RESUMO
OBJECTIVE: Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. DESIGN: The design used was a systematic review of randomized controlled trials. DATA SOURCES: Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. REVIEW METHODS: This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. DATA SYNTHESIS: Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. CONCLUSIONS: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.
Assuntos
Músculos Laríngeos/fisiopatologia , Tono Muscular/fisiologia , Músculos Palatinos/fisiopatologia , Músculos Faríngeos/fisiopatologia , Apneia Obstrutiva do Sono/reabilitação , Língua/fisiopatologia , Resistência das Vias Respiratórias/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Terapia por Estimulação Elétrica , Medicina Baseada em Evidências , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
OBJECTIVE: Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. DESIGN: Transversal study. SETTING: Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. PATIENTS: Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. INTERVENTIONS: Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. MAIN OUTCOME MEASURES: Severity scale for videonasoendoscopic and videotoscopic findings. RESULTS: There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. DISCUSSION AND CONCLUSIONS: Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.
Assuntos
Fissura Palatina/fisiopatologia , Fissura Palatina/cirurgia , Otite Média/fisiopatologia , Músculos Palatinos/fisiopatologia , Músculos Palatinos/cirurgia , Insuficiência Velofaríngea/fisiopatologia , Brasil , Cartilagem/anormalidades , Criança , Endoscópios , Tuba Auditiva/anormalidades , Feminino , Humanos , Masculino , Otite Média/etiologia , Otoscopia , Insuficiência Velofaríngea/etiologia , Gravação em Vídeo/instrumentaçãoRESUMO
Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.
Assuntos
Transtornos da Audição/etiologia , Cavidade Nasal , Músculos Palatinos/fisiopatologia , Tremor/patologia , Adulto , Toxinas Botulínicas Tipo A/uso terapêutico , Vias de Administração de Medicamentos , Feminino , Transtornos da Audição/tratamento farmacológico , Transtornos da Audição/patologia , Humanos , Fármacos Neuromusculares/uso terapêutico , Músculos Palatinos/efeitos dos fármacos , Tremor/complicações , Tremor/tratamento farmacológicoRESUMO
O tremor palatal é caracterizado clinicamente por contraçöes rítmicas e involuntárias dos músculos do palato mole. Existem dois tipos de tremor palatal: o sintomático, com o acometimento do músculo levantador do véu palatino por lesäo na via denteado-rubro-olivar e o tremor palatal essencial , em que há o envolvimento do músculo tensor do véu palatino, mas sem lesäo orgânica. Vários tratamentos säo propostos como o emprego de benzodiazepínicos, anticonvulsivantes, anticolinérgicos, precursores de neurotransmissores e toxina botulínica. Os autores apresentam uma breve revisäo a respeito desta desordem e discutem dois pacientes com tremor palatal.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Músculos Palatinos/fisiopatologia , Tremor , ZumbidoRESUMO
Säo relatadas quatro observaçöes concernentes a crianças com quadro de tinitus objetivo e miocloniais velopalatinas. Os aspectos etiopatogênicos, evolutivos e terapêuticos säo analisados e comparados com os da literatura