bluuebunny/crossref_metadata_2025 huggingface dataset:
The Increase of Global Health‐Related Research in Otolaryngology
Authors: Chambers Kyle J. , Creighton Pete , Abdul‐Aziz Dunia , Randolph Gregory W.
Published: August 2013

Objectives:

Determine trends in global health‐related otolaryngology publications.

Methods:

A systematic search of publications available on PubMed was undertaken reviewing two time periods ten years apart for the timeframes 1998 to 2002 (early time period) and 2008 to 2012 (recent time period) using the search word “otolaryngology” in combination with “developing countries,” “global health,” or “low income countries”; specifying human studies with abstracts in the English language. Publications related only to specific populations within the United States or Europe were excluded. The region of origin and type of publication were assigned as well as the author origin. Chi‐squared and t‐test analysis was used to identify trends.

Results:

In the 1998‐2002 time period, a total of 11 publications met inclusion criteria for the study with a mean of 2.2+/‐1.3 publications per year. In the 2008‐2012 time period, a total of 39 publications met inclusion criteria with a mean of 7.6+/‐3.1 publications per year. The 354% increase in global health‐related publications identified between the two study periods was statistically significant (P = 0.01). Eighteen percent of primary authors were from high‐income countries in the early time period versus 38% in the recent time period (P = 0.028). Asia and Africa were the most common region of origin in the recent time period with 49% and 23% of publications, respectively.

Conclusions:

There is a significant increased volume of global health‐related publications in English language otolaryngology journals over the past decade, providing strong evidence of the increasing trend of global health as an academic pursuit within otolaryngology.
Experimental System for the Analysis of Nasal Procedures: Initial Experience with Inferior Turbinate Reduction
Authors: Willson Thomas J. , Dion Gregory R. , Weitzel Erik K.
Published: August 2013

Objectives:

1) Develop simple cadaveric flow/pressure analysis system for experimental use for nasal procedure simulation. 2) Assess changes in nasal airway resistance in simulated inferior turbinate (IT) hypertrophy, normal state, and reduced, out‐fractured conditions.

Methods:

An open thermodynamic nasal cavity experimental cadaveric model was created using an Omega HHP‐103 digital manometer and oxygen flow regulator. For pressure testing, one pressure measurement catheter was placed at the internal nasal valve, isolating the nasal cavity from external nasal valve resistance. The second pressure measurement catheter was placed at the choana of the tested side, and the position was confirmed endoscopically. Repeatability was tested among nasal cavities, specimens, and repeat setups. Pressure measurements were taken incrementally between 0 and 25 liters per minute (Lpm) at each of three conditions: 1) control state, without augmentation, 2) simulated IT hypertrophy with 20% benzocaine topical anesthetic gel filler placed within sub‐periosteal flap, and 3) out‐fractured, reduced inferior turbinates.

Results:

The experimental system was simple to set up and repeatable. Experimentally, nasal airway resistance measurements revealed decreased resistance under control and out‐fractured configuration versus hypertrophied turbinates. Initial studies trended, under all conditions, to have exponential growth of pressure as flow rate increased.

Conclusions:

The physiologically isolated test system allows anatomic manipulation and measurement of resulting pressure‐flow relationships. IT alterations resulted in expected pressure‐flow changes, indicating future analysis at other anatomic locations, such as olfactory epithelium, septum, or middle turbinate, is feasible.
Flagellin/Toll‐like Receptor 5 Induces Interleukin‐17C in Human Nasal Epithelia
Authors: Kim Chang‐Hoon , Kim Jin Kook
Published: August 2013

Objectives:

Recently, it has been reported that IL‐17C mediates innate immune responses against microbial infection and inflammation in mucosal epithelium. However, little is known about the expression and biological function of IL‐17C in human airway epithelium.

Methods:

The family of Interleukin‐17 (IL‐17) cytokine is involved in host defense responses and various inflammatory diseases. Many studies indicate that IL‐17A and IL‐17F play an important role in the pathogenesis of airway inflammatory diseases. In this study, we found that IL‐17C mRNA expression was strongly induced by inflammatory cytokines such as TNF‐Î± or IL‐1Î2 and bacterial flagellin, recognized by toll‐like receptor 5 (TLR5), in primary cultured normal human nasal epithelial (NHNE) cells. We also confirmed that IL‐17C protein production was enhanced by TNF‐Î±, IL‐1Î2 and flagellin.

Results:

We demonstrated that pretreatment of neutralizing antibody against TLR5 completely inhibited flagellin‐induced IL‐17C expression, indicating elevated IL‐17C expression is specifically mediated by flagellin/TLR5 engagement. Moreover, IL‐17C stimulation induced innate immune responses including the expression of antibacterial peptides and proinflammatory cytokines in NHNE cells. Taken together, these results show that IL‐17C expression is enhanced in response to inflammation and flagellin/TLR5 activation and involved in inflammatory process in human nasal epithelial cells.

Conclusions:

Our findings suggest that IL‐17C cytokine may play an important role in TLR5‐dependent innate immune responses of human airway epithelia.
Olfactory‐Related Cerebral Representation with Odorant‐Induced Stimulation: A Preliminary Study Using Functional MRI
Authors: Choi Jee‐Min , Cho Jae‐Hoon , Moon Cheil , Kim Jin‐Kook
Published: August 2013

Objectives:

Recent neuroimaging studies have shown that odorant‐induced responses to prolonged stimulation in primary olfactory cortex (POC) are characterized by a rapidly habituating time course. We hypothesized that the different part of brain area would be activated when stimulating pleasant or unpleasant odors.

