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Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome
Medical Policy Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 130 BCBSA Reference Number: 7.01.101 Related Policies None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Uvulopalatopharyngoplasty (UPPP) may be MEDICALLY NECESSARY for the treatment of clinically significant obstructive sleep apnea syndrome (OSAS) in appropriately selected adult patients who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: Apnea/hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. Hyoid suspension, surgical modification of the tongue, and/or maxillofacial surgery, including mandibular- maxillary advancement (MMA), may be MEDICALLY NECESSARY in appropriately selected adult patients with clinically significant OSA and objective documentation of hypopharyngeal obstruction who have failed an adequate trial of continuous positive airway pressure (CPAP) or failed an adequate trial of an oral appliance (OA). Clinically significant OSA is defined as those patients who have: AHI or RDI 15 or more events per hour, or AHI or RDI 5 or more events and 14 or less events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke. -
Szanowni Państwo, Ladies and Gentlemen
Szanowni Państwo, Oddajemy w Państwa ręce piąte wydanie Katalogu Szpitali Prywatnych. Lecznice, skupione w Ogólnopolskim Stowarzyszeniu Szpitali Prywatnych, dysponują ilością niemal 10 000 łóżek, zatrudniają ponad 35 000 personelu i prawie 60 000 osób współpracujących. Zarządy naszych placówek wciąż podkreślają swą misję publiczną, jaką pełnią szpitale prywatne, świadcząc leczenie w ramach Narodowego Funduszu Zdrowia (96% wykonanych zabiegów). W tym roku Ogólnopolskie Stowarzyszenie Szpitali Prywatnych weszło w 16 rok działalności. Katalog nasz pokazuje, ile ciężkiej pracy wykonali polscy pracodawcy, tworząc tak piękne i przyjazne dla pacjenta ośrodki, które za sprawą Narodowego Funduszu Zdrowia świadczą wysokospecjalistyczną pomoc dla każdego polskiego obywatela. Uzupełnieniem katalogu od kilku lat stał się wydawany cyklicznie zeszyt statystyczny opisujący w sposób uporządkowany funkcjonowanie i toczenie ekonomiczne sektora szpitali prywatnych. Andrzej Sokołowski Prezes Zarządu Ogólnopolskiego Stowarzyszenia Szpitali Prywatnych Ladies and Gentlemen, We are pleased to present to you the fifth edition of the Catalogue of Private Hospitals. The entities affiliated in the Polish Association of Private Hospitals have almost 10.000 hospital beds, employ over 35.000 medical staff and almost 60.000 other personnel. Our hospitals’ directors keep underlining that the private medical centres also fulfil a public healthcare mission, delivering healthcare services within the National Health Fund (96% of all their procedures). UNION EUROPEENNE HOSPITALISATION -
Tonsillotomy (Partial) and Complete Tonsillectomy
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY TONSILLOTOMY (PARTIAL) & COMPLETE TONSILLECTOMY - SURGICAL TECHNIQUE Klaus Stelter and Goetz Lehnerdt Acute tonsillitis is treated with steroids e.g. first and easiest-to-reach station of the dexamethasone, NSAIDs e.g. ibuprofen and mucosa associated lymphoid tissue system beta-lactam antibiotics e.g. penicillin or cef- (MALT) 2-4. As the main phase of the im- uroxime. Only 10 days of antibiotic therapy mune acquisition continues until the age of has proven to be effective to prevent rheu- 6yrs, the palatine tonsils are physiological- matic fever and glomerulonephritis. ly hyperplastic at this time 5, 6. This is followed by involution, which is reflected Tonsillectomy is only done for recurrent by regression of tonsil size until age 12yrs acute bacterial tonsillitis, or for noninfec- 7. tious reasons such as suspected neoplasia. The lymphoid tissue is separated by a cap- Partial tonsillectomy (tonsillotomy) is the sule from the surrounding muscle (superior 1st line treatment for snoring due to tonsillar pharyngeal constrictor) 8. The blood supply hyperplasia. It is low-risk, and postopera- originates from four different vessels, the tive pain and risk of haemorrhage are much lingual artery, the ascending pharyngeal less than with tonsillectomy. It is immate- artery and the ascending and descending rial whether the tonsillotomy is done with palatine arteries. These vessels radiate laser, radiofrequency, shaver, coblation, bi- mainly to the upper and lower tonsillar polar scissors or monopolar electrocautery, poles, as well as to the centre of the tonsil as long as the crypts remain open and some from laterally 9. -
