bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Two-Dimensional Displays as an Alternative to Three-Dimensional Displays in Telerobotic Tasks
Authors: Park Sung Ha , Woldstad Jeffrey C.
Published: January 2007

In this study a multiple-view two-dimensional (2D) display was compared with a three-dimensional (3D) monocular display and a 3D stereoscopic display using a simulated telerobotic task. As visual aids, three new types of visual enhancement cues were provided and evaluated for each display type. The results showed that the multiple-view 2D display was superior to the 3D monocular and the 3D stereoscopic display in the absence of the visual enhancement depth cues. When participants were provided with the proposed visual enhancement cues, the stereoscopic and monocular displays became equivalent to the multiple-view 2D display. Actual or potential applications of this study include the design of visual displays for teleoperation systems.
The Effect of Handle Angle on MAWL, Wrist Posture, RPE, and Heart Rate
Authors: Wang Mao-Jiun J. , Chung Hsiu-Chen , Chen Hsin-Chung
Published: January 2007

In manual material handling tasks, the handle serves as the interface between the human operator and the box (the materials). Handle angle design can affect both wrist posture and lifting ability. This study was designed to evaluate the effect of handle angle on maximal acceptable weight of lifting (MAWL), perceived whole-body exertion, whole-body workload, wrist posture, and perceived wrist exertion. The results indicate that handle angle had a significant effect on wrist posture and wrist rating of perceived exertion (RPE). A box with a 0° handle angle induced the greatest ulnar deviation and the highest wrist RPE. A 75° handle angle induced the greatest radial deviation and a relatively high wrist RPE. A 30° handle angle resulted in the greatest MAWL and the lowest level of wrist RPE. Overall, these findings suggest that 30° and 45° handle angles can provide favorable coupling conditions for the cutout-type handhold container handle. Actual or practical applications include the ergonomic design of container handles for manual material handling tasks industry.
The Framing of Drivers' Route Choices when Travel Time Information Is Provided under Varying Degrees of Cognitive Load
Authors: Katsikopoulos Konstantinos V. , Duse-Anthony Yawa , Fisher Donald L. , Duffy Susan A.
Published: January 2007

In two experiments, participants chose between staying on a main route with a certain travel time and diverting to an alternative route that could take a range of travel times. In the first experiment, travel time information was displayed on a sheet of paper to participants seated at a desk. In the second experiment, the same information was displayed in a virtual environment through which participants drove. Overall, participants were risk-averse when the average travel time along the alternative route was shorter than the certain travel time of the main route but risk-seeking when the average travel time of the alternative route was longer than the certain travel time along the main route. In the second experiment, in which cognitive load was higher, participants simplified their decision-making strategies. A simple probabilistic model describes the risk-taking behavior and the load effects. Actual or potential applications of this research include the development of efficient travel time information systems for drivers.
Postural Instability and Motion Sickness in a Fixed-Base Flight Simulator
Authors: Stoffregen Thomas A. , Hettinger Lawrence J. , Haas Michael W. , Roe Merry M. , Smart L. James
Published: January 2007

We evaluated the prediction that postural instability would precede the subjective symptoms of motion sickness in a fixed-base flight simulator. Participants sat in a cockpit in a video projection dome and were exposed to optical flow that oscillated in the roll axis with exposure durations typical of flight simulation. The frequencies of oscillation were those that characterize spontaneous postural sway during stance. Head motion was measured prior to and during exposure to imposed optical flow. Of 14 participants, 6 were classified as motion sick, either during or after exposure to the optical oscillation. Prior to the onset of subjective symptoms, head motion among participants who later became sick was significantly greater than among participants who did not become motion sick. We argue that the results support the postural instability theory of motion sickness. Actual or potential applications include the prevention or mitigation of motion sickness in virtual environments.
Visual Search in Complex Displays: Factors Affecting Conflict Detection by Air Traffic Controllers
Authors: Remington Roger W. , Johnston James C. , Ruthruff Eric , Gold Miri , Romera Maria
Published: January 2007

Recent free flight proposals to relax airspace constraints and give greater autonomy to aircraft have raised concerns about their impact on controller performance. Relaxing route and altitude restrictions would reduce the regularity of traffic through individual sectors, possibly impairing controller situation awareness. We examined the impact of this reduced regularity in four visual search experiments that tested controllers' detection of traffic conflicts in the four conditions created by factorial manipulation of fixed routes (present vs. absent) and altitude restrictions (present vs. absent). These four conditions were tested under varying levels of traffic load and conflict geometry (conflict time and conflict angle). Traffic load and conflict geometry showed strong and consistent effects in all experiments. Color coding altitude also substantially improved detection times. In contrast, removing altitude restrictions had only a small negative impact, and removing route restrictions had virtually no negative impact. In some cases conflict detection was actually better without fixed routes. The implications and limitations of these results for the feasibility of free flight are discussed. Actual or potential applications include providing guidance in the selection of free flight operational concepts.
Evaluation of Alternative Waveforms for Animated Mimic Displays
Authors: Bennett Kevin B. , Malek David A.
Published: January 2007

