In Reference to Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta-analysis.

We first want to express appreciation for publishing “Hyoid Surgery Alone for Obstructive Sleep Apnea: A Systematic Review and Meta-analysis” in a recent issue of The Laryngoscope. We recognize the need for an improved understanding of the isolated hyoid procedures for patients suffering from obstructive sleep apnea (OSA). However, our own experience regarding hyoid myotomy with mandibular suspension versus hyothyroidpexy has been counter to the conclusions of the article, and we believe that errors in the subanalysis of surgical techniques may have led to incorrect conclusions in the article. The introduction properly categorizes the Riley et al. 1984 article as reporting on hyoid myotomy with mandibular suspension, and the Riley et al. 1994 article as reporting on hyothyroidpexy techniques. However, Table 3 then incorrectly categorizes the Riley et al. 1994 et al. article as “Hyoid myotomy with suspension.” We believe that this miscategorization then leads to the misplacement of the Bowden et al. and Stuck et al. articles, which both reference the Riley et al. 1994 publication as the surgical technique used. If this is correct, then 30 of the 37 patients cited for this section are wrongly classified and should be placed under the hyothyroidpexy section. Additionally, although we only have access to the English translated abstract and a crude Web-based translation of the full article (from German), the Holzl et al. reference is placed under hyothyroidpexy when the article appears to describe seven patients who were differentially treated with hyoid suspension without myotomy, hyoid myotomy with suspension, and hyothyroidpexy. Furthermore, the surgery performed by den Herder may not have been isolated hyothyroidpexy because nasal reconstruction was performed as needed, although the timing of these procedures was not delineated. Song et al. concludes that hyothyroidpexy produces a 50.7% reduction in the apnea-hypopnea index (AHI), and hyoid myotomy with suspension produces a 38.3% reduction in the AHI. We have performed a quick weighted mean analysis with the above miscategorizations corrected. We have excluded the Holzl et al. article given that AHI reductions were not reported for each of the seven patients who received different operations. In our analysis, hyothyroidpexy produces a 32.1% reduction in AHI, and hyoid myotomy with suspension produces a 35.5% reduction in the AHI. The N-values are now skewed with 61 hyothyroidpexy patients and only six hyoid myotomy with suspension patients. Again, we appreciate publications investigating the role of the hyoid in improving OSA treatment.