bluuebunny/crossref_metadata_2025 huggingface dataset:
Acetylcysteine in Treatment of Subacute Sinusitis: A Double Blind Placebo Controlled Clinical Trial Study
Authors: Bahtouee Mehrzad , Adibi Hooman , Langroodi Mazyar Motiei
Published: September 2011

Objective

Acetylcysteine (AC) is an antioxidant agent with mucolytic effect and reported to enhance mucosal immunity. Our hypothesis was that adding AC to currently used drugs in patients with subacute sinusitis increases improvement and prevents further complications, such as progression to chronic sinusitis.

Method

Forty‐five patients with subacute sinusitis were enrolled in trial. All received Amoxicillin‐Clavulanic acid, Pseudoephedrine, and saline drop. In addition patients received AC in the intervention group but placebo in control group. Symptoms and CT findings were assessed at baseline and 45 days after by Snot 20 questionnaire and Lund‐Mackay score.

Results

No significant improvement was seen in the clinical and radiological findings by adding oral AC to Amoxicillin‐Clavulanic acid, Pseudoephedrine, and nasal saline drop, comparing Snot 20 and Lund‐Mackay score after treatment between groups.

Conclusion

Adding oral Acetylcysteine to currently used drugs in the treatment of subacute sinusitis has no significant benefit.
Anatomic Access to the Petrous Apex: Comparing Nasal and Lateral Approaches
Authors: Iseli Tim A. , King James , Yahng John , Leung Randal
Published: September 2011

Objective

Compare the anatomic access to the petrous apex via the nasal and lateral approaches using CT reconstructions.

Method

A total of 200 consecutive fine cut CT temporal bones performed at Royal Melbourne Hospital from July 27, 2007, to October 30, 2010, were reviewed. Easy lateral access allowed use of a 4mm burr past vital structures. Easy nasal access was when the sphenoid was pneumatized to back of sella/beyond and laterally beyond V2/vidian junction.

Results

Easy surgical access via the lateral approach occurred in 74 sides (37%), with easy access via the supra‐labyrinthine approach occurring in 4 sides (2%) and infra‐labyrinthine approach in 72 sides (36%). Easy surgical access via the nasal approach occurred in 79 sides (39.5%). There was a poor correlation between easy nasal access and easy lateral access (r=0.1011 with P =. 154). 125 (62.5%) had a pneumatized mastoid, and 126 (63%) had a large sphenoid sinus allowing easy surgical access. There was a significant correlation between mastoid and sphenoid pneumatization (P <. 001).

Conclusion

Surgical access to the petrous apex via the lateral and nasal approaches are limited by tight anatomic confines. Ease of access via one or other approach does not correlate with ease via the other approach. However, pneumatization of the mastoid/ear does correspond to the anatomic size of the sphenoid.
Angiofibroma Arising from the Uncinate
Authors: Kamal Sally M. , Strong Edward Bradley
Published: September 2011

Objective

1) Report the case of a nasal angiofibroma that presented in an unusual location in an adult patient. 2) Review the available literature on nasal angiofibroma, with a focus on atypical presentations.

Method

An adult male presented with left‐sided nasal obstruction. Examination revealed a polypoid mass obscuring the middle meatus. Intraoperatively, the mass appeared to originate from the uncinate process. Minimal bleeding was encountered. Pathology revealed nasal angiofibroma. Three months postoperatively, he is free of disease.

Results

This represents a rare presentation of nasal angiofibroma, which is a primarily nasopharyngeal lesion seen in adolescent males. Review of the literature confirmed this. The most common atypical locations were the middle and inferior turbinates. No cases of angiofibroma arising from the uncinate process were previously reported. Angiofibroma is a highly vascular tumor, frequently requiring preoperative embolization. In this case, however, we did not embolize preoperatively and did not encounter significant bleeding. Endoscopic technique is becoming more common for excision of nasal angiofibromas. We were able to completely excise the tumor using an endoscopic approach.

Conclusion

Nasal angiofibroma is a rare tumor presenting predominately as a nasopharyngeal lesion in adolescent males. Uncommonly, this tumor presents in adults or in varying locations within the nose. Angiofibroma should be included in the differential diagnosis of atypical nasal masses. These patients require close follow‐up given the propensity for recurrence.
Atypical Skull Base Osteomyelitis in an Immunocompetent Patient
Authors: Haffey Timothy Michael , Woodard Troy D.
Published: September 2011

Objective

1) Present an abnormal case presentation of an already rare and deadly disease process. 2) Critically review/summarize the literature as it pertained to this case. 3) Increase awareness of a diagnostically challenging reversible deadly disease process. 4) Review current treatment options/recommendations for atypical SBO.

Method

This is an unusual case of atypical skull base osteomyelitis in an immunocompetent patient diagnosed in 2010 at the Cleveland Clinic Foundation (CCF). A literature review for “atypical” and “central skull base osteomyelitis” was performed using PubMed.

Results

As with other published cases of atypical skull base osteomyelitis, this patient was an elderly male, had no preceding infective source, and presented initially with headache that progressed to multiple lower cranial neuropathies (CN 8, 9, 10, 12). However, our patient is unique because he was not diabetic and had no immunodeficiencies. His work‐up initially centered on ruling out a primary headache disorder, temporal arteritis, and oncologic pathology. Biopsy, culture, and an indium tagged WBC scan were pivotal in proving an infectious etiology. Prolonged IV antibiotics were vital in clearing the infection.