Animated mimic displays can be used to present system information regarding physical form, function, and causality. However, a potential limitation in current designs has been identified: the presence of ambiguous apparent motion. Two theoretical explanations of ambiguous apparent motion are discussed (Fourier and correspondence hypotheses). Two alternative designs (stair-step and approximate sinusoid luminance waveforms) were evaluated. The velocity matches obtained in Experiment 1 indicate that the sinusoidal waveform produced significantly better performance for both accuracy and latency than the stair-step waveform. The velocity estimates obtained in Experiment 2 indicate that ambiguous apparent motion was not visible with the sinusoidal waveform, but was with the stair-step waveform. One of the two hypotheses (correspondence) provides a reasonable fit with the obtained velocity estimates. A fundamental goal in the design of animated mimic displays is to provide unambiguous mappings between perceived velocity and actual flow rates. Critical factors in design (e.g., waveform, chromatic/luminance contrast, spatial/temporal frequency) are discussed. Actual or potential applications of this research include the design of more effective animated mimic displays.
Human Versus Automation in Responding to Failures: An Expected-Value Analysis
Authors: Sheridan Thomas B. , Parasuraman Raja
Published: January 2007

A simple analytical criterion is provided for deciding whether a human or automation is best for a failure detection task. The method is based on expected-value decision theory in much the same way as is signal detection. It requires specification of the probabilities of misses (false negatives) and false alarms (false positives) for both human and automation being considered, as well as factors independent of the choice - namely, costs and benefits of incorrect and correct decisions as well as the prior probability of failure. The method can also serve as a basis for comparing different modes of automation. Some limiting cases of application are discussed, as are some decision criteria other than expected value. Actual or potential applications include the design and evaluation of any system in which either humans or automation are being considered.
Linguistic Cues and Memory for Synthetic and Natural Speech
Authors: Paris Carol R. , Thomas Margaret H. , Gilson Richard D. , Kincaid J. Peter
Published: January 2007

Past research has demonstrated that there are cognitive processing costs associated with comprehension of speech generated by text-to-speech synthesizers, relative to comprehension of natural speech. This finding has important performance implications for the many applications that use such systems. The purpose of this study was to ascertain whether certain characteristics of synthetic speech slow on-line, real-time cognitive processing. Whereas past research has focused on the phonemic acoustic structure of synthetic speech, we manipulated prosodic, syntactic, and semantic cues in a task requiring participants to recall sentences spoken either by a human or by one of two speech synthesizers. The findings were interpreted to suggest that inappropriate prosodic modeling in synthetic speech was the major source of a performance differential between natural and synthetic speech. Prosodic cues, along with others, guide the parsing of speech and provide redundancy. When these cues are absent or inaccurate, the additional burden placed on working memory may exceed its capacity, particularly in time-limited, demanding tasks. Actual or potential applications of this research include improvement of text-to-speech output systems in warning systems, feedback devices in aerospace vehicles, educational and training modules, aids for the handicapped, consumer products, and technologies designed to increase the functional independence of older adults.
Fleet Study Evaluation of an Advance Brake Warning System
Authors: Shinar David
Published: January 2007

The advance brake warning system (ABWS) is a mechanism that activates the brake lights in response to a rapid disengagement of the gas pedal, before the driver's foot reaches the brake pedal. Two previous studies showed that (a) such rapid releases of the gas pedal are typically followed by brake activation, and (b) the ABWS can prevent a high percentage of rear-end collisions in which an attentive following driver maintains a headway of 1.0 s or less from the vehicle ahead. In the present study the crash involvement of 764 government cars and light trucks was tracked over an average period of 35 months. The vehicles were matched in pairs - one of each pair with the ABWS and one without it. Data analyses focused on collisions in which the government vehicles were rear-ended. Overall, ABWS-equipped vehicles were not significantly less involved in rear-end collisions. However, an examination of the struck vehicles only showed that the ABWS-equipped vehicles were involved in fewer rear-end collisions per kilometer driven than were the vehicles without the ABWS. In conclusion, despite the theoretical appeal and the results of earlier studies, the fleet study failed to demonstrate that such a system is a cost-effective safety device for the prevention of rear-end crashes. Actual or potential applications include the evaluation of new in-vehicle technologies by a hierarchy of multiple validation studies prior to consideration.
Training Concurrent Multistep Procedural Tasks
Authors: Peck Andrew C. , Detweiler Mark C.
Published: January 2007

This study assessed the effectiveness of traditional whole-task, pure part-task, and two forward-chaining part-task techniques to train rapidly presented concurrent multistep tasks. When training was equated for the total number of training trials, the forward-chaining technique that included practice with concurrent responses promoted as much transfer to whole-task conditions as whole-task training and more than traditional pure part-task training. When training was equated for the total number of response opportunities, the same concurrent forward-chaining technique also promoted superior whole-task transfer. Actual or potential applications of this research include suggestions that trainers should (a) structure concurrent-task training around critical intratask invariants to promote whole-task transfer, (b) realize that the concurrent-task training techniques that promote the best training performance may not promote the best transfer to whole-task situations, and (c) consider using forward-chaining techniques that provide practice with concurrent responses when training concurrent multistep tasks.
A Dyadic Protocol for Training Complex Skills: A Replication Using Female Participants
Authors: Sanchez-Ku Maria L. , Arthur Winfred
Published: January 2007