Methods:

Functional magnetic resonance imaging (fMRI) was used in an experiment comparing brain activation related to a pleasant (Citraval) and an unpleasant odor (Î2‐mercaptometh‐anol). The stimulation period was 10 seconds with 50 second interval. The total stimulation time was 50 seconds.

Results:

In normal group, the pleasant odor activated the area including the prefrontal cortex, anterior cingulum, and anterior insular cortex. The unpleasant odor activated the area including the prefrontal cortex and posterior cingulum. In the abnormal group, the brain activated area was scattered among 10 patients, and it was hard to categorize the activated brain areas in Z=4.59 (p<0.05).

Conclusions:

Olfactory stimulation with pleasant and unpleasant odor produces the activation of specific brain areas. The brain areas activated differed according to the specimen of odor and trauma. Further studies are needed to elucidate brain activation response according to the different kinds and intensities of olfactory stimulation.
Sublingual Immunotherapy for Allergic Rhinitis: A Prospective Study Based on AAOA Consensus Dosing Protocol
Authors: Leong Jern‐Lin , Zhang Edward Z.
Published: August 2013

Objectives:

Study the efficacy and safety of sublingual immunotherapy (SLIT) based on the original American Academy of Otolaryngologic Allergy (AAOA) Consensus dosing protocol for treatment of allergic rhinitis (AR).

Methods:

Patients undergoing SLIT for more than 12 months between 2007‐2010 were prescribed escalation (over 3 months) and maintenance doses as recommended by AAOA. Sinonasal‐Outcome‐Test‐20 (SNOT‐20) questionnaire scores were used for calculations of repeated measures analysis of variance (ANOVA) with contrast testing to define trends.

Results:

Data from fifteen males and six females with a mean follow‐up duration of 17.57 months were analyzed. Fourteen patients had minor side effects, including AR exacerbation (5 cases), itching (8), rash (2), diarrhea (1), and palatal ulcer (1). None required admission or treatment discontinuation. ANOVA testing revealed a significant linear decreasing trend in rhinological (F1,13 = 11.2), ear/facial (F1,13 = 5.4), sleep (F1,13 = 6.9), psychological (F1,13 = 13.1), and overall SNOT‐20 (F1,13 = 14.5) scores. Our results show overall SNOT‐20 scores improving by 31% from baseline within 3 months initiation of therapy, and continued to improve progressively during the maintenance phase up to 69%. Domain scores analyzed showed greatest improvements in ear/facial symptoms (up to 86%) and psychological function (up to 77%). Rhinologic and sleep function scores also showed impactful improvements of up to 56% and 61% respectively.

Conclusions:

This is the first published paper to study and demonstrate the safety and efficacy of SLIT based on AAOA consensus dosing protocol. A standardized regime will allow more meaningful comparison between studies.
Xanthoma of the Sphenoid Sinus: A Rare Presentation
Authors: Mercado Gustavo J. A. , Torre Carlos A. , Hernandez Gabriel , Salcedo Federico , Marcos Maria , Busquets Jose M.
Published: August 2013

Objectives:

1) Present what is to the best of our knowledge the first reported case of a patient with a sphenoid sinus xanthoma. 2) Discuss the details of the clinical presentation, histopathological and radiological findings, and management of this patient.

Methods:

Medical charts and the scientific literature were reviewed.

Results:

A 36‐year‐old female patient with family history of hyperlipidemia presented with a 1‐year history of sporadic epistaxis and an episode of severe headache 2 months prior to evaluation. The rest of her medical history and physical examination were unremarkable. Computed tomography (CT) scan and magnetic resonance images revealed a soft tissue lesion occupying and infiltrating the posterolateral aspect of an expanded sphenoid sinus on the left side. Patient underwent endoscopic sinus surgery in December 2011 with intraoperative findings of a yellow‐tan, friable soft tissue filling the left sphenoid sinus. Biopsy was taken for which histologic and immunohistochemical analysis revealed proliferating foamy histiocytes consistent with xanthoma cells. As of her last follow‐up examination (9 months post‐op), the patient has remained asymptomatic without evidence of disease progression on nasal endoscopy or CT scan.

Conclusions:

Very few cases of xanthomas arising in the paranasal sinuses have been described in the literature. Those that have been described have only occurred in the maxillary sinus. We present the case of a 36‐year‐old woman with family history of herlipidemia with a left sphenoid sinus xanthoma. This is to our knowledge the first case of such a lesion reported in the English literature.
Biological Effects of OSAHS Surgery on Endothelial Dysfunction and Oxidative Stress
Authors: Lin Hsin‐Ching , Friedman Michael
Published: August 2013

Objectives:

Prospectively study the changes of biomarkers related to cardio‐ or cerebro‐vascular diseases in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) before and after OSAHS surgery.

Methods:

Patients who failed continuous positive airway pressure (CPAP) therapy and then underwent OSAHS surgery were enrolled in this study. We assessed serum biomarkers of metabolic status, oxidative/antioxidative balance and sICAM‐1, sVCAM‐1, sE‐selectin, sL‐selectin and sP‐selectin preoperatively and postoperatively at 6 month follow‐up.

