bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pylori Is Present in Head and Neck Cancer Lesions
Authors: Lechner Matthias , Rees Louisa , Cogan Tristan A. , Weinberger Paul , Birchall Martin A.
Published: February 2015

Objective

To investigate the presence of Helicobacter pylori (H pylori), a key pathogen in chronic gastritis and recognized as a major cause of gastric cancer, in cancer samples and adjacent normal tissues of the head and neck region.

Method

Twenty‐eight fresh‐frozen HNSCC samples and 11 biopsies from normal tissue were obtained from fully informed and consented patients at GSHU. From 8 of these cancer samples adjacent normal tissue was available. FISH using a probe for H pylori was used to examine sections of these samples and enumerate the bacterium.

Results

The average number of H pylori per biopsy section was significantly higher in the SCC group (P <. 03) than controls for all sites examined. Most interestingly, in paired SCC and adjacent normal biopsies from the same patient the average number of H pylori per biopsy was significantly higher in the SCC tissue compared with the adjacent normal tissue (P <. 006). These data indicate that H pylori shows a numerical and spatial association with squamous cell cancer lesions of the head and neck.

Conclusion

The fact that H pylori is present in higher numbers in the tumor tissue compared with adjacent tissue and tissue obtained from healthy individuals suggests either a predisposition for the colonization of SCC with H pylori, or a causative role for the bacterium in cancer at these sites.
Office‐Based Injection Laryngoplasty with Hyaluronic Acid Gel
Authors: Upton David , Johnson Matthew , Zelazny Sherri , Dailey Seth H.
Published: February 2015

Objective

Many injectables are available for vocal fold augmentation, but the role of Juvederm Ultra Plus hyaluronic acid gel has not been well examined. This study was conducted to assess the safety and clinical effectiveness of office‐based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency (GI).

Method

Prospective case series of 27 patients with GI treated with unsedated office‐based injection laryngoplasty of Juvederm Ultra Plus gel over a 20 month period. Preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months postinjection.

Results

Data for 26 patients were available for follow‐up analysis at 1 month, and 12 patients’ data were available at 4 months. Etiologies of GI included presbylaryngis (n = 11), unilateral vocal fold paralysis (n = 10), scar (n = 2), and others (n = 5). Eighty‐nine percent underwent transoral injection, and 11% received transcervical injections. Significant improvements compared to preinjection levels (P <. 03) were shown in all outcome measures at 1 and 4 months, respectively. Although there were no procedural complications, 1 patient required intravenous steroid therapy for temporary glottic inflammation that resolved without permanent sequelae.

Conclusion

The injection of Juvederm Ultra Plus gel is a safe procedure that allows for reliable improvements in objective and subjective outcome measures of vocal function in patients with GI provided the surgeon remains alert for the possibility of postprocedural injection site inflammation.
Stem Cell–Coated Tracheal Replacement in a Rabbit Model
Authors: Wood Megan W. , Wright Stephen C.
Published: February 2015

Objective

Design a single‐stage stem‐cell based tracheal replacement technique to expand tracheal reconstructive options.

Method

A pilot study using 4 rabbits was performed in October through December of 2011 at Wake Forest Institute of Regenerative Medicine. Two procedures were performed on cadaveric animals, and 2 survival surgeries were performed on live animals. Our technique combined a segment of fixed, cell‐free cadaveric donor trachea and adipose or marrow derived stem cells harvested from the recipient animal. These acellular donor conduits were seeded with host stem cells and implanted.

Results

Tracheal reconstruction for tracheal stenosis is an evolving field. Recent success using a stem‐cell based engineered trachea required a prolonged incubation ex vivo in a novel “bioreactor.” Taking this idea a step further, a single‐stage method would be optimal. After completion of both cadaveric surgeries, the surgical procedure was optimized. The following 2 live‐animal procedures were successful demonstrations of the ability to suspend stem cells in fibrin glue, seed the conduit, and replace a segment of trachea. Although both animals were euthanized following completion according to approved IACUC protocol, the final animal was extubated prior to euthanasia, and demonstrated comfortable, spontaneous respiration.

Conclusion

Based on pilot study technical success of short segment tracheal replacement with the use of fixed donor trachea and stem cell support, additional animal studies with extended follow‐up will provide the necessary data to improve tracheal reconstruction in a single‐stage surgical model.
The Effect of Acidity on the Electrical Barrier of Trachea
Authors: Miwa Masato , Miwa Mayumi , Shiozawa Akito , Ikeda Katsuhisa
Published: February 2015

Objective

Gastric acid can affect the laryngopharyngeal mucous membranes recognized as laryngopharyngeal reflux disease (LPRD). The aim of this study is to 1) Evaluate the electrical barrier function induced by acid by measuring transepithelial electrical resistance (TER) of tracheal epithelial cells. 2) Determine the effect of proton pump inhibiter (PPI) on TER.

Method

Tracheal epithelial cells were harvested from the trachea excised from a guinea pig (n = 20). Measurement of TER was performed after application of acid, PPI, and ion channel blockers in vitro. TER was measured with an epithelial voltameter (EVOM, WPI, Sarasota, USA) equipped with STX‐2 “chopstick” electrodes.

Results

After the apical administration of hydrochloric acid at a variety of pH values, TER of the epithelial cells decreased, and the electrical barrier was significantly down regulated from pH3. In the groups of cells cultured with a PPI, Lansoprazol (10‐50 µM), there was no significant variation in TER of the epithelial cells, regardless of the variations in acidity. There was an additive increase in TER values along with the addition of 100 µM of the channel blockers DPC and amiloride.

