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Epiglottic Collapse in Obstructive Sleep Apnea
배미례,정유삼 대한수면학회 2021 sleep medicine research Vol.12 No.1
Along with the development of diagnostic techniques, many studies have been conducted to find the anatomical causes of obstructive sleep apnea (OSA). The velum, oropharynx, tongue base, and epiglottis have been widely considered to be the common obstruction sites. However, the role of the epiglottis in sleep apnea is poorly understood compared to the other anatomical sites. The epiglottis causes OSA either alone or simultaneously with other obstruction sites. We have here reviewed the epidemiology, pathophysiology, diagnosis, and treatment of epiglottic collapse in patients with OSA based on the literature published to date.
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배미례,강우석,정종우 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.2
Objectives. We aimed to compare clinical outcomes including hearing improvement and cholesteatoma recurrence between endoscopic and conventional microscopic surgeries in patients with attic cholesteatoma. Methods. We collected data from patients with attic cholesteatoma who were treated using endoscopic (10 patients) and microscopic (10 patients) approaches by a single surgeon. The data were retrospectively reviewed for patient characteristics, intraoperative findings, hearing levels, and follow-up clinical status. Recurrence of the cholesteatoma, improvement of hearing, and operation time were evaluated. Results. Ossiculoplasty was performed in four patients in the endoscopic group and two patients in the microscopic group. Lempert endaural incision II was used in all the patients in the microscopic group, whereas Lempert I incision was used in all the patients in the endoscopic approach group. There were no significant differences between the two groups regarding hearing improvement and operating time. And, there were no recurrences during the follow-up period in both groups. Conclusion. The endoscopic approach for the management of attic cholesteatoma is as useful as the microscopic approach.
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최우리,배미례,정유삼 대한이비인후과학회 2022 Clinical and Experimental Otorhinolaryngology Vol.15 No.1
Objectives. Compliance with positive airway pressure (PAP) in patients with obstructive sleep apnea (OSA) directly affects its treatment efficacy. Since July 2018, polysomnography and PAP therapy have been covered by the National Health Insurance (NHI), which has reduced the price barrier and promoted PAP therapy in Korea. This study aimed to compare changes in PAP compliance before and after NHI implementation. Methods. This study is a retrospective analysis in a tertiary hospital setting in Korea. From 2011 to 2019, patients with OSA (apnea-hypopnea index ≥5) treated using a PAP device for ≥1 month were included. They were classified as belonging to the pre-insurance (PI) group (having started PAP before July 2018) or the NHI group (having received a PAP reimbursement by the NHI service). We collected and analyzed medical records and PAP use information for between-group comparisons of compliance. We defined compliance as the percentage of usage days, the percentage of days with usage for ≥4 night hours, and average daily usage hours. Results. We included 146 and 100 patients in the PI and NHI groups, respectively. Automatic PAP mode and NHI were independent predictors of compliance B at the 3- and 9-month follow-up points. The NHI group showed significantly higher compliance A at 3, but not 9 months. For compliance B, the NHI group showed significantly higher compliance than the PI group at 1 month and 3 months, but not at 9 months. Compared with the PI group, the NHI group showed significantly higher compliance C only at 3 months. Conclusion. The NHI has positively affected PAP therapy in patients with OSA. Insurance policy may affect compliance within the first 3 months of PAP therapy.
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좌우 비대칭형 난청 환자에서 CROS 보청기와 이식형 골도보청기의 선택 과정과 착용 전후 청력역치의 비교
김용한,이호준,배미례,구자윤,신철호,박홍주 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.3
Background and Objectives We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds. Subjects and Method Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains. Results When the hearing thresholds of the better hearing ears were >30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p<0.001). Conclusion Both groups showed significantly increased functional gains. CROS HAs were preferred when hearing thresholds in better hearing ears were >30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device.
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