Conclusion

Skull base osteomyelitis should be considered even in immunocompetent patients presenting with headache and cranial neuropathies. When possible, culture, biopsy, and indium‐tagged‐WBC scan should be performed to help distinguish an infectious process over malignancy, and guide antibiotic therapy. Early diagnosis and treatment is imperative in managing this life‐threatening disease.
Biofilm Disruption: Combined Modality Treatment Using Hydrodynamic Therapy and Laser
Authors: Kanotra Sohit P. , James Garth , Kizhner Victor Z. , Krespi Yosef P. , Myntti Matthew F.
Published: September 2011

Objective

Biofilms have been increasingly implicated as an underlying factor in refractory chronic rhinosinusitis (CRS). This study researches the efficacy of a combination of hydrodynamic therapy and laser in disrupting bacterial biofilms.

Method

Isolates of Staphylococcus aureus and Pseudomonas aeruginosa were cultured and divided into 3 groups. Group 1 was the control group, Group 2 was treated with saline delivered with hydrodynamic force, and Group 3 was treated with both hydrodynamic force and a near infrared diode laser.

Results

For both the bacterial species, the use of laser augmented the reduction of Colony Forming Units obtained with hydrodynamic shearing, with an additional reduction in CFUs counts ranging from 0.94‐2.18 logs and 0.68‐1.15 logs for P Aeroginosa and S Aureus respectively. The overall log reduction obtained by combined modality treatment ranged from 4.57‐5.06 for P Aeroginosa and 3.55‐3.67 for S Aureus; both of these were statistically significant (P <. 005).

Conclusion

A combination of hydrodynamic therapy and laser produces superior results in disrupting biofilm in in vitro models, and further studies of this combined modality treatment are warranted in living tissues and animal models.
Chitosan Membrane for Nasal Packing
Authors: Hernandez Maria I. M. , Ojeda Alejandro G. , Lopez‐Dellamry Toral Fernando A. , Estrada Joaquin G. , Jimenez Jose C. V. , Plascencia Miguel R. O. , Marcias‐Reyes Hector
Published: September 2011

Objective

Synthesize chitosan membranes for nasal packing. This is the first part of a clinical trial (preliminary results).

Method

We made a 3% chitosan in 2% acetic acid solution. After mixing, filtration, and sonication, it was placed in a Petri plate (0.21g/cm2), frizzed at −5°C (24‐hours), and lyophilized (in ultra vacuum and temperatures less than −45°C) until complete drying. Chitosan polymer membrane was stabilized with NaOH 1mM w/v solution.

Results

We obtained a membrane with neutral pH. It is placed in sterile distillated water in glass containers. After that, it is placed in a neutral solution of sodium hypochlorite for the sterilization. This solution does not affect the stability of the polymer. We proceed to use it as nasal packing in the clinical trial we are working on.

Conclusion

The chitosan membrane is stable, is not harmful for nasal mucosa, and can be used as nasal packing. This is the preliminary result of a clinical trial.
Effects of Mometasone Furoate Nasal Spray on Patients with Seasonal Grass Pollinosis
Authors: Ota Nobuo , Suzuki Yusuke , Aoyagi Masaru
Published: September 2011

Objective

Seasonal grass pollinosis has recently become a major problem because many people suffer from this allergy. In this study, we evaluate the clinical effects of mometasone for seasonal grass pollinosis, the changes of chemical mediators in nasal lavage fluid, and their correlation with the clinical response.

Method

Twenty patients were treated with mometasone from May to August 2009. To assess the clinical response, we focused on the changes of symptoms shown by the allergy diary of each patient. We also investigated the correlation of ECP, VEGF, and eotaxin levels in nasal lavage fluid with the severity of symptoms.

Results

There was a significant reduction of the symptom score, medication score, and symptom medication score after administration of mometasone, and also ECP, VEGF, and eotaxin levels showed significant reduction in nasal lavage fluid. We found a significant correlation with VEGF and nasal symptoms.

Conclusion

These results may allow us to speculate that mometasone furoate nasal spray is effective for the treatment of patients with seasonal grass pollinosis and also useful to improve QOL of these patients.
Endoscopic Marsupialization of Congenital Nasolacrimal Duct Cysts
Authors: Dogan Ersoy , Yaman Aylin , Berk Ayse T. , Ecevit Mustafa Cenk , Yuksel Nesibe G. , Sutay Semih
Published: September 2011

Objective

Provide information on the clinical characteristics and management of an uncommon congenital nasolacrimal duct anomaly with intranasal cysts.

Method

Three cases of intranasal nasolacrimal duct cysts are presented with a brief literature review. Patients were presented from 2007 to 2010. Diagnosis was made by clinical observation and endoscopic examination with a search for a cyst in the inferior meatus. The intranasal cysts were successfully treated with nasal endoscopic marsupialization.

Results

We report 3 cases of congenital nasolacrimal duct anomaly with intranasal extension presenting as intranasal cystic masses. The first case is a 60 days old child presented with bilateral intranasal cystic masses that caused nasal obstruction and respiratory distress. The second case is a 1‐year‐old child presented with congenital dacryocystocele and coexisting ipsilateral intranasal cyst explored by nasal endoscopy. The last case is a 6 days old newborn presented with respiratory distress and found to have bilateral choanal atresia and left side intranasal cyst. All 3 cases were treated with nasal endoscopic marsupialization. All children with intranasal cysts were cured.