The effectiveness and efficiency of the active interlocked modeling (AIM) dyadic protocol in training complex skills has been extensively demonstrated. However, past evaluation studies have all used male participants exclusively. Consequently, the present study investigated the generalizability of the effectiveness and efficiency gains to women. We randomly assigned 108 female participants to either the AlM-dyad condition or a standard individual control training condition. The results supported the robustness and viability of the AIM protocol. Although their overall performance was lower than that obtained for men in previous studies, women trained in the AIM-dyad condition performed as well as those trained in the individual condition. Thus, the efficiency gains associated with the AIMdyad protocol, which result from the ability to train two people simultaneously to reach the same performance level as a single person with no increase in training time or machine cost, are generalizable to female participants. The applied and basic research implications of the present study are discussed within the context of well-documented male/female differences in the performance of complex psychomotor tasks. For instance, given the number of women entering the workforce and the significant proportion of women in professions previously deemed to be male-dominated (e.g., air navigation), it is reassuring to know that sex differences in task performance do not necessarily imply sex differences in the effectiveness of training protocols.
Team Play with a Powerful and Independent Agent: A Full-Mission Simulation Study
Authors: Sarter Nadine B. , Woods David D.
Published: January 2007

One major problem with pilot-automation interaction on modern flight decks is a lack of mode awareness; that is, a lack of knowledge and understanding of the current and future status and behavior of the automation. A lack of mode awareness is not simply a pilot problem; rather, it is a symptom of a coordination breakdown between humans and machines. Recent changes in automation design can therefore be expected to have an impact on the nature of problems related to mode awareness. To examine how new automation properties might affect pilot-automation coordination, we performed a full-mission simulation study on one of the most advanced automated aircraft, the Airbus A-320. The results of this work indicate that mode errors and "automation surprises" still occur on these advanced aircraft. However, there appear to be more opportunities for delayed or missing interventions with undesirable system activities, possibly because of higher system autonomy and coupling.
Overcoming Representational Errors in Complex Environments
Authors: Jones Debra G. , Endsley Mica R.
Published: January 2007

Errors in situation awareness (SA) can degrade the decision process. One particularly troublesome SA error is the representational error, which reflects problems with the misinterpretation of information based on a person's current mental model of a situation. This study investigates whether the schema-relatedness of information affects the likelihood that a person will fall prey to a representational error. Using a high-fidelity simulation of an air traffic control task, two hypotheses were examined: (a) Schema-bizarre information will affect SA more than schema-irrelevant information, and (b) schema-unexpected information will impact SA more than the absence of schema-expected information. The results supported the first hypothesis but not the second. These results provide an indication of the types of information that affect SA. Enhancing SA by emphasizing the type of information to which an operator is naturally less inclined to respond is one approach to improving system design and thereby performance.
The Design and Delivery of Crew Resource Management Training: Exploiting Available Resources
Authors: Salas Eduardo , Rhodenizer Lori , Bowers Clint A.
Published: January 2007

Despite widespread acceptance throughout commercial and military settings, crew resource management (CRM) training programs have not escaped doubts about their effectiveness. The current state of CRM training is an example of how an entire body of pertinent research and development has not had the impact on practice that it could. In this paper we outline additional resources (i.e., principles, information, findings, and guidelines) from the team training and training effectiveness research literatures that can be used to improve the design and delivery of CRM training. Some of the resources discussed include knowledge about training effectiveness, training teamwork-related skills, scenario design, and performance measurement. We conclude with a discussion of emerging resources as well as those that need to be developed. The purpose of this paper is to provide the CRM training developer with better access to resources that can be applied to the design and delivery of CRM training programs.
The Potential for Misinterpretation Considered More Globally: A Response to Vicente and Ethier
Authors: Bennett Kevin B. , Malek David A. , Woods David D.
Published: January 2007

The notion that one can capture some aspect of reality by making a description of it using a symbol ... seems to me a fascinating and powerful idea. But . . . there is a trade-off; any particular representation makes certain information explicit at the expense of information that is pushed into the background and may be quite hard to recover.
Stature, Age, and Gender Effects on Reach Motion Postures
Authors: Chaffin Don B. , Faraway Julian J. , Zhang Xudong , Woolley Charles
Published: January 2007

The rapid adoption of software to simulate human reach motions in the design of vehicle interiors and manufacturing and office workstations has required a sophisticated understanding of human motions. This paper describes how more than 3000 right-arm reaching motions of a diverse group of participants were captured and statistically modeled. The results demonstrate that stature and age have a larger effect than does gender on reach motion postures for motions chosen by the participants while reaching to targets placed throughout a typical automobile interior. We propose that these methods, models, and results can assist the further development of human motion simulation software for ergonomic purposes, such as for the design or evaluation of vehicle interiors or industrial workplaces, to ensure that various population groups are physically accommodated.
Once-Daily Administration of Intranasal Corticosteroids for Allergic Rhinitis: A Comparative Review of Efficacy, Safety, Patient Preference, and Cost
Authors: Herman Howard
Published: January 2007

Background

The aim of this review was to compare the efficacy, safety, patient preference, and cost-effectiveness of once-daily budesonide aqueous nasal spray (BANS), fluticasone propionate nasal spray (FPNS), mometasone furoate nasal spray (MFNS), and triamcinolone aqueous nasal spray (TANS) for treatment of allergic rhinitis (AR) in adult patients.

