bluuebunny/crossref_metadata_2025 huggingface dataset:
Toward the Treatment of Paranasal Sinus Biofilms Using a Novel Nuclease
Authors: Shakir Adam , Burgess Grant , Jakubovics Nick , Shields Robert , El‐Badawey Mohamed Reda
Published: September 2011

Objective

1) Characterize the microstructure of paranasal sinus biofilms. 2) Characterize the microbial composition of sinus biofilms. 3) Develop techniques to treat sinus infections by breaking up sinus biofilms using surfactants and a novel, marine derived nuclease.

Method

Sinus biofilms were collected intraoperatively. Microbial composition was investigated by culturing and 16S rDNA sequencing, and the biofilm structure was analyzed by electron microscopy. Duplicate samples were treated with or without the marine nuclease (NucB) at 370C. The effect of NucB was measured by mass reduction before and after treatment.

Results

16SrDNA analysis demonstrated populations of Staphylococcus aureus, S epidermis, and Kocuria rhizophila. Anaerobic bacteria were recovered in limited numbers, and few fungal strains were observed. Transmission electron microscopy of characteristic tenacious biofilms showed an unusual layered structure. Samples consisted of endogenous mucin‐rich layers with occasional pockets of bacterial cells, which were found throughout the biofilm. A commercially available surfactant was used to disperse the upper layers of mucin to allow penetration by the nuclease into the deeper bacterial biofilm. In vitro studies with the nuclease against model organisms also showed effective breakup of biofilms.

Conclusion

We have shown that characteristic tenacious sinus “biofilm” has an unusual microscopic structure. Bacteria appeared to be localized in foci and may have been responsible for stimulating a host response. We are developing methods to remove sinus biofilms using a microbial nuclease that breaks down DNA holding the biofilm together.
Upregulation of Genes for Innate Immune Signaling and Apoptosis after Surgery for Chronic Rhinosinusitis: Evidence of a Mucosal Immune Dysfunction in CRS?
Authors: Hubin Gregory , Divoy Celine , Desrosiers Martin Y. , Filali‐Mouhim Ali , Mfuna‐Endam Leandra
Published: September 2011

Objective

Endoscopic sinus surgery (ESS) for chronic rhinosinusitis is a frequently performed surgical procedure. However, the mechanism by which it improves disease is unknown. We wished to determine patterns of changes in gene expression associated with resolution of disease following ESS in order to identify mechanisms implicated in resolution of disease.

Method

Twelve patients undergoing ESS for CRS were recruited. An epithelial sample from the frontal sinus was collected using a cytology brush at time of surgery and repeated 3 months after surgery. Microarray analysis of gene expression was performed using the Illumina Human HT‐12 Beachip v3.

Results

Both single gene expression analysis (using Limma package from Bioconductor software.) and gene set analysis (using Ingenuity Pathway Analysis software) were used to identify implicated genes and pathways (or networks), respectively. All patients resolved CRS with surgery. A total of 4707 genes or transcripts showed significant differential expression changes (pFDR). Healing was associated with increased expression of cytokines and transcription factors in the IL1B signaling pathway (IL8 (FC: 8.56; P =. 00027) IL1B (FC: 4.21; P =. 0008) NFkBIZ (FC: 2.27; P =. 0008), innate immune signaling (IRAKs‐1, ‐2, and ‐3, CD14, MD2, MyD88), and apoptosis (CASP3, BAK, BID).

Conclusion

Resolution of CRS after ESS is characterized by marked upregulation of the IL‐1B and innate immune signaling pathways and increased expression of pro‐apoptosis genes. This supports the concept that microbial detection and clearance are impaired in CRS, and that strategies increasing immune activation may represent novel therapeutic opportunities.
Validation of a Low‐Cost Sinus Surgery Task Trainer
Authors: Steehler Matthew K. , Na Hana , Pfisterer Michael , Hesham Hosai N. , Malekzadeh Sonya
Published: September 2011

Objective

Assess the face, content, and construct validities of a low‐cost sinus surgery task trainer in acquisition of skills for endoscopic sinus surgery.

Method

Participants performed nasal endoscopy and 5 specific tasks using this model. Face and content validities were assessed based on the attendings’ responses to a questionnaire evaluating the task trainer. Construct validity was determined by comparing novice to expert performance using a checklist and global rating scale.

Results

A total of 77 subjects, including attending otolaryngologists, otolaryngology residents at various levels of training, and medical students, participated in the study. On the questionnaire, 80% of evaluators rated the trainer as realistic and agreed that this model correlates with the essential skills needed for endoscopic sinus surgery; 90% felt this model provided adequate training and would increase resident competency, and 90% were interested in using the model to train residents. On the task trainer, experienced otolaryngologists and senior residents scored significantly higher than junior residents and medical students using the objective measures of global rating scale and checklist.

Conclusion

Our study demonstrates face, content, and construct validity of the low cost sinus surgery task trainer. This model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents.
One Hundred Consecutive Patients Undergoing Drug Induced Sleep Endoscopy (DISE): Results and Evaluation
Authors: Ravesloot Madeline , De Vries Nico
Published: September 2011

Objective

Document the results of 100 consecutive DISE and investigate associations between PSG and DISE findings.

Method

Between June and August 2010, 100 consecutive patients, eligible for sleep surgery or MRA underwent a PSG and DISE. DISE findings were reported using the VOTE classification system; site, degree of airway narrowing, and configuration of obstruction were reported. Associations were analyzed between PSG results, patient characteristics and DISE findings.