Results:

Eighty OSAHS patients (mean, 45 years) completed data for analysis. When both mild/moderate and severe OSAHS patients were considered, the level of triglyceride, sICAM‐1, and sE‐selectin were significantly decreased 6 months following surgery, while body mass index did not show significant decrease. Most biomarkers on endothelium dysfunction (sICAM‐1 in mild/moderate and severe OSAHS patients, sL‐selectin in mild/moderate group, and sE‐selectin in severe group) showed a decrease 6 months following surgery. There is a trend of decrease changes on level of TBARS and increased level of superoxide dismutase 6 months after surgery.; However, the difference is not significant.

Conclusions:

This study shows that surgical treatment could improve some of the biomarkers of metabolic status, oxidative/antioxidative balance, and inflammatory cell adhesion molecules in OSAHS patients. The successful translation of these approaches may offer the promise of reducing the cardiovascular risks associated with OSAHS patients undergoing upper airway surgery.
Comparative Analysis of Diagnostic Methods in Obstructive Sleep Apnea Syndrome: Polysomnography and Use Watch PAT 200
Authors: Silva Evandro M. , Balieiro Fernando O. , Xavier Sandra D. , Stamm Aldo E. C. , Kitice Adriano T. , Coronel Natalia W. , Calegaro Bibiana F.
Published: August 2013

Objectives:

Obstructive sleep apnea syndrome (OSAS) is a public health problem in terms of its impact on quality of life and increased risk of cardiovascular disease. One of the few national epidemiological studies was published and showed a prevalence of 32.8% of OSA in the population of Sao Paulo. The gold standard for diagnosis of OSA is polysomnography (PSG). Despite this, tests often show the same individual variability and inter night to night. Because it is costly and time consuming, other diagnostic tools such as the Watch PAT 200 (WP) were developed. This is an ambulatory device that consists of a actgraphy, sensors capturing peripheral arterial tonometry (PAT) and body position, pulse oximetry, and microphone to capture snoring.

Objectives:

Evaluate the difference between two diagnostic methods for OSAS: PSG and WP.

Methods:

A study in the sleep laboratory of the Complexo Hospitalar Edmundo Vasconcelos from June to August 2012, including 20 volunteers who had no exclusion criteria and performed using the same night of PSG and WP 200,interpreted by two different examiners.

Results:

20 patients, 70% male and 30% female, mean age 37.1 years (standard deviation ‐ SD ± 12.1), mean BMI 29.1 (SD ± 5.2), and Epworth average score of 11.9 (SD ± 3.1). There was agreement among examiners quantitative bias of PSG with average DP of 9.7 and ‐2.9, between the WP and the mean AHI of examiners was average bias of 3.2 and SD of 8.8. There was qualitative agreement between examiners. PSG AHI was classified in the same category by the two examiners in 13 (65%) between the average of PSG and WP no agreement in 13 subjects (65%). Accuracy of WP as a screening test for OSA, using PSG as the gold standard, the WP showed 100% sensitivity for the diagnosis of OSA (AHI 5), specificity 33.3%, positive predictive value of 89.4% and negative predictive value 100% for OSA.

Conclusions:

AHI agreement between WP and PSG was good. Being sensitive and 100% negative predictive value for the diagnosis of OSA (AHI 5) are ideal characteristics for a screening test.
Failure of Quality‐of‐Life Measures to Discriminate between Primary Snorers and Patients with Obstructive Sleep Apnea
Authors: Liu Jiaying , Toh Song‐Tar
Published: August 2013

Objectives:

Investigate differences in quality of life (QoL) between primary snorers and obstructive sleep apnea (OSA) patients using 2 measures: Short‐Form 36 (SF‐36) and Functional Outcomes of Sleep Questionnaire (FOSQ).

Methods:

This cross‐sectional study involved 69 patients who were investigated for snoring between February ‐ December 2011. Each patient completed a SF‐36 and FOSQ prior to polysomnogram. Based on polysomnogram outcomes, 4 patient groups were derived: normal, mild, moderate, and severe OSA. Variables analyzed were body‐mass‐index (BMI), Epworth‐ sleepiness‐score (ESS), SF‐36, and FOSQ scores.

Results:

Fourteen patients were normal (mean AHI 2), 14 mild OSA (mean AHI 7.7), 9 moderate OSA (mean AHI 21.9), and 32 severe OSA (mean AHI 57.5). BMI and ESS indices increased progressively from normal to severe OSA. We found no difference in SF‐36's Physical Health component among normal, mild, and moderate OSA, and though it was lowered in severe OSA this was not statistically significant (p = 0.273). Mental health component scores were similar across all groups. OSA patients scored higher across all 5 FOSQ domains compared with simple snorers, but none were statistically significant. However, primary snorers had a significantly higher (p= 0.013) self‐reported health state (67.3% +/‐16.85) than OSA patients (54.08% +/‐17.45).

