European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 8, pp 2339–2343 | Cite as

Effects of Pillar implants for sleep-related breathing disorders on middle ear function

  • Hsin-Ching Lin
  • Michael Friedman
  • Hsueh-Wen Chang
  • Chi-Chih Lai
  • Chien-Hung Chin
  • Meng-Chih Lin
  • Thomas Pott
  • Christian Samuelson
Miscellaneous

Abstract

Pillar implants provide a reasonable outcome with minimal post-operative morbidity and complications in treating patients with sleep-disordered breathing (SDB) who had obvious palatal obstruction. The palatal structure is responsible for a normal functioning Eustachian tube; however, little is known if there is any potential otologic implication of minimally invasive palatal stiffening surgery for SDB. The aim of this study is to evaluate the effects of Pillar implantation on middle ear function. We performed a prospective study in a tertiary referral center. Thirty SDB patients (25 men, 5 women; mean age, 44.3 years) who underwent Pillar implants for treating palatal obstruction were enrolled. The subjects had normal otologic exam and no previous history of chronic ear disease. Pure-tone audiometry and tympanometry were performed pre-operatively, and post-operative days 1 and 7, and months 1 and 3. Baseline and post-operative middle ear pressures (MEPs) in decipascals were compared. Statistical analysis was performed by repeated measures of ANOVA. Eight patients (8/30, 26.7 %) reported otologic complaints such as ear pressure and/or otalgia within 1 week post-operatively. No permanent otologic discomfort occurred. A trend toward reduced MEP was noted in this study. The decrease in MEP became apparent on post-operative day 1 after surgery. However, mean pressure changes were no longer significantly different from pre-operative values by 1 week after surgery. Pillar implantation for SDB induces changes in middle ear function. However, the changes were temporary and not significant 1 week after surgery.

Keywords

Snoring Obstructive sleep apnea/hypopnea syndrome Pillar implant OSA surgery Eustachian tube Middle ear function 

References

  1. 1.
    Steward DL, Weaver EM, Woodson BT (2004) A comparison of radiofrequency treatment schemes for obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 130:579–585PubMedCrossRefGoogle Scholar
  2. 2.
    Farrar J, Ryan J, Oliver E et al (2008) Radiofrequency ablation for the treatment of obstructive sleep apnea: a meta-analysis. Laryngoscope 118:1878–1883PubMedCrossRefGoogle Scholar
  3. 3.
    Steward DL, Huntley TC, Woodson BT et al (2008) Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg 139:506–510PubMedCrossRefGoogle Scholar
  4. 4.
    Friedman M, Schalch P, Lin HC et al (2008) Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 138:209–216PubMedCrossRefGoogle Scholar
  5. 5.
    Nordgård S, Wormdal K, Bugten V et al (2004) Palatal implants: a new method for the treatment of snoring. Acta Otolaryngol 124:970–975PubMedCrossRefGoogle Scholar
  6. 6.
    Maurer JT, Sommer JU, Hein G et al (2012) Palatal implants in the treatment of obstructive sleep apnea: a randomised, placebo-controlled single-centre trial. Eur Arch Otorhinolaryngol 269:1851–1856PubMedGoogle Scholar
  7. 7.
    Friedman M, Lin HC, Gurpinar B et al (2007) Minimally invasive single-stage multilevel treatment for obstructive sleep apnea/hypopnea syndrome. Laryngoscope 117:1859–1863PubMedCrossRefGoogle Scholar
  8. 8.
    Gillespie MB, Wylie PE, Lee-Chiong T et al (2011) Effect of palatal implants on continuous positive airway pressure and compliance. Otolaryngol Head Neck Surg 144:230–236PubMedCrossRefGoogle Scholar
  9. 9.
    Nordgård S, Stene BK, Skjøstad KW (2006) Soft palate implants for the treatment of mild to moderate obstructive sleep apnea. Otolaryngol Head Neck Surg 134:565–570PubMedCrossRefGoogle Scholar
  10. 10.
    Saylam G, Korkmaz H, Firat H (2009) Do palatal implants really reduce snoring in long-term follow-up? Laryngoscope 119:1000–1004PubMedCrossRefGoogle Scholar
  11. 11.
    Friedman M, Tanyeri H, La Rosa M et al (1999) Clinical predictors of obstructive sleep apnea. Laryngoscope 109:1901–1907PubMedCrossRefGoogle Scholar
  12. 12.
    Friedman M, Soans R, Gurpinar B et al (2008) Interexaminer agreement of Friedman tongue positions for staging of obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 139:372–377PubMedCrossRefGoogle Scholar
  13. 13.
    Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: UCLA Brain Information Service, Brain Research InstituteGoogle Scholar
  14. 14.
    Kushida CA, Littner MR, Morgenthaler T et al (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28:499–521PubMedGoogle Scholar
  15. 15.
    American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of sleep medicine task force. Sleep 22:667–689Google Scholar
  16. 16.
    Friedman M, Vidyasagar R, Bliznikas D et al (2006) Patient selection and efficacy of Pillar implant technique for treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg 134:187–196PubMedCrossRefGoogle Scholar
  17. 17.
    Bluestone CD (2005) Eustachian tube: structure, function, role in otitis media. BC Decker Inc., Hamilton, Ontario, 41–44 and 124–125Google Scholar
  18. 18.
    Finkelstein Y, Talmi Y, Zohar Y et al (1987) Can uvulopalatopharyngoplasty be harmful to eustachian tube function? Acta Otolaryngol 104:511–520PubMedCrossRefGoogle Scholar
  19. 19.
    Marais J, Armstrong MW (1999) Effect of laser uvulopalatoplasty on middle ear function. Laryngoscope 109:1947–1949PubMedCrossRefGoogle Scholar
  20. 20.
    Lin HC, Friedman M, Chang HW et al (2011) Effects of obstructive sleep apnea surgery on middle ear function. Arch Otolaryngol Head Neck Surg 137:373–376PubMedCrossRefGoogle Scholar
  21. 21.
    Barsoumian R, Kuehn DP, Moon JB, Canady JW et al (1998) An anatomic study of the tensor veli palatini and dilator tubae muscles in relation to the eustachian tube and velar function. Cleft Palate Craniofac J 35:101–110PubMedCrossRefGoogle Scholar
  22. 22.
    Huang MH, Lee ST, Rajendran K (1997) A fresh cadaveric study of the paratubal muscles: implications for Eustachian tube function in cleft palate. Plast Reconstr Surg 100:833–842PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hsin-Ching Lin
    • 1
  • Michael Friedman
    • 2
    • 3
  • Hsueh-Wen Chang
    • 4
  • Chi-Chih Lai
    • 1
  • Chien-Hung Chin
    • 5
  • Meng-Chih Lin
    • 5
  • Thomas Pott
    • 3
  • Christian Samuelson
    • 3
  1. 1.Department of OtolaryngologySleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung CityTaiwan
  2. 2.Department of Otolaryngology-Head and Neck SurgeryRush University Medical CenterChicagoUSA
  3. 3.Department of OtolaryngologyAdvanced Center for Specialty Care, Advocate Illinois Masonic Medical CenterChicagoUSA
  4. 4.Department of Biological SciencesNational Sun Yat-Sen UniversityKaohsiungTaiwan
  5. 5.Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Sleep CenterKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan

Personalised recommendations