Results

82% suffered from OSA, 52% from positional OSA. 75% were found to have a multi‐level obstruction, which was associated with a higher AHI value, as was a complete collapse and a tongue base collapse. A tongue base collapse or epiglottal collapse was associated with positional OSA. And lastly, a complete concentric collapse was associated with an increased BMI.

Conclusion

PSG is mandatory in the diagnostic work‐up of OSA; DISE a valid addition. The results of this small scale study help us understand the pathogenesis of OSA and the various associations between PSG outcomes and DISE results, as well as assisting the sleep surgeon to tailor surgery for the patient.
Analysis of the Correlation between Sleep Hygiene and Clinical Symptoms in Obstructive Sleep Apnea Patients
Authors: Lee Joonseok , Lee Kunhee , Shin Seungyoup , Kim Sungwan , Jung Su Young
Published: September 2011

Objective

By doing a survey on obstructive sleep apnea patients, this study tried to analyze the relationship between the various subjects relating to sleep hygiene and clinical symptoms.

Method

A total of 197 patients completed the survey. The survey was composed of 4 categories; daytime symptoms, nighttime symptoms, the Epworth Sleepiness Scale, and sleep hygiene. The daytime and nighttime symptoms were graded by the 10 point Visual Analogue Scale, and sleep hygiene by the 3 Point scale, the higher points indicating severity.

Results

The result of figuring out the correlation between the 9 categories of sleep hygiene and the 3 categories of the symptoms, showed that in cases of inappropriate temperature and humidity, the 3 symptom categories were more severe (nighttime symptoms r = 0.565, daytime symptoms r = 0.379, ESS r = 0.318). Drinking before sleep (nighttime symptoms r = 0.647, daytime symptoms r = 0.455, ESS r = 0.297) and emotional excitement or arousal (nighttime symptoms r = 0.542, daytime symptoms r = 0.392, ESS r = 0.336) caused higher severity results in each symptom category.

Conclusion

If patients who complain of sleep apnea symptoms were to control the factors in sleep hygiene mentioned above, it could be possible to hope for an improvement in daytime symptoms as well as increase in sleep quantity and satisfaction.
Hypoglossal Nerve Stimulation and Airway Changes under Fluoroscopy
Authors: Goding George , Tesfayesus Wondimeneh , Kezirian Eric J.
Published: September 2011

Objective

Characterize the changes in tongue base position, the anteroposterior dimension of the retropalatal and retrolingual airway spaces, and the hyoid bone during hypoglossal nerve stimulation in OSA subjects under general anesthesia.

Method

Twenty‐four subjects underwent implantation of the Apnex Medical Hypoglossal Nerve Stimulation (HGNS) system, with cross‐table fluoroscopy imaging during hypoglossal nerve stimulation under general anesthesia. Standardized measurements determined changes in tongue base position, the retrolingual and retropalatal airways, and the hyoid bone. Airway changes were compared with subject’s C3 vertebral width.

Results

During hypoglossal nerve stimulation, all subjects demonstrated anterior displacement of the tongue base. The resulting anteroposterior retrolingual airway opening was at least one‐third the width of the C3 vertebral body in all subjects, with a mean ratio of 0.61 ± 0.15. Opening of the retropalatal airway with stimulation occurred in 74% (14/19) of subjects; in 5 cases the fluoroscopy videos did not permit adequate visualization of the retropalatal region. There was a wide variation in the change of hyoid bone position during stimulation.

Conclusion

Hypoglossal nerve stimulation created anterior tongue base displacement and an increase in the anteroposterior retrolingual airway dimensions in all subjects. Opening of the retropalatal airway occurred in the majority of subjects. Further study is warranted to evaluate 3‐dimensional airway changes and the mechanisms of action, especially for the retropalatal airway.
Influence of Intranasal Corticosteroids on Sleep Parameters and Airway Inflammation
Authors: Lavigne François , Petrof Basil J. , Dubé Normand , Lavigne Philippe , Hamid Qutayba , Benedetti Andrea
Published: September 2011

Objective

Fatigue is associated with obstructive sleep apnea (OSA). Increased inflammation in the pharyngeal tissues of OSA patients may further exacerbate the disease. This study evaluates the effects of intranasal corticosteroid (INCS) treatment on sleep parameters and airway inflammation in AR vs non‐AR OSA patients.

Method

Allergic rhinitis (34), non‐AR (21) received mometasone. Before and after treatment, patients underwent polysomnography, MWT, Epworth assessment, and tissue biopsies from the turbinate, nasopharynx, uvula. The biopsies were processed for EG2, CD4, CD8, macrophages and neutrophils.

Results

There were no differences in age, sex, BMI, or apnea‐hypopnea index (mean AHI = 28.4 vs 27.7/h) at baseline. After treatment, AR group showed significant improvements in: 1) supine AHI (55.85 vs 39.7/h), 2) oxygen saturation nadir (86.42 vs 88.8%), and 3) Epworth scores. This improvement was associated with reduction of eosinophils (P <. 0001), and to lesser extend CD4 positive cells (P <. 05) in the tissue obtained from the 3 sites, CD68 decreased at the uvula. Allergic subjects had a higher nasal symptoms score before treatment, not statistically significant, nor was there evidence that change over time differed by allergy status.