Conclusions:

The broad‐based SF‐36 fails to distinguish differences in QoL between normal and OSA patients. FOSQ's psychometric properties have been reported to better reflect functional impairment caused by OSA. However, in our series, FOSQ has not been statistically significant in differentiating between patients with and without OSA.
Is the Trend in Indications for Tonsillectomy and Adenotonsillectomy Really Changing?
Authors: Ahmed Abdulazeez , Aliyu Ibrahim , Kolo Emmanuel
Published: August 2013

Objectives:

Infection and obstruction are the most common indications for performing tonsillectomy and adenotonsillectomy. In the past, infection was the main indication for these procedures; however, in the last few decades, obstruction is said to be more prominent as an indication when compared to infection. This study evaluates the changing trend in indications for tonsillectomy and adenotonsillectomies.

Methods:

This is a 2 year retrospective analysis of case records of patients aged 0‐18 years who have had tonsillectomy or adenoidectomy and tonsillectomy performed in Aminu Kano Teaching Hospital. IBM SPSS (for Windows, version 19) software was used to analyze these data.

Results:

A total of 115 patient case records were reviewed. 33.9% were children under 3 years old, 60.0% were between 4‐10 years, and 6.1% were between 11‐18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indications for these procedures. There was a significant association between age groups and indications for adenotonsillectomies (P = 0001, Phi and Cramer's V = 0.363, respectively).

Conclusions:

Obstruction as an indication is proportionally higher in younger children, while infection is proportionally higher in older children.
Nasal Symptoms, Resistance, and AHI Contributions to Subjective Sleep Outcomes
Authors: Woodson B. Tucker , Helm Cole
Published: August 2013

Objectives:

The contribution of nasal obstruction to sleep related quality of life is poorly understood. This study assesses the contribution of: 1) nasal symptoms and effective nasal resistance;2) AHI to sleep‐related quality of life.

Methods:

70 unselected adult patients (age 52.2 (13.9) years) undergoing polysomnography at an academic sleep center were evaluated with four phase rhinomanometry (RhinoLab, Rendsburg, Germany) in the upright and supine body positions and completed validated quality of life measures.

Results:

AHI demonstrated no associations with nasal obstruction symptom questionnaire (NOSE), insomnia score (PSQI), hypersomnia (ESS), or functional quality of life (FOSQ‐10). However, both nasal symptoms (NOSE) and resistance (Rsupine/effective) were associated with sleep metrics. NOSE was associated with insomnia, hypersomnia, and QOL (r = 0.44,0.29, and 0.40 respectively, all p < 0.01) while Rsupine/effective was associated with hypersomnia (r=0.24,p<0.02) and a trend to insomnia (p< 0.09). No association with change in upright to supine resistance was observed. In the group with OSA (AHI > 5/hr., n= 49) and without OSA (AHI < 5/hr.,n=21) nasal symptoms and Rsupine/effective maintained associations (r=0.30 and 0.32 p<0.05) with hypersomnia (ESS) but not AHI (p=NS) in either group.

Conclusions:

In a sleep lab cohort referred for evaluation of possible sleep disordered breathing, both subjective and objective measures of nasal obstruction but not AHI contribute to sleep related subjective outcomes. Further research is needed on the nasal contribution to sleep disorders independent of AHI.
Neurogenic Model of Obstructive Sleep Apnea in Rabbits
Authors: Lee Woo‐Hyun , Kim Jeong‐Whun , Joe Sam
Published: August 2013

Objectives:

An animal model of obstructive sleep apnea (OSA) can be helpful for evaluating the pathophysiology of OSA and application of novel treatment modalities. This study aimed to establish new OSA animal model simulating real upper airway conditions during sleep.

Methods:

A total of 27 New Zealand white male rabbits were used. Sleep was induced by intramuscular injection of 0.3 ml/kg of Zoletil and 0.2 ml/kg of Rompun. Drug‐induced sleep was evaluated using Embletta X100 for electroencephalography, electrooculography, chin electromyography, nasal airflow, breathing efforts, and pulse oxymetry. Upper airway obstruction was induced by injecting botulinum toxin into the genioglossus. Respiratory events (apneas or hypopneas) during sleep were evaluated using ApneaLink.

Results:

All the rabbits showed no apneas or hypopneas before injection of botulinum toxin. In the control rabbits injected with normal saline, apneas or hypopneas were not found. The respiratory events were observed in 5 of 8 rabbits injected with 2.5 units of botulinum toxin whereas they were observed in 7 of 10 rabbits injected with 5.0 units of botulinum toxin. The median AHI was 9.6 (5.3 – 14.8)/h and 45.6 (21.5 – 70.5)/h in the rabbits injected with 2.5 units and 5.0 units of botulinum toxin, respectively (P =. 028).

Conclusions:

The animal model of OSA could be developed by paralyzing the genioglossus in rabbits.
Predictors of Uvulopalatopharyngoplasty Success in the Treatment of Obstructive Sleep Apnea Syndrome
Authors: Valera Fabiana , Braga Adriano , Grechi Tais H. , Eckel Alan , Itikawa Carla E. , Trawitzk Luciana V. V. , Felicio Claudia M.
Published: August 2013

Objectives:

Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of this study is to correlate UPPP success to craniofacial bony structure and orofacial muscle function.

Methods:

Prospective longitudinal study in a tertiary clinical center. Fifty‐four patients who underwent UPPP in the last 7 years were followed, and UPPP succeeded or failed based on the results of pre‐operative and post‐operative polysomnography. Clinical variables’ body mass index (BMI), age, and pre‐operative apnea‐hypopnea index (AHI)’s cephalometric measurements (craniofacial region and hyoid bone position), and muscle function variables (clinical protocol and tongue strength measures) were evaluated and compared between the groups (failure or success after UPPP).