Conclusion

The electrical barrier of the trachea was significantly down regulated by acid from pH3 and PPI might recover the down regulation via sodium and chloride channels.
Value of Ultrasonagraphy in Diagnosis of Laryngeal Lesions
Authors: Gomaa Mohammed A. , Hamad Mostafa S. , Osman Naser
Published: February 2015

Objective

Evaluate the value of high‐resolution ultrasonography (HRUS) in diagnosis of various laryngeal lesions.

Method

A prospective study done from March 2010 to July 2011 on 66 patients suffering from voice changes, pre‐examined by rigid endoscopy and diagnosed to have a laryngeal lesion, and 32 volunteers composed the control group. All 98 persons (patients and control groups) were examined by HRUS.

Results

HRUS was helpful in describing various laryngeal lesions as vocal cord nodules (13) 19.6%, vocal cord polyps (17) 25.7%, epiglottal enlargement (2) 3.03%, and vocal cord mass (6) 9.09%. It was highly significant in diagnosis of early subglottic lesions—(10) 15.2%—that were missed by rigid endoscopy. Also, vocal cords mobility can be demonstrated by HRUS. However, interarytenoid edema (18) 27.3% was difficult to detect.

Conclusion

Rigid endoscopy is difficult to diagnose laryngeal lesions in patients with sensitive gag reflex, neck or jaw diseases, and stridor and in infants. HRUS is an alternative method in diagnosis of some laryngeal lesions in these patients, and it is superior in the diagnosis of small subglottic lesions.
Antimicrobial Properties of Copper in Hearing Aid Users
Authors: Bravo Gustavo , Duran Claudia , Carrasco Maria I. , Bahamonde Hector , Prado Valeria
Published: February 2015

Objective

1) Evaluate the antimicrobial properties of copper in hearing aid molds against the most prevalent pathogens of otitis externa in an in vitro system. 2) Determine the most suitable mold material to allow adequate diffusion of copper ions to perform its antimicrobial action.

Method

Experimental study conducted from January to December 2010, consisting of an in vitro system with hearing‐aid molds made from different materials with and without copper in them, which were inoculated with external otitis pathogens at different concentrations (S aureus, P aeruginosa, C albicans, and A niger), then determine percentage of bacterial adhesion to materials.

Results

There was a significant reduction in the percentage of microbial adherence to different mold materials with copper in them, in relation to those without copper, at different levels of microbial concentration for S aureus, P aeruginosa, C albicans, and A niger, while the percentages of adherence reduction fluctuated between 27% and 100% in those molds that contained copper. We have observed an inverse relation between the adherence reduction and the concentration of inoculated microorganisms. A greater microbial adherence reduction was shown in molds made of UV sensitive polymer with copper in their interior, compared with other materials.

Conclusion

Results show that copper exerts its antimicrobial properties through different materials, which opens an interesting challenge in the otolaryngological field and public health area to develop clinical studies focused on confirming whether the use of hearing aids with copper sheets inside reduces the risk of infectious external otitis.
Cytokines Induced by Gentamicin and Sepsis in the Cochlea
Authors: Quintanilla‐Dieck Lourdes , Larrain Barbara , Trune Dennis R. , Steyger Peter
Published: February 2015

Objective

The mechanism by which sepsis‐induced inflammation enhances aminoglycoside trafficking into the cochlea remains poorly understood. This study sought to determine if protein expression of inflammatory‐mediated cytokines in the cochlea is modulated by systemic sepsis and/or drug treatment.

Method

Three groups of mice received 1 of the following treatments: gentamicin, lipopolysaccharide for sepsis induction, or both gentamicin and lipopolysaccharide. A fourth group served as controls. After sacrifice, cochleae were collected and homogenized for protein extraction. This was followed by an enzyme‐linked immunosorbent assay for analysis of 16 inflammatory‐mediated cytokines.

Results

There was substantial elevation in cochlear expression of multiple cytokines in mice treated with bacteria‐derived lipopolysaccharide, with or without gentamicin. The most salient cytokines were interleukin‐1α, interleukin‐6, monocyte chemotactic protein‐1, and macrophage inflammatory protein‐α. Gentamicin alone did not induce a significant inflammatory response, compared to lipopolysaccharide. This suggests that in the cochlea, specific pro‐inflammatory cytokines are massively produced during a systemic infection, but not in the presence of aminoglycosides as the sole insult. Given that these cytokines increase permeability across blood‐endothelial barriers, permitting transendothelial migration of inflammatory cells, they may also enhance aminoglycoside trafficking and contribute to its ototoxicity.

Conclusion

Aminoglycosides are usually prescribed for prophylaxis or systemic bacterial infection. The latter induces a pro‐inflammatory state that could enhance aminoglycoside uptake by cochlear tissues. Unveiling the mechanisms mediated by sepsis that contribute to cochlear uptake of aminoglycosides will aid the development of strategies to ameliorate or prevent this devastating side‐effect.
Efficacy of Multimodality Approach at Sudden Hearing Loss
Authors: Naiboğlu Barış , Külekçi Semra , Toros Sema Z. , Verim Ayşegül , Ertugay Çiğdem K. , Oysu Cagatay
Published: February 2015

Objective

The etiological spectrum of sudden hearing loss is ample and ambiguous. The combined form of different treatment modalities geared toward the hypothetical etiologies given at once must work better theoretically. This study is a trial to see whether addition of intratympanic steroid to systemic steroid and hyperbaric oyygen treatment works better or not.

