Abstract

Background: The curative impact of nasal surgery on patients undergoing septal and turbinate surgery for obstructive sleep apnea (OSA) has been minimal. New models of nasal airflow have shed important light on key functional elements of nasal obstruction, including the middle meatus and swell body. Based on this information, we evaluated middle meatal and nasal surgery targeting areas of maximum nasal airflow as treatment for patients with OSA.

Methods: An IRB-approved prospective study included consecutive adult patients with the diagnosis of OSA who underwent nasal surgery by a single rhinologic surgeon during a 36-month period. Surgery included: uncinectomy, anterior ethmoidectomy, reduction of concha bullosa, endoscopic septoplasty, radiofrequency ablation of the inferior turbinate and septal swell body, and nasal valve repair. The primary outcome measure was change in apnea-hypopnea index (AHI). Additional outcome measures included change in Epworth Sleepiness Score (ESS), body mass index and oxygen-saturation (O₂)-nadir.

Results: 43 patients were enrolled with pre- and postoperative polysomnography results. Average preoperative AHI was 31.2; Range 8.3 - 97 to postoperative mean of 16.4; Range 0.3 - 79.2 (n = 42; p < 0.0001). Average ESS was reduced from 12 to 4.2. O₂-nadir and BMI remained stable (∆ O₂-nadir -0.1; ∆BMI 0.2). Absolute cure rate = 37.2%, Surgical cure rate = 46.5%. No surgical complications occurred.

Conclusion: Targeted middle meatal surgery, swell body ablation, and nasal valve repair, concurrent with septal and inferior turbinate surgery, further optimizes nasal surgery for OSA. Our surgical protocol demonstrates significant reduction in AHI and ESS for patients with OSA regardless of BMI.

Keywords: Obstructive Sleep Apnea; Nasal Airflow Dynamics; Nasal Obstruction; Nasal Surgery; Nasal Valve

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Citation

Citation: Peter J Catalano., et al. “Middle Meatal and Nasal Surgery for Obstructive Sleep Apnea: An Effective New Paradigm for Reducing the Apnea-Hypopnea Index". Acta Scientific Otolaryngology 2.10 (2020): 37-43.

Copyright

Copyright: © 2020 Peter J Catalano., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.