bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome of Tympanomastoidectomy in Children with Chronic Otitis Media
Authors: Bliss Morgan R. , Duval Melanie , Muntz Harlan R.
Published: September 2014

Objectives:

Analyze outcomes of tympanomastoidectomy for chronic otitis media in children at a tertiary care referral center with a high prevalence of patients with genetic syndromes, craniofacial anomalies, and medical comorbidities.

Methods:

A retrospective review of tympanomastoidectomy performed for chronic otitis media at a single pediatric tertiary care hospital from 1995 through 2013 was performed. Factors evaluated included presence of immunodeficiency or craniofacial anomaly, change in air‐bone gap and speech reception threshold, and need for additional otologic procedures.

Results:

Fifty‐six tympanomastoidectomies on 47 patients were evaluated. A total of 25% of the children had a genetic syndrome and 17% had an immunodeficiency. Average age at surgery was 7.5 years with an average duration of follow‐up of 2.7 years. Previous treatment included prolonged oral antibiotics (43), prolonged intravenous antibiotics (11), and middle ear irrigation and exchange of tympanostomy tube (7). Twenty‐nine ears had undergone 2 or more tympanostomy tube insertion. A total of 28 (50%) ears continued to have some otorrhea postoperatively. Complete audiologic data were available for 23 patients. Improvement in air‐bone gap was seen in 87% of cases, with an average improvement of 11.9 dB (P =. 01). Improvement in speech reception threshold was seen in 65%, with an average decrease in threshold of 10 dB (P =. 27). Of the cases, 8.9% required revision tympanoplasty following tympanomastoidectomy.

Conclusions:

Tympanomastoidectomy in children with severe chronic otitis media improves hearing function and may be beneficial in some patients to cease otorrhea. This should be considered as a treatment option in children that have failed previous conservative management.
Pediatric Head and Neck Complications of Invasive Streptococcus pneumoniae before and after PCV7 Vaccination
Authors: Pierce Matthew L. , Walls Andrew D. , Krishnan Nathan , Harley Earl H.
Published: September 2014

Objectives:

Discuss pediatric head and neck complications of invasive pneumococcal infections including the incidence, mean hospital cost, length of stay, and admittance from the emergency department before and after the PCV7 vaccine.

Methods:

A retrospective cross‐sectional analysis of the National Inpatient Database yielded (N = 31,738) pediatric incident reports involving meningitis, mastoiditis, otitis media, periorbital cellulitis, sigmoid sinus thrombosis, and bezold abscess due to invasive Streptococcus pneumoniae infections. Each report was analyzed for incidence, length of stay, mean hospital cost, and admittance from the emergency room. Finally, we calculated the expected annual incidence of each complication via least squares analysis to determine the expected incidence if the vaccine was not administered.

Results:

We identified a significant decrease in the incidence of all described complications after the introduction of the PCV7 vaccine and also when compared to our predicted incidence calculations. Emergency department admittance for bezold abscess, periorbital cellulitis, mastoiditis, sigmoid sinus thrombosis and meningitis were significantly increased in the pediatric age group (ages 1‐4) (P <. 05). Furthermore, there was a significant increase the hospital charge to provide care for each of the described conditions (P <. 05).

Conclusions:

The PCV7 vaccine produced a measurable reduction in invasive pediatric pneumococcal complications of the head and neck. However, our data suggests these benefits were also met with increased emergency department admittance, hospital costs, and length of stay, each of which may be due to selection of a more invasive species.
A Revised CAO Staging Classification to Predict the Prognosis of Acquired Cholesteatoma in Children
Authors: Kuo Chin‐Lung , Shiao An‐Suey , Liao Wen‐Huei , Lien Chiang‐Feng
Published: September 2014

Objectives:

A CAO (cholesteatoma extent, atelectasis degree and ossicle involvement) staging system for cholesteatoma was described at the XIII World Congress of Otorhinolaryn‐gology in Florida in 1985. Because of 30 years of accumulated clinical data, we propose a revised and simplified model of stratification. This study aimed to investigate the prognosis of pediatric acquired cholesteatoma based on this revised staging system.

Methods:

Between 1982 and 2012, 132 ears in 128 children (≤18 years of age) with acquired cholesteatomas after primary surgery were included. Each case was scored for cholesteatoma extent, history of grommet insertion, age, ossicular destruction, and otorrhea. The total score classified the patients as stage I (5‐6 points), stage II (7‐9 points) or stage III (10‐12 points). The staging system was applied to the first (66 ears) and second (66 ears) halves of the cohort, and the entire cohort (132 ears). Differences between stages were compared using Kaplan‐Meier cumulative recidivism curves.