Conclusion

This study confirmed the implication of inflammation in sleep apnea and showed that controlling inflammation in the upper airways is very useful in improving clinical symptoms associated with this disease.
OSAS and Bariatric Surgery: Incidence of OSAS in the Bariatric Surgery Population
Authors: Ravesloot Madeline , De Vries Nico
Published: September 2011

Objective

Obesity is a significant risk factor for OSA. The benefits of bariatric surgery (BS) are increasingly reported, but concern about the safety is also heightened. With the aim to prevent OSA related complications of BS, we were interested to see which percentage of patients undergoing BS in our clinic have OSA.

Method

The prospective, multidisciplinary, single‐center, observational study enrolled 289 consecutive patients eligible for BS from June 2009 until June 2010. Irrespective of history or clinical findings, all patients on the waiting list for BS visited our ENT out‐patient clinic and underwent a full night polysomnography, unless performed previously.

Results

A total of 69.9% fulfilled the criteria for OSA (mean BMI: 44.2 ± SD 6.4). A total of 40.4% of the patients met the criteria for severe OSA. A mere 13.3% of the patients were aware with OSA before being placed on the waiting list for BS. Increased neck circumference, BMI, or ESS were found to be insufficient predictors of OSA presence on linear stepwise regression and ROC curve.

Conclusion

In this large patient series, 69.9% of patients undergoing BS meet the criteria for OSA. Increased neck circumference, BMI, or ESS are insufficient predictors of OSA presence. Polysomnography is an essential component of the preoperative workup of patients undergoing BS. When OSA is found, specific perioperative measures are indicated.
PASS Palatal Ablation and Suspension Suture Technique: A Novel, Minimally Invasive UPPP Technique for Sleep Apnea
Authors: Melder Patrick C.
Published: September 2011

Objective

1) Develop a minimally invasive surgical technique to treat the palatal component of OSA. 2) Ccombine a proven ablation technology to create palatal stiffening with a novel suspension technique to relieve palatal obstruction. 3) Perform a pilot trial to determine feasibility.

Method

The PASS technique was used to treat the palatal component of obstruction for OSA. Palatal ablation was performed. Four permanent, submucosal, periosteal based sutures were placed from the hard palate to the palatopharyngeus muscle and free edge of the soft palate (bilateral). Gentle tension resulted in advancement of the palate.

Results

Twenty patients were studied. Each patient had a preoperative/postoperative PSG. The PASS technique was used for the palatal component to treat mild apnea or as a part of multilevel surgery for moderate to severe OSA. The PASS technique proved to be a consistently reliable method to advance, suspend, and stiffen the palate without mucosal/muscular (palatal) disruption to correct the palatal component of OSA. The average palatal advancement noted bilaterally at the palatal arches was 7.5 mm. Postoperatively, the mucosal sparing technique resulted in no complications of velopharyngeal insufficiency. Isolated PASS procedures for mild apnea resulted in a 70% reduction in RDI.

Conclusion

The PASS technique was proven as a functionally and anatomically superior nondestructive treatment for palatal obstruction. The PASS technique resulted in no complications of VPI. The limitations of the study are the limited number of patients and lack of a control arm with the gold standard UPPP.
Quantification of Retropalatal Region in Sleep Apnea
Authors: Tanyeri Hasan M. , Serin Gediz M. , Polat Senol
Published: September 2011

Objective

Fiberoptic nasopharyngolaryngoscopy (FNPL) allows us to visualize the obstructive sleep apnea (OSA) related airway passages. However, objective data presenting evidence of OSA through this perspective is lacking. The aim of this study was to quantify the surface area of the retropalatal region in normal and OSA patients utilizing FNLP images.

Method

Fifty‐two OSA patients in group 1 and 68 patients with no complaints of OSA in group 2 were retrospectively evaluated. Retropalatal region photos were captured at the base of uvula through endoscopic images. Retropalatal surface area (RPSA) was measured using AutoCad. Results were analyzed using unpaired t test.

Results

The RPSA measurements in group 1 were between 20 and 143 [mean (sd) 64.13 (27.4)]. The RPSA measurements in group 2 were between 51 and 202 [mean (sd) 121.9 (32.4)]. The mean difference was 57.761. RPSA values of group 2 were significantly higher than group 1.

Conclusion

The RPSA is significantly higher in OSA group 2, implicating prediction of OSA. Therefore, RPSA can be used as a sign of OSA during FNLP.
Reduction of CRP after CPAP Treatment of OSA: A Systematic Review and Meta‐Analysis of the Literature
Authors: Friedman Michael , Kelley Kanwar , Fischer Michelle , Lin Hsin‐Ching , Wang Pa‐chun
Published: September 2011

Objective

1) Determine the effect of continuous positive airway pressure (CPAP) on C‐reactive protein (CRP) levels in patients with obstructive sleep apnea (OSA). 2) Demonstrate the effect of CPAP on general health status using CRP as a marker for cardiovascular health.

Method

A computerized search was conducted using PubMed, Ovid, and the Cochrane database. A systematic review was preformed to identify studies that included CRP levels in adult patients (age >18 years) with OSA pre‐ and post‐CPAP treatment.

Results

Initial search results identified 136 articles of which 64 articles then underwent second‐stage review. Ten studies met the inclusion criteria and a meta‐analysis was performed to determine the overall change in CRP levels. Meta‐analysis included 325 subjects (mean sample size of 32.5 patients) with mean BMI of 33.12. The mean CRP level in patients with OSA decreased from 0.43 ± 0.39 mg/dL to 0.35 ± 0.346 mg/dL following CPAP treatment (p = 0.002).