Method

Prospective randomized study in a tertiary referral hospital. Fifty‐eight patients who presented with sudden hearing loss between 2008 and 2011 were enrolled into the study. Twenty patients who had received systemic steroid and hyperbaric oxygen composed group I while 38 patients who had received intratympanic steroid in addition to systemic steroid and hyperbaric oxygen composed group II.

Results

Posttreatment hearing improvement was statistically significant in both groups in terms of pure tone average according to Siegel’s criteria (P <. 05). Treatment was successful for 55% of patients in group I and 63% in group II. Although there is an increase in success rate with the addition of intratympanic steroid, this was not statistically significant (P >. 05). Regarding profound hearing loss over 90 dB, there seems a strong statistically significant difference. Treatment didn’t work in group I for a total of 6 patients (0%) while addition of intratympanic steroid to the protocol yielded success for 6 patients over 12 (50%) in group II (P <. 05).

Conclusion

Addition of intratympanic steroids to systemic steroid and hyperbaric oxygen yielded better results, but this was not statistically significant in general. However, intratympanic steroid injection seems beneficial for patients with profound sudden hearing loss.
Endoscopic Cochlear Implantation: A Prospective Study
Authors: Hershcovitch Meir , Samy Ravi N. , Nistor Vasile
Published: February 2015

Objective

To assess the hypothesis that an endoscopic technique would allow a resident to: 1) be able to create a cochleostomy in a proper location and 2) understand how to more accurately place an electrode into the scala tympani.

Method

Twenty cadaveric specimens had a posterior tympanotomy approach performed using standard microscopic techniques. After this approach, a prospective single‐blinded, randomized study was performed with the resident completing 10 cochleostomies using only a microscope and 10 using only an endoscope. After the procedures were completed, both the resident and faculty expert reviewed the bones and assessed placement of cochleostomy, size of cochleostomy, and time to perform the cochleostomy.

Results

The average time to the cochleostomy using the endoscopic technique was 5 min: 15 sec; with the microscope, this was 2 min: 41 sec. The average size of the cochleostomy with the endoscopic technique was 1.0 mm and with the microscope, it was larger than 1.0 mm. In terms of placement of the cochleostomy, only 5/10 (50%) were placed properly with the microscope but 8/10 (80%) were placed properly with the endoscope. This difference was statistically significant.

Conclusion

This study points to some potentially significant advantages in using the endoscope vs the microscope for placement of the cochleostomy. While using the endoscope took longer to create the cochleostomy, the endoscope allowed a smaller cochleostomy with a more accurate placement, in this prospective, cadaveric study. Further study is warranted in the operating room with this technique, as endoscopic techniques may further enhance current microscopic placement.
oVEMP to High Frequencies Show Semicircular Canal Dehiscence
Authors: Manzari Leonardo , Burgess Ann M. , McGarvie Leigh A. , Curthoys Ian S.
Published: February 2015

Objective

In 26 patients with CT‐verified SSCD, to investigate the effect of frequency on the n10 component of the ocular vestibular‐evoked myogenic potential (oVEMP n10) evoked by air conducted sound (ACS) and bone conducted vibration (BCV) at the midline forehead at the hairline (Fz).

Methods

A handheld Bruel and Kjaer 4810 minishaker provided BCV stimulation was used, using surface EMG electrodes beneath both eyes to record oVEMP n10. The stimulus ACS and BCV at either Fz or at the vertex of the skull (Cz) were tone bursts ranging from 125 Hz to 8000 Hz. Twenty‐seven healthy subjects were tested in the same paradigm.

Results

In response to ACS and Fz BCV from 125 Hz until 8000 Hz in SSCD patients the oVEMP n10 amplitude beneath the contraSSCD eye was substantially and significantly larger than the oVEMP n10 beneath the ipsiSSCD eye. In normal patients, ACS oVEMPs n10 is present and reproducible until 1000 Hz, while in SSCD ACS oVEMPs n10 is present up to far higher frequencies (8000 Hz). To Fz BCV oVEMPs n10 is present until 8000 Hz in 23 patients but only to 1000 Hz in normal patients.

Conclusion

Testing OVEMP frequency tuning with ACS and BCV allows very simple, very fast identification of a probable unilateral SSCD in a manner which is very easy even for senior patients.
Tinnitus Disturbance in Normal Hearing Patients
Authors: Oliveira Carlos A.C.P. , Sampaio Andre L. L. , Granjeiro Ronaldo C. , Kehrle Helga M. , Oliveira Taciana S. C.
Published: February 2015

Objective

To evaluate the annoyance of tinnitus by means of the Tinnitus Handicap Inventory (THI) in normal hearing patients and to correlate it with outer hair cell function by means of the evoked otoacustic emission tests and with anxiety and depression disorders investigated by the Beck scale.

Method

This case‐control study was performed in 2 groups of normal hearing patients: study group (SG): 68 patients with tinnitus; and control group (CG): 46 patients without tinnitus. Patients were submitted to otoacoustic emissions tests, to THI evaluation, and to anxiety and depression search by Beck Scale.

Results

Seventy‐five ears (67.0%) in SG showed abnormal TOAE versus 18 ears (19.6%) in CG (P <. 0001). Sixty‐eight ears (65.2%) had abnormal DPOAE in SG versus 46 ears (50%) in the CG (P <. 029). There was no correlation between THI and the results of TOAE (P =. 799) and DPOAE (P >. 7) tests. SG had 44.1% (N = 30) individuals with anxiety versus 17.4% (N = 8) in CG (P <. 003). There was a statistical difference between the presence and absence of depression and anxiety and the THI (P <. 001). The ones with these disturbances showed higher THI scores.