New Surgical Technique That Stabilizes Uvulopalatinal Segment in Patients with Loud Snore
Global Journal of Otolaryngology ISSN 2474-7556 Review Article Glob J Otolaryngol Volume 8 Issue 5 - July 2017 Copyright © All rights are reserved by Jon Garito DOI: 10.19080/GJO.2017.08.555748 New Surgical Technique That Stabilizes Uvulopalatinal Segment in Patients with Loud Snore Novak Vukoje1 and Jon Garito2* 1ENT office “dr Vukoje”, Petrovaradin, Serbia 2PhD, Inventer the dual Frequency device and the RF electrodes, USA Submission: July 01, 2017; Published: July 13, 2017 *Corresponding author: Jon Garito, PhD, Inventer the dual Frequency device and the RF electrodes, 1111 Crandon, BLVD, FL 33149, USA, Tel: ; Email: Abstract This method is author’s innovative technique which follows number of applied surgical procedures on palate and uvula with only goal to advance functional results and avoid complications like velofaringeal insufficiency. Task of this method is to solve uvulopalato lateral obstruction and to expand oropharyngeal airway. It was introduced in the year 2000 by Dr. Vukoje. It requires strict indications for application and correct selection of patients. Author has done this surgical procedure in the period from 2000 to 2004, on 36 patients (19 males and 17 females) with the average age of 45.3 years. Patient selection followed thorough diagnostic procedure (Figure 1). Figure 1: Ellman Surgitron 4.0 Dual RF, patented by Ellman International Company, Oceanside, New York, USA. (US Patent reference number # 5.954.686-Inventor dr Jon C. Garito). Interventions have been executed using radio wave surgical apparatus “Ellman Sugitron 4.0MHz combined with classical surgical technique. Follow-up, done two years after the surgery, imply that noisy sleep ceased to exist in 72.2% of cases (26) and in 19.4% of cases (7) it was reduced to tolerable level. -
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021
Surgical Treatments for Obstructive Sleep Apnea (OSA) Policy Number: PG0056 ADVANTAGE | ELITE | HMO Last Review: 06/01/2021 INDIVIDUAL MARKETPLACE | PROMEDICA MEDICARE PLAN | PPO GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each individual policyholder terms, conditions, exclusions and limitations contract. It does not constitute a contract or guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede this general policy when group supplementary plan document or individual plan decision directs otherwise. Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy and adherence to accepted national standards. This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to assist in making coverage decisions and administering benefits. SCOPE X Professional _ Facility DESCRIPTION Sleep apnea is a disorder where breathing nearly or completely stops for periods of time during sleep. In obstructive sleep apnea (OSA), the brain sends the message to breathe, but there is a blockage to air flowing into the chest. It is a condition in which repetitive episodes of upper airway obstruction occur during sleep. The obstruction may be localized to one or two areas, or may encompass the entire upper airway passages to include the nasal cavity (nose), oropharynx (palate, tonsils, tonsillar pillars) and hypopharynx (tongue base). The hallmark symptom of OSA is excessive daytime sleepiness, and the typical clinical sign of OSA is snoring, which can abruptly cease and be followed by gasping associated with a brief arousal from sleep. The snoring resumes when the patient falls back to sleep, and the cycle of snoring/apnea/arousal may be repeated as frequently as every minute throughout the night. -