Conclusion

In patients with OSA, CRP levels significantly decrease after CPAP therapy. Therefore, using CRP as a marker systemic inflammation, CPAP reduction of CRP levels may benefit patients’ cardiovascular health in addition to controlling OSA symptoms.
Robotic Glossectomy for the Treatment of Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Friedman Michael , Kelley Kanwar , Taylor David , Maley Alex , Pearson‐Chauhan Kristine
Published: September 2011

Objective

1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base‐of‐tongue (RFBOT) MG.

Method

Retrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications.

Results

Twenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for (P <. 05). Twenty patients with moderate disease treated with palatal stiffening + RG were compared with 20 patients with RFBOT + palatal stiffening. Pain outcomes measured on postoperative days 0‐5 using the Faces Visual Analogue Scale (VAS) resulted in no statistical difference between RG and coblation whereas RG vs RFBOT showed higher pain levels for RG.

Conclusion

This is the first recorded series of robotic MG performed without the need for tracheotomy. Results demonstrated an excellent safety profile with no significant complications. Although morbidity vs standard hypopharyngeal treatments is significant, robotic glossectomy allows for more aggressive tissue removal vs coblation and RFBOT thereby significantly improving efficacy.
Thermoplastic Mandibular Advancement Devices for the Treatment of OSAHS
Authors: Friedman Michael , Maley Alex , Taylor David , Kelley Kanwar , Pearson‐Chauhan Kristine
Published: September 2011

Objective

1) Report our experience with custom‐made and thermoplastic mandibular advancement devices (MADs). 2) Compare the cost, efficacy, and compliance of thermoplastic mandibular advancement devices vs custom made MADs.

Method

Retrospective review of 287 consecutive adult outpatients treated between July 2009 and August 2010. Compliance was assessed using chart review and phone interviews after 1 and 6 months. Endpoints included: 1. Efficacy measured by post‐MAD AHI.

Results

The percentage of patients achieving AHI reduction criteria for efficacy was 70.3% and 72.2% for thermoplastic vs custom‐made devices (P =. 204). Compliance more than 4 hours a night for 70% of nights within the first month after receiving MAD was 88.2% for thermoplastic vs 64.3% for custom‐made (P <. 001). At 6 months compliance was 47.4% for thermoplastic devices vs 61.1% for custom devices (P =. 01). The average cost for the thermoplastic devices was $150 vs $1450 for the custom‐made devices.

Conclusion

Thermoplastic devices resulted in slightly better compliance rate compared with the custom‐made devices during the first month after prescription, but reversed at 6 months. Thermoplastic devices have the advantage of significantly lower cost, higher initial acceptance, and comparable efficacy, whereas custom‐made devices result in higher long‐term compliance.
Minimum Extremes in Otolaryngology Resident Surgical Case Numbers
Authors: Rosenberg Tara L. , Franzese Christine B.
Published: September 2011

Objective

1) Understand the significance between the mean and minimum case numbers for surgical procedures among otolaryngology residents nationwide. 2) Understand potential weaknesses of the ACGME resident case log system and possible errors contributing to inaccurate data. 3) Understand educational definitions of competency and proficiency.

Method

Retrospective review of otolaryngology resident national data reports from ACGME resident case log system for three academic years (2007‐2010). Minimum, mean, and standard deviation about the mean for total number of cases and for specific surgical procedures were compared. Comparison of “tracked” vs “untracked” CPT codes was also performed.

Results

The total number of cases for residents graduating from 2008 to 2010 remained fairly constant, ranging from a mean of 1701.5 ± 486 in 2008 to 1772.2 ± 517 in 2010. The minimum total number of cases also remained somewhat constant, ranging from 730 in 2009 to 811 in 2008, with these values falling approximately two standard deviations below the mean for most years. Comparison of case numbers for procedures such as parotidectomy, thyroidectomy, mastoidectomy, and endoscopic sinonasal surgeries, among others, yielded similar results. “Tracked” CPT codes tended to be fewer than “untracked” CPT codes for some surgical procedures.

Conclusion

Large differences between the mean and minimum case numbers for resident surgical procedures exist. Establishing minimum case number requirements for otolaryngology residents should be considered. Closer critical examination of the ACGME resident case log system and resident documentation habits is needed to improve accuracy of reporting.
Trends in Facial Fracture Repairs, 1996 to 2006
Authors: Lee Linda N. , Bhattacharyya Neil
Published: September 2011

Objective

1) Learn how rates of operative facial fractures may have changed between 1996 and 2006. 2) Determine potential impact of such change on otolaryngology residency surgical key indicator cases.

Method

The National Hospital Discharge Survey (NHDS) and National Survey of Ambulatory Surgery (NSAS) 1996 and 2006 cases were reviewed, extracting all cases of nasal, malar/zygomatic, maxillary, and mandibular fracture reductions, in inpatient and outpatient settings, respectively. Procedure rates for each facial fracture were tabulated and compared between 1996 and 2006.

Results

Overall in 1996, there were an estimated 113,041 ± 3,740 operative facial fracture repairs performed. Among the 3 key indicator fracture repairs most relevant to otolaryngologists, there were 15,810 ± 2,143 open nasal fracture reductions, 9,360 ± 1,742 open zygomaticomaxillary (ZMC) fracture reductions, and 20,214 ± 2,585 open mandibular fracture repairs. Overall in 2006, there were 120,463 ± 7,554 total facial fracture procedures, with 11,613 ± 2,846 open nasal fracture reductions, 10,216 ± 2,881 open ZMC fracture reductions, and 17,965 ± 3,171 open mandibular repairs. Comparing cohorts, there was no significant change in number of open nasal, ZMC, or mandibular fractures repairs (P =. 24, P =. 58, P =. 80, respectively).