Results:

The mean follow‐up period was 12 years. The 15‐year cumulative recidivism rate was 19.6% overall, 0% in stage I, 10.4% in stage II, and 30.6% in stage III. The cumulative recidivism curves were well stratified by stage, with differences reaching statistical significance in the second half and entire cohort (P =. 048 and. 026, respectively).

Conclusions:

The proposed revised staging classification may adequately stratify patients regarding the prognosis, facilitating the identification of children at risk of recidivism. Further external validation on an independent data set is warranted before broad application can be recommended.
Revision Thoracic Slide Tracheoplasty for Congenital Tracheal Stenosis: Outcomes following Unsuccessful Prior Tracheal Reconstruction
Authors: Sidell Douglas R. , de Alarcon Alessandro , Manning Peter B. , Hart Catherine K. , Balakrishnan Karthik , Meinzen‐Derr Jareen , Rutter Michael J.
Published: September 2014

Objectives:

Over the past decade, thoracic slide tracheoplasty (TST) has become the principal operation in the management of congenital tracheal stenosis. The purpose of this report is to (1) describe our experience with revision TST following unsuccessful prior tracheal reconstruction and (2) compare our outcomes with primary TST.

Methods:

Patients undergoing TST on cardiopulmonary bypass between January 2005 and 2014 were reviewed. Patients with a history of prior airway surgery were extracted for further analysis. Preoperative patient variables and postoperative outcomes were evaluated.

Results:

A total of 108 patients were reviewed over the study period. Twenty‐two revision patients (20 referrals, 2 primary patients) met inclusion criteria. Eighteen patients had a history of complete tracheal rings and 4 patients had cartilaginous deficiency. A total of 35 tracheoplasties (rib graft = 6; slide tracheoplasty = 5; pericardial patch = 4; homograft = 3;resection = 1; cricoid split = 1; combined tracheal reconstruction = 15) had been performed prior to revision TST. Following revision TST, additional endoscopic interventions were required in 5 patients (23%). Twelve balloon dilations (average 2.4 per child) and 4 endoscopic stent placements were performed in these 5 patients. The majority (68%) of children required <48 hours of ventilator support following revision. There was one nonsurgical postoperative mortality.

Conclusions:

Despite some differences in the postoperative management when compared to nonrevision cases, revision TST can be successfully performed after prior tracheal reconstruction with good postoperative outcomes.
3D‐CT Comparison of the Stylohyoid Chain in Eagle's Syndromes, Glossopharyngeal Neuralgia, and Asymptomatic Controls
Authors: Kent David T. , Rath Tanya J. , Snyderman Carl H.
Published: September 2014

Objectives:

(1) Describe 3‐dimensional (3D) computed tomography (CT) anatomic features of the stylohyoid chain in Eagle's syndrome patients (ES), glossopharyngeal neuralgia patients (GPN), and normal asymptomatic controls (NC). (2) Understand 3D‐CT features findings associated with Eagle's syndrome.

Methods:

Retrospective chart review from November 2000 to November 2013. 3D shaded surface display CT reconstructions of the stylohyoid chain were generated for 10 ES patients, 16 GPN, and 15 NC patients. Demographic and clinical symptom data were recorded. Anatomic data collected from CT scans included: length of ossified styloid process, anterior‐posterior (APA) and medial‐lateral (MLA) styloid process angulation, ossification pattern of the stylohyoid chain, and minimum distances between the styloid process and the internal carotid artery, C1 transverse process, and tonsillar fossa.

Results:

The average distance from the styloid process tip to the tonsillar fossa was found to be significantly shorter in ES patients (12.7 mm) compared with GPN (21.4 mm; P <. 05) or NC (24.8 mm; P <. 001) patients. No other measured variables were found to be significantly different between groups, including average styloid process length (ES: 48.0 vs GPN: 40.3 vs NC: 40 mm; P >. 05).

Conclusions:

The styloid process was found to be significantly closer to the tonsillar fossa in ES patients as compared to GPN and NC patients by 3D‐CT reconstructions. No significant differences were found in other measures, including styloid process length. Distance to the tonsillar fossa may be a more appropriate diagnostic criterion for ES than styloid process length, and may contribute to the pathophysiology of ES.
The Role of Tympanostomy Tubes in Surgery for Acquired Retraction Pocket Cholesteatoma
Authors: Govil Nandini , Stapleton Amanda L. , Yellon Robert F.
Published: September 2014

Objectives:

(1) Determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) results in improved hearing outcomes or decreased recurrence of ARPC. (2) Determine the need for subsequent TT in children that did not receive TT at initial surgery.

Methods:

Institutional review board–approved retrospective review of children 4 to 18 years, who underwent primary surgery (tympanoplasty or tympanomastoidectomy) for ARPC at a tertiary care children's hospital from January 1, 2000, to December 31, 2012. Audiometry, operative reports, office findings, TT, and recurrence data for ARPC were analyzed. The chi‐square test was used for statistical analysis.