Conclusion

Because the extension of nasolacrimal cysts into the nose may lead to respiratory distress and difficulty in feeding, nasal examination must be performed to exclude coexistence of nasolacrimal cysts. Endoscopic marsupialization is a safe and curative treatment. Both ophthalmologist and otorhinolaryngologist should be involved in the diagnosis and management.
Endoscopic Medial Maxillectomy for Infected Dental Implants
Authors: Hahn Samuel , Palmer James , Adappa Nithin D.
Published: September 2011

Objective

Chronic maxillary sinusitis of dental origin (CMSDO) is a known complication of osseointegrated dental implants. Treatment of CMSDO currently involves antibiotics, steroids, and nasal irrigation. When medical management has failed, standard of care is removal of the dental implant. We propose performing endoscopic medical maxillectomy (EMM) as an alternative therapy.

Method

Single center retrospective chart review on five patients with recalcitrant maxillary sinusitis secondary to dental implants into the maxillary sinus that were subsequently treated with EMM. Review included preoperative symptoms and SNOT‐20 scores, medical treatment, computed tomography findings, intraoperative findings, postoperative medical management, postoperative symptoms, and SNOT‐20 scores.

Results

All 5 patients underwent endoscopic medial maxillectomy, postoperative culture‐directed antimicrobial therapy, oral steroids, and nasal irrigation. The patients were followed postoperatively from a period of 3 months to 2 years. All 5 patients demonstrated complete resolution of symptoms of chronic sinusitis and did not require removal of the osseointegrated dental implants.

Conclusion

Endoscopic medial maxillectomy provides a safe treatment option for CMSDO due to osseointegrated dental implants that have failed maximal medical therapy. Based on our series, we propose EMM as a viable alternative for those patients who have traditionally required implant removal as definitive therapy.
A Novel Technique in Repair of Moderate‐sized Nasal Septal Perforations
Authors: Raol Nikhila , Olson Krista L
Published: September 2011

Objective

1) Describe a novel technique which has been successful in closure of moderate‐sized nasal septal perforations. 2) Review the current literature on various techniques that have been previously described for closure of nasal septal perforations.

Method

Retrospective review of a successful technique used at our institution for closure of septal perforations over a 5‐year span (2006‐2010) at a facial plastic surgery practice. Charts were reviewed to find patient characteristics, symptoms, etiologies of perforation, and outcomes, including patient satisfaction and rate of recurrent perforation.

Results

Over the past 5 years at our institution, 12 patients were identified with nasal septal perforations, which were closed using bilateral mucosal advancement flaps: one inferiorly‐based flap advanced from the floor of the nose and another superiorly‐based flap advanced from the lateral nasal wall and upper lateral cartilage. The size of the perforations ranged from 0.6 cm to 1.6 cm. The majority of patients had excellent outcomes with resolution of symptoms and a low rate of recurrence.

Conclusion

Nasal septal perforations have been approached traditionally with 2 superiorly based or 2 inferiorly based flaps. We present a technique with a combination of both flaps for closure of a moderate‐size perforation. This decreases the risk of recurrence of the perforation, flap necrosis, and development of a new perforation.
Audit of Flexible Nasoendoscope Decontamination: Clinical Efficacy and Cost Effectiveness
Authors: Phua Chu Qin , Mahalingappa Yogesh , Karagama Yakubu
Published: September 2011

Objective

There are various methods available for flexible nasoendoscope decontamination. Department of Health, United Kingdom, advocates the use of an automated washer, as it has the advantage of reducing errors resulting from variability of human practice. We aim to compare the efficacy and cost effectiveness of chlorine dioxide wipes versus the automated washer.

Method

The tip of a flexible nasoendoscope is immersed into a Staphylococcus epidermidis culture, with bacteriological swabs taken from the tip before immersion and after the process of decontamination with either chlorine dioxide wipes or automated wash. Bacteriological swabs are then checked for growth of STE. Cost calculation is performed.

Results

Postdecontamination, samples from chlorine dioxide wipes showed 2% (1 out of 50 swabs) growth of STE as opposed to 28% (14/50) from the automated wash. P =. 00. On a 10‐year cost calculation, the automated wash had a lower cost.

Conclusion

From the study, wipes are more efficacious in decontamination compared with the washer. However, the automated washer costs less. Further studies should also be performed on real patients to check the significance of improper decontamination and the actual risk of disease transmission.
House Dust Mite Nonspecifically Induces Fluid Secretion from Nasal Glands
Authors: Cho Hyung‐Ju , Lee Hyun Jae , Kim Chang‐Hoon , Choi Jae Young , Yoon Joo‐Heon , Kim Kyubo
Published: September 2011

Objective

Investigate the effects of the house dust mite (HDM) on fluid secretion in submucosal glands in nasal tissue and to compare its effects in control and diseased groups. In addition, we looked to see if PAR2 was involved in the HDM‐induced fluid response.

Method

Inferior nasal turbinate tissue was harvested from 26 patients with either allergic rhinitis (with HDM‐specific IgE) and/or chronic rhinosinusitis, and eight controls. We used a microscope attached to a camera to quantify mucus bubbles secreted from individual submucosal glands in response to HDM extract and PAR2‐AP (activating peptide).