Conclusion

There was a correlation between anxiety and depression and the annoyance of tinnitus. Tinnitus annoyance showed no association to the outer hair cells’ function in this study.
Video Head Impulse Test Diagnoses Vestibulotoxicity
Authors: Halmagyi Gabor M. , MacDougall Hamish , Curthoys Ian S. , McGarvie Leigh A.
Published: February 2015

Objective

Video oculography is a simple, accurate alternative to the scleral search coil method measuring individual semicircular canal function in Head Impulse Testing (HIT). Here we compare the video HIT with the caloric test for the diagnosis of unilateral or bilateral vestibulotoxicity due to systemic gentamicin therapy.

Method

Using the video HIT (ICS Impulse – GN Otometrics, Taastrup, Denmark) we studied 23/126 patients with gentamicin vestibulotoxicity; 5 unilateral, 18 bilateral. All 126 had caloric testing (30°C, 44°C); 82 also had 0°C testing. The video HIT took about 15 minutes and gave immediate results.

Results

All 126 patients had severe unilateral or bilateral impairment of lateral semicircular canal function on caloric testing. Slow phase velocity was under 5°/s for each 30 or 44°C irrigation and under 7°/s for each 0°C irrigation. The video HIT correctly detected this loss in all 23 patients tested. During the video HIT the gain of the vestibulo‐ocular reflex from each lateral semicircular canal varied from 0.3 to 0.9 (N > 0.95). While a gain of 0.9 is near normal, the data in each patient showed covert or overt catch‐up saccades, confirming the vestibulo‐ocular reflex deficit.

Conclusion

The video HIT is a simple, accurate way of immediately diagnosing unilateral or bilateral gentamicin vestibulotoxicity avoiding the need for caloric testing. It might be applicable for monitoring of patients receiving potentially vestibulotoxic drugs and might in time replace the caloric test for the diagnosis of peripheral vestibulopathies.
Aortopexy for Vascular Tracheal Compression in Children
Authors: Wine Todd M. , Colman Kathryn L. , Mehta Deepak K. , Maguire Raymond C. , Morell Victor O. , Simons Jeffrey P.
Published: February 2015

Objective

1) Evaluate the presentation, diagnostic workup, and outcomes of contemporary surgical intervention for airway obstruction from innominate artery tracheal compression in children. 2) Assess the significance of synchronous airway lesions in the treatment of innominate artery tracheal compression.

Method

This study is a retrospective medical record review of 26 consecutive children who underwent aortopexy for innominate artery tracheal compression at a tertiary‐care children’s hospital. Presenting symptoms, diagnostic workup, presence of synchronous airway lesions, length of hospitalization, and treatment outcomes were examined.

Results

Twenty‐six patients (17 male, 65%) were included in the study. All were diagnosed with bronchoscopy and confirmed with radiographic imaging. Median age at diagnosis and surgery was 9.7 and 10.1 months, respectively. Presenting symptoms included noisy breathing (93%), cough (78%), dyspnea (44%), apnea (44%), cyanosis (19%), and recurrent respiratory infections (15%). Average degree of tracheal compression was 71% (SD 12%). Fifteen of 26 (58%) patients had synchronous airway lesions, including mild laryngomalacia and subglottic stenosis. Median length of stay was 2 days. Median follow‐up was 10 months. Subjective improvement occurred in all 20 patients for whom follow‐up information was available.

Conclusion

Anterior tracheal vascular compression can cause a variety of airway symptoms. Mild synchronous airway lesions are common and do not prevent successful aortopexy. Aortopexy is a safe and effective treatment for symptomatic anterior tracheal vascular compression from the innominate artery.
Effect of Adenotonsillectomy on Attention Tests
Authors: Abreu Cassiana B. , Pascoto Gabriela R. , Guedes Mariana , Weber Raimar , Pignatari Shirley S. N. , Stamm Aldo E. C.
Published: February 2015

Objective

To evaluate the performance of children and adolescents in tests of visual attention before and after surgical treatment of upper airway obstruction (adenotonsillectomy).

Method

Study group: 27 children (6‐17 years) with excessive daytime sleepiness undergoing surgical treatment of upper airways obstruction. Control group: 30 children (same age) without respiratory or sleep‐related complaints. TAVIS‐3 test was performed at baseline and 60 days after the surgery (patients) or first evaluation (controls).

Results

The initial study population was comprised of 60 children, 29 in the treatment group and 31 in the control group. The final analysis included 57 patients, 27 in the treatment group and 30 in the control group. Mean Epworth Sleepiness Scale–Children (ESSC) decreased from 9.9 ± 2.8 to 5.1 ± 2.1 (P <. 001) in patients and from 4.7 ± 1.6 to 4.6 ± 1.7 for controls. Response time, number of action errors, and number of omission errors decreased significantly (P <. 001) between the 2 evaluations in patients when compared to controls.

Conclusion

Surgical treatment of upper airway obstruction and resolution of daytime sleepiness promote improvement in visual attention in children and adolescents.
Predicting Surgical Intervention in Micrognathic Infants
Authors: Tonsager Sara C. , Scott Andrew R. , Mader Nicholas S. , Vecchiotti Mark A. , Sidman James D.
Published: February 2015

Objective

To determine which factors in the early neonatal period may predict subsequent need for surgical intervention in infants with micrognathia.

Method

A retrospective case series of 123 infants from 2 tertiary pediatric referral centers over a 10‐year period.

