bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Subjective Voice Changes in Seasonal Allergic Rhinitis
Authors: Uyar Yavuz , Salturk Ziya , Atar Yavuz , Kumral Tolgar L. , Yildirim Guven , Aydogdu Imran , Atac Enes
Published: September 2014

Objectives:

Voice is a person's main communication tool and affected by many factors, including the upper respiratory tract. The upper respiratory tract influences mainly resonation, and the nose is one of the key points. Seasonal allergic rhinitis may affect voice quality via changing resonation. This study aims to evaluate the possible changes on voice caused by seasonal allergic rhinitis subjectively.

Methods:

Between October 15, 2013, and January 15, 2014, 28 patients who applied to our out‐patient clinic and diagnosed with seasonal allergic rhinitis were included in the study. Mean age of the patients was 28.4 and all were female. Patients were asked to complete voice handicap index 30. Control group was composed of 30 female patients who did not have seasonal allergic rhinitis. Values were analyzed in statistically nonpaired samples using Student t test.

Results:

The mean voice handicap index score was 16.4 in the study group and 5.5 in the control group. There was a statistically significant difference between the 2 groups (P <. 05).

Conclusions:

Seasonal allergic rhinitis has an adverse affect on vocal quality, subjectively.
Ethnic Disparities in Myringoplasty Surgery in New Zealand
Authors: Kwon Hyok Jun , Dowley Andrew , Mason Paul
Published: September 2014

Objectives:

(1) Examine and analyze whether there are ethnic disparities in myringoplasty rates and outcomes in New Zealand.

Methods:

Prospective cohort of 167 consecutive myringoplasty surgeries performed at the only public regional hospital in a district of New Zealand between 2003 and 2012. Basic patient demographics including ethnicity and nature of perforation (size, location, and active infection) were recorded preoperatively. Primary outcomes were of successful perforation repair on postoperative review, hearing improvement on pre‐ and postoperative audiograms, and prevention of recurrent infections of the middle ear.

Results:

In our cohort, the native Maori of New Zealand have disproportionately high incidences of myringoplasty surgery compared with the majority Europeans (28.7/100,000 vs 6.2/100,000 persons/year, P =. 0001). Maori patients tend to be younger on average (16.80 vs 23.4 years old, P =. 001) with larger perforations (25.9% vs 24.3%, P =. 029), but there were no significant ethnic disparities in primary surgical outcomes.

Conclusions:

Our study supports the hypothesis that native Maori of New Zealand have a greater burden of middle ear disease compared with the majority Europeans but shows that Maori are just as likely to benefit from myringoplasty surgery. Further population‐level studies are required to verify this.
Importance of Human Papillomavirus Integration in Malignant Transformation of Inverted Papilloma
Authors: Suzuki Mikio , Deng Zeyi , Hasegawa Masahiro
Published: September 2014

Objectives:

This study investigated the role of human papillomavirus (HPV) in malignant transformation of paranasal inverted papilloma (IP).

Methods:

HPV presence and viral load and physical status of HPV‐16 were examined by polymerase chain reaction‐based methods using fresh frozen samples or paraffin‐embedded samples obtained from 17 patients with IP (IP group), 5 with IP and squamous cell carcinoma (IP+SCC group), 16 with SCC (SCC group), and 67 with chronic inflammatory lesions (inflammatory group).

Results:

The presence of the HPV genome was detected in 29.4%, 40.0%, 25.0%, and 6.0% of patients in the IP, IP+SCC, SCC, and inflammatory groups, respectively. The IP group showed significantly higher HPV‐positive rates than the inflammatory group. All types of HPV detected were high‐risk HPV, especially HPV‐16. The relative HPV‐16 copy numbers varied from 2.5 to 7953 per 50 ng genomic DNA. Viral load was higher in the IP+SCC group than in the inflammatory group. In the IP group, no significant relationship was found between HPV‐16 viral load and clinical characteristics. All patients with IP+SCC and SCC showed integration of HPV‐16.

Conclusions:

High viral load and integration of HPV have an important role in malignant lesion in association with IP.
Inverted Papillomas: Retrospective Review
Authors: Moura Ivo M. , Soares Mafalda , Delgado Inés P. , Gabriel Teresa , Cardoso Marta , Leandro João Pedro , Veiga Gabão
Published: September 2014

Objectives:

Inverted papillomas are benign sinonasal tumors arising from Schneiderian mucosa. The inverted papillomas represent 0.5% to 4% of all sinonasal tumors. The purpose of this review was to analyze the patients with inverted papilloma treated in Hospital Prof. Doutor Fernando Fonseca, Portugal.

Methods:

A retrospective review was performed of patients with inverted papilloma over a 10‐year period.

Results:

The authors found 12 cases of inverted papilloma, mean age of 63 years old with male predominance. In collaboration with the neuroradiology department, the authors found 1 case in Stage I, 4 cases in stage II, 5 cases in stage III, and 2 cases in stage IV of Krouse's Staging System. The endoscopic surgical approach was used in 11 cases (combined with external approach in 7 cases) and isolated external approach in 1 case. The meantime of follow‐up was 28 months. There was recurrence in 4 cases and 1 had malignant transformation.