Results

HDM stimulated fluid secretion, and the diseased group showed a higher secretion rate than did the controls. Interestingly, there was no significant difference between the three diseased groups, and CRS patients without HDM‐specific IgE were also stimulated by HDM. The nonspecific response induced by HDM was hypothesized to be through PAR2. The expression of PAR2 was predominant on the basolateral side of gland acini. HDM‐induced secretion rates positively correlated with PAR2‐AP‐induced secretion rates. Carbachol responses and gland density were not different among the three groups.

Conclusion

These findings suggest that HDM induces an IgE‐independent nonspecific response from nasal submucosal glands, generating fluid secretion in allergic or infective nasal tissue, and PAR2 is at least partially involved in this process.
Bitter Taste Receptor Gene in Patients with Taste Disorders
Authors: Hirai Ryoji , Ikeda Minoru
Published: September 2011

Objective

Examine changes in the expression of taste receptor genes in patients who had loss of taste and those who had phantogeusia.

Method

The subjects of this study consisted of 51 patients with loss of bitter taste and 43 patients with phantogeusia. The control group consisted of 24 subjects. We took specimens by scraping their foliate papillae. T2R family and TAS2R family gene expression was detected using RT‐PCR and electrophoresis.

Results

The patients with loss of bitter taste showed a significant decrease in the frequency of expression of taste receptor genes T2R8 (P =. 002), 10 (P =. 001), 13 (P =. 003), 16 (pTAS2R40 (p48 (P =. 007) compared with the control group. The frequency of gene expression of TAS2R42 (P =. 008) and T2R3 (P =. 033) were significantly increased in patients with phantogeusia.

Conclusion

Expression of some genes was decreased in patients with loss of taste, while expression of other genes was increased in patients with phantogeusia. It was suggested that conflicting changes in taste receptor gene expression were involved in the pathogenesis of the loss of taste and phantogeusia.
Identification of Chronic Rhinosinusitis Phenotypes
Authors: Nakayama Tsuguhisa , Asaka Daiya , Okushi Tetsushi , Moriyama Hiroshi , Otori Nobuyoshi , Yoshikawa Mamoru , Matsuwaki Yoshinori
Published: September 2011

Objective

The pathogenesis of chronic rhinosinusitis is still unclear. A variety of factors are thought to be involved in the pathogenesis of chronic paranasal sinusitis. We sought to identify the phenotypes of chronic paranasal sinusitis patients by means of a cluster analysis.

Method

We conducted a retrospective analysis of prospectively collected data from April 2007 to March 2008 in a multicenter study involving 5 hospitals.

Results

The cluster analysis yielded 6 phenotypes: Cluster 1(n = 102), low blood and tissue eosinophil counts; Cluster 2 (n = 118), slightly increased blood and tissue eosinophil counts, but higher CT polyp score than in Cluster 1; Cluster 3 (n = 84), moderately elevated IgE level and high blood eosinophil counts, but mild increase in tissue eosinophil counts, and common aspirin‐tolerant asthma as comorbidity; Cluster 4 (n = 69), extremely high tissue eosinophil counts, but mild blood eosinophil increase; Cluster 5 (n = 20), hyperimmunoglobulinemia E and specific IgE antibodies to fungi and house dust mites; Cluster 6 (n = 6), all aspirin‐intolerant.

Conclusion

Chronic rhinosinusitis was classified into 6 phenotypes according to the eosinophil, IgE, asthma, and nasal polyp findings. The pathogenesis of chronic paranasal sinusitis needs to be further investigated by including cases of recurrent disease.
Local Anesthetic Nasal Polypectomy: The Patient Perspective
Authors: Green Richard , Blackmore Kate , Hogg Richard , Kara Naveed
Published: September 2011

Objective

Assess patient satisfaction with endoscopic nasal polypectomy carried out under local anesthesia. Patient consultation allows us to review and amend practice and is a fundamental aspect of clinical governance, hence ensuring good medical practice.

Method

A 16‐point questionnaire was sent to all patients who underwent the procedure over a 2‐year period. They were asked about previous operative history, quality of operative information given, level of pain and how well it was managed, effectiveness of procedure on their symptoms, and overall perception of the experience.

Results

Of 32 patients the response rate was 81%. Half of the patients had previously had nasal polypectomy under general anesthetic. Ninety‐four percent felt their pain was dealt with appropriately, and all patients were discharged uneventfully within 6 hours. Ninety‐two percent reported symptomatic improvement and were happy with the procedure. All but one of the patients preferred avoiding a general anesthetic, and 88% would happily have the procedure performed again under a local anesthetic.

Conclusion

We demonstrate a high level of overall patient satisfaction with this procedure, and conclude that endoscopic nasal polypectomy can be safely and effectively carried out as a day‐case local anesthetic procedure. This is in keeping with the Department of Health proposals to maximize day‐surgery, and it also represents significant cost savings.
Suspension Sutures in Management of Nasal Valve Collapse
Authors: Zaman Azrina S. K. , Raghavan Ullas , Eng Chee‐Yean
Published: September 2011

Objective

Assess the efficacy of ala suspension sutures in the management of nasal valve collapse causing nasal obstruction.

Method

Retrospective study of patients with ala suspension sutures inserted for nasal valve collapse in Doncaster Royal Infirmary from January 2009 to December 2010. Subjective nasal congestion was measured using visual analogue scale (VAS 0‐10), and objective measurement using Peak inspiratory flow rate (PIFR) before and after the operation was performed.