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M
32 Surgical Treatment of Sleep-Related Breathing Disorders Donald M. Sesso Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A. Nelson B. Powell and Robert W. Riley Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center and Department of Behavioral Sciences, Division of Sleep Medicine, Stanford University School of Medicine, Stanford, California, U.S.A. INTRODUCTION Snoring, upper airway resistance syndrome (UARS), obstructive sleep apnea (OSA), and obstructive sleep apnea-hypopnea syndrome (OSAHS) are collectively referred to as sleep- related breathing disorders (SRBD). These terms describe a partial or complete obstruction of the upper airway during sleep. Patency of the pharyngeal airway is maintained by two opposing forces: negative intraluminal pressure and the activity of the upper airway musculature. Anatomical or central neural abnormalities can disrupt this delicate balance and result in compromise of the upper airway. This reduction of airway caliber may cause sleep fragmentation and subsequent behavioral derangements, such as excessive daytime sleepiness (EDS) (1–3). The goal of medical and surgical therapy is to alleviate this obstruction and increase airway patency. The first therapeutic modality employed to treat SRBD was surgery. Kuhlo described placement of a tracheotomy tube in an attempt to bypass upper airway obstruction in Pickwickian patients (4). Although effective, tracheotomy does not address the specific sites of pharyngeal collapse and is not readily accepted by most patients. These sites include the nasal cavity/nasopharynx, oropharynx, and hypopharynx. Often, multilevel obstruction is present. Consequently, the surgical armamentarium has evolved to create techniques that correct the specific anatomical sites of obstruction. -
Aadsm Annual Meeting San Antonio: June 7-919
AADSM ANNUAL MEETING SAN ANTONIO: JUNE 7-919 FINAL PROGRAM WELCOME to the 2019 AADSM Annual Meeting 2 This year’s meeting features: • Three rooms of general sessions on Saturday and Sunday – Fundamentals, Clinical Applications and Advances in DSM; • Poster presentations, located just outside of the exhibit hall, including new “late-breaking abstracts;” • Lunch presentations from vendors during the industry product theatres on Saturday; • A lounge for Diplomates of the ABDSM and dental directors of AADSM-accredited facilities to network; and • Special sessions for dentists on faculty at dental schools, interested in performing clinical research, looking for information on getting more involved with the AADSM. Information about these opportunities can be found in the pages of this final program. I have no doubt that this year’s meeting will offer you the opportunity to renew and initiate relationships with colleagues from around the world while expanding your knowledge of dental sleep medicine. Enjoy, Sheri Katz, DDS Chair, Annual Meeting Committee AADSM ANNUAL MEETING SAN ANTONIO: JUNE 7-919 ON-SITE REGISTRATION HOURS EXHIBIT HALL HOURS Salon A- F Friday, June 7 6:30am – 5:30pm Saturday, June 8 7:00am – 5:00pm Friday, June 7 10:00am – 4:00pm Sunday, June 9 7:00am – 1:30pm Saturday, June 8 10:00am – 4:00pm Sunday, June 9 10:00am – 12:30pm The registration desk is located in the Salon Ballroom Foyer of the Marriott Rivercenter. Learn about the newest products and services in the field by visiting Your registration includes admission to: the exhibit hall! The AADSM Annual • General Sessions (Friday-Sunday) Meeting exhibit hall showcases oral appliance manufacturers, • President’s Reception dental laboratories, software • Industry Supported Events companies and more. -
Otolaryngology Annual Report 2020