Conclusions:

The treatment of inverted papilloma is surgical, with the endoscopic approach the choice in the majority of the cases. A follow‐up for a long period is necessary. A larger number of cases for analysis would be necessary to confirm the review's results.
Maintaining Favorable Middle Turbinate Position after Endoscopic Sinus Surgery
Authors: Torres Lisa , Shaari Christopher M. , Ghalili Andrew
Published: September 2014

Objectives:

(1) Analyze the safety of using Propel mesh implant in revision sinus surgery. (2) Analyze the efficacy of maintaining a medial position of the middle turbinate without synechiae in the postoperative period.

Methods:

This was a retrospective study between July 2012 and February 2014 in 16 patients with chronic rhinosinusitis undergoing revision sinus surgery and who underwent placement of a Propel mometasone implant into the ethmoid bowl at end of the procedure. Placement of the Propel was unilateral in some or bilateral in others. Surgery was conducted at outpatient surgical centers. Safety measures included incidence of bleeding, orbital migration of mesh, and chronic scabbing. Efficacy measures included incidence of synechiae and maintenance of medial position of the middle turbinate.

Results:

A total of 26 Propel implants were placed. The incidence of complications from the implant was zero and the efficacy of maintaining a medialized middle turbinate without synechiae was 100%.

Conclusions:

In selected patients with chronic rhinosinusitis undergoing revision sinus surgery, the placement of a Propel mometasone implant into the ethmoid bowl is safe and effective at maintaining a medialized position of the middle turbinate without synechiae formation.
Operative Interventions for Clivus Osteoradionecrosis with CSF Leak following Stereotactic Radiosurgery for Nasopharyngeal Carcinoma
Authors: Oliveira Vitor M. , Campelo Paula , Silva Deodato , Escada Pedro A. , De Almeida Gonçalo Neto , Carmo Diogo O. , Paco Joao‐Carlos L. S.
Published: September 2014

Objectives:

Nasopharyngeal carcinoma (NPC) local recurrence still represents a major clinical challenge and a high mortality and morbidity cause. The authors report a case of a 44‐year‐old male with clivus osteoradionecrosis (ORN) and dural radionecrosis who presented with cerebrospinal fluid (CSF) leak, 6 months after a boost of stereotactic radiosurgery using gamma knife for the treatment of locally recurrent NPC, following conventional external beam radiotherapy (EBRT) with chemotherapy.

Methods:

A direct transnasal endoscopic‐assisted approach with multiple reconstructive pedicled flap technique was used to achieve watertight dural reconstruction.

Results:

Despite CSF leak recurrence, after the second attempt we achieved a successful clivus reconstruction using a bilateral posterior pedicle inferior turbinate flap (PPITF). The reconstruction withstood a watertight seal for 1 month, until patient death from cardiopulmonary arrest as a result of ventilator‐associated pneumonia.

Conclusions:

We recommend an early diagnosis and surgical intervention in the setting of clivus ORN. Local debridement of necrotic bone is critical for local nasal graft adherence and survival. The evidence of dural radionecrosis is a predictor of bad prognosis. As a result, broad dural defect exposition should be the standard procedure with the use of a multi‐layered technique combined with vascularized pedicle flaps regardless of the dural tear dimension.
Prevalence of Fungal Sensitization in Patients with Polypoid Chronic Rhinosinusitis: A Cross‐Sectional Study
Authors: De Vilhena Ditza , Lopes Gustavo , Martins Cidália , Duarte Delfim , Opes Cristina
Published: September 2014

Objectives:

Although allergic fungal rhinosinusitis (AFRS) is a well‐recognized entity, few data are published concerning the prevalence of mold sensitization in patients with polypoid chronic rhinosinusitis (PCRS). Our aim was to determine the prevalence of fungal and common aeroallergen sensitization in a sample of adult patients with PCRS at an ear, nose, and throat clinical setting.

Methods:

All adult patients with PCRS who underwent sinus surgery between September 2012 and December 2013 were invited to participate. Prick tests were done with Alternaria alternata (Aa), Cladosporium herbarum (Ch), Aspergillus fumigatus (Af), Curvularia lunata (Cl), Fusarium monilifo (Fm), Dermatophagoydes pteronyssinus (Dp), and grass‐pollen extract (extracts Merck). T Student and chi‐square tests were determined using SPSS v22, and applied when appropriate. A P value <.05 was considered significant.

Results:

Sixty‐three patients were included (60% men), mean age (SD) 45 (15.4) years old. Of the patients, 14.3% had at least 1 positive skin prick test for molds (9.5% for Aa, 4.8% for Ch, 6.3% for Af, 4.8% for Cl and 4.8% for Fm). Forty‐percent were allergic to dust mite and 27% to pollen. We failed to detect an association between fungal sensitization and age (P =. 838), sex (P =. 674), and Dp sensitization (P =. 074), but we found a positive association between fungal and grass‐pollen sensitization (41.2% vs 4.3%, P <. 001).

Conclusions:

Almost one‐sixth of our patients were mold sensitized. The routine determination of fungal allergic profile may improve the assessment of patients with PCRS, increasing awareness to AFRS diagnosis.
Safety and Efficacy of Frontal Sinus Stents: A Systematic Review
Authors: Hussein Ahmed , Turner Justin
Published: September 2014

Objectives:

Postsurgical stenosis of frontal sinus can be a challenging problem for the endoscopic sinus surgeon. Frontal sinus stents are often used in an attempt to maintain frontal outflow patency. The current study systematically reviews the literature to determine the safety and efficacy of frontal stents.

Methods:

The Pubmed, Google Scholar, and Cochrane databases were reviewed and studies evaluating the usage and reliability of frontal sinus stents were extracted based on defined inclusion criteria.