Methods

A MEDLINE search (1966 to January 2004) was conducted to identify potentially relevant English language articles. Pertinent abstracts from recent allergy society meetings were identified also. The medical subject heading search terms included were intranasal corticosteroid (INS), nasal steroid, BANS, MFNS, FPNS, or TANS and AR. Selected studies were randomized, controlled, comparison trials of patients with AR treated with once-daily BANS, MFNS, FPNS, or TANS.

Results

All four INSs administered once daily were effective and well tolerated in the treatment of AR in adult patients, with similar efficacy and adverse event profiles. No differences were seen between INSs in systemic effects, except for significantly lower overnight urinary cortisol levels in healthy volunteers treated with FPNS compared with placebo. Based on sensory attributes, patients preferred BANS and TANS versus MFNS and FPNS. BANS was associated with more days of treatment per prescription at a lower cost per day for adults compared with the other INSs and is the only INS with a pregnancy category B rating.

Conclusion

BANS, FPNS, MFNS, and TANS have similar efficacy and safety profiles. Differences in sensory attributes, documented safety during pregnancy, and cost may contribute to better patient acceptance of one INS versus another and promote better adherence to therapy.
Cavernous Carotid Injury during Functional Endoscopic Sinus Surgery: Case Presentations and Guidelines for Optimal Management
Authors: Pepper Jon-Paul , Wadhwa Ashish K. , Tsai Fong , Shibuya Terry , Wong Brian J.F.
Published: January 2007

Background

Surgery in the parasellar and paranasal regions is technically challenging because of the complex anatomic relationships between the sphenoid sinus, cavernous sinus, optic nerve, and internal carotid artery. Normal anatomic variations and pathological changes can lead to disastrous outcomes including carotid artery injury.

Methods

We present two cases of carotid injury managed at our institution. The first case involves an elective endoscopic biopsy of a clival tumor encasing a friable carotid artery. The second case features a patient transferred emergently to our medical center when brisk bleeding was encountered during functional endoscopic sinus surgery (FESS). Both carotid injuries were managed via balloon embolization with close interaction between otolaryngology and interventional radiology. We review pertinent anatomic and surgical considerations as a backdrop to a treatment algorithm for cavernous carotid hemorrhage secondary to FESS complication.

Results

The treatment algorithm prevented mortality and minimized morbidity in the two cases considered.

Conclusion

Through rare, injury to the cavernous carotid during FESS can be managed successfully given efficient hemostasis and seamless cooperation among emergency room physicians, otolaryngologists, and interventional radiologists.
Efficacy and Safety of Topical Combinations of Ipratropium and Xylometazoline for the Treatment of Symptoms of Runny Nose and Nasal Congestion associated with Acute Upper Respiratory Tract Infection
Authors: Eccles Ronald , Pedersen Anette , Regberg Dan , Tulento Heikki , Borum Peter , Stjärne Pär
Published: January 2007

Background

Rhinorrhea and nasal congestion are simultaneous symptoms associated with the common cold. This study investigated the efficacy and safety of a combination nasal spray of ipratropium and xylometazoline for simultaneous treatment of these symptoms.

Methods

The trial was a multicenter double-blind, parallel-group, randomized design on patients with common cold symptoms. Patients scored symptoms of runny nose and nasal congestion and recorded adverse events in a diary for up to 7 days. Patients also recorded tissue use. The five test treatments consisted of ipratropium, 0.6 mg/mL, and xylometazoline, 1.0 mg/mL; ipratropium, 0.6 mg/mL, and xylometazoline, 0.5 mg/mL; ipratropium, 0.6 mg/mL; xylometazoline, 1.0 mg/mL; and placebo solution.

Results

Eight hundred sixty-four patients were screened and 786 patients received treatment. One day after treatment there was a clear separation between the scores for the placebo and ipratropium treatment groups for rhinorrhea and between the placebo and xylometazoline treatment groups for congestion. Both ipratropium/xylometazoline 1.0 and ipratropium/xylometazoline 0.5 treatments were superior to xylometazoline with respect to rhinorrhea (p < 0.0001) and superior to ipratropium with respect to nasal congestion scores (p < 0.001). Both the ipratropium combination treatments had significantly lower tissue use than the xylometazoline treatment group (p < 0.0001). Adverse events were distributed equally between the treatments, except mucus tinged with blood, epistaxis, nasal passage irritation, and nasal dryness, which had a higher incidence in the three groups that received medicines containing ipratropium.

