Bansberg, Stephen F.

Abstract Introduction Hypoglossal nerve stimulators (HGNS) are used in patients with moderate-to-severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy. However, a subgroup of patients fail to achieve resolution of OSA with HGNS alone. Previous studies have shown that lower BMI, lower nadir oxygenation, decreased sleep latency, and higher VOTE score on drug-induced sleep endoscopy (DISE) predict better treatment outcome. We hypothesize that baseline diagnostic polysomnography (PSG) may further predict which patients will achieve successful therapeutic outcome with HGNS therapy. Methods We conducted a retrospective analysis of all adult patients who underwent HGNS implantation at Mayo Clinic Arizona between 2019-2025 and had a pre-implantation diagnostic PSG available for review. Treatment success was defined by Sher Criteria: >50% reduction in post-treatment apnea hypopnea index (AHI) to a final AHI of < 20/hr. Responders met Sher criteria and non-responders did not meet Sher criteria. Demographics, sleep questionnaire results, PSG variables, and VOTE score on DISE were collected and analyzed using Spearman’s rank correlation of reduction in AHI. Results Twenty-three patients (11M/12F, median age: 69[IQR:64,75] years) met inclusion criteria. Median baseline AHI was 24[IQR:19,37]/hr. Median post-implant AHI was 8 [IQR:3, 14]/hr. Responders (n=15, 65%) and non-responders (n=8, 35%) demonstrated median post-implant AHI of 4.5[IQR:2.3,7.3]/hr and 15.7[IQR:12.3,28.5]/hr, respectively. Treatment response was associated with less time with SpO2 < 88% (T88%) (21min [IQR:3,64] vs. 73[IQR:36,105mins]; p=0.023) and higher central apnea index (CAI) (1[IQR:0.1,3] vs. 0[IQR:0,1], p=0.03) on pre-implantation PSG. Conclusion In this small cohort of OSA patients, less nocturnal hypoxemia as defined by T88% and higher baseline central apnea index were predictors of better treatment response to HGNS therapy as measured by Sher criteria. We hypothesize that greater nocturnal hypoxemia likely reflects more severe airway obstruction during sleep. Our analysis also showed that responders had higher baseline CAI than non-responders, however we believe this association is not clinically significant and likely driven by one outlier (CAI 13/hr). Further analysis in a larger HGNS cohort is needed to confirm these findings. Data enrichment efforts and more sophisticated analyses are underway. Support (if any)

ABSTRACT Objective Surgical repair and 3D‐printed customized septal prosthesis (3D‐PCSP) are options for septal perforation treatment. We performed a study to compare the clinical outcomes of surgery and 3D‐PCSP using the NOSE‐Perf Scale (NPfS). Methods A chart review was performed on patients undergoing surgical repair or 3D‐PCSP placement between January 2018 and July 2024. The change in NPfS was used as primary endpoint. Demographics, ASA score, perforation size, etiology, and follow‐up duration were reported. Results Thirty‐five patients, 23 for surgical repairs and 12 for 3D‐PCSP, were included in this review [median (IQR)]. In the surgical repair group, perforation length and height measured 12 (10–18) mm and 10 (8–15) mm, respectively. Baseline NPfS was 24 (16–32), and this decreased to 8 (6–13) following surgical repair ( p < 0.001). Follow‐up time was 12 (5–21) months. In the 3D‐PCSP group, septal perforation length and height measured 25 (15–30) mm and 17 (15–20) mm, respectively. The baseline NPfS was 17 (3–24.5), and this decreased to 9.5 (7–13) following 3D‐PCSP placement ( p = 0.001). The follow‐up was 18.4 (16–23) months. NPfS reduction was greater for surgical repair ( p = 0.018). Conclusions Surgery and 3D‐PCSP offer meaningful symptom relief for NSP patients. Treatment decisions should be individualized through shared decision‐making that considers patient comorbidities, preferences, surgeon experience, and risk tolerance. In this cohort, surgical repair was associated with greater NPfS reduction compared with 3D‐PCSP placement. Level of Evidence 3.

ABSTRACT Objectives To review septal perforation management and outcomes in patients with hereditary hemorrhagic telangiectasia (HHT). Methods Collection and presentation of patient demographic, perforation size, and prior perforation and HHT treatment data over a 20‐year period. Symptom and quality of life treatment outcomes were determined using the Nasal Obstruction Symptom Evaluation (NOSE)‐Perf scale and the 5‐Factor Glasgow Inventory (GBI‐5F), respectively, in patients treated since 2017. Results Nine patients met study criteria. Mean (range) age was 64.4 (52–80) years and seven were biological males. Mean (range) perforation length and height were 1.9 (1.2–2.6) and 1.4 (1.0–1.8) cm. Four patients were treated with a customized septal button, one with posterior septal resection, and four with endonasal bilateral mucosal flap repair supported with an interposition graft. The button prostheses were well tolerated and the surgical closures successful at 8–60 months postoperatively. Subjective responses in the first three patients, and NOSE‐Perf with GBI‐5F scores in the latter six patients, demonstrated symptom and quality of life improvement for all patients. Perforation repair patients demonstrated substantial improvement in mean GBI‐5F subdomain scores for quality of life, self‐confidence, and social involvement and all have undergone sodium tetradecyl sclerotherapy injection postoperatively without re‐perforation. Conclusion Symptom and quality of life improvement can be achieved in HHT patients with a perforation using customized septal buttons, posterior septal resection, or bilateral flap surgical repair. Surgical closure combined with injection sclerotherapy is feasible with a low risk of re‐perforation and represents an effective treatment strategy in selected patients. Level of Evidence 4.