Results:

Eleven studies comprising a total of 192 patients met inclusion criteria and were evaluated for stent material, stenting duration, surgical techniques, patient outcomes, and complication. All studies were classified as level 4 evidence provided by the Oxford Center for Evidence Based Medicine. Multiple stent materials were used with varying duration. Complications were generally minor and included stent migration, pain, epistaxis, and infection. Frontal sinus patency following stent replacement varied from 71.4% to 100%, however, the efficacy of stent placement in maintaining frontal sinus patency could not be evaluated due to a lack of controlled studies.

Conclusions:

Current literature evaluating the use of frontal sinus stents is limited and comprised entirely of level 4 studies. The efficacy of frontal sinus stenting could not be accurately evaluated because of the small number of studies and variable outcome measures. Larger, high‐quality studies are needed to support the use of stents in endoscopic surgery of frontal sinus.
Simvastatin Inhibited the IL‐5–Induced Chemotaxis toward Eotaxin and CCR3 Expression of HL‐60–Derived Eosinophils
Authors: Fu Chia‐Hsiang , Pang Jong‐Hwei Su , Huang Chi‐Che , Lee Ta‐Jen
Published: September 2014

Objectives:

IL‐5‐induced chemotaxis of eosinophils is an important feature for atopic diseases. Lipid lowering agents, statins, have been shown with inhibitory ability for inflammatory process and leukocyte accumulation. We herein investigate their effects on chemotaxis of eosinophils and the possible regulating mechanisms.

Methods:

Eosinophils were derived by treating HL‐60 clone 15 (HC15) with butyric acid in an alkaline condition. The 2 most potent chemokine and cytokine receptors for eosinophils, CC‐chemokine receptor‐3 (CCR3) and IL‐5 receptor (IL5R), were verified on the cell line. Dose effect of IL‐5 stimulation for chemotactic ability toward eotaxin and CCR3 presentation was measured. Simvastatin effect for IL‐5 induced chemotaxis and these two receptors was analyzed in RNA and protein level. Mevalonate effect for the behaviors of simvastatin was also evaluated.

Results:

IL‐5 in the dosage of 10 ng/mL had the most impressive enhancement on chemotaxis and CCR3 presentation for eosinophils harvested from HC15. Simvastatin inhibited IL‐5‐induced chemotaxis and CCR3 presentation in both mRNA and protein level but had no effect on IL5R. Mevalonate could reverse those inhibitory effects of simvastatin.

Conclusions:

Simvastatin inhibited IL‐5‐induced chemotaxis of HC15‐derived eosinophils by repression of CCR3 presentation instead of IL5R. This inhibitory effect of simvastatin acted via mevalonate pathway which could be reversed by mevalonate replacement.
Sleep Quality after Endoscopic Sinus Surgery in Patients with Sinonasal Polyposis
Authors: Majidi Mohammad R. , Nourizadeh Navid , Rasoulian Bashir , Ardani Amir Rezaei , Asadpour Hadi , Rezaeitalab Fariborz , Hassanzadeh Nadia
Published: September 2014

Objectives:

Evaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters.

Methods:

This clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery.

Results:

The evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P =. 002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P =. 233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P =. 02) and sleep efficiency index was improved after the surgery (P =. 008).

Conclusions:

This study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality.
Staphylococcus Enterotoxin A Induces MUC5B Expression via TLR2‐dependent MAPK in Airway Epithelial Cells
Authors: Kim Young‐Dae , Choi Yoon Seok , Bae Chang Hoon , Song Si‐Youn
Published: September 2014

Objectives:

Staphylococcus aureus enterotoxins are known to induce an inflammatory response of the airways, increase sensitization to inhaled allergens, and decrease T‐cell sensitivity to steroids. However, the effects of Staphylococcus enterotoxin A (SEA) on mucin secretion of airway epithelial cells have not yet been reported. Therefore, in this study, the effect and brief signaling pathway of SEA on MUC5B expression were investigated in human airway epithelial cells.

Methods:

In the mucin‐producing human NCI‐H292 airway epithelial cells and the primary cultures of normal nasal epithelial cells, the effect and signaling pathway of SEA on MUC5B expression were investigated using reverse transcriptase‐polymerase chain reaction (RT‐PCR), real‐time PCR, enzyme immunoassay, and immunoblot analysis with several specific inhibitors and small interfering RNA (siRNA).

Results:

SEA increased MUC5B mRNA and protein expression. Toll‐like receptor 2 (TLR2) mRNA expression was significantly increased after treatment with SEA. Knockdown of TLR2 by siRNA significantly blocked SEA‐induced MUC5B mRNA expression. SEA significantly activated phosphorylation of extracellular signal‐regulated kinase 1/2 (ERK1/2) and p38 mitogen‐activated protein kinase (MAPK). U0126 (ERK1/2 MAPK inhibitor) and SB203580 (p38 MAPK inhibitor) significantly inhibited SEA‐induced MUC5B mRNA expression. In addition, knockdown of ERK1/2 and p38 MAPK by siRNA significantly blocked SEA‐induced MUC5B mRNA expression. Furthermore, the phosphorylation of ERK1/2 and p38 MAPK was significantly blocked by knockdown of TLR2 by siRNA.