Conclusion

The results indicate that a combination medicine of ipratropium and xylometazoline is safe and effective for treatment of rhinorrhea and nasal congestion associated with common cold.
An Animal Model for the Study of Topical Medications in Sinusitis
Authors: Chiu Alexander G. , Antunes Marcelo B. , Feldman Michael , Cohen Noam A.
Published: January 2007

Background

Rhinosinusitis after functional endoscopic sinus surgery often is recalcitrant to conventional medical management. Topical therapies have been popularized as a method to deliver powerful medications to diseased mucosa while limiting systemic toxicity. The aim of this study was to develop an animal model that will provide objective data in studying the efficacy of topical medications and establish a platform for translation to human clinical trials.

Methods

The maxillary sinus ostium of white rabbits was obstructed with a pledget through an antrostomy created in the anterior face of the maxilla. The sinus was inoculated with Pseudomonas aeruginosa (PAO1) and 7 days later the antrostomy was reopened, the ostial obstruction was removed, and a single lumen catheter was placed. Normal saline was irrigated through the catheter for 7 days in one group of rabbits while a control group received no irrigation. At the end of 7 days, the rabbits were euthanized, analyzed under light microscopy, and bacterial counts of the nasal lavage were determined.

Results

Sinusitis was confirmed in all rabbits 7 days after inoculation. Purulence, mucosal, and underlying bony inflammation persisted in both the control and the saline irrigation groups at study end. Nasal lavage bacterial counts were persistently elevated throughout the study period, indicative of bacterial viability.

Conclusion

An animal model has been created for the study of topical medications in sinusitis. A novel catheter delivery system within an unoccluded maxillary sinus is described that will aid in efficacy studies of topical medications in the management of recalcitrant rhinosinusitis.
The Delta F508 Mutation in Cystic Fibrosis and Impact on Sinus Development
Authors: Woodworth Bradford A. , Ahn Chadwick , Flume Patrick A. , Schlosser Rodney J.
Published: January 2007

Background

Cystic fibrosis (CF) patients often have widespread inflammatory paranasal sinus disease with an increased incidence of frontal, maxillary, and sphenoid hypoplasia. The most common genetic defect in CF is the delta F508 mutation. The effect of specific CF genotypes on phenotypic sinus development and infections is not well understood. The purpose of this study was to determine whether the homozygous delta F508 mutation is associated with an increased incidence of sinus hypoplasia when compared with other mutations.

Methods

This study is a retrospective review of all adult patients seen at our CF center from 1996 to 2005. Patients ≥18 years old with a CF diagnosis using genetic and sweat chloride testing and sinus CT scans were included. Frontal sinus aplasia/hypoplasia and maxillary and sphenoid sinus hypoplasia were documented using published criteria. Data collected included patient demographics, genetic mutations, and prior sinus surgeries.

Results

Forty-five patients were identified with an average age of 32 years (range, 18–48 years). Thirty-one patients had prior sinus surgeries. Delta F508 homozygotes (n = 25) had a significantly increased frequency of underdeveloped frontal (98%), maxillary (70%), and sphenoid (100%) sinuses (p < 0.001) when compared with other mutations (69, 8, and 50%, respectively).

Conclusion

CF patients homozygous for the delta F508 mutation have a greater incidence of hypoplastic or underdeveloped sinuses. Whether this is secondary to an increased frequency of sinus infections or a phenotypic expression of the genetic mutation itself remains an area for further investigation.
Intracranial Polyps in Patients with Samter's Triad
Authors: Majithia Anooj , Tatla Taran , Sandhu Gurpreet , Saleh Hesham M. , Clarke Peter M.
Published: January 2007

Background

We describe three patients with Samter's triad (nasal polyps, aspirin intolerance, and asthma) with skull base dehiscence in whom the polyps extended into the extradural space and also resulted in hypertelorism and widening of the nasal bridge.

Methods

One patient died in a road traffic accident while awaiting surgery. The other two patients underwent endoscopic resection of the polyps with a combined osteoplastic flap.

Results

Histology confirmed benign eosinophilic polyps with edematous stroma and a markedly thickened basement membrane. There were no complications or revision procedures. Both are symptomatically well with improvement of the hypertelorism.

Conclusion

These cases indicate that polyps in Samter's triad may be extremely aggressive, resulting in intracranial extension. A combined endoscopic and osteoplastic flap approach is a safe and effective surgical option.
Fos Expression in the Brainstem Nuclei Evoked by Nasal Air-Jet Stimulation in Rats
Authors: Kunibe Isamu , Nonaka Satoshi , Katada Akihiro , Adachi Masaaki , Arakawa Takuya , Harabuchi Yasuaki
Published: January 2007

Background

Noxious stimulation of the nasal mucosa may induce protective reflexes in the upper airway in rats. Previously, we have reported that nasal air-jet stimulation increases the activities of the laryngeal muscles in decerebrate cats; however, the neuronal mechanism of this phenomenon still is not clarified.

Methods

After the application of nasal air-jet stimulation for 2 hours, we investigated the distribution of Fos-positive cells (FPCs) throughout the medulla compared with sham-operated rats using Fos immunoreactivity.

Results

FPCs in the spinal trigeminal nucleus, the parvocellular reticular nucleus, and the nucleus of the solitary tract were more frequent than the sham-operated rats.

