations of this study are described in reference to implications for future clinical research on the efficacy of this therapy approach.

Traditional sound sources and sound detectors are usually independent and discrete in the human hearing range. To minimize the device size and integrate it with wearable electronics, there is an urgent requirement of realizing the functional integration of generating and detecting sound in a single device. Here we show an intelligent laser-induced graphene artificial throat, which can not only generate sound but also detect sound in a single device. More importantly, the intelligent artificial throat will significantly assist for the disabled, because the simple throat vibrations such as hum, cough and scream with different intensity or frequency from a mute person can be detected and converted into controllable sounds. Furthermore, the laser-induced graphene artificial throat has the advantage of one-step fabrication, high efficiency, excellent flexibility and low cost, and it will open practical applications in voice control, wearable electronics and many other areas. The functional integration of sound generation and detection on a single device is required to assist mute people. Here, the authors demonstrate a graphene-based artificial throat capable of detecting and converting diverse throat vibrations into meaningful sound within a single device.

To examine dose-dependent effects of mandibular advancement on collapsibility of the passive pharynx and sleep-disordered breathing (SDB). Prospective, randomized study. University hospital. Thirty-seven adult patients with SDB. Oral appliances with 2-, 4-, and 6-mm advancement of the mandible. Overnight oximetry was performed with and without oral appliances. Each 2-mm mandibular advancement coincided with approximately 20% improvement in number and severity of nocturnal desaturations. Percentages of patients producing a > 50% improvement rate of the number of desaturations were 25%, 48%, and 65% with use of oral appliances with 2-, 4-, and 6-mm mandibular advancement, respectively. Static pharyngeal mechanics were evaluated in six completely paralyzed patients with SDB under general anesthesia with and without the oral appliances. Advancement of mandibular position was found to produce dose-dependent closing pressure reduction of all pharyngeal segments. Normalization of nocturnal oxygenation was associated with negative closing pressure, especially at the velopharynx. We conclude that improvement of both nocturnal oxygenation and pharyngeal collapsibility significantly depends on the mandibular position.