METHODOLOGY: This is a descriptive cross-sectional study at the Sleep Clinic, Department of Otorhinolaryngology-Head and Neck Surgery. Flexible nasopharyngolaryngoscopy was performed in seated erect and supine position. Retropalatal and retroglossal regions were continuously recorded during quiet breathing and Mueller's maneuver in both positions. Captured images were measured using Scion Image software and narrowing rate was calculated. Level of each site was classified based on Fujita classification and severity of obstruction using Sher scoring system for Mueller's maneuver.
RESULTS: A total of 59 patients participated in this study. Twenty-nine (49.2%) participants had type 1 (retropalatal) obstruction, 23 (38.9%) had type 2 (retropalatal and retroglossal), and seven (11.9%) in type 3 (retroglossal) obstruction. Fifty (84.7%) of the patients have severe obstruction at the retropalatal region in supine position (SRP) followed by 35 (59.3%) at retropalatal region in erect position (ERP), 27 (45.8%) at retroglossal region in supine position (SRG) and eight (13.5%) at retroglossal region in erect position (ERG). The average oxygen saturation showed significant association in ERP (P = 0.012) and SRP (P < 0.001), but not significant in ERG and SRG.
CONCLUSIONS: Videoendoscopy utilizing flexible nasopharyngolaryngoscopy and Scion Image software is reliable, minimally invasive, and useful as an office procedure in evaluating the multilevel obstruction of upper airway in OSA patients. The retropalatal region has more severe obstruction compared with retroglossal region either in erect or supine position.
DESIGN: Cross-sectional study.
METHODS: All adult patients with patent osteotomies post-external dacryocystorhinostomy (Ex-DCR) or post-endoscopic dacryocystorhinostomy (EDCR) for NLDO were included in this cross-sectional investigation. Patients with dry eye and endoscopically unidentified osteotomy sites were excluded from the study. The FDDT grade, EDTT and lacrimal symptom questionnaire (Lac-Q) scores were documented for all patients.
RESULTS: This study included 39 patients. Nineteen had undergone EDCR, twenty Ex-DCR. The FDDT grade and EDTT were positively correlated (r=0.32, P=0.045). The mean Lac-Q score was not correlated with FDDT grade (r=-0.01, P=0.951) or EDTT (r=0.07, P=0.669). There were no significant differences in the FDDT grade, EDTT, Lac-Q score or ostial characteristics between Ex-DCR and EDCR.
CONCLUSION: FDDT grading correlates with EDTT, suggesting that these tests may be used interchangeably based on the clinician's ease of access and instrumentation. There was no correlation between the symptoms of lacrimal outflow obstruction with objective evidence of drainage.