Conclusion

Despite perceptions, facial fracture procedure rates have remained largely stable over the past 10 years. These data have implications for otolaryngology training programs and could help guide resident education in facial trauma.
A Study of the PEAK PlasmaBlade TnA in Adult Tonsillectomy Compared to Traditional Electrosurgery
Authors: Vose Joshua G. , Atmodjo Dominique , Weeks Brian H.
Published: September 2011

Objective

Recently, the use of low temperature pulsed radiofrequency (RF) energy has emerged as a method for efficient tissue dissection with minimal thermal damage. When used for tonsillectomy, anecdotal reports have cited improved recovery compared with traditional electrosurgery (ie, Bovie). We evaluated this technology in adults undergoing subcapsular tonsillectomy.

Method

Twenty adults were prospectively enrolled in this pilot study. Subjects were randomized to tonsillectomy with the PlasmaBlade (PB) or traditional electrosurgery (ES). Intra‐operative time and blood loss were recorded; postoperatively, subjects blindly reported visual analog scale painscores, narcotic consumption, diet volume, and activity level using a validated form.

Results

The population age (34.7 ± 18.7 years, P =. 75) and BMI (24.7 ± 3.9 kg/m2, P =. 44) were equivalent. Operative time was also equivalent for both technologies (7:36 ± 1:58 min, P =. 99) with PB subjects demonstrating a 69% reduction in IBL (1.6 ± 1.8 vs 5.3 ± 7.9mL, P =. 02) compared with ES. Postoperatively, PB subjects demonstrated a 40% (2.5 ± 1.2 vs 4.1 ± 0.7 Tylenol‐Codeine/d, P =. 002) reduction in narcotic consumption over the 10‐day monitoring period. Modest improvements in activity level (6%; P =. 83), diet volume (20%, P =. 32), and VAS pain score (12%, P =. 41) were also reported. However, these were not statistically significant.

Conclusion

The use of this new low‐thermal damage electrosurgical technology for adult tonsillectomy appears to offer several advantages over traditional electrosurgery, notably in reducing narcotic consumption in the postoperative period. Larger population‐based studies should be conducted to further examine these endpoints.
Automated Tube Deployment: Success Demonstrated in OR
Authors: Syms Charles A. , Gould Andrew R. , Zeiders Jacob W. , Faw Kenneth D.
Published: September 2011

Objective

Investigate the safety and efficacy of a novel automated tympanostomy tube delivery system for the creation of a myringotomy and the placement of a tympanostomy tube for patients presenting with chronic otitis media with effusion and/or recurrent acute otitis media.

Method

A prospective, multicenter, single arm clinical study enrolled 53 subjects. Tube placement was performed in an operative setting using the Acclarent Tympanostomy Tube Delivery System (TTDS). Patients underwent physical examination and audiometry preoperatively and at one week postoperatively.

Results

A total of 53 subjects (47 subjects 5 years of age and younger) were enrolled in the study at 4 United States centers. From these subjects, 101 ears were enrolled and 5 were excluded because of study criteria related to condition of the tympanic membrane. There were no serious device‐related adverse events. The primary efficacy endpoint, successful tube deployment across the tympanic membrane, was achieved: 95 of 101 (94%) attempted deployments in the cohort were successful. Tube retention was also evaluated as a secondary endpoint, and 94 of 95 (99%) tubes placed with the device were retained at follow‐up.

Conclusion

The Acclarent TTDS is a safe and effective device for placement of tympanostomy tubes in patients with chronic otitis media with effusion and recurrent acute otitis media. Given the device’s safety, efficacy, and speed of tube delivery, further investigation of its in‐office application under local anesthesia is warranted.
Characteristics of Dysphagia after Cerebellopontine Angle Surgery
Authors: Starmer Heather M. , Hillel Alexander T , Francis Howard W. , Akst Lee M. , Best Simon R. , Chien Wade W. , Agrawal Yuri
Published: September 2011

Objective

Describe swallowing disorders encountered after Cerebellopontine Angle (CPA) surgery as well as to explore variables associated with increased incidence of postoperative dysphagia.

Method

Retrospective chart review of 181 consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Presence and characteristics of dysphagia were determined by speech pathologist reports. Clinical variables were extracted from the electronic medical record.

Results

Postoperative dysphagia was identified in 57 out of 181 patients (31%). Oral, oropharyngeal, and pharyngeal deficits accounted for 49%, 37%, and 12% of dysphagic symptoms respectively. Facial nerve weakness in the immediate postoperative period was noted in 91% of dysphagic subjects (mean House‐Brackmann score of 4) compared with 43% of those without dysphagia (mean House‐Brackman score of 2). Diet alterations were required for 65% of dysphagic individuals, and an additional 9% required tube‐feeding. Common findings during Videofluoroscopic Swallowing Studies (VFSS) were pharyngeal residue, reduced pharyngeal constriction, and anterior bolus loss. Abnormal Penetration‐Aspiration Scores (≥3) were found in 59% of those undergoing VFSS.