Results:

The variables BMI, pre‐operative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol was also similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure. This movement is primarily performed by genioglossus muscle.

Conclusions:

OSAS is a multifactorial disease, and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, because they might influence the evolution of the disease.
The Junior Resident's Perspective of Learning in a Simulation‐Based Otolaryngology Boot Camp
Authors: Zapanta Philip E. , Adler Jamie , Constant Joelle , Malekzadeh Sonya , Deutsch Ellen S. , Fung Kevin , Malloy Kelly M.
Published: August 2013

Objectives:

1) Determine what residents experience in an otolaryngology boot camp (OBC). 2) Understand how the individual resident's background influences learning.

Methods:

Using a qualitative phenomenological approach, investigators interviewed 36 junior otolaryngology residents who had participated in a one‐day simulation‐based OBC. The residents attended camps in Washington, DC (July 2012), or in London, Ontario (September 2012). A semi‐structured interview of each resident was recorded and transcribed. Using Moustakaa'ss analysis, the interviews were broken up into codes and clusters to create a codebook. To ensure trustworthiness of the qualitative data, investigators used upfront debriefing, investigator triangulation, epoche, reciprocal coding of transcripts, member checks, and thick, rich description.

Results:

Five learning themes emerged during OBC: 1) Residents aim to gain knowledge and experience to positively affect their performance and patient outcomes. 2) Prior clinical experience and OBC's realistic scenarios influenced resident learning. 3) The residents valued their development of leadership and teamwork. 4) Residents actively learn by synthesis and application of their knowledge. 5) The faculty plays a critical role in the boot camp.

Conclusions:

The Accreditation Council for Graduate Medical Education (ACGME) has specific core requirements to improve resident performance and competency. To address this, innovative otolaryngology faculty has developed specialty specific boot camps, and quantitative research has documented the learners’ performance gains. Using the residents’ own words, this qualitative research study shows how residents learn and why residents benefit from attending a simulation‐based otolaryngology boot camp. This research will help us better understand our learners and how we can improve their learning experience.
Transoral Robotic Surgery (TORS) for the Management of Obstructive Sleep Apnea from Tongue Base Hypertrophy
Authors: Ahn Jeffrey M. , Hsu Nicole M.
Published: August 2013

Objectives:

Obstructive sleep apnea (OSA) is a medical problem that afflicts millions of Americans with considerable sequelae. The base of tongue is recognized as a significant site of obstruction leading to hypopharyngeal collapse during sleep. Many existing procedures implemented for the management of OSA typically have restricted surgical access to the base of tongue. However, transoral robotic surgery (TORS) provides excellent exposure to the tongue base and lingual tonsils. We aim to assess the success of robotically assisted partial glossectomy for tongue base reduction in patients with OSA.

Methods:

Medical records of patients ages >18 who underwent TORS for surgical management of OSA from 2011 through 2012 were retrospectively reviewed. Pre‐operative and post‐operative polysomnography were performed, and the results were compared to assess for improvement in OSA.

Results:

Twenty‐one patients completed the pre‐ and post‐operative evaluations. The mean apnea hypopnea index (AHI) decreased from 37.0 pre‐operatively to 14.9 post‐operatively, with a mean AHI reduction of 22.1 (p = <0.01). The mean oxygen saturation nadir was 79.2% pre‐operatively and 83.3% post‐operatively, with a mean increase in oxygen saturation nadir of 4.1% (p = 0.04).

Conclusions:

TORS provides excellent surgical access to the tongue base, allowing for improved base of tongue reduction for the management of OSA. In our patients who underwent robotically assisted partial glossectomy for OSA, there was a significant reduction in AHI, as well as a significant increase in oxygen saturation nadir.
Nasal Valve Collapse: An Unrecognized Cause of Eustachian Tube Dysfunction
Authors: Dean Marc , Bowen Rebecca
Published: August 2013

Objectives:

1) Demonstrate that correction of nasal valve collapse leads to improvement in eustachian tube dysfunction. 2) Describe the relationship between eustachian tube dysfunction and nasal valve pathology.

Methods:

A retrospective analysis of patients who underwent surgical treatment for nasal valve collapse from 2010 to 2011 was undertaken looking for associated eustachian tube dysfunction (ETD) and the effect correction of the nasal valve had on ETD. Each chart was analyzed for preoperative otologic complaints consistent with ETD and the effect correction of nasal valve collapse had on these complaints.

Results:

Forty patients underwent surgical treatment of nasal valve collapse; 37.5% of these patients reported symptoms consistent with eustachian tube dysfunction. Of these patients 87% reported improvement of their otologic symptoms.

