Hypoglossal Research Articles

A Protocolized Approach to Awake Endoscopy With Advanced Programming to Optimize Hypoglossal Nerve Stimulation.

Hypoglossal nerve stimulation is a treatment option for patients with obstructive sleep apnea who are intolerant to positive airway pressure therapy. In the post-implant period, awake endoscopy with advanced programming (AEAP) can be employed to optimize apnea-hypopnea index reduction and/or patient comfort and usage. The report herein describes awake endoscopy with AEAP as a guide to providers involved in post-implant care. The first 5 consecutive patients were reviewed to provide general understanding of outcomes and safety when implementing such a protocolized approach.

Case Report: Tongue deviation due to supranuclear injury with a rare semiological feature

Abstract* Hypoglossal nerve injuries are classified according to their anatomical localization in: Infranuclear, nuclear, and supranuclear. Supranuclear injuries can occur in cerebral cortex, corticobulbar tracts, internal capsule, cerebral peduncles, or in the pons, and most often caused by a stroke. These lesions usually do not generate a significant alteration of tongue motility due to the bilateral innervation of both nuclei from the cortex. We present a case of a 43-year-old male with dysarthria, left central facial paralysis, and an important tongue palsy and deviation to the same side. Brain CT revealed a right frontotemporal stroke with little hemorrhagic transformation, and an EKG that showed auricular fibrillation. He received treatment with amiodarone and rivaroxaban was initiated when a second brain CT scan showed no evidence of hemorrhage. This case is remarkable due the unusual presentation in a supranuclear lesion of the hypoglossal nerve. It is important to enrich the semiology and consider the possibility of cortical cerebrovascular events in patients with acute deviation of the tongue, even in the absence of involvement of other cranial nerves; or marked ipsilateral motor implication.

Device-related outcomes following hypoglossal nerve stimulator implantation.

Hypoglossal nerve stimulation (HGNS) has been widely used to treat obstructive sleep apnea in selected patients. Here we evaluate rates of revision and explant related to HGNS implantation and assess types of adverse events contributing to revision and explant. Postmarket surveillance data for HGNS implanted between January 1, 2018 and March 31, 2022, were collected. Event rates and risk were calculated using the postmarket surveillance event counts and sales volume over the same period. Indications were categorized for analysis. Descriptive statistics were reported and freedom from explant or revision curves were grouped by year of implantation. Of the 20,881 HGNS implants assessed, rates of explant and revision within the first year were 0.723% and 1.542%, respectively. The most common indication for explant was infection (0.378%) and for revision was surgical correction (0.680%). Of the 5,820 devices with 3-year postimplantation data, the rate of explant was 2.680% and of revision was 3.557%. During this same interval, elective removal (1.478%) was the most common indication, and for revisions, surgical correction (1.134%). The efficacy of HGNS is comparable in the real world setting to published clinical trial data. Rates of explant and revision are low, supporting a satisfactory safety profile for this technology. Moroco AE, Wei Z, Byrd I, etal. Device-related outcomes following hypoglossal nerve stimulator implantation. J Clin Sleep Med. 2024;20(9):1497-1503.

0594 Novel Device to Simulate Hypoglossal Nerve Stimulation Response to Predict Surgical Success

0594 Novel Device to Simulate Hypoglossal Nerve Stimulation Response to Predict Surgical Success

0545 Hypoglossal Nerve Stimulation: Does Higher Pre-Implantation PAP Pressure Result in Less Successful Outcomes?

0545 Hypoglossal Nerve Stimulation: Does Higher Pre-Implantation PAP Pressure Result in Less Successful Outcomes?

0589 Evaluating the Impact of Sleep Position on Efficacy of Hypoglossal Nerve Stimulation

0589 Evaluating the Impact of Sleep Position on Efficacy of Hypoglossal Nerve Stimulation

0601 Hispanic Ethnicity Is Associated with Decreased Adherence to Hypoglossal Nerve Stimulation

0601 Hispanic Ethnicity Is Associated with Decreased Adherence to Hypoglossal Nerve Stimulation

0598 Hypoglossal Nerve Stimulation: Does the Ratio of Apneas to Hypopneas Matter When It Comes to Successful Outcomes?

0598 Hypoglossal Nerve Stimulation: Does the Ratio of Apneas to Hypopneas Matter When It Comes to Successful Outcomes?

0596 Comparative Analysis of Continuous Positive Airway Pressure and Hypoglossal Nerve Stimulation

0596 Comparative Analysis of Continuous Positive Airway Pressure and Hypoglossal Nerve Stimulation

1207 Intercostal Monitoring as a Novel Approach to Polysomnography During Hypoglossal Nerve Stimulator Titration

1207 Intercostal Monitoring as a Novel Approach to Polysomnography During Hypoglossal Nerve Stimulator Titration

1188 Decreased Tolerance to Hypoglossal Nerve Stimulator After Cardioversion

1188 Decreased Tolerance to Hypoglossal Nerve Stimulator After Cardioversion

0590 Hypoglossal Nerve Stimulation for OSA – a Systematic Review of Adverse Events in Clinical Trials & Real-world-data

0590 Hypoglossal Nerve Stimulation for OSA – a Systematic Review of Adverse Events in Clinical Trials & Real-world-data

Does hypoglossal nerve stimulation decrease disease severity in those with obstructive sleep apnea?

Does hypoglossal nerve stimulation decrease disease severity in those with obstructive sleep apnea?