Conclusion

Oral and pharyngeal swallowing deficits are commonly encountered after CPA surgery. Consultation with a speech‐language pathologist appears most critical for any individuals demonstrating postoperative cranial nerve dysfunction, particularly for those with evidence of facial nerve weakness. Early consultation may help to manage short‐ and long‐term functional difficulties.
Cost Analysis of Postthyroidectomy Hypocalcemia
Authors: Young Jadrien
Published: September 2011

Objective

One of the more common complications following total thyroidectomy is postoperative hypocalcemia. Numerous protocols have been developed over the years for management including perioperative parathyroid hormone (POPTH) levels and obtaining ionized calcium levels postoperatively with supplementation based on the values. Our goal was to perform a cost analysis of POPTH.

Method

We examined the postoperative hypocalcemia using ICD‐9 codes for thyroid nodules and examined those that underwent total thyroidectomy. We excluded revision surgeries and pathology of cancer. The postoperative PTH values, initial ionized calcium, and number of calcium draws were obtained. The patients were then stratified based on initial PTH value.

Results

For initial PTH For initial PTH 21‐50, the initial ionized calcium was 3.99 ± 0.38 and the number of laboratory draws was 3.8 ± 3.3. For initial PTH >50, the initial ionized calcium was 4.27 ± 0.37 and the number of laboratory draws was 2.5 ± 1.7. There was no significant difference in the initial ionized calcium between those that had an initial PTH drawn and those that did not.

Conclusion

For total thyroidectomies (benign goiter), there was no difference in the initial ionized calcium for PTH90 (P =. 29). This suggests that PTH is not an adequate predictor of postoperative calcium level. Also there is a significant cost burden with obtaining the PTH level where tremendous savings could be achieved.
Estrogen Receptors in Nasal Mucosa
Authors: Millas Ieda , Liquidato Bianca M. , Correa Carla Sant`Anna , Buck Hudson S. , Dolci Jose‐Eduardo L. , Barros Mirna Duarte , Paes Roberto Antonio Pinto
Published: September 2011

Objective

Evaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.

Method

There were selected 2 groups of 32 women, with regular menstrual cycles, who had undergone nasal surgery. One group of women was taking oral contraceptives and the other was not. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta estrogen receptors.

Results

A decrease of beta‐receptor in lamina propria cells with the use of oral contraceptives was observed. On the other locations there was not any statistically significant difference. In both groups there was a predominance of beta‐receptor presence.

Conclusion

Women taking contraceptive pills had a decrease of beta‐receptor in lamina propria cells.
Half‐time SPECT Acquisition with Resolution Recovery for 99mTc‐sestaMIBI SPECT/CT Imaging in the Assessment of Primary Hyperparathyroidism
Authors: Bar Ronen , Frenkel Alex , Netzer Aviram , Golz Avishay , Israel Ora , Keidar Zohar
Published: September 2011

Objective

99mTc‐sestaMIBI SPECT/CT has a proven value for diagnosis and localization of parathyroid adenoma (PTA). Present study compared diagnostic accuracy and image quality of half‐time SPECT to standard full‐time SPECT.

Method

A total of 90 patients performed 99mTc‐sestaMIBI scintigraphy. “H”‐mode, 360 degrees SPECT was performed 45 minutes after injection using standard and half‐time protocols. The SPECTs were reviewed randomly. Results were graded as negative, probable, and positive. SPECT image quality was graded as poor, good and excellent. PTA detection and image quality were compared.

Results

A total of 85 studies demonstrated cervical 99mTc‐sestaMIBI foci and 5 were ectopic. A total of 73 studies (81%) showed congruent PTA detection scoring. In 17 studies a difference of one level in the probability for PTA was found. One of the ectopic foci was demonstrated on standard full‐time SPECT only. Image quality was graded as good or excellent in all studies. 64 studies (71.1%) showed the same image quality on full‐ and half‐time SPECT acquisition including 39 graded good, and 25 graded excellent. No significant difference in image quality was found between SPECT techniques.

Conclusion

Significant reduction in acquisition time of 99mTc‐sestaMIBI SPECT can be successfully implemented into SPECT/CT for a total study time of 9 min. Diagnosis and precise preoperative localization is obtained without compromising clinically significant information.
Hedgehog Pathway in HNSCC: A Target in Future Therapies?
Authors: Mozet Christian , Dehghani Faramarz , Wichmann Gunnar , Dimitrova Kamelia , Stöhr Matthäus , Dietz Andreas
Published: September 2011

Objective

Demonstrate the expression of components of the Hedgehog signaling pathway (Hh) in HNSCC. A subsequent over‐stimulation of this pathway is described in several types of malignancies and is associated with poor prognosis. Hh inhibition with antagonists like Cyclopamin (Cyc) may reveal a potential therapeutic relevance.

Method

iParaffin‐embedded sections of 10 HNSCC were incubated with Alexa 568‐labeled antibodies specific for Hh proteins. Further, we tested the effects of Cyc on the growth of KB cells and on HNSCC cells ex vivo in FLAVINO‐bioassays alone and in combination with chemotherapeutic agents. Immunofluorescent colonies of epithelial cells were counted.

Results

Epithelial cells in HNSCC expressed components of the Hh‐pathway (PTCH‐1, PTCH‐2, SMO, GLI, andSHH) preferentially at the invading tumor margins. The intensity and distribution of the staining was heterogeneous but significant. Peritumoral stroma cells stained partly positive, too. Cyc alone suppressed mitosis and proliferation of KB cells and suppressed the formation of cytokeratin‐positive (CK+) colonies of HNSCC ex vivo in a concentration dependent manner. Further, Cyc enhanced the inhibitory effects of Cisplatin (Cis) and Docetaxel (DTX) on colony formation of CK+ cells in the KB cell line and in HNSCC ex vivo.

