中田 誠一

気管切開人工呼吸中の神経疾患患者6例で、短時間腹臥位(1日1回、30〜45分)を約3年間連日施行し、腹臥位を施行しない6例と1対1の比で、急性中耳炎の発生の有無を比較した(予備的介入試験)。急性中耳炎は腹臥位患者の1人で2回、腹臥位を行わなかった患者の4人で延べ7回発生し、腹臥位が急性中耳炎の発生を有意に減らした(p=0.046)。急性中耳炎は気管切開下人工呼吸中にしばしばみられる合併症であるが、腹臥位による口腔や鼻咽頭の即効的なドレナージ効果はケアに利用できるかもしれない。(著者抄録)

Objective: To investigate the contributions of adenoid and tonsil sizes to obstructive sleep apnea syndrome (OSAS) in normal-weight children in two age categories: preschool and schoolchildren. Methods: Fifty-eight normal-weight (body mass index z-score < 2) symptomatic children with OSAS (apnea-hypopnea index >= 2) were evaluated. The patients were divided into two age categories: preschool (age < 6; n = 33) and schoolchildren (age >= 6; n = 25). Polysomnographic findings and adenoid and tonsil sizes were compared. The relative contributions of body mass index and adenoid and tonsil sizes were also investigated with a regression analysis. Results: Adenoid grade and apnea index correlated significantly in preschool children (r = 0.45, p < 0.01). On regression analysis, adenoid grade was a significant predictor of the apnea index in preschool children. The influence of adenoid hypertrophy decreased from preschool to schoolchildren. Tonsil size had little influence on the apnea index in either group. Conclusion: Adenoid hypertrophy was a major contributor to OSAS in normal-weight preschool children. The upper airway morphology of younger children with OSAS differed from that of older children with OSAS. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Conclusion: Persistent obstructive sleep apnoea syndrome (OSAS) occurs in approximately 20% of normal-weight children after adenotonsillectomy (T&A) and, in nearly 70% of them, it is caused by adenoid regrowth. Patients with severe or moderate OSAS showed a high incidence of persistent disease even after T&A. Allergic disease, severity and large adenoid size are associated with adenoid regrowth and persistent disease. Objectives: To investigate factors contributing to persistent OSAS and adenoid regrowth after T&A in normal-weight children. Methods: This was a prospective, observational study at a single institute and involved 49 normal-weight children with severe or moderate OSAS (apnoea-hypopnoea index, AHI, >= 5) who underwent T&A. Background information, nasal endoscopic data and pre- and postoperative polysomnographic data were collected. A third polysomnography (PSG) was performed 1.5 year postoperatively in children who subsequently developed symptoms of sleep disturbance. Results: Thirteen children (27%, 13/49) were symptomatic 1.5 years after T&A. Allergic rhinitis (38.5% vs 11.1%, p = 0.03) and allergic disease (69.2% vs 30.6%, p = 0.02) were seen more frequently in these children. A third PSG confirmed persistent disease (AHI >= 5) in nine children (18.4%, 9/49). Six children (12.2%, 6/49) were diagnosed as having adenoid regrowth and three (6.1%, 3/49) underwent revision adenoidectomy.

Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index a parts per thousand yen5/h or Cheyne-Stokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial. Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea-hypopnea index a parts per thousand yen15/h (age 51.4 +/- 13.3 years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients. Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n = 38) and the CompSAS patients (CompSAS group, n = 5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30 +/- 0.10 vs. 0.19 +/- 0.07 Pa/cm(3)/s, P = 0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF. CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS.

