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In response to Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta‐analysis
Author(s) -
Camacho Macario,
Wei Justin M.,
Tolisano Anthony M.,
Song Sungjin A.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26187
Subject(s) - otorhinolaryngology , medicine , head and neck surgery , obstructive sleep apnea , sleep medicine , head and neck , general surgery , surgery , sleep disorder , psychiatry , insomnia
We would like to thank Dr. Fox and Dr. Takashima for their interest in our article “Hyoid Surgery Alone for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.” We undertook the study in order to identify how effective hyoid surgeries are based on the international literature. The authors make two important points: First, in the article by Riley et al. in 1984, the technique utilized hyoid myotomy with mandibular suspension, whereas the article by Riley and Powell in 1994 describes the modified hyoid suspension (hyothyroidopexy). Despite having at least two authors review all the articles, we missed this important finding, likely because Figure 1 in the article by Riley and Powell in 1994 demonstrates the mandibular osteotomy with genioglossus advancement and hyoid suspension, which we believe is what led to our error in categorization. Second, regarding the study by Holzl et al., in our word-by-word translation we did not encounter nasal surgery in the article; however, there was a reference to nasal continuous positive airway pressure (CPAP) on page 716. Additionally, we agree after re-review that Holzl et al. performed variations of hyoid surgeries and did not substratify the outcomes; therefore, the data should be viewed as contributing to the outcomes for isolated hyoid surgeries as a broad category. Based on the re-categorizing and the findings by the researchers in the Letter to the Editor, it does seem more likely that hyothyroidpexy alone would reduce apnea-hypopnea index (AHI) less (32.1% reduction) when compared to the more involved hyoid myotomy with suspension (35.5% reduction). It is interesting to note that the effect of either surgery reduces the AHI by about one-third. A major goal of the authors of this and other sleep surgery and medicine systematic reviews and metaanalyses is to help determine the outcomes for isolated obstructive sleep apnea (OSA) treatments such as supraglottoplasty and tonsillectomy. By providing outcomes for isolated OSA treatments, we will all be able to better counsel patients on current treatment options, and the research may also potentially stimulate innovative techniques or treatments for OSA. We again would like to thank the attention to detail that Dr. Fox and Dr. Takashima have provided and appreciate the respectful and collegial tone of their letter to the editor. Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.