Results

Forty‐eight (39%) of micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of tracheostomy (n = 12), mandibular distraction osteogenesis (MDO) (n = 33), or prolonged intubation prior to withdrawal of care (n = 3). Factors associated with a need for definitive airway intervention included a history of intubation or tracheotomy in the first 24 hours of life (OR: 8.22; CI: 3.14‐21.54), a history of intrauterine growth restriction (OR: 4.1; CI: 1.00‐16.71), neurologic impairment (OR: 3.83; CI: 1.33‐11.06), and prematurity (<37 weeks gestational age) (OR: 2.38; CI: 1.02‐5.56). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR: 0.2; CI: 0.05‐0.71).

Conclusion

While it is understood that the need for MDO or tracheostomy should be determined on a case‐by‐case basis, this study identifies a number of factors, which may predict which neonates with micrognathia are at increased risk for requiring early surgical intervention for respiratory and feeding problems.
Fifteen‐Degree Reverse Trendelenburg Position for FESS
Authors: Hathorn Iain F. , Habib Al‐Rahim , Manji Jamil , Javer Amin R.
Published: February 2015

Objective

1) To determine whether the 15‐degree reverse Trendelenburg position (RTP) during FESS improves endoscopic field of view compared to the horizontal position (HP). 2) To determine whether the 15‐degree RTP during FESS reduces intraoperative blood loss compared to the HP.

Method

Fifty CRS patients undergoing FESS were randomized to either 15‐degree RTP (experimental arm) or HP (control arm) from October 2011 to February 2012. Boezaart endoscopic field of view grading system was the primary outcome measure. Total blood loss, blood loss/minute, MAP, heart rate, anesthetic technique, and surgery time were recorded.

Results

The 43 patients currently studied show a significant difference in mean Boezaart scoring between RTP and HP: 1.698 vs 2.124 (P =. 009), with RTP producing a better endoscopic field of view. There was also less blood loss per minute with RTP (P =. 05). No significant difference was found in total blood loss (P =. 236), time of surgery (P =. 458), or mean arterial pressure (P =. 825) between the 2 surgical positions.

Conclusion

The 15‐degree RTP improves the endoscopic field of view during FESS and also reduces blood loss per minute during surgery. We would therefore recommend its use.
Balloon Dilatation for the Frontal Sinus
Authors: Pace‐Asciak Pia , Hathorn Iain F. , Sunkaraneni Vishnu , Chen Rui , Habib Al , Javer Amin R.
Published: February 2015

Objective

1) To evaluate frontal sinus ostia patency after balloon dilation with the Ventera Sinus Diltation System (which has not been tested before) compared with traditional frontal sinusotomy. 2) To compare the mean blood loss and the mean surgical time for frontal sinusotomy during balloon dilatation compared with traditional methods.

Method

A single‐blinded, randomized, controlled, prospective study of 30 patients will be conducted. Patients undergoing FESS for chronic rhinosinusitis are randomized to balloon dilation of 1 frontal sinus and traditional frontal sinusotomy on the opposite sinus. Patients act as their own controls. Ostial patency and size will be assessed 5 weeks, 3 months, and 6 months postoperatively using endoscopy and curved suctions.

Results

Our initial results in 19 patients are promising. All frontal sinus ostia in both groups were successfully opened and 100% were patent with both techniques at 5 weeks and 3 months postoperatively. Balloon dilatation shows a mean surgical time of 10 minutes compared with 18 minutes in traditional FESS. Mean blood loss is less with balloon dilatation (54 mL vs 86 mL).

Conclusion

The initial findings suggest the Ventera Sinus Dilation System is easy to use and successfully dilates the frontal sinus ostia quicker and with less blood loss. Also, short‐term patency appears to be comparable to traditional frontal sinusotomy.
Chordomas and Chondrosarcomas of the Clivus
Authors: Hermann Diego R. , Balsalobre Leonardo , Balieiro Fernando O. , Weber Raimar , Stamm Aldo E. C.
Published: February 2015

Objective

To report chordomas and chondrosarcoma cases treated with endoscopic assisted transnasal transclival approach.

Method

Retrospective case series of 26 patients with clivus chordomas and 2 patient with chondrosarcoma, treated between 1996 and 2011 at a tertiary referral center using the endoscopic assisted transnasal‐transclival approach. The extension of the surgical procedure was classified in gross‐total, subtotal and partial resection. Eighteen were primary cases and 10 had previous operation. The most common symptoms was diplopia (VI nerve palsy: 61%), all regions involved by the tumor were reported. Patients were submitted to endoscopic assisted transnasal‐transclival (TN‐TC) approach with or without transpterygoidal (TP) approach. Four patients were also submitted to petrous approach.

Results

In patients who presented chordomas/chondrosarcomas (28 cases), range of surgical resection was: in 14 patients (50%) gross total resection, in 7 (25%) subtotal removal, and in 7 (25%) partial removal. In 10 cases there was tumor extension to posterior fossa, and 6 cases achieved gross total resection. Postoperative complications were: CSF leak (6 cases), 5 of them before using the nasal septal flap. Meningitis (3 cases). Pneumoencephalus (2) and 3 deaths.

Conclusion

Endoscopic assisted transnasal surgery is an alternative way to treat these cases and in expert hands this technique can obtain good results. The extent of resection was better in cases without previous surgery than in reoperation cases. Posterior fossa invasion was not a restriction factor to gain a gross total resection, using this technique. Complication as CSF leak dropped dramatically after skull base reconstruction using the triple “F”(fat, fascia and nasal septal flap).
Modified Endoscopic Frontal Sinus Surgery
Authors: Ma Yanhong , Tan Guolin
Published: February 2015

Objective

To modify the endoscopic frontal sinus surgery and improve the therapeutic effect of recurrent chronic frontal sinusitis.

