Eric Thuler

University of Pennsylvania | UP · Department of Otorhinolaryngology - Head and Neck Surgery

Objective Positive airway pressure (PAP) titration during drug‐induced sleep endoscopy (DISE) provides objective measures of upper airway collapsibility. While skeletal measurements relate to collapsibility measures on DISE, the influence of soft tissue dimensions on upper airway collapsibility is not known. We analyzed the relationship of measures...

Objective With the recent addition of airflow and respiratory effort channels, our group has observed central and mixed apnea events during drug‐induced sleep endoscopy (DISE). We measured the frequency and timing of sentinel central and/or mixed events (SCents), as well as assessed for differences in velum, oropharynx, tongue, and epiglottis (VOTE...

(1) Background: Drug-Induced Sleep Endoscopy (DISE) enables the three-dimensional and dynamic visualization of the upper airway (UA) during sleep, which is useful in selecting the best treatment option for obstructive sleep apnea (OSA) patients, particularly for surgical procedures. Despite international consensus statements or position papers, a u...

Objectives Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation. Methods A prospective cohort of adult sleep su...

Introduction Increased pharyngeal collapsibility leads to obstructive sleep apnea (OSA). Positive airway pressure titration during drug‐induced sleep endoscopy (DISE‐PAP) provides objective collapsibility metrics, the pharyngeal opening pressure (PhOP), and active pharyngeal critical pressure (Pcrit A ). We examined the interrelationships between r...

Objective Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving ant...

Introduction: The significance of hyoid dynamics in OSA pathophysiology remains unclear. Drug-induced sleep endoscopy (DISE) is often used for evaluating patients intolerant to positive airway pressure (PAP) therapy. We performed DISE with concurrent hyoid-focused ultrasonography to quantify hyoid dynamics during obstructive and non-obstructive br...

Introduction Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal obstruction at one or more collapse sites. Multilevel collapse is a negative predictive factor for PAP-alternative surgical treatments. Pharyngeal manometry during drug-induced sleep endoscopy (DISE) permits an objective evaluation of anatomical obstruc...

Background Literature has demonstrated hypoglossal nerve stimulation to be a safe and effective treatment for patients with obstructive sleep apnea nonadherent to positive airway pressure therapy. However, the recommended criteria for patient selection are still unable to identify all the unresponsive patients, highlighting the need for improved un...

Objective: To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility. Study design: Cross-se...

Objective To examine the accuracy and interrater reliability of a visually assessed vs airflow-based measure of pharyngeal collapsibility obtained in patients with obstructive sleep apnea undergoing drug-induced sleep endoscopy (DISE). Study Design Prospective observational study. Setting Academic tertiary care practice. Methods Patients underwe...

Introduction The VOTE score, critical closing pressure (Pcrit), and therapeutic CPAP levels are assessments that quantify upper airway collapse by either subjective visual scoring or objective pressure-flow analysis. We hypothesized that there would be an association between collapse severity and physiologic metrics (VOTE versus Pcrit and PAP level...

Obstructive Sleep Apnea is characterized by recurrent episodes of partial or complete collapse of the pharynx, followed by decreased oxyhemoglobin saturation and frequent arousals. It is regarded as a public health issue with important night and day symptoms that impact life quality. Its effects are associated with the areas of competence of Speech...

Study objectives: There is increasing recognition that environmental factors affect human craniofacial development and our risk for disease. A scoping review of the literature was performed looking at environmental influences on craniofacial development to better understand this relationship and investigate what further study is needed to determin...

Purpose No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. Methods An international online survey was developed with the coll...

Study objectives: Acquiring a better comprehension of obstructive sleep apnea (OSA) physiopathology can contribute to improve patient selection for surgical treatments. We hypothesize that maxillary transverse deficiency restricts the space available for the tongue, leading to upper airway obstruction during sleep. Our primary hypothesis is that m...

Editorial highlighting the underdiagnose role of maxillary deficiency in OSA

109 ] Impacto do desenho e do material na eficácia dos aparelhos de avanço mandibular para tratamento da Apneia Obstrutiva do Sono: relato de caso Resumo OBJETIVO: Demonstrar que o desenho do aparelho intra-bucal pode influenciar a eficácia do tratamento do ronco e apneia obstrutiva do sono (AOS). MÉTODO: Relato de caso de paciente com AOS, ronco e...

Purpose To investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). Materials and Methods The study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23...