Results

Twenty‐six patients with ala suspension sutures inserted were identified. Five patients who had concurrent procedures carried out on septum and turbinates were excluded. Twenty‐one patients were included in our study. Ninety percent of patients were satisfied with the surgery, supported by significant improvement in the VAS (0 ‐ 10) for nasal congestion and PIFR scores. The average VAS score improvement was 4.6 points, and PIFR increased by 23.3L/min. Of the 21 patients, 4 required revision procedures to achieve satisfactory outcome. Two out of these 4 developed neuralgia, which was controlled with Amitriptyline.

Conclusion

The result of our study shows a significant improvement in patient symptoms following insertion of ala suspension suture for nasal valve collapse causing nasal obstruction. This is a short and well tolerated procedure with minimal side effects.
The Evaluation of Effects of Pseudoephedrine, Xylometazoline, and Budesonide on the Rat Nasal Mucosa
Authors: Basutcu Ibrahim Serhat , Gozeler Mustafa Sitki
Published: September 2011

Objective

Systemic decongestants, topical decongestants, and topical corticosteroids have been used in treatment of upper respiratory tract diseases. We proposed to find out histopathological changes caused by these drugs in therapeutic dosages in rat nasal mucosa, so we tried to compare the effects of pseudoephedrine, xylometazoline, and budesonide.

Method

The rats in the first group took 80 microL of liquid pseudoephedrine for 15 days twice daily. 10 microL of xylometazoline was administered to rats in the second group for 10 days. 10 microL of budesonide was administered to the third group for 21 days.

Results

The whole slides were evaluated histopathologically under 400X microscopic magnification. The evaluation parameters were mucosal edema level, the loss of ciliated epithelium, intraepithelial gland proliferation, vascular changes, and the changes in epithelial thickness. In any group, a significant mucosal edema was detected. In the second group (xylometazoline), ciliated epithelium loss and goblet cell proliferation were detected in posterior nasal slides. In the third group (budesonide), partial fibrosis was detected in some slides. In the first group (pseudoephedrine), statistically significant epithelial thinning was detected.

Conclusion

We concluded that xylometazoline causes ciliary epithelium loss and goblet cell proliferation. This change probably is due to preservatives in this medication. The budesonide, the topical corticosteroid, caused no significant side effect, especially ciliated epithelium loss. We could not assess the effect of budesonide in inflammation.
Upper Airway in the Adult Population of São Paulo, Brazil
Authors: Stefanini Renato , Haddad Fernanda , Bittencourt Lia , Mattos Soares Maria C. , Santos‐Silva Rogerio , Tufik Sergio , Gregorio Luis‐Carlos
Published: September 2011

Objective

1) Study the prevalence of otolaryngologic symptoms and findings of physical examination of upper airway of a representative sample of the adult population of São Paulo, Brazil. 2) Correlate subjective symptoms with physical findings.

Method

A total of 1101 randomly selected volunteers representing the adult population of São Paulo according to gender, age, and socioeconomic class were included in this study. The sampling process was probabilistic, consisting of 3 stages. Otolaryngologic examination included investigation of nasal complaints, physical examination of the upper airway, and facial inspection.

Results

A total of 993 volunteers (53.9% women) underwent otolaryngologic examination, with a mean age of 41.8 ± 0.89 years. The most prevalent symptoms were rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). On physical examination, the most common findings were web palate (62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant correlations between symptoms and physical examination variables were nasal obstruction with septum deviation, inferior turbinate hypertrophy, high‐arched palate, and class II dental occlusion; symptoms of rhinitis with inferior turbinate hypertrophy; and snoring with deviated septum obstruction, Mallampati III and IV, increased neck circumference, and age ≥ 50 years.

Conclusion

The prevalence of otolaryngologic symptoms and changes in physical examination of the upper airway are high in the adult population of São Paulo, Brazil. There is a significant association between snoring and nasal obstruction with objective signs of physical examination of upper airway and inspection of the facial skeleton.
Acoustic Features of Voice in Patients with Snoring
Authors: Guastini Luca , Crippa Barbara , Mora Francesco , Salzano Francesco‐Antonio , Mora Renzo , Santomauro Valentina
Published: September 2011

Objective

Determine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice.

Method

Group A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too.

Results

Compared with control group, in group A: the acoustic parameters presented a statistically significantly higher value (P <. 05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of group B).

Conclusion

The study indicates that snoring affects voice production by changing its acoustic parameters. A voice analysis program MDVP can be used for snoring sound analysis as a noninvasive procedure for examination of sleep‐related breathing disorders.
Coblation Channeling for the Tongue
Authors: Zhang Qingfeng , Qin Wenfei , Liu Delong
Published: September 2011

Objective

Investigate the efficacy of coblation‐channeling for the tongue (CCT) in treatment of tongue hypertrophy in OSAHS.

Method

CCT was performed on 30 patients with OSAHS with tongue Friedman III or IV. Tongues were channeled perpendicularly to tongue base with laterally to tongue body from 10mm before FC and 25 mm from apex using Coblator II Wand Reflex55.

Results

MRI was done at 12 month follow‐up and showed the retrolingual airway space had widened significantly without severe complications. Tongue base were decreased from Friedman III or IV to I or II.