Conclusions:

These results show for the first time that SEA induces MUC5B expression via TLR2, ERK1/2, and p38 MAPK signaling pathway in human airway epithelial cells.
Image Evaluation of Nasopharyngeal Mucosa Physical Change of Laryngopharyngeal Reflux Disease
Authors: Niwa Hideo , Shan Chong H. , Zhang Zhong , Horihata Satoshi , Makiyama Yasuhide
Published: September 2014

Objectives:

Evaluate a picture of narrow band imaging (NBI) examination for a diagnosis of laryngopharyngeal reflux disease (LPRD) using the image processing analysis objectively.

Methods:

Ten patients who underwent NBI were studied. Eight patients were LPRD and 2 patients were non‐LPRD patients. We performed image processing for pictures after NBI examination by using the application software of a perfect translation invariance complex discrete wavelet transform (PTI‐CDWT) developed at Toyohashi University of Technology and MATLAB (The MathWorks, Inc.). We looked into the nasopharyngeal mucosa physical changes that were detected by PTI‐CDWT and analyzed by MATLAB.

Results:

Images with LPRD showed many round opaque dots mostly consistent with round wavelet transform. On the contrary, images without LPRD represented a small number of linear lines, and any other area showed no feature. Morphologic operation by MATLAB distinguished the difference of nasopharyngeal mucosa physical exchange between LPRD and non‐LPRD.

Conclusions:

Though LPRD is a common disease for otolaryngologists to see, it may not yet be a definite diagnosis like gastroesophageal reflux disease. We have presented a correlation between LPRD and nasopharyngeal mucosa examination as mackerel cloud pattern at American Academy of Otolaryngology—Head and Neck Foundation annual meetings. We showed the possibility of image processing to diagnose LPRD with PTI‐CDWT last year. Images which were implemented morphological operation by MATLAB may show representative for each nasopharyngeal mucosa physical change. MATLAB characterized images which were modified using PTI‐CDWT. To use PTI‐CDWT and MATLAB is not only useful in diagnosing LPRD but may possibly allow one to develop image diagnosis or an analysis instrument.
The Association between Sleep Duration and Metabolic Variables in Obese Children with Obstructive Sleep Apnea
Authors: Bhushan Bharat , Maddalozzo John P. , Hoff Stephen , Ida Jonathan B. , Billings Kathleen
Published: September 2014

Objectives:

Sleep loss is problematic in adults and children. Decline in sleep duration has paralleled an increase in the prevalence of obesity and diabetes. The aim of this study was to analyze the association between sleep duration, severity of obstructive sleep apnea (OSA), and metabolic variables in obese children.

Methods:

In this study, patients between the ages of 2 and 12 years who had overnight polysomnography (PSG) at a tertiary care medical center were included. Patients were identified from a xenobase search of medical records. All patients had lipid levels, blood glucose, and insulin evaluated within 3 months of PSG. The demographics, laboratory data, body mass index (BMI), and blood pressure were collected from the medical records.

Results:

A total of 31 patients were studied. Twenty‐one (67.7%) were male, and the mean age of patients was 8.5 ± 1.9 years. The mean BMI z score was 2.7 ± 0.81. All patients were obese. Patients were categorized into groups with total sleep duration >6 hours and <6 hours. Sixteen patients slept <6 hours and 15 patients slept >6 hours. There was no statistical difference in the lipid variables and blood pressure in these patients. A nonsignificant trend of decreased sleep duration with an increase in severity of OSA was observed. Blood sugar was significantly increased in patients with sleep <6 hours (100.2 ± 8.1 mg/dL) when compared with patients with sleep >6 hours (95 ± 4.4 mg/dL; P =. 05). The homeostasis model assessment (HOMA) values were significantly higher in children with sleep <6 hours (1.81 ± 0.51) when compared with patients with sleep >6 hours (1.33 ± 0.55; P =. 04).

Conclusions:

Short sleep duration is associated with insulin resistance in obese children with OSA.
A New Technique of Virtual Modeling of Individual Patient Airways in Obstructive Sleep Apnea
Authors: Mitchell Jennifer L. , Liu Yang , Wang Robert C. , Orr Katelyn , Yim Woosoon , Chen Yitung
Published: September 2014

Objectives:

Up to 14% of the US population is estimated to have obstructive sleep apnea (OSA) related to obesity. Other than continuous positive airway pressure, treatments have had variable results since the exact site(s) of obstruction and the optimal method of modifying those sites with devices or surgery can be difficult to establish. We introduce a technique for modeling the upper airway that shows the behavior of the airway and predicts the location of collapse in OSA.

Methods:

Accurate modeling of air to solid fluid‐structure interaction, challenging to model in the past, was accomplished using ANSYS software applied to a 3‐dimensional rendering of an OSA patient's airway (with an AHI of 87.6/h) using thin‐cut computed tomographic scan data. Viscoelastic properties of the pharyngeal walls, tongue and palate, not previously well characterized, were measured using 5 fresh porcine cadaver heads with a Bose ElectroForce test instrument with Dynamic Mechanical Analysis software. Various dynamic displacements were applied to tissue samples and associated forces measured simultaneously to obtain dynamic material properties.

Results:

Areas of lowest pressure during inspiration were identified as likely regions of collapse during apneic episodes, such as the base of the tongue with pressures as low as –4730 Pa (–48.23 cm H2O), similar to values reported in human esophageal pressure measurements in upper airway resistance syndrome.