Conclusion

Our results underline a potential relevance of Hh in HNSCC. Additional targeting of Hh components may support established therapy regimens in HNSCC‐treatment in the future and, therefore, represents a promising aim for drug discovery.
How Good Is Google? The Quality of Otolaryngology Information on the Internet
Authors: Pusz Max Daniel , Brietzke Scott E.
Published: September 2011

Objective

Despite any cautionary warnings from medical providers, searching internet websites is likely to be a patient’s (or parent’s) first step in obtaining timely information on the treatment of common otolaryngology problems. The quality of the information a patient (parent) may encounter using a Google search for typical otolaryngology ailments was critically examined.

Method

A Google keyword search was performed for 10 common otolaryngology problems including ear infection, hearing loss, tonsillitis, etc. The top 10 search results for each were critically examined using the 16 item (1‐5 scale) standardized DISCERN instrument. The DISCERN instrument was developed to assess the quality of patient treatment choice literature.

Results

A total of 100 websites were assessed. Nineteen (19%) were primarily advertisements for products and were excluded from DISCERN scoring. Searches for more typically chronic otolaryngic problems (eg, tinnitus, sleep apnea) resulted in more biased, advertisement results than typically acute problems (eg, ear infection, sinus infection, P =. 03). The search for “sleep apnea treatment” produced the highest scoring results (mean overall DISCERN score, 3.49; range, 1.81‐4.56), and the search for “hoarseness treatment” produced the lowest scores (mean, 2.49; range, 1.56‐3.56). Results from major comprehensive websites (WebMD, EMedicinehealth.com, Wikipedia, etc) scored higher than other websites (Mean DISCERN score, 3.46; vs 2.48; P <. 001).

Conclusion

There is marked variability in the quality of website information for the treatment of common otolaryngologic problems. Searches on more chronic problems resulted in a higher proportion of biased advertisement websites. Larger, comprehensive websites generally provided better information but were less than perfect in presenting complete information on treatment options.
Inservice Exam Predicts Written Board Passage
Authors: Puscas Liana
Published: September 2011

Objective

Determine if there is any association between the Resident Otolaryngology Training Examination (OTE) score and the pass rate on the American Board of Otolaryngology (ABOto) Written Qualifying Examination.

Method

Data from the 2005 to 2009 OTE and the 2007 to 2010 ABOto Written Examination were available for comparison. Odds ratio, chi‐squared test of independence, and logistic regression were used to determine the relationship between OTE score and passage of the written ABOto examination.

Results

The proportion of Board examination failures for those whose OTE score was in the bottom 10th percentile is 25%. Proportion of Board examination failures for those whose OTE score was above the 10th percentile is 7.29% (P = <. 0001). Odds ratio analysis revealed that every 10 point increase in percentile corresponds to an estimated 50% increase in odds of passing the examination on the first attempt (OR = 1.54, SE = 0.08; CI = 1.39, 1.71). Logistic modeling showed no significant association for year of exam or cohort of residents.

Conclusion

There is a significant association between a lower score on the OTE and increased failure rate on the first attempt at the ABOto Written Qualifying Examination.
Nationwide Multicenter Study on Posttonsillectomy Bleeding
Authors: Sarny Stephanie , Ossimitz Guenther , Habermann Walter , Stammberger Heinz
Published: September 2011

Objective

1) Assess risk factors for the frequency of postoperative hemorrhage. 2) Apply a new classification of postoperative hemorrhage using a clear definition and 7 grades depending on severity. 3) Assess multiple bleeding episodes after tonsil surgery.

Method

The study is based on a complete census of tonsillectomies (TE), tonsillotomies (TO), and adenoidectomies (AE) within 9 months in Austria. Postoperative hemorrhage was defined as every bleeding episode after extubation and classified in grades A1, A2, B1, B2, C, D, and E according to severity and the treatment needed.

Results

Included were 9,405 patients: 48.5% TE with or without (±) AE, 37.1% AE, and 14.0% TO ± AE. Postoperative hemorrhage was far more frequent for TE than for TO or AE (P <. 001). A return to theater was necessary for 4.6% after TE. Adults had a significantly higher risk of postoperative bleeding than children for all types of surgeries (P <. 05). Males had a significantly higher risk of postoperative bleeding episodes (P <. 05). The “hot” operation techniques (bipolar diathermy or Coblation) showed a significantly increased risk of hemorrhage (P <. 05). The evidence of a light bleeding episode increased the risk of a severe bleeding episode (P <. 05).

Conclusion

Assessing all grades of postoperative hemorrhage offers a far more precise picture about postoperative bleeding. Risk factors for postoperative hemorrhage have been the type of surgery, age, and operation technique.
Surgical Patient Tracking with the Karl Storz OR‐Ticket
Authors: Fischer Milos , Dressler Christian , Dietz Andreas , Strauss Gero
Published: September 2011

Objective

Patient safety of surgical patients depends on correct identification and tracking in the operating theater. Additionally, surgical resources, presented patient data from the electronic patient chart, and surgical documentation are highly variable depending on the surgical procedure.