Conclusion

These results suggest that the afferents induced by air-jet stimulation were conveyed to these FPCs and that some of these cells might participate in the augmentation of laryngeal muscle activities during nasal air-jet stimulation.
Antiadhesive Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose after Endoscopic Sinus Surgery
Authors: Kim Jeong Hong , Lee Joo-Hwan , Yoon Joo-Heon , Chang Jung Hyun , Bae Jung Ho , Kim Kyung-Su
Published: January 2007

Background

We evaluated the clinical efficacy and safety of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HA-CMC) for prevention of adhesion after endoscopic sinus surgery.

Methods

Preoperative computed tomography (CT) scans were graded. At the completion of surgery, HA-CMC was applied to Merocel and repeatedly applied after the removal of Merocel. As a control, normal saline was applied. Endoscopic examination was performed postoperatively and grading was done.

Results

The rate of adhesion was the highest at 2 weeks postoperatively and was significantly lower in the HA-CMC–treated group than the control on all postoperative days. The grouping of cases by CT scores at 2 weeks postoperatively showed lower adhesion formation with the HA-CMC treatment than the control. The safety profile of the patients was normal at 4 weeks postoperatively.

Conclusion

HA-CMC is an efficacious and safe material in decreasing the incidence of adhesion after endoscopic sinus surgery.
Endoscopic Resection of Malignant Tumors of the Nose and Sinuses
Authors: Lund Valerie , Howard David J. , Wei William I.
Published: January 2007

Background

Since the introduction of endoscopic surgery, its role has been gradually extended to encompass a range of pathologies, including sinonasal tumors, facilitated by the ability to repair significant skull-base defects. However, the rarity and long natural history of malignant tumors make it difficult to accrue cohorts comparable with the established gold standard of craniofacial resection.

Methods

In this prospective cohort study, after histological confirmation and a staging imaging protocol, patients deemed suitable were offered the option of an entirely endoscopic resection as an alternative to craniofacial resection. The procedure was performed under frozen section control. The long-term follow-up protocol included both MRI and examination under anesthesia at 3- to 4-month intervals in the first 2 years and 6-month intervals thereafter.

Results

There were 49 patients, 26 men and 23 women, aged 34–88 years (mean, 60 years). Follow-up ranged from 6 to 126 months (mean, 36 months). Thirty-seven cases underwent radiotherapy and 14 cases underwent adjuvant chemotherapy. A wide range of pathologies included 15 cases of adenocarcinoma, 11 malignant melanomas, and 11 olfactory neuroblastomas. Hospital stay was a mean of 5 days, with no significant postoperative complications. Thirty-six patients are alive and well, 7 patients have residual disease, 4 patients are dead of disease, and 2 patients have died of intercurrent disease. Three patients have been subsequently converted to craniofacial resection. Overall survival was 88% at 5 years.

Conclusion

These initial results suggest that endoscopic resection may provide an alternative to craniofacial resection in selected cases of sinonasal malignancy.
Clinical Outcomes of Chronic Rhinosinusitis in Response to Medical Therapy: Results of a Prospective Study
Authors: Hessler Jill L. , Piccirillo Jay F. , Fang David , Vlahiotis Anna , Banerji Aleena , Levitt Robert G. , Kramper Maggie A. , Thawley Stanley E. , Hamilos Daniel L.
Published: January 2007

Background

Little information exists regarding the outcome of medical management of chronic rhinosinusitis (CRS) in adults. The aim of this study was to examine whether baseline patient demographics, symptoms, objective findings, or treatment strategies were associated with improved CRS outcomes over time.

Methods

Eighty-four new patients with CRS were evaluated and medically treated for up to 12 months. Patients completed monthly health status questionnaires. The average change of symptom scores using the Sino-Nasal Outcome Test plus one additional symptom–-sense of smell (SNOT-20+1)–-was the primary outcome measure.

Results

Overall, patients experienced a modest improvement in SNOT-20+1 scores (Δ = -0.61; p< 0.0001), but this did not reach the predetermined level of a clinically meaningful effect (Δ = -0.80). Baseline facial pain or facial pressure was negatively associated with outcome (p = 0.048 and 0.029, respectively) and did not correlate with extent of disease by sinus CT scoring. Other factors, including nasal discharge, hyposmia, cough, nasal polyps, and sinus CT severity, did not predict outcomes. The use of either oral antibiotics or oral steroids was associated with trends toward improved outcomes only when sinus-specific symptoms alone were considered.

Conclusion

The majority of CRS patients receiving medical treatment show modest improvement over time in SNOT-20+1 scores. Facial pain or facial pressure at entry are negatively associated with outcomes and may reflect causes other than CRS. These findings highlight the limitations of current medical treatment for CRS and the need for novel treatment strategies.
Indications for Image-Guided Sinus Surgery: The Current Evidence
Authors: Smith Timothy L. , Stewart Michael G. , Orlandi Richard R. , Setzen Michael , Lanza Donald C.
Published: January 2007

Background

Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence supporting the indications for image guidance in sinus surgery, examining two important questions: (1) Does image-guided sinus surgery (IGSS) reduce complication rates? (2) Does IGSS improve clinical outcomes?