Conclusions:

The relationship between chronic sniffing and negative middle ear pressures has been well established. Chronic sniffing creates negative middle ear pressures leading to ETD. Nasal valve collapse creates a setting physiologically similar to the chronic sniffer; thus, we hypothesize that nasal valve collapse is as an unrecognized cause of ETD, and correction will improve symptoms of ETD. This study demonstrates that patient have significant improvement in ETD symptoms related to ETD after undergoing correction of nasal valve collapse. This study suggests that correction of nasal valve collapse improves symptoms of ETD. However, this study is limited due to the retrospective design and small sample size; further prospective analysis is needed to study the effect of the nasal valve on ETD.
Needle Aspiration versus Incision and Drainage for the Treatment of Peritonsillar Abscesses
Authors: Thamboo Andrew , Chang Brent , Diamond Christopher , Nunez Desmond A.
Published: August 2013

Objectives:

Peritonsillar abscesses are a common otolaryngological emergency. Needle aspiration and incision and drainage are the two main treatment modalities currently used. The effectiveness of one versus the other remains an area of debate among otolaryngologists. The objective of this review is to recognize whether needle aspiration or incision and drainage is the superior treatment for peritonsillar abscesses.

Methods:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); PubMed; EMBASE; Web of Science; ClinicalTrials.gov; and Google Scholar for relevant English studies. Selection criteria were applied to limit the review to randomized controlled trials comparing needle aspiration to incision and drainage in humans over the age of 12 years. The primary outcome studied was abscess recurrence rate.

Results:

Five studies were identified which compared needle aspiration to incision and drainage. All were of poor quality with no paper having a Jadad score above 2. One study reported a higher recurrence rate with needle aspiration and four no obvious difference in recurrence rate between the two techniques. Meta‐analysis was inappropriate.

Conclusions:

Currently, there is insufficient evidence to determine which if any of the two treatments is superior. A sufficiently powered, well‐designed randomized controlled clinical trial is required to compare the effectiveness of needle aspiration with incision and drainage for the treatment of peritonsillar abscesses.
Otolaryngology Education in the University of Calgary Undergraduate Medical Curriculum: A Needs Assessment Study
Authors: Liu C. Carrie , Hoy Monica , Marck Paul A.
Published: August 2013

Objectives:

Perform a needs assessment study on otolaryngology teaching in pre‐clerkship medical students. Secondary outcomes include evaluating the quantity and nature of, as well as student perceptions of, current otolaryngology teaching at the University of Calgary.

Methods:

This is a survey based cohort study of first and second year medical students at the University of Calgary, completed in January and February 2013. The survey was based on the otolaryngology competencies outlined by the national medical board (MCCQE Part I objectives).

Results:

There were 150 responses (response rate of 42.9%). Thirty‐eight (74.5%) of first year respondents have had less than 10 hours of otolaryngology teaching, and of these experiences, 19 (50%) were with family physicians and only 2 (5%) were with otolaryngology staff. For the second year class, 60 (60.6%) have had less than 10 hours of otolaryngology teaching, 24 (24.2%) have had between 10‐24 hours, and 15 (15.2%) have had greater than 24 hours. Forty‐eight students (48.5%) received teaching by otolaryngology staff/residents and 19 (19.2%) by family physicians. Low confidence was expressed by both cohorts in performing head and neck exams as well as approaching common otolaryngology pathologies.

Conclusions:

There is a perceived deficiency in the otolaryngology component of the undergraduate medical curriculum, especially in the areas of performing otolaryngologic physical examinations and approaching otolaryngologic pathologies. Learning strategies perceived to have high educational value include physical exam sessions and small group case‐based learning sessions facilitated by an otolaryngology staff or resident, as well as attending otolaryngology clinics.
Say What? Disparity between Resident and Faculty Perceptions of Immediate Postoperative Feedback
Authors: Meyers Jason A. , Yueh Bevan , Gladding Sophia , Boyer Holly
Published: August 2013

Objectives:

1) Investigate differing perceptions between otolaryngology residents and faculty regarding immediate post‐operative feedback. We hypothesized that residents would be less satisfied with the degree of feedback. 2) Identify factors that might explain observed differences between perceptions.

Methods:

Prospective observational study of residents and faculty for one month during a university based otolaryngology residency rotation. Immediately following each operation, the faculty surgeon provided the resident surgeon with post‐operative feedback. Both then independently completed an identical confidential survey. Both surgeons were asked to address the amount, quality, content, and satisfaction about the immediate feedback and rate the resident's operative performance in 9 core areas on a 5 point Likert scale. Wilcoxon signed‐rank test was used to determine significance.

Results:

To date, 142 surveys were completed by 22 faculty and 16 residents following 71 operations. Contrary to expectations, the faculty were less satisfied with overall feedback given (4.06 vs 4.45; P < 0.001), sufficiency of feedback given (4.04 vs 4.45; P < 0.001), and specificity of feedback given (4.06 vs 4.39; P < 0.005). Compared to faculty evaluations, the residents rated their surgical performance lower in all 9 core areas and overall assessment of operative ability (4.17 vs 3.77; P < 0.001). Senior faculty level described fewer differences in perception of surgical performance.

Conclusions:

Faculty were less satisfied with the post‐operative feedback they provided, while residents were more critical of their own operative performance. These results will direct future efforts to improve educational feedback within our specialty.
Survival Outcome and Treatment Strategies in Advanced Stage (III‐IV) Laryngeal Cancers at Two European Centers
Authors: Karlsson Therese R. , Al‐Azzawe Mohammed , Aziz Luaay , Hurman David C. , Finizia Caterina A.
Published: August 2013

Objectives:

In light of continued uncertainty regarding efficacy of treatment of stage III and stage IV laryngeal tumors, this study aims to evaluate organ preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy± adjuvant treatment) by encompassing the long‐established practice at two internationally acclaimed tertiary centers not previously presented in published literature.

