Macario Camacho

Tripler Army Medical Center | TAMC · Department of Otorhinolaryngology

Currently, the relationship between uvula size and sleep-disordered breathing (snoring and obstructive sleep apnea) lacks data for objective interpretation. This study conducted a systematic review of the international literature for research describing the measurable characteristics of the uvula (i.e., size, length, width) and any association with...

Objectives During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because: 1) the lack of space with nasal...

Objectives/hypothesis: To develop a validated inferior turbinate grading scale. Study design: Development and validation study. Methods: Phase 1 development (alpha test) consisted of a proposal of 10 different inferior turbinate grading scales (>1,000 clinic patients). Phase 2 validation (beta test) utilized 10 providers grading 27 standardize...

INTRODUCTION: Treatment-emergent central sleep apnea (TECSA) is observed in some patients when they are treated with positive airway pressure (PAP) after significant resolution of the preexisting obstructive events in patients with obstructive sleep apnea. The objective of this study was to systematically review the literature for studies describin...

Objective The cochlear implant (CI) improves quality of life for people who are severely and profoundly deafened, allowing implantees to perceive speech at levels similar to those of individuals with normal hearing. However, patients with CIs generally report a reduced appreciation of music after implantation. We aimed to systematically review the...

Introduction: During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices has resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operat...

Objectives Despite the growth of social media in healthcare, the appropriateness of online friendships between otolaryngological residents and attendings is poorly defined in the current literature. This issue is of growing importance, particularly as residency programs increasingly utilize social media as a means of connecting with and evaluating...

Purpose The objective of this study is to systematically review the international literature for dynamic sleep magnetic resonance imaging (MRI) as a diagnostic tool in obstructive sleep apnea (OSA), to perform meta-analysis on the quantitative data from the review, and to discuss its implications in future research and potential clinical applicatio...

Introduction Myofunctional therapy (MT) improves obstructive sleep apnea (OSA) in patients. Areas Covered We systematically reviewed publications to evaluate MT as a treatment for OSA. We identified relevant articles and performed a meta-analysis on apnea-hypopnea index (AHI) scores, lowest oxygen saturation (LSAT), and Epworth Sleepiness Scale (E...

Purpose of Review This review focuses on the literature from the recent conflicts in Iraq/Syria and Afghanistan as well as techniques for addressing combat related craniofacial trauma. This review also includes practical lessons, techniques, tips, and “pearls” from several military experts with operational deployment experience. Recent Findings Cr...

Introduction To compare pain medication refill rates for adult septoplasty and rhinoplasty patients before and after initiating a multimodal analgesic protocol for reducing opioid prescriptions (PROP). Materials and Methods Data from 58 adult patients were retrieved by retrospective chart review (19 septoplasties and 10 rhinoplasties before initia...

Myofunctional therapy describes a set of exercises that focus on increasing the muscle tone of the oral and oropharyngeal airway. It has also been termed myofascial reeducation, orofacial, upper airway exercises myotherapy, oropharyngeal exercises throughout the literature. There are many benefits of MT in adults including improving quality of life...

Objective To systematically review the current literature for articles describing the effect of myofunctional therapy on pediatric obstructive sleep apnea (OSA) and to perform a meta-analysis on the sleep study data. Methods Three authors (A.B., K.K. and M.C.) independently searched from inception through April 20, 2020 in PubMed/MEDLINE, Scopus,...

Objective To systematically review the international literature for studies evaluating the effect of alcohol consumption on the occurrence and severity of snoring and obstructive sleep apnea and to use the available data to perform a meta-analysis. Data Sources MEDLINE, Embase, The Cochrane Library, CINAHL/EBASCO, and Scopus. Review Methods The p...

Evaluating and performing open surgical tracheotomy for critical care patients requires special considerations and techniques. Although percutaneous dilational tracheotomy is largely performed in critical care patients, it has not completely eliminated the need for the open surgical approach. A preoperative evaluation with a safety checklist derive...

Study Objectives To conduct a systematic review of the medical literature evaluating the effects of playing a musical instrument on obstructive sleep apnea (OSA). Data Sources Scopus, CINAHL, PubMed, and OVID. Review Methods Searches were performed through October 22, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (P...