Method

Endoscopic frontal sinus surgery through an approach of frontomaxillary process‐agger nasi (FPA) was carried out in 51 patients with recurrent frontal sinusitis.The therapeutic effect was prospectively evaluated with statistically validated measures of sinusitis‐specific quality of life (SNOT20).

Results

Both 6 and 12 months after surgery significant improvements were found in sinus specific health status, including a reduction of total score of SNOT20 and mean score of identified 5 important symptoms (P <. 05). The globe evaluation showed “Much improved” in 35 patients (68.6%), “Improved” in 9 patients (17.6%), and “Not improved” in 7 patients (13.7%). An overall frontal sinus patency rate was achieved in 85% patients.

Conclusion

Endoscopic frontal sinus surgery through an approach of FPA is a brief, less invasive endoscopic procedure to treat the recurrent chronic frontal sinusitis.
Vertical Dome Division: A Quality‐of‐Life Outcome Study
Authors: Lavinsky‐Wolff Michelle , Camargo Humberto L. , Manzini Michelle , Romanczuk Sabrina , Pizzoni Rodrigo , Dolci Jose E.L. , Polanczyk Carisi A.
Published: February 2015

Objective

To assess quality‐of‐life outcomes in patients undergoing vertical dome division technique using a validated instrument, the Rhinoplasty Outcome Evaluation (ROE).

Method

Patients undergoing primary cosmetic and functional rhinoseptoplasty using vertical dome division were consecutively evaluated from December 2010 through October 2011 at a facial plastic clinic of a tertiary center in Brazil. During surgery patients were classified as normal‐, thin‐, or thick‐skinned. ROE and 100‐mm visual analogue scales (VAS) were administered pre‐ and postoperatively.

Results

Thirty‐one patients were included, and all answered pre‐ and postoperative questionnaires. Mean age was 31 ± 13 years, 18 (58%) were female, and mean follow‐up was 92 days (range 30‐191). ROE scores was higher postoperatively (75 [±16] vs 32 [±18]; P <. 001). Post‐ and preoperative ROE and VAS variation were 42 (±17) and 68 (40‐81), P <. 001. Postoperative ROE scores were similar among normal or thin‐skinned and thick‐skinned patients (78 [±13] vs 69 [±19]; P =. 123). VAS postoperative scores were higher among normal or thin skinned (90 mm [77‐100]) than among thick‐skinned patients (69 mm [51‐93]; P =. 008). Follow‐up is ongoing.

Conclusion

Our preliminary results demonstrated that vertical dome division is a versatile technique to nasal tip refinement that resulted in improvement of rhinoplasty‐related short‐term quality‐of‐life outcomes. Skin thickness does not seem to be a condition for using vertical dome division technique. Follow‐up is still ongoing.
Systematic Review: The Rhinological Manifestations in Women
Authors: Pace‐Asciak Pia , Kozak Frederick K. , Chadha Neil K.
Published: February 2015

Objective

1) To understand the current evidence between the effects of pregnancy, postpartum, menopause, contraception, and hormone replacement therapy (HRT) on diseases of the nose. 2) To appraise the level of evidence in the current literature.

Method

Systematic search strategy using PubMed (1966‐2011) and EMBASE (1980‐2011) was done to study diseases of the nose in women during different stages of life. Study appraisal and data extraction were performed independently by 2 authors. The level of evidence was categorized according to the Oxford Center of Evidence‐Based Medicine.

Results

Titles and abstracts of 1005 studies from PubMed and 1756 studies from EMBASE were reviewed, resulting in 429 being retrieved. Included articles were categorized as related to pregnancy, postpartum, menopause, contraception, or hormone replacement therapy with the following findings: Pregnancy: changes reported in olfaction (12 studies), allergy (30 studies), rhinitis (25 studies), epistaxis (8 studies), tumor growth (31 studies), Wegener’s (23 studies), and Churg‐Strauss disease (8 studies); Postpartum: effects included allergic rhinitis (20 studies), altered olfaction (7 studies), choanal atresia with drug ingestion (5 studies), and nasal tumors (8 studies); Menstruation: alteration in olfaction (17 studies), rhinitis (7 studies), and allergy (3 studies); Menopause: rhinitis (5 studies); HRT: alteration in olfaction (3 studies), and rhinitis (11 studies); and Estrogen therapy: considered for recurrent epistaxis (15 studies).

Conclusion

The various stages of life in women have been shown to have impact on nasal pathophysiology, altering olfaction and increasing epistaxis, allergic symptoms, tumor growth, and auto‐immune disease.
Temporary Sphenopalatine Artery Occlusion: A Cadaver Study
Authors: Fitzgerald Patrick J.
Published: February 2015

Objective

To assess the ability of a surgical device (SinuStat, Sinocclusive LLC) to temporarily occlude flow in the sphenopalatine artery in the human cadaver model.

Method

The experiment was performed on January 28, 2012, in the setting of a fully accredited ambulatory surgical suite. A human cadaver model simulating hydraulic pressure of 100 mm Hg in the maxillary artery was obtained by cannulating this artery via external dissection to the infratemporal fossa. The sphenopalatine artery and its immediate branches were identified endoscopically and perforated distal to the foramen with a 21G spinal needle. Control (without device in place) and study (with device in place) flow were evaluated endoscopically for the amount of penetration to the nasal cavity of dye‐enhanced normal saline. Four sequential insertions and removals of the device were tested.