Methods

Primary research articles evaluated for this report were identified using appropriate search terms and a PubMed search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines: level 1 = randomized trials, level 2 = prospective cohort studies with comparison group, level 3 = case-control studies, level 4 = retrospective case series, and level 5 = expert opinion.

Results

We identified 105 articles for full review and highlight 5 articles in our report. Primarily, there is expert opinion (level 5) and case series (level 4) with and without comparison groups supporting the indications for IGSS. In addition, authors point out that sample size and design issues preclude definitive randomized trials using IGSS.

Conclusion

Although randomized trials of IGSS are not practical, ethical, or feasible, clinical experience, expert opinion, and case series support the current indications for IGSS. Studies designed to draw conclusions about the role of IGSS in decreasing major complications of sinus surgery are not possible.
Steroid Injection for Sinonasal Polyps: The University of Virginia Experience
Authors: Becker Samuel S. , Rasamny JK , Han Joseph K. , Patrie James , Gross Charles W.
Published: January 2007

Background

Sinonasal polyps are treated with topical steroids, systemic oral steroids, surgical excision, and intrapolyp steroid injection. Use of steroid injection is not widespread because of reported complications. The objective of this study was to evaluate the complications of intrapolyp steroid injections and compare it to the complications of surgical removal of polyps.

Methods

All patients seen between 1994 and 2003 with a diagnosis of nasal polyps were reviewed retrospectively. Demographics, complications, follow-up, and comorbidities were collected. Frequency of each treatment modality used and complications of each treatment were compared.

Results

Three hundred fifty-eight patients were in the study with a mean follow-up of 30 months. Respiratory comorbidities were asthma alone (35%), aspirin triad (16%), and cystic fibrosis (15%). Other comorbidities were smokers (21%). Treatment modalities were medical treatment alone (14%); medical treatment and steroid injections (19%); medical treatment and surgery (33%); and medical treatment, injections, and surgery (34%). Patients who underwent injection had fewer surgeries (p < 0.001). There was 1 minor complication associated with 1495 injections and 11 major and 16 minor complications associated with the 310 surgeries. The differences in complication rates were statistically significant (p < 0.001). There was no significant difference in demographics, follow-up, or comorbidities between patients who received injections and patients who underwent surgery.

Conclusion

Intrapolyp steroid injection is associated with a significantly lower rate of complication than is surgical excision of sinonasal polyps. Steroid injection also may decrease the need for further surgical intervention of polyps.
Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis associated with Sinonasal Polyposis
Authors: Poetker David M. , Mendolia-Loffredo Sabrina , Smith Timothy L.
Published: January 2007

Background

The aim of this study was is to investigate the outcomes of endoscopic sinus surgery (ESS) when performed for chronic rhinosinusitis associated with sinonasal polyps.

Methods

Forty-three patients with polyps were compared with 76 patients without polyps before and after ESS. Mean follow-up was 1.5 years. Patients were analyzed prospectively based on computed tomography (CT), endoscopy, quality-of-life (QOL) assessment, and visual analog scales (VASs). Univariate analyses were performed to evaluate whether the presence of polyps was predictive of outcome.

Results

Patients with polyps had worse CT and endoscopy scores both pre- and postoperatively when compared with patients without polyps (p < 0.0001 for each). All patients, regardless of polyps, improved on endoscopic exam; however, patients with polyps showed a greater degree of improvement (p = 0.002). Despite this, postoperative endoscopic scores in patients with polyps were worse than those without polyps (p < 0.0001). Patients with polyps had better QOL as measured by the Chronic Sinusitis Survey (CSS) both pre- and postoperatively (p = 0.001 and 0.044, respectively). The preoperative VAS indicated that patients with polyps had increased nasal obstruction compared with patients without polyps (p = 0.002) while having less facial pain and headache (p = 0.002 and 0.005, respectively). Patients with polyps showed a greater postoperative improvement in nasal congestion (p = 0.003) but no difference in level of improvement in postoperative headache or pressure.

Conclusion

Despite significantly worse objective testing scores, patients with polyps report significantly better QOL as measured by the CSS and less facial pain/headache as measured by VAS scores pre- and postoperatively. Polyps were not found to be predictive of QOL or endoscopic outcome.
Chronic Rhinosinusitis Patients with Polyps or Polypoid Mucosa have a Greater Burden of Illness
Authors: Banerji Aleena , Piccirillo Jay F. , Thawley Stanley E. , Levitt Robert G. , Schechtman Kenneth B. , Kramper Maggie A. , Hamilos Daniel L.
Published: January 2007

Background

Recent studies suggest chronic rhinosinusitis without nasal polyposis (CRSsNP) and CRS with nasal polyposis (CRScNP) represent distinct pathological entities. The aim of this study was to determine whether patients with CRSsNP, CRScNP, and polypoid CRS could be distinguished by clinical features, radiologic extent of disease or use of medications.

Methods

New patients with CRS (n = 126) were enrolled in a prospective outcomes study. Rhinoscopic evaluation was used to classify patients. The relationship between disease phenotype and clinical parameters was examined.