Conclusions:

This novel investigation virtually and accurately models the upper airway in OSA, and allows virtual modification of the airway to predict effects of treatment.
Outcomes of Patients Presenting to Sleep Disorder Clinic in Otolaryngology Practice
Authors: Ng Christina Hui Lee , Tan Alvin Kah Leong , Hsu Pon Poh
Published: September 2014

Objectives:

Continuous positive airway pressure (CPAP) has become the standard of care for obstructive sleep apnea (OSA). However, CPAP compliance has been shown to be poor and surgical correction of upper airway may be an option for selected patients. The study aimed to assess the outcomes of patients presenting to sleep disorder clinic with OSA.

Methods:

Subjects were identified by reviewing sleep laboratory records of patients presented for full polysomnography from 2010 to 2014. Case notes were traced and data collected retrospectively. The treatment prescribed include weight reduction, CPAP, surgery and oral appliance. The outcomes of treatment options offered were analyzed and full polysomnography parameters before and after treatment were compared.

Results:

Less than 20% of patients underwent surgical correction of the upper airway. Less than 50% of the patients used an oral appliance. More than 60% of patients showed improvement in the respiratory disturbance index (RDI) after the surgery. About 80% of patients defaulted treatment subsequently. A small proportion of patients were discharged from the sleep disorder clinic after significant improvement of symptoms.

Conclusions:

Surgery is indicated in patients who have a specific underlying abnormality causing the OSA and if they refused or failed CPAP therapy. However, only a small proportion of patients have such correctible lesions.
Polysomnography Outcomes after Transoral Robotic Lingual Tonsillectomy for Obstructive Sleep Apnea
Authors: Smith Chelsey , Argo Jimmy L. , Jones Kellie , Anderson Michael , Vasan Nilesh R.
Published: September 2014

Objectives:

Compare polysomnography (PSG) results before and after transoral robotic lingual tonsillectomy (TORLT) in patients with obstructive sleep apnea (OSA).

Methods:

Lingual tonsillar or base of tongue hypertrophy can be a cause of OSA but has proven difficult to address because of difficulty in accessing this area of the oropharynx through traditional surgical techniques. TORLT provides a simple, minimally invasive surgical technique for lingual tonsillectomy. Patients with OSA symptoms were assessed with preoperative PSG and sleep endoscopy for base of tongue obstruction. Selected candidates underwent TORLT followed by repeat PSG and nasal endoscopy after full recovery from the procedure. The pre‐ and postoperative PSG data were compared for each patient. Nonparametric comparisons were made using the signed rank test becasue of small sample size.

Results:

Ten patients underwent preoperative PSG and subsequent TORLT. Postoperative polysomnography data as available for 8 patients. Pre‐ and postoperative PSG comparisons (pre, post, P value) showed improvements in the median apnea‐hypopnea index (49.8, 19.5, P =. 84), sleep onset latency (11.8 minutes, 17.5 minutes, P =. 84), sleep efficiency (80.5%, 92.3%, P =. 2), and Epworth Sleepiness Scale (14.5, 10, P =. 88), but none were statistically significant.

Conclusions:

Transoral robotic lingual tonsillectomy improved polysomnography measures but not to a level of significance. This study is limited by small sample size and associated limited statistical power. Further study with larger sample sizes should be undertaken to more definitively study outcomes for this surgical technique.
Relationship between Oral Flow Patterns, Nasal Airway, and Respiratory Events
Authors: Suzuki Masaaki
Published: September 2014

Objectives:

Few investigations have examined oral flow (OF) patterns during sleep. This study aimed to clarify the relationship between OF patterns, nasal airway obstruction, and obstructive respiratory events.

Methods:

Nasal flow and OF were measured separately by polysomography. OF was measured 2 cm in front of the lips using a pressure sensor. Subjects were categorized into 2 groups: those with nasal obstruction (n = 44) and those without nasal obstruction (n = 41).

Results:

OF could be divided into 3 patterns: postapneic OF, OF during flow reduction (OF during FR), and spontaneous arousal‐induced OF (SpA‐induced OF). Postapneic OF refers to OFs that begin at the end of obstructive respiratory events (eg, flow limitation, hypopnea, and apnea), are preceded by respiratory arousals, and are accompanied by postapneic hyperventilation. OF during FR refers to OFs that occur during respiratory event‐like nasal flow reduction. SpA‐induced OFs are OFs that begin during stable breathing, are preceded by spontaneous arousal but not accompanied by apnea or hypopnea. Multivariate regression analysis showed that nasal obstruction was predictive of SpA‐induced OF. Only 1.3% of SpA‐induced OF led to apnea or hypopnea. SpA‐induced OF showed a negative correlation with the apnea‐hypopnea index.

Conclusions:

Postapneic OF and OF during FR led to apnea or hypopnea and were typical patterns seen in patients with moderate and severe sleep‐disordered breathing (SDB). By contrast, SpA‐induced OF was not associated with apnea or hypopnea but functioned as a “nasal obstruction bypasser” seen mainly in normal subjects and patients with mild SDB.
Subjective Assessment of Voice, Nasality, and Swallowing Changes in Patients with OSAS after Anterior Uvulopalatoplasty
Authors: Lisauskaite Laura
Published: September 2014

Objectives:

None provided.

Methods:

In this prospective clinical study, 41 adult patients (32 males, 9 females) diagnosed for obstructive sleep apnea syndrome (OSAS) and operated at university hospital by anterior uvulopalatoplasty between December 2008 and December 2010 at least 6 months (median 10.0 months) before investigation, formed the study group. A total of 17 nonoperated OSAS patients matched by age, sex, smoking rate, and OSAS severity served as controls. Post service with questionnaires and telephone conversation was accomplished. Patient and control symptoms (hoarseness, nasality of voice, and dysphagia) were assessed using 10‐point Likert scale (1‐normal). Voice quality was assessed by voice handicap index (VHI), and hypernasality by auditory perceptual Gutzmann hypernasality test.