DEPARTMENTOTOLARYNGOLOGY OF ANNUAL REPORT 2020 State University of New York Downstate Health Sciences University Maimonides Medical Center Kings County Hospital Center University Hospital of Brooklyn New York - Presbyterian Brooklyn Methodist Hospital Manhattan Eye, Ear & Throat Hospital / Lenox Hill Hospital Design & Photography The Office of Communications and Marketing SUNY Downstate Medical Center TABLE OF CONTENTS 2 Vision, Mission, & Values Statement 3 State of the Department 8 Department Organization 10 Faculty 10 Faculty 16 Volunteer Faculty and Other Contributing Physicians 19 Professional Society Membership/Activity 23 Visiting Lecturers 25 Awards, Honors, Activities and Special Achievements 26 Department Events 34 Publications 36 Presentations 41 Affiliated Hospitals 41 University Hospital of Brooklyn 41 Kings County Hospital Center 41 Maimonides Medical Center 42 New York-Presbyterian Brooklyn Methodist Hospital 42 Manhattan Eye, Ear, & Throat Hospital/Lenox Hill 43 Educational Programs 44 Goals and Objectives for Resident Education 53 Medical Student Program and Opportunities 54 Temporal Bone Surgical Dissection Laboratory 55 Frank E. Lucente Alumni and Resident Research Day 63 Grand Rounds Schedule 68 Residents 70 Annual Department Photographs 72 Resident Rotation Schedule 74 Residency Experience 83 Service Chief Reports 83 Division of Pediatric Otolaryngology 83 Division of Facial Plastic and Reconstructive Surgery 83 Division of Otology and Neurotology 84 Division of Head, Neck Surgery and Oncology 85 Division of Laryngology, Voice and Swallowing Disorders 86 Communicative Disorders 86 Audiology 86 Cochlear Implant Program 87 Communicative Disorders Staff 88 Research Report 91 Communication Information 2 VISION Our vision is a community where individuals can access optimal care for disorders of the ears, nose, throat, head and neck. -
Functional Morphology of Tissues in Children with Bilateral Lip
Liene Smane-Filipova FUNCTIONAL MORPHOLOGY OF TISSUES IN ONTOGENETIC ASPECT IN CHILDREN WITH COMPLETE BILATERAL CLEFT LIP AND PALATE Summary of the Doctoral Thesis for obtaining the degree of a Doctor of Medicine Speciality – Morphology Scientific supervisors: Dr. med., Dr. habil. med. Professor Māra Pilmane Riga, 2016 1 The Doctoral Thesis was carried out at the Department of Morphology, Institute of Anatomy and Anthropology, Rīga Stradiņš University, Latvia Scientific supervisors: Dr. med., Dr. habil. Med., Professor Māra Pilmane, Rīga Stradiņš University, Latvia Official reviewers: Dr. med., Professor Ilze Štrumfa, Rīga Stradiņš University, Latvia Dr. med. vet., Professor Arnis Mugurēvičs, Latvia University of Agriculture Dr. med., Associate Professor Renata Šimkūnaitėi-Rizgeliene, Vilnius University, Lithuania Defence of the Doctoral Thesis will take place at the public session of the Doctoral Council of Medicine on 9 December 2016 at 15.00 in Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīga Stradiņš University. Doctoral thesis is available in the RSU library and at RSU webpage: www.rsu.lv The Doctoral Thesis was carried out with “Support for Doctoral Students in Mastering the Study Programme and Acquisition of a Scientific Degree in Rīga Stradiņš University”, agreement No 2009/0147/1DP/1.1.2.1.2/09/IPIA/VIAA/009” Secretary of the Doctoral Council: Dr. med., Assistant Professor Andrejs Vanags 2 TABLE OF CONTENTS Introduction ................................................................................................... 4 -
Treatments for Ankyloglossia and Ankyloglossia with Concomitant Lip-Tie Comparative Effectiveness Review Number 149
Comparative Effectiveness Review Number 149 Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie Comparative Effectiveness Review Number 149 Treatments for Ankyloglossia and Ankyloglossia With Concomitant Lip-Tie Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2012-00009-I Prepared by: Vanderbilt Evidence-based Practice Center Nashville, TN Investigators: David O. Francis, M.D., M.S. Sivakumar Chinnadurai, M.D., M.P.H. Anna Morad, M.D. Richard A. Epstein, Ph.D., M.P.H. Sahar Kohanim, M.D. Shanthi Krishnaswami, M.B.B.S., M.P.H. Nila A. Sathe, M.A., M.L.I.S. Melissa L. McPheeters, Ph.D., M.P.H. AHRQ Publication No. 15-EHC011-EF May 2015 This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. -