Objectives: To investigate the pharyngeal morphologic features and its pathogenic role on obstructive sleep apnoea syndrome in the elderly population. Design: Prospective controlled, comparative cohort study. Setting: Territory referral centre. Participants: We enroled 320 consecutive patients with complaints of snoring who visited Nagoya University Hospital from January 2004 to December 2007. We also collected 26 control subjects aged over 60 years from community-dwelling people. Main outcome measures: We underwent a morphological evaluation, measurement of nasal resistance, assessment of daytime sleepiness and nocturnal polysomnography. Results and conclusions: Two hundred and ninety-two patients were analysed. The constitution ratio of men, the body mass index and Epworth sleepiness scale were decreased with ageing. Tonsil size was reduced progressively with ageing. Retroglossal space was wider, and soft palate was lower in >= 60 year group than in < 40 year group. Retroglossal space was wide in elderly patients with sleep apnoea compared with control subjects. Tonsil size was not correlated to apnoea/hypopnoea index in >= 60 year group unlike the other generations. Modified Mallampati Score and tongue size were significantly but mildly correlated only in >= 60 year group. Width of fauces was correlated in all the groups. Multiple regression analysis showed that body mass index, age, gender, tonsil size and width of fauces were independent factors for apnoea/hypopnoea index. Conclusions: Morphologically, the tonsil could play a minor role but the width of fauces could play relatively a major role. Additionally, wide retroglossal space, low positional soft palate and large tongue size may be characteristics for elderly patients of obstructive sleep apnoea syndrome.

Conclusion: Among patients with facial nerve paralysis, significant difference was observed on three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) between those with and without audio-vestibular disturbance. This MRI technique may contribute to elucidation of the pathology of Ramsay Hunt syndrome and Bell's palsy. Objective: To evaluate the 3D-FLAIR MRI findings in patients who have facial nerve paralysis with and without audio-vestibular disturbance. Methods: 3D-FLAIR MRI was performed with and without gadolinium enhancement in 15 patients (5 men and 10 women) with unilateral facial nerve paralysis: 3 patients with Ramsay Hunt syndrome, 3 patients having facial nerve paralysis with hearing loss or vertigo without vesicles, and 9 patients with Bell's palsy. Results: Five of the six patients with audio-vestibular disturbance showed high signals in the inner ear on precontrast 3D-FLAIR. In comparison, among nine patients with Bell's palsy, only one patient showed high signals in the inner ear on precontrast 3D-FLAIR (p < 0.05).</.

Objective: To review previous reports and to discuss the management of branching polycystic and giant thyroglossal duct cysts. Case report: We present two cases of thyroglossal duct cyst: one a branching, polycystic thyroglossal duct cyst in an 11-year-old boy, and the other a giant thyroglossal cyst in a 41-year-old man. Such cysts are rare. Both patients were operated upon according to the methods of Sistrunk and Horisawa, and both had a satisfactory post-operative course. Discussion: We discuss the most important aspects of such cyst removal procedures. Conclusion: Our experience suggests that surgery to remove an anomalous thyroglossal duct cyst should be performed using a technique based on the anatomy of the hyoid bone region.

Background: The role of increased nasal resistance in obstructive sleep apnea syndrome (OSAS) remains controversial. The aim of this study was to examine the pathogenetic role of nasal obstruction in obese patients with OSAS. Methods: Patients with OSAS (n = 125) at a university hospital were divided into three groups according to body mass index (BMI): nonobese (BMI < 25 kg/m(2)), mildly obese (25 kg/m(2) <= BMI < 30 kg/m(2)), and obese (BMI >= 30 kg/m(2)). The subjects underwent nasopharyngoscopy, measurement of nasal resistance, and polysomnography. Results: We studied 42 nonobese, 47 mildly obese, and 36 obese patients with OSAS. Among the obese, but not the nonobese and mildly obese patients, we found significant correlations between the oxygen desaturation index (ODI) and bilateral nasal resistance (BNR; r = 0.412; p = 0.013), between the ODI and unilateral higher nasal resistance (UHNR; r = 0.413; p = 0.012), and between the apnea index anti UHNR (r = 0.334; p = 0.046). Multiple regression analysis incorporating all patients showed that BMI (p < 0.001) and BNR (p = 0.033) were independently related to the ODI. Conclusion: In obese patients with OSAS, increased nasal resistance could play an important pathogenetic role in hypoxemic apnea. (Am J Rhinol Allergy 24, 51-54, 2010; doi: 10.2500/ajra.2010.24.3382)