Results:

Hoarseness ratings for OSAS patients were similar before and after the surgery, with no significant impact on voice handicap. Moreover, total VHI score significantly dropped after the surgery from 9.2 points to 5.4 points out of maximum 120 (P <. 05). Mild nasality of voice with mean intensity score of 1.4 ± 1.0 points was self‐rated by 17.1% of patients, but postoperative rating was significantly lower than that before surgery (2.0 ± 1.9; P <. 05). No significant differences were found in dysphagia scores and Gutzmann test before and after the palatal surgery and between treated by surgery and control groups.

Conclusions:

Anterior uvulopalatoplasty does not result in significant changes in voice, nasality and swallowing when rated by OSAS patients and by clinical assessment.
Use of Modified Swallow Study to Measure Posterior Airway Space in Obstructive Sleep Apnea Patients
Authors: Phillips Jeffrey , Carbo Alberto , Babcock Kelley , Nathan Cherie Ann O.
Published: September 2014

Objectives:

Obstructive sleep apnea affects over 15% of the population, presenting a major health burden. Research has focused on exploring imaging modalities that supplement polysomnography, eliciting potential sites of airway obstruction. While computed tomography (CT) imaging and sleep endoscopy have been used to accurately assess the posterior airway space (PAS), sedated endoscopy is invasive, and repeated CT imaging risks higher radiation exposure and does not assess the dynamics of the tongue base and PAS. We propose the use of modified barium swallow study as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. We hypothesize cephalometric measurements obtained using modified barium swallow (MBS) will correlate well with CT.

Methods:

Retrospective chart review, tertiary care hospital. Thirty‐six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT or MBS.

Results:

The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm when using MBS and CT imaging, respectively. There were no statistical differences based on age, sex, or cancer site. In comparing the 2 modalities, Pearson correlation between CT and MBS measurements revealed an extremely significant positive correlation between r = 0.6382 and 0.8932 (P <. 0001).

Conclusions:

Cephalometric measurement of the PAS using MBS appears to correlate well with CT imaging. These data suggest MBS may be an effective way to assess the PAS in patients with OSA.
WatchPAT versus Polysomnography: A Meta‐analysis
Authors: Camilon P. Ryan , Nguyen Shaun A. , Camilon Marc P. , Gillespie M. Boyd
Published: September 2014

Objectives:

Recognize the correlation between WatchPAT and Polysomnography (PSG) results including the apnea‐hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI).

Methods:

A systematic literature review was performed by searching Pubmed, OVID Medline, and the Cochrane database for articles from June 2000 comparing WatchPAT to PSG. Meta‐analysis of continuous measures using the fixed effect model was performed.

Results:

Twelve studies that directly compared the results of AHI, RDI, and ODI between WatchPAT and PSG were identified. Five of the 12 studies, involving a total of 476 patients, measured AHI. WatchPAT AHI was not found to be significantly different from PSG AHI (standardized mean difference [SMD], 0.10; 95% confidence interval [CI], –0.08 to 0.28). RDI values, obtained from 5 studies with a total of 612 patients, did not significantly differ between WatchPAT and PSG (SMD, 0.08; 95% CI, –0.07 to 0.24). No significant difference was found between WatchPAT ODI and PSG ODI values from 2 studies with a total of 298 patients (SMD, 0.11; 95% CI, –0.12 to 0.34).

Conclusions:

The respiratory indices provided by WatchPAT are comparable to those obtained by PSG. This meta‐analysis reinforces the validation of WatchPAT as an alternative to PSG in the diagnosis of obstructive sleep apnea (OSA). With WatchPAT, patients can be evaluated in their own habitual environment rather than in a sleep lab. Therefore, the use of WatchPAT provides a less stress‐inducing option for patients and a more financially efficient method for the evaluation of OSA.
Long‐term Outcomes of Treating Middle Ear Cholesteatoma with Intact‐Canal Wall and Scute Repairing Techniques
Authors: Du Lijun
Published: September 2014

Objectives:

Assess the long‐term outcomes of treating middle ear cholesteatoma with multiple techniques including intact‐canal wall and scute repairing techniques.

Methods:

One hundred thirteen patients had been treated between 2001 and 2006. Multiple techniques including harvesting bone chips with air drill, sculpting of autologous bone grafts, chorda tympani nerve tightening prosthesis, preventing adhesion with hyaluronic acid ester membrane, lesion cleaning, reconstruction of ear canal wall, re‐gasification of attic and/or mastoid cavity, and early catheterization of the Eustachian tube were performed.

Results:

One hundred twelve ears only received the operation once, and the preoperative air bone conduction gap (ABG) was 33.61 ± 12.35 dB, which was significantly higher than postoperative ABG (13.58 ± 9.27 Db, t = 18.35, P <. 01 [G1]). Success rate of the treatment was 85.48% (106/124), and the effective rate was 47.58% (59/124). Significant improvement in the bone conduction threshold was also found (17.3 ± 13 vs 15.15 ± 11.79 dB, t = 4.77, P <. 01). Twenty‐one ears (16.93%) had increased bone conduction, 61 ears (49.19%) had decreased bone conduction, and the other 42 ears (33.87) had no change in the bone conduction. The long‐term success rate was 83.87% (104/124), and the effective rate was 38.7% (48/124). No significant difference was found in the GAP, GAP change, and AC between the values measured at the last follow‐up of the long‐ and short‐term follow‐up study (P >. 05).