Method

We compared the surgical workflow of ENT‐surgical patients equipped with a QR‐code based OR‐Ticket. The ticket provided relevant electronic patient data: name, surname, date of birth, surgical procedure, operative site and side. The time for pre‐ and postoperative patient tracking and surgical documentation was investigated for 50 exemplary procedures.

Results

The time for the generation of the OR‐ticket could be neglected because it was directly printed from the electronic patient documentation system. There were no technical problems with the readout from the OR‐ticket. All patients were identified correctly. The time for patient identification was reduced compared with standard procedure. The time for documentation purposes was reduced compared with standard documentation.

Conclusion

The OR‐ticket provides the possibility to improve patient safety and ergonomics in the operating theater. Further technical development may provide automatic presentation of relevant patient data in the surgical cockpit and concentrate surgical resources depending on the identified patient and procedure, especially in operating theaters with a high patient turnover.
Postoperative Medication Errors in Otolaryngology
Authors: Gonzalez Danny S. , Antonelli Patrick J. , Winterstein Almut
Published: September 2011

Objective

The epidemiology of medication errors (MEs) in ambulatory and inpatient care is well understood, but little is known about ambulatory surgery. This study aims to quantify the incidence and nature of MEs after ambulatory otolaryngologic surgery.

Method

Ambulatory surgery patients were assessed for 1) pre‐surgical home medications, 2) clinical history, 3) written prescriptions, 4) discharge instructions, and 5) medication use reported by patients within 48 hours of discharge. Potential MEs were reviewed by an expert panel to determine validity, contributing factors, and potential preventative measures.

Results

From 100 surgeries, 12 postoperative MEs were identified. All were without clinical sequelae, in part due to investigator involvement. Contributing factors included providers (2), patients (5), and the healthcare system (5). Causes for MEs included failure to verify patient information (eg, allergies), failure to accurately reconcile medications, and misunderstanding of instructions by the patients. Discharge instructions and medication reconciliation protocols appeared insufficient for optimal postoperative care and resulted in many after‐hours calls for clarification.

Conclusion

MEs are common following ambulatory otolaryngologic surgery even though regimens are simple and limited to few medications. Key targets for quality improvement include fragmentation in information flow and physician‐patient communication.
Risks and Benefits of DVT/PE Prophylaxis in Otolaryngology
Authors: Shuman Andrew G. , Jackson Christopher , Hu Hsou Mei , Bahl Vinita , Bradford Carol R.
Published: September 2011

Objective

The consequences of perioperative venous thromboembolism (VTE) can be devastating. This study is designed to 1) correlate the incidence of VTE with perioperative risk assessment, 2) determine whether VTE prophylaxis effectively decreases the risk of perioperative VTE, and 3) assess if VTE prophylaxis increases bleeding complications in otolaryngology.

Method

A retrospective case‐control study was conducted at a tertiary care medical center among adults presenting for otolaryngologic surgery from 2003 to 2010 (n = 3498). Patients treated before the implementation of guideline‐based VTE prophylaxis protocols were compared to patients treated after implementation. Primary outcome variables were Caprini risk level, perioperative VTE, and bleeding complications.

Results

The odds of a VTE increased 1.435 times with each level increase in the Caprini VTE risk level (P =. 048). The VTE rate after implementation of prophylactic protocols was significantly lower than prior to implementation (OR 0.286, P =. 005). However, the type of VTE prophylaxis had no significant effect on the likelihood of developing a VTE. The likelihood of a bleeding complication was not significantly different before and after implementation. The odds of a bleeding complication increased for patients receiving twice daily enoxaparin (OR 4.546, P =. 032) or a treatment (rather than prophylactic) dose of anticoagulant (OR 3.546, P <. 001).

Conclusion

Perioperative VTE risk stratification based on Caprini risk assessment in otolaryngology is effective. The odds of VTE decreased after the implementation of guideline‐directed VTE prophylaxis. Although perioperative bleeding complications did not increase after the implementation of VTE prophylaxis protocols, therapeutic anticoagulation is associated with a higher incidence of bleeding complications.
The Outcomes of 4 Different Techniques of Tonsillectomy
Authors: Civelek Senol , Sayin Ibrahim , Caglayan Volkan , Emre Ismet E. , Turgut Suat
Published: September 2011

Objective

Compare 4 different techniques of tonsillectomy reagarding operative time, intra‐operative blood loss, and pain scores.

Method

A total of 160 patients were randomly assigned to the cold dissection tonsillectomy (CDT), bipolar elecrocautery tonsillectomy (BPT), Harmonic Scalpel tonsillectomy (HST), and Thermal Welding tonsillectomy (TWT) groups. Patients underwent tonsillectomy where intraoperative blood loss and time were evaluated. Patients where then followed for pain analysis.

Results

Operative time varied from 6 to 31 minutes, and mean operative time was 13.76 ± 5.28 minutes. Operative time in the HST group was significantly shorter than in the CDT and TWT groups (p = 0.001). Highest intraoperative bleeding was observed in the CDT group (68.6 ± 35.3 ml) and was significantly higher than in the HST (9.4 ± 3.1ml) and BPT groups (13.4 ± 3.8 ml) (P =. 001, resp P =. 022). Pain scores in the HST group were much lower than in the CDT and BPT groups (P =. 022, resp P =. 001). Pain scores between other groups did not show any statistically significant difference (P >. 05).

Conclusion

The 4 techniques compared all show different attributes useful during surgery, but considering long learning curves and high prices we believe that cold dissection tonsillectomy still has the upper hand.