Biomechanical increase in cervical esophageal wall tension during peristalsis.

During pharyngeal phase of swallowing, circumferential tension of the cervical esophagus (CTE) increases caused by a biomechanical process of laryngeal elevation pulling the cervical esophagus orad. The esophagus contracts longitudinally during esophageal peristalsis, therefore, we hypothesized that CTE increases during esophageal peristalsis by a biomechanical process. We investigated this hypothesis using 28 decerebrate cats instrumented with electromyographic (EMG) electrodes on the pharynx and esophagus, and esophageal manometry. We recorded CTE, distal esophageal longitudinal tension (DET), and orad laryngeal tension (OLT) using strain gauges. Peristalsis was stimulated by injecting saline into esophagus or nasopharynx. We investigated the effects of transecting the pharyngo-esophageal nerve (PEN), hypoglossal nerve (HG), or administering (10 mg/kg iv) hexamethonium (HEX). We found that the durations of CTE and DET increased and OLT decreased simultaneously during the total extent of esophageal peristalsis. CTE duration was highly correlated with DET but not esophageal EMG or manometry. The peak magnitudes of the DET and CTE were highly correlated. After HEX administration, peristalsis in the distal esophagus did not occur, and the duration of the CTE response decreased. PEN transection blocked the occurrence of cricopharyngeal or cervical esophageal response during peristalsis but had no significant effect on the CTE response. HG transection had no significant effect on CTE. We conclude that there is a significant CTE increase, independent of laryngeal elevation or esophageal muscle contraction, which occurs during esophageal peristalsis. This response is a biomechanical process caused by esophageal shortening that occurs during esophageal longitudinal contraction of esophageal peristalsis.NEW & NOTEWORTHY Circumferential tension of cervical esophagus (CTE) increases during esophageal peristalsis. CTE response is correlated with distal longitudinal tension on cervical esophagus during esophageal peristalsis but not laryngeal elevation or esophageal muscle contraction. CTE response is not blocked by transection of motor innervation of laryngeal elevating muscles or proximal esophagus but is temporally reduced after hexamethonium administration. We conclude that the CTE response is a biomechanical effect caused by longitudinal esophageal contraction during esophageal peristalsis.

Hypoglossal Nerve Neuropathies-Analysis of Causes and Anatomical Background.

The hypoglossal nerve is the last, and often neglected, cranial nerve. It is mainly responsible for motor innervation of the tongue and therefore the process of chewing and articulation. However, tumors, aneurysms, dissections, trauma, and various iatrogenic factors such as complications after surgeries, radiotherapy, or airway management can result in dysfunction. Correct differential diagnosis and suitable treatment require a thorough knowledge of the anatomical background of the region. This review presents the broad spectrum of hypoglossal neuropathies, paying particular attention to these with a compressive background. As many of these etiologies are not common and can be easily overlooked without prior preparation, it is important to have a comprehensive understanding of the special relations and characteristic traits of these medical conditions, as well as the most common concomitant disorders and morphological traits, influencing the clinical image. Due to the diverse etiology of hypoglossal neuropathies, specialists from many different medical branches might expect to encounter patients presenting such symptoms.

Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in a Young Child With Down Syndrome.

Obstructive sleep apnea (OSA) is common in children with Down syndrome (DS). Adenoidectomy and/or tonsillectomy are the usual first interventions employed to treat OSA in children with DS but sometimes do not achieve adequate resolution of clinical signs. Positive airway pressure treatment is often used next, but this treatment is poorly tolerated by this population. Persistent OSA can adversely affect a child's health and cognitive development. Hypoglossal nerve stimulation (HGNS), previously shown to be safe and effective in adults with OSA, has been used in children as young as 10 years old with DS and has achieved measurable neurocognitive benefits. The US Food and Drug Administration recently lowered the age for HGNS implantation to 13 years for children with DS. However, questions remain regarding treatment of refractory OSA in younger children. Here, we report the case of a 4-year-old boy with DS and treatment-refractory OSA who underwent successful HGNS implantation. The decision to proceed with HGNS implantation in such a young child involved discussions about anatomic feasibility and potential neurocognitive benefits. The device was implanted without complication and with minimal postoperative bulk. This case suggests a possible treatment option that can be discussed in the course of shared decision-making between clinicians and families of young children with DS and treatment-refractory OSA.

Transoral robotic surgery with free flap reconstruction: Functional outcomes of 241 patients at a single institution.

Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR). Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022. Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS). 241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = [7.0, 7.0], [2.0, 4.0]), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long-term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05). TORS with FFR leads to good long-term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes.

Isolated Unilateral Hypoglossal Nerve Palsy in a Man with Anterior Cervical Osteophyte (P9-4.008)

Isolated Unilateral Hypoglossal Nerve Palsy in a Man with Anterior Cervical Osteophyte (P9-4.008)

Hypoglossal Nerve Stimulation as a Treatment of Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-analysis (P7-11.007)

Hypoglossal Nerve Stimulation as a Treatment of Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-analysis (P7-11.007)

Gradenigo Syndrome With Facial and Hypoglossal Nerve Impairment Caused by Nontuberculous Mycobacteria Successfully Treated by Antibiotics Without Surgery.

Gradenigo Syndrome With Facial and Hypoglossal Nerve Impairment Caused by Nontuberculous Mycobacteria Successfully Treated by Antibiotics Without Surgery.