Results

The placement of the SinuStat device into the sphenopalatine foramen, compared to control flow, resulted in complete or near complete cessation of flow in 4 of 4 insertions.

Conclusion

In the model studied, the SinuStat temporary sphenopalatine artery occlusion device completely or near‐completely occludes flow from the sphenopalatine artery when subjected to a static hydraulic pressure of 100 mm Hg. Use of the SinuStat device in endonasal procedures is thus anticipated to completely or near‐completely occlude blood flow through the sphenopalatine artery at mean arterial pressures around 100 mm Hg. More studies will be required to determine the impact this will have on the quality of the surgical field during endonasal surgery.
Safety of Outpatient Surgery for Obstructive Sleep Apnea
Authors: Baugh Reginald F. , Burke Bonnie , Fink Brian , Garcia Richard , Kominsky Alan , Yaremchuk Kathleen L.
Published: February 2015

Objective

This retrospective cohort study of adult Medicaid obstructive sleep apnea (OSA) patients undergoing head and neck airway surgery sought to determine their safety experience. Physicians will: 1) Gain insight into inpatient and ambulatory management considerations for OSA. 2) Understand how administrative data sets can be used to answer quality questions.

Method

Four hundred fifty‐two patients (404 ambulatory, 48 inpatient) receiving head and neck airway surgery from 01/01/2009 to 06/30/2011. Four safety indicators were reported from administrative data for 30 days: ER visit, inpatient admission, observation day, and 3 or more PCP visits. MI, DVT, stroke, PE, tracheostomy, or transfusions were noted.

Results

OSA subjects (3.29 ambulatory, 3.78 inpatient) had greater risk scores (sicker) than plan members (P <. 05). The majority (89%) of the surgeries were ambulatory. No difference in safety indicator rates was identified between ambulatory and inpatient groups (P >. 61). ER visit was the most common adverse outcome (19% overall). Median time to first ER visit was significantly longer among ambulatory patients (7 days) than inpatients (3 days) (P =. 03). The observed catastrophic complication rate among ambulatory patients was zero (95% CI: 0.0%‐1.1%). Administrative data sets can be used to provide insight into practice safety questions.

Conclusion

Contrary to guidelines, OSA patients are undergoing ambulatory head and neck airway surgery. Administrative data sets can be used to provide insight into practice safety questions. Further study is warranted of ambulatory surgery management of adult sleep apnea patients.
Sleep Architecture Patterns in Enuretic Children with OSA
Authors: Thottam Prasad J. , Kovacevic Larisa , Madgy David , Abdulhamid Ibrahim
Published: February 2015

Objective

Nocturnal enuresis (NE) has been described in children with obstructive sleep apnea (OSA) related to adeno‐tonsillar hypertrophy. For those affected adeno‐tonsillectomy has demonstrated to improve both NE and OSA in many patients. Our objective is to determine if preoperative sleep architecture is associated with complete resolution of NE after adeno‐tonsillectomy.

Method

A prospective study of 18 pediatric patients (1/2011‐2/2012) with primary NE who underwent adeno‐tonsillectomy for OSA was conducted. Both preoperative polysomnograms (PSG) and pre‐ and postoperative reports of NE were recorded. Resolved vs unresolved postoperative nocturnal enuresis (RNE vs UNE) was the outcome evaluated. Data was assessed via chi‐square/t test analyses.

Results

Mean child age was 8.28 (SD = 2.3 years). All children reported presurgical primary NE. No RNE vs UNE age/gender differences were identified. Postsurgery, over half of participants reported NE resolution. Significant improvement of NE was identified in children with higher preoperative AHIs (RNE mean = 21.4; UNE mean = 3.6; t = 2.33, P =. 03) and lower preoperative oxygen saturations (RNE lowest % = 78.1; UNE lowest % = 89.6; t = 2.72, P =. 03). All children with prolonged stage 2 sleep reported postsurgical NE resolution, whereas two‐thirds of the children with prolonged delta sleep and all with above normal REM reported persistent postsurgical NE.

Conclusion

Adeno‐tonsillectomy is a treatment option for OSA with NE. Preliminary data demonstrates that children with high AHIs, significant oxygen desaturations, and abnormally prolonged stage 2 sleep have a high resolution rate of NE postoperatively. There are significant differences in preoperative sleep architecture between UNE and RNE patients with OSA.
Section for Residents and Fellows‐in‐Training Survey Results
Authors: Kelley Kanwar , Rosenberg Tara L. , Dowdall Jayme R. , Liu Jeffrey C. , Raol Nikhila P. , Zafereo Mark E.
Published: February 2015

Objective

1) To present data from the Section for Residents and Fellows‐in‐Training (SRF) annual survey from 2002‐2011. 2) To compare and analyze trends in resident demographics and posttraining career choices.

Method

We conducted a retrospective review of data from surveys distributed between 2002 and 2011. Respondent demographic data including age, postgraduate year, gender, and geographic distribution were analyzed. Responses about training experiences, fellowship selection, debt burden, and posttraining practice choice were studied in order to elicit trends.

Results

Respondents have consistently rated otolaryngology, anesthesia, and trauma/critical care as the most important intern rotations for otolaryngology residents. Each year, approximately 70% of respondents have reported interest in pursuing a fellowship. Pediatric otolaryngology fellowship is now the most popular fellowship among respondents. There has been a recent increase in the percentage of respondents who are interested in pursuing a career in academics. Location, family, and lifestyle have consistently been the most important factors in determining choice of practice. Respondents have reported increasing levels of educational debt over the 10 years of the survey.