Objectives Intermittent hypoxemia is a risk factor for developing complications in obstructive sleep apnea (OSA) patients. The objective of this systematic review was to identify articles evaluating the accuracy of the oxygen desaturation index (ODI) as compared with the apnea–hypopnea index (AHI) and then provide possible values to use as a cutoff...

Background: To systematically review the literature for methods to localize the genial tubercle as a means for performing an advancement of the genioglossus muscle. Methods: PubMed, Google Scholar, CRISP, EMBASE, CINAHL, and Scopus were searched from inception through June 16, 2015. Results: One hundred fifty-two articles were screened, and th...

Obstructive sleep apnea (OSA) is a highly morbid disease associated with increased risk for all-cause mortality. The incidence and prevalence of OSA is increasing in the adult population. While alcohol is a known risk factor for increasing severity of OSA, the exact impact of alcohol on AHI and LSAT is not well-defined in the literature. The goal...

Background: Ankyloglossia is a condition of altered tongue mobility due to the presence of restrictive tissue between the undersurface of the tongue and the floor of mouth. Potential implications of restricted tongue mobility (such as mouth breathing, snoring, dental clenching, and myofascial tension) remain underappreciated due to limited peer-re...

Objective: To perform a systematic review with meta-analysis of data to determine the rates of repeat surgery and supraglottic stenosis in unilateral versus bilateral supraglottoplasty for laryngomalacia. Data sources: PubMed/Medline, Cochrane Central, Scopus, Google Scholar, Web of Science, and Embase. Review methods: Databases were searched...

Purpose: To systematically review the literature for articles evaluating differences in polysomnography (PSG) data when patients are on primarily daytime hemodialysis (conventional hemodialysis or continuous ambulatory peritoneal dialysis) versus nocturnal hemodialysis (nocturnal hemodialysis or nocturnal peritoneal dialysis). Then to perform a me...

Objective: Laser-assisted uvulopalatoplasty (LAUP) has been used as a treatment option for snoring and obstructive sleep apnea for almost three decades. It has been previously reported that some patient’s sleep-disordered breathing worsened following surgery. The aim of this paper is to further elucidate the specific complications of LAUP. Data sou...

Objective To examine outcomes in the intermediate term (1 to <4 years), long term (4 to <8 years), and very long term (≥8 years) for maxillomandibular advancement (MMA) as treatment for obstructive sleep apnea (OSA). Data Sources The Cochrane Library, Google Scholar, Embase, Cumulative Index to Nursing and Allied Health, and PubMed/MEDLINE. Revie...

INTRODUCTION: Nonbenzodiazepine (non-BZD) sedative hypnotics (NBSH) refer to non-BZD sedatives that act as BZD receptor agonists such as zolpidem, zaleplon, and eszopiclone. Today, there is a high prevalence of insomnia with or without concurrent obstructive sleep apnea (OSA). Our goal was to study how NBSH use impacts the baseline apnea–hypopnea i...

Objective: To systematically review the literature on anti-inflammatory medications for treating pediatric obstructive sleep apnea and perform meta-analysis of the available data. Data sources: PubMed/MEDLINE and 4 additional databases. Review methods: Three authors independently and systematically searched through June 28, 2018, for studies t...

Objectives/hypothesis: The objective of this study was to systematically review the English literature for articles that have described skeletal surgeries in the treatment of obstructive sleep apnea in both adults and children. From these articles trends and patterns in the treatment of OSA with skeletal procedures are described. Study design: T...

OBJECTIVE: To systematically search the literature for studies evaluating the typical presentation and testing that is performed for divers with inner ear symptoms and then to create a tool for clinicians when evaluating a diver with inner ear symptoms. METHODS: Nine databases, including PubMed/MEDLINE were systematically searched through 31 Janua...

Introduction: Positive airway pressure (PAP) devices are generally considered to be the first-line treatment of choice for most adults with obstructive sleep apnea (OSA). However, there are several alternatives. It is important for patients and their sleep providers to be aware of the most-up to date information regarding the current international...

Objective To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA). Methods Five databases (including PubMed/MEDLINE) were searched through July 12, 2017. Results Eight studies (307 patients) met criteria. Overall, CAPSO alone (80 patients) improved AHI from...