Methods:

Retrospective review of non‐randomized prospectively maintained patient databases at two tertiary centers from 1998‐2008; Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Patients with stage III and IV disease were included in the study. Primary outcome measures included 3‐year overall and disease‐specific survival depending on treatment.

Results:

A total of 176 patients were identified, of whom 83% were male and 17% were female with an average age of 65. Sixty‐five patients (37%) presented with stage III tumors, of which 51 patients received organ‐preserving treatment and 14 patients underwent total laryngectomy. Corresponding figures for the 111 patients (63%) presenting with stage IV disease were 42 and 69. Three‐year overall and disease‐specific survival for stage III were 58% and 73% respectively. Corresponding figures for stage IV disease were 42% and 53%. Choice of treatment did not significantly influence survival for stage III (P = 0.56) or IV (P = 0.93) disease.

Conclusions:

Choice of treatment, whether it be organ preservation or surgery, does not significantly influence overall or disease‐specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate preferred treatment options.
Tonsillar Biopsy as Diagnostic Choice in Variant Creutzfeldt‐Jakob Disease
Authors: Setabutr Dhave , Fornadley John A. , Goldman John N.
Published: August 2013

Objectives:

We attempt to publish the first U.S. report of proceeding with biopsy of tonsillar tissue to diagnose vCJD and review the literature.

Methods:

We review an interesting case of a patient who underwent tonsillectomy to potentially diagnose a variant of Creutzfeldt‐Jakob disease (vCJD) in November of 2012. Variant Creutzfeldt‐Jakob disease (vCJD) has impacted the British medical community for some time now. In the appropriate clinical context, a tonsil biopsy sample that is positive for PrPSc, variant CJD could be diagnosed, which obviates the need for a brain biopsy sample to be taken.

Results:

From other studies conducted in the British literature, tonsillar biopsy has been advocated for the diagnosis of a variant of Creutzfeldt‐Jakob disease preventing unnecessary morbidity from brain biopsy. The patient we reviewed was a young male who presented to the Emergency Room with a weeklong history of worsening headache. Magnetic resonance imaging (MRI) of the brain revealed signs consistent with encephalitis while electroencephalogram ruled out seizure activity and spinal fluid specimen was negative for meningitis. Infectious disease was consulted and recommended tonsillar biopsy to rule out variant Creutzfeldt‐Jakob disease. We review the literature on the utility of tonsillar biopsy for diagnosis of Creutzfeldt‐Jakob disease and report the first published report of this diagnostic modality in the United States.

Conclusions:

Tonsillar biopsy can safely be used in the diagnosis of variant Creutzfeldt‐Jakob disease obviating the need for more invasive procedures and at this time while disposal of instrumentation used for the tonsillectomy is the current recommended practice.
Tube Education Device (TED) Simulator for Myringotomy with Tube Insertion for Resident Training Purposes
Authors: Son Eugene L. , Pine Harold S. , Mukerji Shraddha S. , Young Dayton L.
Published: August 2013

Objectives:

1) Implement a training device to train otolaryngology residents to perform myringotomy with tube insertion. 2) Analyze data on the performance of medical students with this device.

Methods:

After approval by University of Texas Medical Branch Institutional Review Board, medical students were recruited to partake in the study from June 2012 to present. An instructional video on this procedure was shown to each subject before each trial. In the operating room, the subjects performed the procedure 5 consecutive times while being recorded through the ear microscope. An otolaryngology resident performed the duties of a surgical tech. The videos were then all randomized and reviewed by 3 attending otolaryngologists with the following criteria: average time, number of errors, and subjective numerical grading of each attempt.

Results:

To date, 7 subjects have participated. From the first attempt to the fifth attempt, the average time for procedure decreased from 160 seconds to 80 seconds. The average times the myringotomy knife touched the sides of the simulated ear canal dropped from over 2.6 to 0.7 times. The average percentage of instances the grader would allow the subject to perform procedure on a real patient increased from 38% to 91%. The success of the procedure determined by the grader increased from 52% to 95%.

Conclusions:

No standardized training is available for myringotomy with tube insertion. Training with this device can decrease procedure time by 50%, reduce errors, and increase the confidence of attending otolaryngologists of trainees. These results show potential benefits to translate to real patients.
Does Correction of Caudal Septal Deflection Affect Nasal Angle Parameters?
Authors: Kim Kyung Su
Published: August 2013

Objectives:

Verify whether one's external appearance may change after correction of caudal septal deflection by estimating nasal angle parameters.

Methods:

Correction of caudal septal deflection was performed by first releasing the caudal septal cartilage along the maxillary crest and excising excessive portions. The incised cartilage was sutured, and the detached ventral cartilage of caudal septum was fixed at the midline. Preoperative and postoperative photographs (lateral view) were taken at postoperative 6 months. Nasolabial angle (NLA) and nasal tip angle (NTA), as well as the angle between the columella and a perpendicular line to the Frankfort line (CFL), were evaluated. The visual analogue score (VAS) for nasal obstruction was evaluated at pre‐ and post‐operation.

