ENT - September 2020 - 538

538
airway space was narrower than the control group and therefore
more prone to collapse.4,5 To explain that the upper airway
anatomy poses a risk for OSAS, Scwab et al. performed
three-dimensional measurements with MRI. In these measurements, the lateral pharyngeal wall, tongue, and soft tissue were
measured larger in patients with OSAS and explained that they
were the important risk factors for sleep apnea.6 The large
tongue volume, tongue base size, posterior placement of the
mandible, and inferior sagging of the soft palate have been
shown to be crucial for OSAS, and the lateral walls of the upper
airways are important in collapse in recent years.7,8
In the otorhinolaryngology practice, robotic surgery has
gained popularity and with more frequent indications in recent
times. Robotic surgery for the treatment of OSAS was first
utilized by Vicini et al.9 in the pathology related to tongue base
in 2010. Studies involving more cases were reported by the
same group in 2011 and 2012, where OSAS surgery in the form
of transoral robotic surgery (TORS) approach to tongue base
showed statistically significant improvements in Epworth Sleepiness Scale, oxygen saturation, and apnea hypopnea index
(AHI). Additionally, there was no reported increase of complications such as bleeding or airway deterioration during the
application of this technique.9
The pulmonary function test (PFT) is a common diagnostic
method in clinical studies of respiratory diseases. It is an
objective technique used in the evaluation of the ventilation,
diffusion, and physical steps of the respiratory system. In the
mid-1800, Hutchinson was able to measure vital capacity volume with a device similar to a spirometer. Spirometric tests are
the most commonly used diagnostic tests in evaluating pulmonary function.10
Although a number of studies have examined pulmonary
function parameters in patients using CPAP for the treatment
of OSAS, it is noteworthy that a study investigating the effect
of OSAS surgery on respiratory functions is currently not available in the literature.
The aim of our study is to investigate the efficacy of surgical
treatment on respiratory functions in patients with OSAS and to
demonstrate the positive effects of surgical treatment on pulmonary functions, similar to the effects of CPAP.

Materials and Methods
Our study was carried out in the Otorhinolaryngology and Head
and Neck Surgery Clinic of the Istanbul Medipol University
Hospital as per the ethics committee decision number 125 of
the Istanbul Medipol University Clinical Research Local Ethics
Committee.
Thirty-two patients (30 males and 2 females) who had
undergone robotic tongue base resection and uvulopharyngoplasty between the dates of January 1, 2015, to December 31,
2015, were included as study participants. Patients included in
this study had presented to our clinic with the complaints of
snoring, apnea during sleep, daytime fatigue, and falling
asleep. Preliminary examination and evaluation revealed that
study participants ranged between grade 2 and 4 on the

Ear, Nose & Throat Journal 99(8)
Friedmann tonsil hypertrophy classification, grade 2 and 4 on
the Mallampati classification, and all participants were grade 2
(oropharyngeal-hypopharyngeal) on the Fujita classification
for airway obstruction. During the modified Muller maneuver
performed on the endoscopic examination at the preoperative
stage of the surgery, there was a 50% or more circumferential
narrowing in the entire patient population.
In addition, according to the Epworth Sleepiness Scale
questionnaire performed preoperatively, patients scored
between 13 and 20 points. Polysomnography test was performed on all study participants, with a resulting AHI ranging
between 15 and 30. Sleep endoscopy (or sedated endoscopy)
performed on the day of the operation revealed a level of
obstruction which included the palatal, oropharyngeal, and
tongue base in all patients, further supporting the diagnosis
of obstructive sleep apnea. After all these evaluations, all
patients underwent surgery for robotic tongue base resection
and uvulopharyngoplasty.
The inclusion criteria for the study were an AHI score of 15
to 30, and a level of obstruction which involves the palate,
oropharynx, and tongue base altogether. Exclusion criteria for
the study were considered to be the presence of any lung disease and any condition that would contraindicate the administration of general anesthesia.
Pulmonary function test s were performed on all participants
1 day prior to and at 3 and 6 months after the operation with
Winspro Spirolab III. Weight and body mass indices (BMIs)
were recorded at the same intervals for all participants using the
Welch Allyn Health-O-Meter. The following parameters of
PFT were measured and recorded 1 day prior to and at 3 and
6 months after the operation: FVC, FEV1, FEV1/FVC, PEF,
and FEF25-75.
Participants included in the study were placed under general
anesthesia and nasotracheal intubation, followed by placement
of the Feyh-Kastenbauer retractor. Maryland dissector was
placed in one of the robotic arms for grasping and dissecting
the tissues, a monopolar cautery in the second arm, and a 30
endoscope in the third arm. Circumvallate papillae and epiglottis were included within the angle of vision at the base of the
tongue. Subsequently, approximately 2 Â 4 cm from the medial
part, the tongue base was excised with the aid of a robotic
monopolar cautery. Following bleeding control, participants
were placed in an appropriate position for jaw-opening with
Davis Boyle, and uvulopalatopharyngoplasty operations were
performed. All operations were performed by the same
surgeon.

Statistical Method
Mean, standard deviation, median, lowest, highest, frequency,
and ratio values were used in the descriptive statistics of the
data. The distribution of the variables was measured by the
Kolmogorov Smirnov test. Mann-Whitney U test was used for
quantitative analysis. Paired t test and Wilcoxon test were used
for analysis of recurrent measurements. Spearman correlation



ENT - September 2020

Table of Contents for the Digital Edition of ENT - September 2020

The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - Intro
ENT - September 2020 - Cover1
ENT - September 2020 - Cover2
ENT - September 2020 - 489
ENT - September 2020 - 490
ENT - September 2020 - 491
ENT - September 2020 - 492
ENT - September 2020 - 493
ENT - September 2020 - 494
ENT - September 2020 - 495
ENT - September 2020 - 496
ENT - September 2020 - 497
ENT - September 2020 - 498
ENT - September 2020 - 499
ENT - September 2020 - 500
ENT - September 2020 - The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
ENT - September 2020 - 502
ENT - September 2020 - Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
ENT - September 2020 - 504
ENT - September 2020 - Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
ENT - September 2020 - 506
ENT - September 2020 - 507
ENT - September 2020 - Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
ENT - September 2020 - 509
ENT - September 2020 - 510
ENT - September 2020 - 511
ENT - September 2020 - 512
ENT - September 2020 - Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
ENT - September 2020 - 514
ENT - September 2020 - 515
ENT - September 2020 - 516
ENT - September 2020 - 517
ENT - September 2020 - Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
ENT - September 2020 - 519
ENT - September 2020 - 520
ENT - September 2020 - 521
ENT - September 2020 - Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
ENT - September 2020 - 523
ENT - September 2020 - 524
ENT - September 2020 - 525
ENT - September 2020 - 526
ENT - September 2020 - 527
ENT - September 2020 - A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
ENT - September 2020 - 529
ENT - September 2020 - 530
ENT - September 2020 - 531
ENT - September 2020 - A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
ENT - September 2020 - 533
ENT - September 2020 - 534
ENT - September 2020 - 535
ENT - September 2020 - 536
ENT - September 2020 - Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
ENT - September 2020 - 538
ENT - September 2020 - 539
ENT - September 2020 - 540
ENT - September 2020 - 541
ENT - September 2020 - 542
ENT - September 2020 - Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - 544
ENT - September 2020 - 545
ENT - September 2020 - 546
ENT - September 2020 - 547
ENT - September 2020 - 548
ENT - September 2020 - 549
ENT - September 2020 - 550
ENT - September 2020 - 551
ENT - September 2020 - 552
ENT - September 2020 - Cover3
ENT - September 2020 - Cover4
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