Conclusion

The AAO‐HNS SRF survey is an opportunity to collect important data regarding resident/fellow training. Several factors limit the generalizability of these results. Despite its limitations, these unique data provide valuable information for continual evaluation and improvement of physician training in the specialty.
Self Ear Cleaning among Educated Young Adults in Nigeria
Authors: Olaosun Adedayo O. , Ayeni Olusola , Fawole O. I. , Olaosun Oluwafunmilayo A.
Published: February 2015

Objective

The objectives of this study are: 1) Determine prevalence of “self‐ear‐cleaning” and of “ear symptoms” among educated young adults in Nigeria. 2) Identify materials and reasons for self‐ear‐cleaning. 3) Determine association between socio‐demographic characteristics and self‐ear‐cleaning. 4) Determine association between self‐ear‐cleaning and “ear symptoms.”

Method

In a cross‐sectional study in November 2011, semi‐structured questionnaires were administered to subjects recruited by stratified random sampling from a youth camp. Outcome variables were “self‐ear‐cleaning” and “ear symptoms” while independent variables were sociodemographic and “personal history” variables. Statistical analysis employed univariate, bivariate, and multiple regression techniques.

Results

A total of 1012 subjects were studied (M:F = 1.05:1). Prevalence of self‐ear‐cleaning was 93.4%, cotton buds were most commonly used (91.5%), and the most common reasons were health reasons (50.9%). Prevalence of ear symptoms was 34.1%; 79.3% had never visited a doctor for ear complaints. No significant association existed between self‐ear‐cleaning and ear symptoms (χ2– 0.135, P‐.713) or visit to doctor for ear complaints (χ2−0.858, P‐.354). Although significant associations existed between self‐ear‐cleaning and sex, religion, geopolitical zone, parent’s education, and family members’ practice, opinion that the practice is harmful (OR 0.1, P‐.005) and father’s self‐ear‐cleaning (OR‐28.485, P‐.001) were the only significant predictors of self‐ear‐cleaning.

Conclusion

The prevalence of self‐ear‐cleaning in this study and the lack of significant association with the occurrence of ear symptoms challenges traditional thinking. It raises questions about the extent to which self‐ear‐cleaning actually contributes to the development of ear disease. More studies are urgently needed to determine the true relationship.
CCR7 Expression Predicts Cervical Metastasis in Oral Squamous Cell Carcinoma
Authors: Ledgerwood Levi G. , Tinling Steven , Gandour‐Edwards Regina , Farwell D. Gregory
Published: February 2015

Objective

1) Determine whether expression of the chemokine receptor CCR7 is associated with an increased likelihood of cervical lymph node metastasis in oral squamous cell carcinoma. 2) Explore the significance of CCR7 expression in the localization of squamous cell carcinoma cells within the primary tumor and metastatic lymph nodes.

Method

Tissue samples from primary tumors and cervical metastases of patients with oral squamous cell carcinoma were compared for their expression of CCR7 through immunohistochemistry. CCR7 expression was assessed in 30 primary tumor samples from patients without cervical metastases and compared to 30 samples from patients with metastases.

Results

CCR7 expression was found to be significantly higher in squamous cell carcinoma samples from patients with cervical lymph node metastases. Primary tumors of patients with cervical metastases showed significantly higher CCR7 staining, χ2 = 16.936, P <. 001. N0 patients showed small foci of CCR7 positivity while tumors from N+ patients showed large areas of CCR7 positivity.When examining the lymph nodes with metastatic cancer, all patients showed CCR7 expression (30/30 N+ patients). Especially high levels were seen in cells surrounding lymphovascular structures.

Conclusion

CCR7 expression levels are associated with increased likelihood of cervical metastases of squamous cell carcinomas, suggesting a role for this receptor in lymphatic invasion. This finding may provide a novel diagnostic tool to predict the risk of occult lymphatic metastasis in patients with oral squamous cell carcinoma.
Effects of Copper Tripeptide on Healing Irradiated Tissues
Authors: Parker Noah P. , Ardeshirpour Farhad , Schmechel Stephen , Lassig Amy Anne D.
Published: February 2015

Objective

To evaluate clinical and immunohistochemical effects of topical copper tripeptide (GHK‐Cu) on wound healing in an in vivo irradiated rat model.

Method

After dorsal radiation to a human‐equivalent‐dose of 66.67 gray and a recovery period, 2x8‐cm cranially based dorsal flaps were created. Twice daily GHK‐Cu (test) or Eucerin (control) was applied for 10 days. Animals were euthanized, digital images of flaps were taken, and harvested tissues were stained for vascular endothelial growth factor (VEGF).

Results

Thirteen test and 10 control animals were included. Photographs were converted to binary to calculate total pixels within the necrotic region and area of ischemia. The mean ischemic areas were 5.0 cm2 (standard deviation 0.9) for tests and 3.8 cm2 (1.1) for controls, which were significantly different (P =. 01). Digitized slides allowed for calculation of the percent of pixels reaching specific brown calorimetric thresholds and for an intensity staining score with higher scores indicating more intense staining. The VEGF mean intensity scores were 0.34 (0.19) for tests and 0.54 (0.41) for controls, which were not significantly different. Unpaired t tests were utilized for statistical analyses.

Conclusion

In this study, irradiated soft tissue flaps treated with topical GHK‐Cu demonstrated a greater amount of flap ischemia and no difference in VEGF production compared to controls. These findings contrast prior studies suggesting a favorable growth factor environment and an improvement in wound healing with GHK‐Cu treatment.