Pediatric obstructive sleep apnea (OSA) is a serious medical condition with numerous health consequences. Dentists are well suited to recognize and provide medical referrals for pediatric patients at risk for OSA. Timely dental sleep medicine interventions may improve signs and symptoms of OSA in growing children. Orthodontic and dentofacial orthop...

Objective: Minor surgeries on the oral cavity, e.g., frenulectomies, are often performed under general mask anesthesia. The objective is to present the nasal cannula technique for ventilating step-by-step method for ventilating during general anesthesia for minor surgeries in neonates and pediatric patients. Technique: The nasal cannula technique f...

Objective To search the international literature (any language) for publications reporting outcomes of tracheostomy performed to treat obstructive sleep apnoea in children. Method Data sources included: Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, and PubMed/Medline. Four authors searched systematically...

Objectives Mandibular distraction osteogenesis and mandibular advancement, collectively referred to as mandibular advancement surgeries (MAS), have been used to treat children with mandibular insufficiency and obstructive sleep apnea (OSA). The objective is to perform a systematic review and meta-analysis for MAS as treatment for obstructive sleep...

Objective The objective of this study is to review the published literature on supraglottoplasty techniques for correcting laryngomalacia, and to subsequently provide a standardized classification system. Methods Three authors independently and systematically searched Pubmed/MEDLINE and six additional databases for all studies that included descri...

This editorial discusses predatory journals and their effect on residents and staff physicians.

Objective: Tonsillectomy with adenoidectomy is a combination surgery that has been used to treat pediatric obstructive sleep apnea (OSA). For adults, tonsillectomy has also been reported as a primary treatment modality when the tissue is hypertrophied. The objective of this study is to provide an overview of published systematic reviews and meta-an...

PurposeOropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy. Methods PubMe...

Objective A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review...

Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD) in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not...

The article describes the change of the human craniofacial structures from the Pan Troglodyte through the transition to the Homo sapiens. The hypothesis for the effect of the changes to the facial skeleton, changes of oral and pharyngeal structures that have allowed for speech and have predisposed humans to obstructive sleep apnea are discussed.

Objectives/Hypothesis Examine trends in clinical research and levels of evidence related to obstructive sleep apnea (OSA) in the medical literature. Describe the features and trends of OSA research within otolaryngology journals. Study Design Retrospective analysis. Methods Review of OSA research articles from 2006, 2011, and 2016 in four lead...

Objective: To validate the use of Cormack-Lehane and Modified Cormack-Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnea. Study design: Validation study using samples collected from a prospective database. Setting: University Med...

L. David Marquet, a decorated Navy Captain, transformed an underperforming submarine crew by empowering his subordinates to be leaders and reach their full potential. He called this intent-based leadership (IBL). What would happen if Marquet’s model were implemented in Graduate Medical Education (GME)? In this letter to the editor, we summarize the...

Objective/Background Several studies have reported an association between 25-hydroxyvitamin D (25(OH)D) levels and obstructive sleep apnea (OSA) patients. The objective of the current study was to perform a systematic review and meta-analysis of these studies and report the findings. Patients/Methods Authors searched for studies (through January 1...

Objectives: Patients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis. Methods: Four authors searched five databases fro...

Background The purpose of the present study is to review the international literature, using a systematic review, for studies comparing propofol and dexmedetomidine for drug-induced sleep endoscopy (DISE) or sedation in which there is a description of the effect of the agents on the upper airway and associated variables (e.g., vital signs, sedation...

Purpose of Review This study aims to provide an update on surgical modalities targeted specifically at the soft palate as treatment for obstructive sleep apnea (OSA). OSA is an ever-changing field with advancements in not only medical management but also surgical interventions that continue to add to the plethora of treatment options. Though a mul...

Objectives To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries. Methods Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE. Results 351 studies were screened. Eleven studies (116 children) me...

Resident first author publications are discussed in this editorial.

Objective Rapid Eye Movement (REM) rebound is a polysomnographic phenomenon where a substantial increase in REM sleep is noted in patients with untreated obstructive sleep apnea (OSA) when first undergoing continuous positive airway pressure (CPAP) titration. The objectives of this study are to determine: 1) the percentage of patients experiencing...