Conclusion

The results showed that CCT was a safe, minimally invasive, effective and repeatable option for hypertrophy tongue, although long term observations need to be done.
Implant‐Related Outcomes following Hypoglossal Nerve Implant for OSA
Authors: Woodson B. Tucker , Netzer Aviram , Lin Hosheng , Maurer Joachim T. , Hohenhorst Winfried , Van de Heyning Paul
Published: September 2011

Objective

Obstructive sleep apnea (OSA) is a common disorder associated with multiple abnormal health outcomes. Failure of surgical treatment may be secondary to obstruction at the level of the tongue. To assess the non‐disease related outcomes of an implantable hypoglossal nerve (CN XII) stimulating system (Inspire, Inspire Medical, Minneapolis, Minnesota).

Method

Multicenter academic prospective trial of a unilateral hypoglossal nerve implant system (stimulation lead, sense lead and pulse generator). Implant procedure, technical details of stimulation titration, directed functional examinations, tongue EMG studies, and complications were reviewed from 31 implanted subjects.

Results

Follow up averaged 424 days. Serious adverse events included delayed infection with explantation (n = 1), insufficient stimulation with explantation (n = 1), explantation per patient request (n = 1), and acute infection/inflammation (n = 1). Minor local pain/stiffness (n = 7), transient odynophagia (n = 4), stitch abscess (n = 1), local swelling (n = 1), fever (n = 1) were observed. Stimulation thresholds for sensation, morphologic change, and sub‐discomfort (1.6 ± 0.6, 2.1 ± 0.7, 2.6 ± 0.8 respectively) did not change at 2, 4 and 6 months post‐implant). At over 1 year follow‐up, no abnormal findings in speech, swallowing, tongue morphology, or hypoglossal nerve function were observed.

Conclusion

Placement of a CN XII implant system is technically feasible. Serious adverse outcomes occurred in 6% (delayed infection, inadequate stimulation requiring explantation). At over one year, placement of a CN XII implant for treatment of OSA demonstrates stable stimulation thresholds and is functionally well tolerated.
Modified Hyoid Suspension in the Treatment of Obstructive Sleep Apnea
Authors: Piccin Ottavio , Marra Francesca , Sorrenti Giovanni , Scaramuzzino Giuseppe , Gobbi Ricardo
Published: September 2011

Objective

Using the Hormann technique of hyoid suspension in sleep apnea surgery, a steel wire is placed through the thyroid cartilage and slung around the hyoid bone. However, we experienced thyroid cartilage fracture by steel wire traction. A modification is presented to avoid thyroid cartilage fracture.

Method

Twenty‐two patients affected by OSAS underwent Hormann hyoid suspension. In 2 patients of the series, the steel wire caused a fracture of the thyroid cartilage. The technique was therefore modified in 20 subsequent patients. The wire is threaded through an adaptation titanium miniplate placed on the surface of the thyroid cartilage.

Results

AHI decreased from 40 to 11.7. Sixteen patients met the criteria for a successful outcome. There was no change in BMI postoperatively. No complications related to this modification were noted.

Conclusion

The Hormann hyoid suspension is a procedure that advances the hyoid bone in order to expand the airway and its effectiveness has been proven previously. The modified hyoid suspension presented here promises similar results without the risk of serious complications as thyroid cartilage fracture.
Morbidity of Combined Lateral Pharyngoplasty and Midline Glossectomy for Obstructive Sleep Apnea
Authors: Vivero Richard J. , Ruiz Jose W. , Cofnas Paul
Published: September 2011

Objective

1) Describe the technique of lateral pharyngoplasty and midline glossectomy. 2) Evaluate the morbidity of multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy for management of obstructive sleep apnea (OSA).

Method

Retrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care referral center with multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included estimated blood loss, length of hospital stay, and complications during the perioperative and postoperative period.

Results

Thirty‐three patients were identified that met inclusion criteria. Estimated blood loss at time of surgery was 144 milliliters. The average hospital stay was 1.4 days with 1.03 days in an intensive care setting. Sixty‐one percent of patients required postoperative oxygen and 9.1% required postoperative continuous positive airway pressure therapy. The perioperative complication rate was 3% (1/33). There were 21% (7/33)minor and 0% (0/33) major complications in the immediate postoperative period.

Conclusion

Lateral pharyngoplasty and midline glossectomy are safe procedures that present a minimal risk to the patient. Postoperative complications are marked predominantly by treatable complaints, including odynophagia and minor infections requiring antibiotic therapy.
Nasal Obstruction in Patients with Obstructive Sleep Apnea Syndrome
Authors: De Oliveira Barros Thiago , Melo Tavares Lima Marco Antonio , Mendez Raquel , Caiaffa Rosana , Tomita Shiro
Published: September 2011

Objective

1) Evaluate the prevalence of the symptom of nasal obstruction in patients with obstructive sleep apnea syndrome. 2) Identify which polysomnographic variables were most altered by nasal obstruction.

Method

A transversal study was performed through the analysis of overnight polysomnography in association with the Epworth’s Sleepiness Scale, nasal symptoms and clinical assessment of sleep. In this study, 80 patients were evaluated between March and July of 2010, both male and female, with snoring and apnea complaints.

Results

No statistically significant differences between the groups regarding age, gender, body mass index and neck circumference were observed. We found that patients with nasal obstruction were more likely to have a severe obstructive sleep apnea (apnea/hypopnea index >30 per hour of sleep) with an increase of 35.71% in comparison with those without nasal obstruction (P =. 028), as well as an increase in hypopnea index(P =. 026)and latency for REM stage (P =. 020). There was no correlation between excessive daytime sleepiness complaints and the symptom of nasal obstruction.

