Diagnosis
In a systematic review of published evidence, the United States Preventive Services Task Force in 2017 concluded that there was uncertainty about the accuracy or clinical utility of all potential screening tools for OSA, and recommended that current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults.The diagnosis of OSA syndrome is made when the patient shows recurrent episodes of partial or complete collapse of the upper airway during sleep resulting in apneas or hypopneas, respectively. Criteria defining an apnea or a hypopnea vary. The American Academy of Sleep Medicine (AASM) defines an apnea as a reduction in airflow of ≥ 90% lasting at least 10 seconds. A hypopnea is defined as a reduction in airflow of ≥ 30% lasting at least 10 seconds and associated with a ≥ 4% decrease in pulse oxygenation, or as a ≥ 30% reduction in airflow lasting at least 10 seconds and associated either with a ≥ 3% decrease in pulse oxygenation or with an arousal.To define the severity of the condition, the Apnea-Hypopnea Index (AHI) or the Respiratory Disturbance Index (RDI) are used. While the AHI measures the mean number of apneas and hypopneas per hour of sleep, the RDI adds to this measure the respiratory effort-related arousals (RERAs). The OSA syndrome is thus diagnosed if the AHI is > 5 episodes per hour and results in daytime sleepiness and fatigue or when the RDI is ≥ 15 independently of the symptoms.
Perichondritis  is inflammation of the perichondrium, a layer of connective tissue which surrounds cartilage. A common form, auricular perichondritis (perichondritis auriculae) involves infection of the pinna due to infection of traumatic or surgical wound or the spread of inflammation into depth (e.g. Infected transcartilaginous ear piercings). It may lead to severe deformation of the pinna if not treated vigorously with IV antibiotics. The causative organism is usually Pseudomonas aeruginosa. A rare form is laryngeal perichondritis (perichondritis laryngis). It develops suddenly due to an injury, virulent organisms or compromised immune status of the host, and also affects cartilage of the larynx. This may result in deformations and stenoses. Signs and symptoms
Signs of perichondritis or  chondritis  in  patients  with  an  embedded  earring  are  similar (these include pain, swelling and erythema of the overlying skin) and fluctuant swelling indicate an abscess that we should drain (typically associated with chondritis). Clinically, perichondritis can be differentiated from cellulitis of the pinna, in that the first usually does not involve the earlobe.In serious cases pus appears between the perichondrium and cartilage. Purulent melting of auricular cartilage takes place. Dead tissue tears away, as a result, auricle deforms strongly and becomes shrunken. See also
Chondritis

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