Background: Positive airway pressure (PAP) devices are used as treatment for obstructive sleep apnea (OSA). PAP may increase middle ear pressure which is of interest to otologic surgeons. There is a lack of data to guide management of PAP therapy after middle ear surgery. Objective: To elucidate how otologic surgeons manage PAP in their patients...

Prions normally exist as cellular membrane proteins. In humans, 209 amino acids with one disulfide bond form a primarily alpha-helical prion protein structure with a molecular mass of 35 to 36 kDa. The specific role and function of the prion protein elude research efforts and remains a controversial topic. Misfolding of the native prion protein lea...

Social media’s prevalence among the professional world is rapidly increasing. Its use among medical personnel—specifically, medical students, resident physicians, and staff physicians— could compromise personal-professional boundaries. Could the acceptance or lack of acceptance of a friend request bias the medical student application process? If fr...

The objective is to determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve after transpalatal advancement pharyngoplasty (TPAP) with obstructive sleep apnea (OSA) in adults, using a systematic review and meta-analysis. Nine databases, including PubMed/MEDLINE, were searched through April 1, 2016. All studies that includ...

Background Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA) in adults. Objectives To perform a systematic review and meta-analysis for LAUP alone as treatment for OSA. Data sources Five databases (including PubMed/MEDLINE) were searched through October 30, 2016. Study eligibility criteria, p...

Objective To search for studies on tongue–lip adhesion and tongue repositioning used as isolated treatments for obstructive sleep apnoea in children with Pierre Robin sequence. Methods A systematic literature search of PubMed/Medline and three additional databases, from inception through to 8 July 2016, was performed by two authors. Results Seven...

Objective Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA. Methods Three authors...

Study objectives: Catathrenia is an underrecognized nocturnal vocalization phenomenon that can be a source of perplexity to patients, bed partners, and medical providers. Catathrenia is distinct from both sleep talking (a parasomnia with loud talking during sleep) and snoring (noise due to vibration of upper airway soft tissues related to variatio...

Objective The objective of this study was to systematically review the international literature for studies providing a preoperative checklist for medical disorders to be evaluated or treated before performing sleep surgery. If no checklist exists, then the identified studies would be used to develop a checklist de novo. Study design Systematic...

Purpose The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review...

Objectives/Hypothesis To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE and eight additional databases. Review Methods Three authors independently and systematically reviewed the inte...

Objective: To systematically search for studies reporting outcomes for adenoidectomy alone as a treatment for paediatric obstructive sleep apnoea and use the data to perform a meta-analysis. Methods: Nine databases, including PubMed and Medline, were systematically searched through to 1 April 2016. The Preferred Reporting Items for Systematic Re...

This article describes the potential challenges in having attendings and residents as friends on social media accounts.

Objective: To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS) to treat obstructive sleep apnea (OSA). Data sources: Ten databases. Review methods: Three authors searched through November 15, 2015. Results: 1,207 studies were s...

This is a response to the letter to the letter to the editor regarding Hyoid Surgery Alone for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

In this letter to the editor we propose a new tonsillar grading scale, the Friedman-Brodsky Tonsil grading scale.

Objectives/Hypothesis To determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). Study Design Systematic review and meta-analysis. Methods Nine databases (PubMed/MEDLINE included) were searched through Novemb...

This is an update to the recent meta-analysis on expansion sphincter pharyngoplasty.

This is a response to a letter to the editor regarding the manuscript: supraglottoplasty for laryngomalacia with obstructive sleep apnea: a systematic review and meta-analysis.

Objective To perform a systematic review of the international biomedical literature evaluating the effectiveness, complications, and safety of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA). Data Sources PubMed/MEDLINE, Embase, and EMB Reviews databases were searched up to November 27, 2015. Review Methods Two...

Excessive daytime sleepiness (EDS) and neurocognitive dysfunction are commonly observed in patients with obstructive sleep apnea (OSA), and these daytime functional deficits can be reversed partly or completely with treatment such as continuous positive airway pressure (CPAP). Although daytime sleepiness is a possible etiology for neurocognitive dy...

INTRODUCTION: The aim of this paper is to systematically review the international literature regarding new and innovative treatments for obstructive sleep apnea (OSA). EVIDENCE ACQUISITION: Three co-authors independently searched five databases (including PubMed/MEDLINE). EVIDENCE SYNTHESIS: The co-authors screened over 800 articles and identified...