Conclusions:

Treating middle ear cholesteatoma with intact‐canal wall and scute repairing techniques is safe. These surgical procedures involve low relapse rate, and treating patients with relapsed cholesteatoma with these procedures could also result in good outcomes.
Microbial Flora and Antibiotic Resistance in Odontogenic Oral Abscesses in Upstate New York
Authors: Plum Ann W. , Mortelliti Anthony J. , Walsh Ronald
Published: September 2014

Objectives:

(1) Identify the most common bacteria in odontogenic oral abscesses over the past decade. (2) Identify the prevalence of antibiotic resistance of pathogens responsible for odontogenic oral abscesses to guide initial antibiotic treatment.

Methods:

This is a retrospective chart review conducted at a single tertiary academic medical center of adult and pediatric patients who underwent drainage of oral abscesses caused by odontogenic sources (n = 129), during which cultures of the abscess were obtained. The cultures were analyzed for type of pathogen and antibiotic sensitivities. Medical comorbidities and drainage techniques were reviewed.

Results:

Multiple bacteria species were identified in 59.69% of odontogenic abscesses and single bacteria species in 34.11%. The most common bacteria were alpha hemolytic streptococci (34.11%), streptococcus milleri (32.56%), prevotella strains (19.38%), and coagulase negative staphylococcus (14.73%). Clindamycin resistance was identified in stomatococcus (50%), lactobacillus (33.33%), streptococcus milleri (33.33%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Penicillin resistance was identified in stomatococcus (50%) and lactobacillus (33.33%). Methicillin resistance was identified in staphylococcus (10%). Erythromycin resistance was identified in streptococcus milleri (35.71%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Strepto‐coccus milleri was also resistant to tetracycline (2.38%), and morganella morganii was resistant to ampicillin (100%) and cefazolin (100%).

Conclusions:

Most oral odontogenic abscesses were polymicrobial, with the most common pathogens being alpha hemolytic streptococcus, streptococcus milleri, prevotella, and coagulase negative staphylococcus. The most common antibiotic resistances were to clindamycin and erythromycin, which should be considered when deciding initial antibiotic therapy.
Minimal Invasive Nasal Valve Repair in Treatment of Nasal Valve Obstruction
Authors: Said Said M.
Published: September 2014

Objectives:

Nasal obstruction is known to be associated with a major decrease in disease‐specific quality of life, and nasal valve dysfunction can play a considerable role in nasal airflow obstruction. There are many procedures for treating this type of nasal obstruction. Aim: Evaluate the efficiency of minimally invasive valve repair for the treatment of nasal obstruction due to nasal valve stenosis in comparison with the reduction of the size of inferior turbinate by coblation and sub mucosal diathermy (SMD).

Methods:

This is a cross sectional study conducted atl–erbil from November 20, 2011, to September 19, 2013. The study included 43 patients suffering from nasal obstruction for more than 6 months. The patients were divided into 3 groups according to the type of surgery carried out (minimally invasive valve repair, coblation and submucosal diathermy [SMD] of inferior turbinate). Patients were followed for 3 months, and the data were statistically analyzed.

Results:

Patients showed highly significant differences between pre‐ and 1st, 30th, and 90th days postoperative total nose scale scores (P =. 0001). The difference between 1st and 30th and 90th days total score was also significant. While patients treated by coblation and SMD showed no significant difference in the mean nose score (P =. 705 and P =. 2), postoperative morbidity was less in the minimal invasive valve repair group compared with coblation and SMD groups.

Conclusions:

Minimal invasive valve repair had more rapid improvement and less postoperative morbidity in comparison with coblation and SMD of inferior turbinate.
National Trends and Associated Factors of Endotracheal Intubation among Adult Inpatients with Peritonsillar Abscess
Authors: Qureshi Hannan A. , Tan Bruce K. , Chandra Rakesh K. , Kern Robert C. , Smith Stephanie S.
Published: September 2014

Objectives:

(1) Describe national trends in peritonsillar abscess (PTA) requiring endotracheal intubation (ETI). (2) Determine factors associated with ETI in patients with PTA.

Methods:

Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD‐9 code: 475) and ETI (ICD‐9 code: 96.04) in adult patients (age ≥18 years old). Descriptive statistics and multivariate regression modeling were employed to identify factors associated with ETI.

Results:

From 2003 to 2010, 90,941 (95% CI:86, 433‐95, 449) admissions associated with a PTA were identified, of which 1357 (1.5%) underwent ETI. These patients had a higher prevalence of concurrently coded sepsis (7.3% vs 1.2%), severe sepsis (13.0% vs 0.2%), and death (7.9% vs 0.1%) compared with patients without ETI. Intubated patients were significantly (all P <. 001) older (45 vs 34 years old), had a longer hospital stay (10.8 vs 2.4 days), and had more procedures (5.4 vs 0.9). Multivariate regression analysis displayed factors associated with intubation included age group 65 and older (odds ratio [OR] = 6.408, P <. 001), transfer from another hospital (OR = 2.917, P =. 029), alcohol abuse (OR = 6.445, P <. 001), anemia (OR = 2.957, P =. 002), and obesity (OR = 3.301, P <. 001). When controlling for age, sex, hospital characteristics, and number of procedures, general linear modeling demonstrated intubation accounted for $24,374 (P <. 001) in excess total charges per patient. Overall charges for admissions with ETI accounted for $123 million over the study period.