Results:

A total of 35 patients per protocol were included in this study. The mean preoperative NLA was 98.67±9.17° and the mean NLA at postoperative 6 months was 98.64±9.27°; the NTA changed from 84.41±6.96° to 84.33±7.07°; the CFL changed from 80.06±7.91° to 80.08±8.02°. All parameters showed no significant change between pre‐ and post‐operation. Subjective saddle nose or other external deformities were not reported. VAS score of subjective nasal obstruction decreased significantly from 7.89±1.37 to 1.80±1.05.

Conclusions:

After correction of caudal septal deflection, nasal angle parameters were not changed and VAS score was significantly improved. Therefore, caudal septal deflection can be safely and satisfactorily corrected through proper surgical methods.
Voice Rehabilitation: Is It Effective in the Patient's Point of View?
Authors: Tuomi Lisa
Published: August 2013

Objectives:

Investigate the patient's self perceived efficacy of voice rehabilitation after laryngeal cancer.

Methods:

All patients who were diagnosed with laryngeal cancer during the years 2000 through 2011 were asked to participate in a randomized study on voice rehabilitation with a speech language pathologist. 79 patients agreed to participate. 37 of the patients underwent voice rehabilitation after completion of radiotherapy, and 42 worked as a control group. The study group filled in the Swedish version of the Self Evaluation of Communication Experiences after Laryngeal cancer (S‐SECEL) before and after voice rehabilitation, the control group at parallel times.

Results:

81% of the study group experienced an improvement of voice and communication measured with the S‐SECEL. In the control group 33% improved during the same period. In the study group 16% reported a worse perceived vocal function; in the control group corresponding values were 47%. 5% of the patients in the control group did not report any difference. Measurements from 1 and 6 patients in the study group and control group are missing respectively. The difference in mean values between the first and second measurement improved for the study group by 8.4 points. For the control group a deterioration of 4.4 was seen.

Conclusions:

Voice rehabilitation gives the patient a better self‐perceived communication and voice function. Some patients who did not receive vocal rehabilitation experienced improved voice function, but for the patients who received voice rehabilitation improvement was seen in a majority of the cases.
Wand Malposition during Inferior Turbinate Coblation Using Rhinoscopy or External View
Authors: Dion Gregory R. , Willson Thomas J. , O'Connor Peter , Weitzel Erik K. , Barrera Jose E.
Published: August 2013

Objectives:

1) Analyze differences in inferior turbinate coblation wand angles in correct and incorrect positions. 2) Determine whether rhinoscopy images of the coblation wand in the head of the inferior turbinate are adequate to determine distal tip position. 3) Determine whether viewing the coblation wand externally, such as is done by instructors during training, is adequate to determine distal tip position.

Methods:

Arthrocare Reflex Ultra 45 Plasma Wands were placed in inferior turbinates of cadaver specimens in three configurations: 1) ideal location for inferior turbinate reduction; 2) with distal tip where sphenopalatine artery (SPA) enters the nasal cavity; 3) with distal tip in nasal septum. Photos were taken of wand position from external views and an endoscopy view at the nasal vestibule. Angles from midline, the Frankfort horizontal line, and a mid‐sagittal line were calculated under each condition. Images from the three conditions were shown to otolaryngologists to determine if the correct position could be selected.

Results:

Wand angles, in each dimension, varied an average of 12 degrees (SD 10.1 deg). Shifting the wand 12 degrees in any direction corresponds to 4mm motion of the proximal wand with the distal end moving 1cm. Providers trained in facial plastic surgery, rhinology, and sleep medicine identified the correct coblation wand position 33 percent of the time.

Conclusions:

Inferior turbinate coblation is a common office and operating room procedure. Wand malposition using an external viewpoint or rhinoscopy may result in suboptimal turbinate reduction or epistaxis. Placement verification may be beneficial.
When Can Acute Supraglottitis Patients Be Discharged from Intensive Care?
Authors: Shaul Chanan , Israel Ariel , Schwarz Yehuda , Peleg Uri , Sichel Jean‐Yves
Published: August 2013

Objectives:

Acute supraglottitis in adults is usually managed by admitting the patient for airway monitoring in the intensive care unit (ICU). However, data are lacking on when patients could be transferred from the ICU to the ward. Our aim is to suggest decision criteria for transferring patients to the regular ward.

Methods:

A retrospective review of medical records from adult patients admitted for supraglottitis to our center was conducted. The information obtained included airway management, length of stay in the ICU and in the ward, clinical condition of the patients at the time of their transfer from the ICU to the ward, and outcome.

Results:

Between 2006 and 2012, 38 adult patients were treated in our department for supraglottitis with antibiotics and systemic steroids. All patients were admitted to the ICU for monitoring. Fiberoptic laryngoscopy was performed every 12 hours. 5 patients required intubation at admission. 33 patients were admitted to the ICU for monitoring and did not require further intubation. Average time in the ICU was 27.4 hours. We observed that all patients who had a mild swelling regression did not deteriorate or require re‐intubation or re‐admission to the ICU. They were all discharged from the regular ward without any complications.

Conclusions:

Patients without severe airway compromise could undergo monitoring in the ICU without intubation. Since all patients who began to improve did not suffer from deterioration afterwards, we suggest that even mild airway improvement could be considered as a sufficient criterion for safe transfer of patients to the regular ward.