Conclusion

Patients with a nasal obstruction complaint are more likely to present a severe obstructive sleep apnea, hypopnea events and a higher latency of paradoxal sleep stage.
Cytology as an Oral Lesion Surgical Biopsy Timing Instrument
Authors: Seltzer Paul , Gold Daniel R. , Loewenstein Ronald K. , Carroll Deborah J.
Published: September 2011

Objective

For patients with certain risk factors and suspicious oral cavity lesions not meeting criteria for immediate surgical biopsy, we evaluated the use of a brush biopsy cytology as a screening tool to assist in choosing between treatment options of immediate surgical biopsy and patient observation.

Method

Oral mucosal brush biopsy cytology was performed on patients with risk factors and mildly suspicious lesions in the oral cavity. Specimens obtained were reviewed for presence of abnormal or dysplastic cells. Data were collected from 2008 to 2011. We correlated the results with the follow‐up treatment decisions.

Results

During the study period, 52 patients had brush biopsies. Pathology results in 21% (P < 0.01) of cases showed presence of abnormal or dysplastic cells and an immediate follow‐up surgical biopsy was performed. In 71% of cases, results did not reveal abnormal cells, and patients were put under observation. In 7% of cases results indicated a fungal infection, and patients were treated.

Conclusion

Where brush biopsy cytology revealed presence of abnormal or dysplastic cells, an immediate follow‐up scalpel biopsy was recommended. Brush biopsy cytology from suspicious lesions provides information to aid in determining the treatment pathway for suspicious oral mucosal lesions not meeting criteria for an immediate surgical biopsy.
Reliable Calculation of the Efficacy of Nonsurgical and Surgical Treatment of Obstructive Sleep Apnea
Authors: Ravesloot Madeline , De Vries Nico
Published: September 2011

Objective

The effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned. The aim of the study was to measure the effectiveness of compliant CPAP use.

Method

Using mathematical function formulas, the effect on the AHI of various treatment modalities and their respective compliance and success criteria were calculated.

Results

The more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0‐5, respectively). The required nightly percentage use rises as one reduces the AHI target to smaller than 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP).

Conclusion

Using a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.
Turbinate Size and Sleep‐Related Breathing Disorders: Is There a Correlation?
Authors: Forest Veronique‐Isabelle , Benedetti Andrea , Lavigne Francois
Published: September 2011

Objective

The tail of the turbinates is a site of nasal obstruction that may be associated with sleep related breathing disorder (SBD). We describe a technique, the trans‐oral nasopharyngoscopy (TON), to evaluate turbinate size and determine if an association exists between turbinate size and the various parameters measured in SBD.

Method

Thirty‐six patients with SBD completed an Epworth Sleepiness Scale (ESS) and a Quebec Sleep Questionnaire (QSQ). They underwent a nasal examination, allergy skin tests, full night polysomnography, and TON. Turbinate size was divided into two groups: I) turbinate obstructing 1/2.

Results

Sixteen patients were grade I and 20 patients were grade II. Turbinate size at the choana did not show any statistical significant association with nasal congestion, allergies, ESS and QSQ scores. Among the PSG parameters analyzed, no association was found with the apnea‐hypopnea index (AHI), but the size of the turbinate showed a positive correlation with respiratory event related arousals (RERA; P =. 03). Total sleep time spent snoring showed a weak association with turbinate size.

Conclusion

TON is a simple technique allowing the evaluation of the size of the turbinates. Turbinate size was associated with RERA and total sleep time spent snoring, but not with AHI.
Upper Airway Surgery for the Treatment of Obstructive Sleep Apnea: Surgical Outcomes and the Effect on CPAP
Authors: Cowan Douglas H. , Romaker Ann , Larsen Christopher G. , Spake R. Vanneman , Sykes Kevin J.
Published: September 2011

Objective

1) Elucidate the efficacy of upperairway surgery for the treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). 2) Observe the change in polysomnography, continuous positive airway pressure (CPAP) therapy, and sleepiness following upper airway surgical intervention. 3) Objectively measure CPAP compliance using smart card CPAP devices.

Method

Surgical and clinical records were reviewed on patients (N =51) who underwent upper airway surgery for the treatment of moderate‐severe OSAHS from January 2008 to June 2010 at an urban tertiary‐care center. Outcome measurements recorded pre and postoperatively include BMI, Epworth sleepiness score, CPAP settings and compliance, and polysomnography.

Results

Data was collected and is currently undergoing analysis in a collaborative effort between the otolaryngology and pulmonology departments at our tertiary care center. A unique requirement for this study is the use of smart card CPAP devices on all patients allowing an objective measure of CPAP compliance. All patients underwent traditional uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty or expansion sphincter pharyngoplasty. Additionally, patients underwent turbinate reduction (N = 29), septoplasty (N = 20) and base of tongue reduction (N = 16). Initial analysis indicates a significant improvement in polysomnographic data and CPAP compliance. There does not appear to be problems associated with air‐leak postoperatively.

Conclusion

Mucosa‐sparing pharyngoplasty and multilevel upper airway surgery are effective treatment options for moderate‐severe OSAHS. These surgical interventions can significantly reduce CPAP pressure settings and improve CPAP compliance. All patients undergoing CPAP therapy should be required to use smart card devices in order to objectively measure compliance.
Does the Duration of Ofloxacin Otic Drops Matter in Immediate Post‐tube Otorrhea?
Authors: Chen Timothy , Cheng Leah , Chen Sharon , Cheng David
Published: September 2011

Objective

Understand whether the duration of Ofloxacin Otic drops would make a difference in the incidence of immediate postmyringotomy tube otorrhea.