Results

Facial pain/pressure/headache was more prevalent in CRSsNP than CRScNP (p = 0.01). Nasal obstruction and hyposmia/ anosmia were more prevalent in CRScNP than CRSsNP (p = 0.025 and 0.01, respectively). Intermediate symptom prevalence was found in polypoid CRS. Multivariate analysis confirmed that prior surgery, CT scan score, and male gender were independent predictors of polyp/polypoid phenotype. Allergic status was unrelated to CRS classification. Medication use was higher in CRScNP patients than in CRSsNP patients.

Conclusion

Compared with CRSsNP, patients with CRScNP have a greater burden of symptoms, more prior surgery, higher CT scan scores, and greater use of medications.
Cytological Characterization of Persistent Paranasal Sinus Secretions after Endoscopic Sinus Surgery
Authors: Bhattacharyya Neil
Published: January 2007

Background

The aim of this study was to characterize the cellular composition of persisting sinus secretions after endoscopic sinus surgery (ESS).

Methods

Consecutive adult patients with persisting abnormal sinus secretions post-ESS were prospectively evaluated. Sinus secretions were aspirated and submitted for cytological analysis. Semiquantitative cell counts were obtained for epithelial cells (graded as present or absent), eosinophils (graded on a 4-point Likert severity scale), and neutrophils (3-point Likert scale). Prior operative histopathology from ESS and Lund CT scores were reviewed. Statistical analyses were conducted to determine the relationships between preoperative Lund score, operative histopathology, and subsequent cellular infiltrate in sinus secretions.

Results

Forty-three patients (mean age, 49 years) were enrolled. Epithelial cells were present in 13 (30.2%) of these individuals. Cytological eosinophilia was rated as absent in 14 (32.6%) cases, mild in 5 (11.6%) cases, moderate in 18 (41.9%) cases, and severe in 6 (14.0%) cases. Neutrophil presence was absent in 24 (55.8%) cases, present/mild in 15 (34.9%) cases, and severe in 4 (9.3%) cases. No significant correlation could be found between the presence of each of these three cell types, the presence or absence of polyps, or preoperative Lund score (all p > 0.05). Sloughed epithelial cell presence was inversely but significantly correlated with original sinus histopathological inflammation (Spearman's ρ, -0.348; p = 0.04); eosinophilic cytology tended to increase with prior operative histopathology inflammatory grade but neutrophils did not.

Conclusion

The cytological profile of persisting secretions after ESS is dominated by eosinophils and to a lesser degree neutrophils. The presence of sloughed epithelial cells may signify ongoing mucosal damage from persisting sinonasal inflammation.
Nasal Mucosal Temperature in Relation to Nasal Airflow as Measured by Rhinomanometry
Authors: Lindemann Joerg , Keck Tilman , Scheithauer Marc Oliver , Leiacker Richard , Wiesmiller Kerstin
Published: January 2007

Background

The aim of this study was to measure in vivo nasal mucosal temperature and assess its relationship to nasal patency.

Methods

Nasal mucosal temperature of 30 nasal cavities was measured by means of a miniaturized thermocouple within the anterior turbinate area during respiration. Temperature values were compared with corresponding rhinomanometrical data.

Results

The median mucosal temperature ranged from 30.2°C (range, 28.9–31.7°C) after inspiration to 32.2°C (range, 31.0–33.9°C) after expiration. The end-inspiratory (r = -0.85) and end-expiratory mucosal temperature values (r = -0.88) negatively correlated with the rhinomanometrical data.

Conclusion

This study supports the fact that there is a negative correlation between nasal mucosal temperature and nasal resistance. Changes in nasal patency seem to influence nasal mucosal temperature. Within this context, nasal thermoreceptors might play an important role concerning the perception of nasal patency.
Site of Attachment of Inverted Papilloma Predicted by CT Findings of Osteitis
Authors: Yousuf Kashif , Wright Erin D.
Published: January 2007

Background

The treatment of choice for sinonasal inverted papilloma (IP) is surgical resection, which typically includes identification of the site of origin with appropriate inclusion or management of this site in the surgical resection. Appropriate preoperative planning is thus of significant importance and will routinely include CT imaging and nasal endoscopy. The aim of this study was to determine whether findings of osteitis in the patients’ preoperative CT images could predict the site of attachment.

Methods

This bipartite study contained both retrospective and prospective arms. For the retrospective arm, preoperative CT images of all cases were reviewed electronically in a blinded fashion by the senior author and a prediction was made for the site of attachment. The actual site of attachment as documented in the operative note was then compared with the predicted site. A similar process was followed for the prospectively acquired patients except that the site of attachment was predicted preoperatively.

Results

Twenty-eight retrospective and six prospective patients were identified as eligible for the study. Six retrospective patients were excluded because of incomplete data. In patients that were reviewed retrospectively, osteitis was seen in 20/22 patients and was used to correctly predict the site of attachment in 18/20 times. Of the prospectively acquired patients osteitis was seen in 5/6 patients with the site of attachment predicted in 4/5 patients.

Conclusion

In patients in whom osteitis is detectable on the preoperative CT scan, the site of origin of the IP can be predicted with a high degree of accuracy.