Conclusions:

Patients with PTA undergoing ETI have worse in‐hospital outcomes along with higher hospital charges. This study identifies characteristics of a PTA patient in whom clinicians should be wary of respiratory decompensation.
The Negative Effect of Unsupervised Exercises on Patients with Facial Paresis
Authors: MacDowell Sara G. , Arriaga Moises A.
Published: September 2014

Objectives:

Compare facial function at onset of skilled facial rehabilitation of patients with facial paresis performing unsupervised facial exercise routine and patients with no previous intervention.

Methods:

Retrospective chart review at a tertiary referral center including all patients from our institution who had >1/6 House Brackman score and were referred to physical therapy for facial retraining from 2012 to 2013. Patients were excluded from the study if they had a facial reanimation procedure or electrical stimulation prior to onset of physical therapy. The study used House Brackman (HB) and Facial Grading System (FGS) with 3 subscales: resting symmetry (rFGS), voluntary movement (mFGS), and synkinesis (sFGS).

Results:

Fourteen patients were referred to facial retraining therapy and met the specified inclusion and exclusion criteria. The medical diagnoses included postoperative acoustic neuroma resection, Bell's palsy, and Ramsay Hunt Syndrome. Eight patients did not participate in exercise prior to physical therapy evaluation and 6 patients were issued unsupervised facial exercise prior to therapy. Patients who participated in an unsupervised facial exercise program had a significantly higher sFGS score of 6.83 ± 2.23 at initial physical therapy evaluation than those who did not participate in exercises, with a score of 3.75 ± 2.61 (P =. 038). There were no significant differences between HB, FGS, rFGS, or mFGS.

Conclusions:

Patients who participated in unsupervised facial exercises had more synkinesis than those patients who did not. Generic facial exercises prior to formal individualized facial retraining therapy may be counterproductive. Further investigation is necessary to determine if initial synkinesis score impacts overall patient outcomes following intervention.
Risk of Secondary Surgery after Tonsillotomy versus Tonsillectomy: A Population Study in Sweden 2000‐2012
Authors: Odhagen Erik , Hemlin Claes , Ericsson Elisabeth , Söderman Anne‐Charlotte Hessén , Hultcrantz Elisabeth , Sunnergren Ola , Stalfors Joacim
Published: September 2014

Objectives:

In Sweden, tonsillotomy has for a decade been the favored surgical method for reducing airway obstruction from enlarged tonsils. Less postoperative morbidity with comparative symptom relief are the advantages seen. The concern has been raised that tonsillotomy increases risk of secondary tonsil surgery compared with tonsillectomy. The study aimed to evaluate the risk of secondary tonsil surgery following tonsillotomy and tonsillectomy in the Swedish population.

Methods:

This is a retrospective register‐study including all patients registered in the National Patient Register from 2000 until 2012 who underwent tonsil surgery. Personal identity numbers make it possible to follow patients over time in the register. All patients who underwent tonsillectomy and tonsillotomy, with or without simultaneous adenoidectomy, without previous history of tonsil surgery were included in the study. Individual information on demographic data, diagnoses, and surgery performed were recorded.

Results:

A total of 120,719 tonsil surgeries were identified, out of which 98,717 were tonsillectomies and 22,002 were tonsillotomies. A total of 1409 events of revision surgery were identified of which 40.3% were after primary tonsillectomy and 59.7% were after primary tonsillotomy. Tonsillotomy showed a 7‐times higher risk of secondary tonsil surgery. The accumulated risks of secondary tonsil surgery after 5 and 10 years in the tonsillectomy group were 0.6% and 0.8%, respectively. In the tonsillotomy group, the accumulated risks were 6.1% and 7.2%, respectively.

Conclusions:

The risk of secondary tonsil surgery in the Swedish population is 7 times higher after tonsillotomy compared with tonsillectomy. When interpreting this result the differences in postoperative morbidity between tonsillotomy and tonsillectomy must be considered.
Time to Competency: Reliability of Flexible Transnasal Laryngoscopy by Resident Training Level
Authors: Brook Christopher , Platt Michael P. , Cabral Howard , Russell Kimberly , Grillone Gregory A. , Aliphas Avner , Noordzij J. P.
Published: September 2014

Objectives:

Determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training.

Methods:

Prospective study of flexible transnasal laryngoscopy interpretations. Seventeen otolaryngology residents from PGY‐1 to PGY‐5 and 3 attending otolaryngologists viewed 25 selected and digitally‐recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class, and competency compared to attending interpretations.

Results:

Intraclass correlation of residents compared with attending physicians demonstrated significant improvements by year for left vocal fold immobility (ICC 0.85‐0.96), right vocal cord immobility (ICC 0.80‐0.97), subglottic stenosis (ICC 0.70‐0.97), and level of concern (ICC 0.72‐0.87). There were no trends for base of tongue abnormalities, pharyngeal abnormalities, pharyngeal masses, and hypopharyngeal masses. For vocal cord immobility, subglottic stenosis, and level of concern, resident reliability was found to be statistically similar to attending physicians in all categories by PGY‐3.

Conclusions:

Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by PGY‐3 over key facets of the examination. Flexible laryngoscopy may be a useful metric for procedural competency assessment during residency training.