Method

Chart review for myringotomy tube surgery from July 2005 to December 2010 was done. The ears were examined 1 week after myringotomy surgery for otorrhea.

Results

There were 854 ears with no drops used, 182 ears with Ofloxacin Otic drops used once at time of tube insertion, and 303 ears with Ofloxacin Otic drops used twice a day for 5 days postsurgery. Of the ears without any drops used, 51 ears (6.0%) had immediate postmyringotomy tube otorrhea; of the ears with Ofloxacin once, 9 ears (4.9%) had immediate postmyringotomy otorrhea; and of the ears with Ofloxacin for 5 days, 8 ears (2.6%) had immediate postmyringotomy otorrhea. The chi square test showed significant difference between Ofloxacin Otic drops for 5 days and no drops (P value =. 02).

Conclusion

The results seem to indicate that Ofloxacin Otic drops decreased the incidence of postmyringotomy tube otorrhea with single dose administration, with a more significant difference in the 5 day course of Ofloxacin Otic drops.
Juvenile Nasopharyngeal Angiofibroma Sites of Extension
Authors: Khalifa Mohamed Adel , Gamea Ahmed M.
Published: September 2011

Objective

Juvenile nasopharyngeal angiofibroma is a historically benign, yet locally aggressive vascular tumor that affects exclusively adolescent boys. Its etiology is still considered one of the dangerous head and neck tumors. Early diagnosis is now available by the use of endoscopes and advanced imagining.

Method

This retrospective study included 18 patients operated upon in the ENT Department of Tanta University Hospital through the period from 2002 to 2009. Those patients were diagnosed radiologically by CT scan, MRI, and endonasal endoscopic biopsy.

Results

Two cases were confined to the lateral nasal wall extending into the nasopharynx, 9 cases extended to the sphenoid sinus superiorly and to the pterygopalatine fossa laterally, 4 cases extended laterally to the infratemporal fossa, and 1 case extended intracranially to the middle cranial fossa. The rare sites of extension were one case occupying the right ethmoid sinus completely (this mass eroded the fovea to the anterior cranial fossa) and another case of a recurrent mass extending into the right parapharyngeal space through the sinus of morgagni.

Conclusion

The rare sites of extension of juvenile nasopharyngeal angiofibroma included the anterior cranial fossa through the fovea ethmoidalis. It may also spread through the sinus of morgagni to the parapharyngeal space.
Nasal Apocrine Hydrocistoma
Authors: Costa Viviane , Viana Fernanda M. L. , Barnewitz Joao P. , Doria Thais , Riberiro Thais K. , Ribeiro Ulisses J.
Published: September 2011

Objective

Describe a case report of an apocrine hydrocistoma of unusual presentation site (nasal) and a literature review. Its pathogeny seems to be a result of the sudoriferous conduct obstruction just above the glandular wound, due to trauma or an inflammatory process.

Method

Female, 43 years‐old, complaining of a swelling over the right side of the nose, associated to pain and nasal obstruction over 1 year. The examination showed facial asymmetry with an elevated right nasal wing and bulging of nasal floor. We performed cyst resection.

Results

This case shows a nasal apocrine hydrocistoma that differs from its usual eyelid location. The patient’s clinical and physical history, as well CT scan images, guided us to cyst resection with an intraoral access. The anatomopathology study proved to be an apocrine hydrocistoma. The literature review points this case report as a differential diagnosis for diseases in this area, such as inflammatory periapical lesions, nasal boils, nasopalatine duct cysts, dermoid cysts, and nasolabial cysts.

Conclusion

Apocrine hydrocistomas are sudoriferous gland benign tumors in the face. Most people present themselves with a well‐delimitated swelling, local pain, and partial or complete nasal obstruction. CT is the ideal examination for its evaluation, with anatomopathology to confirm the diagnosis. Cyst resection is a choice treatment.
Nasopharyngeal Carcinoma Presenting as Deep Neck Abscess
Authors: Soon Sue Rene , Yuen Heng‐Wai
Published: September 2011

Objective

Nasopharyngeal carcinoma (NPC) is endemic in South East Asia and is the fifth most common cancer in Singapore. The most common presenting symptom is cervical nodal metastasis. There have been only 2 reports of NPC presenting as deep neck abscesses. We present our experience with 4 patients.

Method

Retrospective review of the archives of patients admitted for deep neck abscesses from 2 tertiary hospitals from November 2006 to September 2010 revealed 4 patients with a nasopharynx primary.

Results

The 4 patients consist of 3 males and 1 female with a mean age of 50 years (range, 32‐63 years). All patients presented with fever and a painful fluctuant neck mass. Incision and drainage was performed in 2 patients who did not improve symptomatically from intravenous antibiotics. Computer tomography (CT) showed deep neck abscess in all patients and a nasopharyngeal primary only in 2 patients. Repeat physical examination showed nasopharyngeal mucosa irregularity in these patients and biopsy performed showed undifferentiated NPC. Three patients were stage 4 NPC while 1 patient was stage 2.

Conclusion

The nasopharynx should be carefully examined in patients presenting with deep neck abscess even with normal CT findings, especially in countries where NPC is endemic. Deep neck abscess may be the initial presentation of NPC.