ABSTRACTObjectivesSaddle nose deformity (SND) can be associated with nasal septal perforation (NSP). Both SND and NSP are observed in granulomatosis with polyangiitis (GPA) patients. This study aimed to compare the prevalence and severity of SND in GPA vs. non‐GPA patients with NSP.MethodologyNSP patients who visited tertiary rhinology or facial plastic surgery clinics from January 2010 through December 2023 were grouped into GPA and non‐GPA cohorts. The area of NSP, SND incidence, and SND severity (Daniel and Brenner's classification) were compared between the cohorts.ResultsOf 168 patients identified with NSP, 18 had GPA and 150 had non‐GPA diagnoses. Twelve GPA patients and 10 non‐GPA patients had SND. The odds ratio for SND association in GPA patients with NSP vs. non‐GPA patients was 31.3 (95% CI: 9.5–102.9), and 19.4 (95% CI: 4.3–87.7) after controlling for the NSP area. GPA patients with SND had a larger NSP area (median 670 mm2, IQR: 315.5–1061.3) compared to non‐GPA patients with SND (175.3 mm2, 113.1–204.1; p < 0.001). The severity of SND was similar between GPA and the non‐GPA group (p = 0.09). The area of NSP did not predict the severity of SND (p = 0.17).ConclusionGPA diagnosis was associated with larger NSPs and a higher risk of SND compared to non‐GPA etiologies; however, the severity of saddling did not differ between GPA and non‐GPA etiologies. GPA is an independent risk factor associated with SND irrespective of the size of septal perforation. The NSP area did not predict the severity of SND.Level of Evidence: 4.

Objectives/Hypothesis: Botulinum neurotoxin type-A (BoNT-A) injection into the true vocal cords is an effective treatment for restoring vocal functionality in adductor spasmodic dysphonia (AdSD). The Glasgow Benefit Inventory was developed to measure quality of life change following any otolaryngologic intervention and was recently revised to a 5-factor subdomain (GBI-5F) questionnaire to improve clinical utility. The study aim was to utilize the GBI-5F to measure patient-reported quality of life change in AdSD patients following BoNT-A injection. Methods: The GBI-5F questionnaire was administered to patients diagnosed with AdSD who received a BoNT-A vocal cord injection between December 2022 and May 2023. All patients had received multiple prior injections. GBI-5F subdomains and demographics were analyzed to identify areas for patient-reported improvement. Results: Sixty-six patients completed the GBI-5F. There were 52 (78.7%) females and average age was 69.4 years. The median total benefit score was +40.0 (interquartile range [IQR], 20.0). Median subdomain scores were +83.3 (IQR, 50.0) for quality of life, +50.0 (IQR, 50.0) for self-confidence, +33.3 (IQR, 33.3) for social involvement, +16.7 (IQR, 50.0) for support, and 0.0 (IQR, 16.7) for general health. Differences in the individual subdomain scores were statistically significant ( P < .0001). No significant differences were found in the total GBI-5F score or any subdomain according to sex or presence of vocal tremor (all P > .05). A moderately positive correlation was noted between median total score and percent functional improvement (r = 0.46, P < .001). Conclusion: Botulinum injection therapy for AdSD provides overall benefit to patients as measured by the GBI-5F, with particular improvement observed for perceived quality of life, self-confidence, and social involvement. Sex, presence/absence of vocal tremor, and age do not appear to modify benefit, though degree of functional improvement is positively correlated with total score.

AbstractObjectivePrevious studies synthesizing published data on nasal septal perforation (NSP) repair outcomes have cited the lack of standardization in evaluation and data reporting. The heterogeneity of this literature base limits the quality of available evidence and precludes intercomparison. The aim of this study is to quantitatively characterize trends in NSP evaluation and reporting and identify areas for improvement.Data SourcesPubMed, Scopus, and Web of Science.Review MethodsA comprehensive review of the literature published from 2012 through 2024 investigating NSP repair techniques was conducted, and perforation evaluation and outcome reporting were characterized and compared between contemporary and older cohorts.ConclusionsOutcomes of NSP repair are increasingly studied. The heterogeneity of current literature concerning the evaluation of perforations and the reporting of outcomes precludes high‐quality comparative analyses of outcomes across separate studies. This review demonstrated a lack of progress towards greater standardization over the last 12 years. There remains room for improvement in regard to the evaluation and reporting of etiology, defect size, symptomatology, and objective outcome of repair, allowing for adequate duration of follow‐up.Implications for PracticeThere are many inconsistencies in the collection, organization, and analysis of data implicated in investigations of NSP repair outcomes. The development and agreement upon consensus practice guidelines would engender greater standardization among the evaluation and assessment of treatment outcomes. Based on this review and our institutional experiences, we propose specific measures that would facilitate higher‐quality future research and advance the practice of perforation management.

Abstract Background Central sleep apnea (CSA) is characterized by recurrent central apneas during sleep and obstructive sleep apnea (OSA) is characterized by recurrent apneas during sleep due to upper airway obstruction. While OSA may be treated surgically, soft tissue surgery is not considered for treatment of CSA. Case Presentation We present the case of a patient with severe CSA with an Apnea/Hypopnea Index (AHI) of 122 and a central apnea index (CAI) of 74 who experienced complete resolution of CSA following tonsillectomy and expansion pharyngoplasty. Conclusions Although there is significant overlap between OSA and CSA, this is the first report of resolution of CSA following soft tissue surgical intervention in an adult. This suggests an unusual underlying pathophysiology, possibly post-arousal in nature.