We aim to correlate morphometric measurements obtained from facial CT scan with Tongue base obstruction detected during DISE. We hypothesize that maxillary transverse deficiency leads to tongue base collapse due to lack of space in the upper jaw to support the tongue, condition that is not suitable to be treated by tongue base procedures. Our data...

As a consequence of being a multifactorial disease, multiple mechanisms are involved in OSA pathophysiology, including not only anatomical causes but also causes related to the muscular response during sleep and its effect on pharyngeal wall resistance, both predisposing the upper airway to collapse.The scientific evidence for OSA surgical treatmen...

Complete concentric collapse (CCC) of the velum from drug-induced sleep endoscopy (DISE) is a key finding in surgical selection, particularly for upper airway stimulation. We aim to correlate facial CT morphometric measurements with CCC of the velum. We hypothesize that maxillary transverse hypoplasia is correlated with CCC of the velum.

Introduction Targeted Hypoglossal Neurostimulation (THN) is a novel treatment for OSA that aims to stimulate selective tongue muscles using a 6-contact cuff, placed around the hypoglossal nerve trunk. Selective stimulation and cycling between contacts is used to minimize risk of neuromuscular fatigue. From earlier safety and feasibility trials, pre...

Were selected18 patients that fulfilled the inclusion criteria, 16 man and 2 woman. The average age was 37 years (sd 7,6) with average BMI of 27 (sd 3,4). The average preoperative PSG was 23,6 (sd 5,7) and posoperative PSG was 5,3 (sd 3,6). Our success rate was 89%. During TORS was removed at least 7cc with a maximum of 15 cc of lingual tonsil tiss...

In 2015, there are only 44 Da Vinci platforms for robotic surgery (Intuitive®) in Latin America, 14 in Brazil. Robotic surgery technology is currently limited by cost, particularly in Latin American countries. Our group is the only one that currently performs TORS for OSAS in two private hospitals: Syrian-Lebanese Hospital and Oswaldo Cruz German H...

Diode laser turbinoplasty with submucosal bone resection and mucosal preservation.

Our experience in Laser Submucosal ressection turbinoplasty in OSAS Patients, adding CPAP and MAS compliance.

Uma das principais causas de obstrução nasal é a hipertrofia das conchas nasais inferiores, muitas vezes ocasionada pelo volume da própria estrutura óssea. O uso do laser, quando corretamente indicado pela escolha do comprimento de onda adequado, apresenta boa interação tecidual para o uso na mucosa nasal, permitindo reduzir as conchas nasais atrav...

Hipertrofia da Concha nasal inferior, Turbinoplastia, Laser pulsado. Introdução Uma das principais causas de obstrução nasal é a hipertrofia das conchas nasais inferiores. O uso do laser, quando corretamente indicado pela escolha do comprimento de onda, apresenta boa interação tecidual para o uso na mucosa nasal, permitindo reduzir as conchas nasai...

Unlabelled: Only a few studies have compared the outcomes of patients kept awake during endoscopic examination and subjects submitted to drug-induced sleep endoscopy. Objective: This study aimed to compare the endoscopic findings of patients submitted to outpatient endoscopy and endoscopic examination with sedation by propofol based on the Fujit...

São poucos os estudos que comparam resultados endoscópicos no paciente acordado com o mesmo paciente sob sono induzido por drogas. Objetivos: O objetivo do presente estudo é comparar os acha-dos endoscópicos num mesmo paciente, em dois momentos diferentes: ambulatorial e sob sedação com propofol, por meio da classificação de Fujita. Desenho do estu...

Introdução: O ronco afeta 5 a 50% da população tornando-se um problema médico e social importante. O tratamento pode ser com medidas comportamentais, CPAP e cirúrgico. Objetivo: Avaliar os resultados pós-operatórios dos pacientes submetidos à radiofreqüência em palato. Forma de estudo: retrospectivo clínico. Material e método: 28 pacientes submetid...

Introduction: Snoring is something that can reach between 5 to 50% of the population, thus becoming an important social and medical problem. The treatment for people who present the problem is based on behavioral measurements, CPAP and surgical procedures. Aim: To evaluate the post-surgical results of patients who have undergone Radiofrequency in p...

Introdução: O ronco e a apnéia do sono leve podem ser tratados cirurgicamente com a LAUP, sendo que os resultados dependem diretamente dos critérios adotados para seleção dos pacientes. O objetivo dos autores é analisar comparativamente os critérios adotados para seleção dos pacientes e a respectiva melhora no pós-operatório. Forma de estudo: Clíni...