Z-Palatoplasty (ZPP): a Technique for Patients Without Tonsils
Z-palatoplasty (ZPP): A technique for patients without tonsils MICHAEL FRIEDMAN, MD, HANI Z. IBRAHIM, MD, RAMAKRISHNAN VIDYASAGAR, MBBS, MS, JONATHAN POMERANZ, BS, and NINOS J. JOSEPH, BS, Chicago, Illinois OBJECTIVE: Patients without tonsils and with Fried- In view of its limited success in curing OSAHS,1-3 man tongue position (FTP) III and IV are poor can- many adjunctive procedures have been proposed or didates for uvulopalatopharyngoplasty (UP3). Even performed concurrently or sequentially.3-5 The UP3 when combined with adjunctive hyopharyngeal technique was originally described by Fujito et al6 in techniques, results are poor. We assessed a modi- 1979, and, although many modifications have been fied uvulopalatoplasty based on a bilateral Z-plasty published, the basic procedure involves palate shorten- in treating patients without tonsils who have ob- ing with closure of the mucosal incisions, hence en- structive sleep apnea/hypopnea syndrome (OS- compassing “palatoplasty” component; classical tonsil- AHS). lectomy and pharyngeal closure comprise the METHODS: 25 patients treated with a modified tech- “pharyngoplasty” component of the procedure.7-9 nique were matched with 25 patients previously Several problems continue to exist: (1) No proce- treated with classic UP3. All patients in both groups dure has been studied for post-tonsillectomy patients. also had radiofrequency tongue base reduction. (2) Many patients, especially post-tonsillectomy pa- Preoperative vs. postoperative measures of objec- tients, end up with an extremely narrow palatal arch tive treatment success and subjective symptoms further contributing to airway obstruction. (3) Post- were compared for the 2 groups. Morbidity, includ- tonsillectomy patients have poor results with classical ing pain levels, narcotic use, and return to solid diet UP3.10,11 (4) A significant number of patients are not and normal activity, as well as complications were improved by UP3 but are actually made worse.2 studied. -
Medical Management Prenotification Certification/Prior Authorization
Guideline Name: Medical Management ¾ Prenotification ¾ Certification/Prior Authorization ¾ Predetermination of Benefits Pre-Notification: Pre-note is a non-penalty request made of enrollees/providers to advise of any upcoming hospital admissions. This provides our clinical staff with possible case management/disease management opportunities based on our criteria. The general categories frequently requiring pre-notification: ¾ In Care System or in the Care System “Family” for In Patient Hospitalization and Rehabilitation. ¾ In Care System or in the Care System “family” for In Patient Mental Health/Chemical Dependency. No letters are sent. Certification/Prior Authorization: A determination as to whether a service, treatment, supply or facility is approved as Medically Necessary by the Claims Administrator, on behalf of the Plan , before payment can be made. The general categories frequently required by the Employer’s Summary Plan Description ( SPD) for certification include the following: ¾ All out of area ( not participating in any Care System) for the following: In Patient Hospitalization and Rehabilitation In Patient Mental Health/Chemical Dependency Skilled Nursing and Extended Care Admissions- NOTE: BHCAG requires pre- authorization for In Care Systems and certification for out of area Home Health Care Transplant Care- Note: this applies to both In/Out of Care Systems Durable Medical Equipment over $750 In/ $1500 out of area Letters are generated and sent to Employee, Provider and Facility per URAC requirements. Pre-Determination: A determination of benefits by the Claims Administrator, on behalf of the Plan, prior to services being provided when individuals want to know if the procedure/service is Medically Necessary and/or Covered under the Plan.