Results:

Preoperative Mills staging for extent of cholesteatoma was similar for both groups. A total of 24 patients had TT at initial surgery (TT Group) and 34 patients did not (no TT Group). The average preoperative and postoperative SRT were 23dB and 25dB, respectively, for the TT Group, and 31 dB and 31 dB for the no TT Group. The recurrence rate for ARPC was 29% for the TT Group versus 41% for the no TT Group (P =. 35). Thirty‐five percent of patients in the no TT Group required TT at a subsequent surgery.

Conclusions:

There was no statistical difference in recurrence or audiometric outcomes between patients who underwent TT insertion versus those who did not during initial surgery for ARPC. However, since the incidence of recurrent ARPC was 12% lower when TT were placed, and since the rate of subsequent TT was 35% in the no TT Group, a larger, prospective study of TT at initial surgery for ARPC is needed.
Airway Management in Severe Combat‐Related Maxillofacial Trauma
Authors: Keller Matthew W. , Han Peggy P. , Galarneau Michael R. , Brigger Matthew T.
Published: September 2014

Objectives:

Airway stabilization is critical in combat‐related maxillofacial injury as normal anatomical landmarks can be obscured by blood and debris. The objective of this study was to characterize the epidemiology of airway management in maxillofacial trauma.

Methods:

A total of 1345 military personnel with combat‐related maxillofacial injuries were retrospectively identified from the Expeditionary Medical Encounter Database using ICD‐9‐CM diagnostic codes. Maxillofacial injury severity was quantified with the Abbreviated Injury Scale (AIS). Service members with maxillofacial injury and severe combat trauma were included in the analysis (n = 239). Study variables included the frequency and timing of intubation, presence and severity of burn injury, frequency of tracheostomy, and presence of inhalational injury.

Results:

A total of 239 severe maxillofacial injuries were identified. The most common mechanism of injury was Improvised Explosive Device (IED) (66%), followed by gunshot wounds (8%), mortar (5%), and landmines (4%). A total of 51.0% of the subjects required intubation on their initial presentation to triage facilities. Field surgical airways were rare, but demonstrated a 75% success rate. Of the patients who underwent bronchoscopy, 65.2% were found to have airway inhalational injury. There was a significant relationship between the severity of facial injury and the need for intubation on initial presentation (P =. 0027). Of the subjects, 19.7% had tracheostomy performed. Furthermore, 12.3% of the study subjects required surgical neck explorations.

Conclusions:

There is a high incidence of airway injury in combat‐related maxillofacial trauma, which may be underestimated. Airway management in this population requires a high degree of suspicion and low threshold for airway stabilization.
The Association between Airline Flight Time and Sinus Disease
Authors: Shargorodsky Josef , Zheng Laura , Stillman Frances , Navas‐Acien Ana , Reh Douglas D.
Published: September 2014

Objectives:

Airplane cabin supply air has been shown to have multiple possible respiratory irritants. In addition, changes in barometric pressure in flight may contribute to some respiratory conditions. Therefore, there may be an association between commercial airline flight and sinus disease.

Methods:

Participants of the Secondhand‐Smoke, Air Quality and Respiratory Health Among Flight Attendants study cohort were mailed a questionnaire pertaining to their flight experience and respiratory health. Working years, working days per month, and number of trips per month were quantified, as well as smoking exposure history and self‐reported physician diagnoses of sinusitis, asthma, and rhinitis. The sinonasal outcomes were quantified using a Respiratory Questionnaire Score (RQS). Multivariable analyses were performed to analyze the associations between flight time and sinus disease.

Results:

A total 579 participants met the inclusion criteria, with cohort prevalence of sinusitis, asthma, and rhinitis of 24.8, 13.1, and 20.4%, respectively. There was a significant trend of increasing odds ratios (OR) of sinusitis and rhinitis with increasing working years tertiles (P <. 01 and P =. 016, respectively). Increasing tertiles of working days per month were associated with higher RQS scores (P, trend <.01). Individual symptoms significantly associated with increasing number of working days per month included need to blow nose, sneezing, and thick nasal discharge, among others.

Conclusions:

This is the first study to analyze the relations between airline flight time and sinonasal disease. Sinusitis diagnosis, numerous sinonasal symptoms, and cumulative symptom scores were all shown to be significantly associated with flight time.
Awareness of General Practitioners of the Current Recommended Management Guidelines for Allergic Rhinitis
Authors: Okpala Nnaemeka C.
Published: September 2014

Objectives:

(1) Determine general practitioners’ (GP) awareness of the guidelines for allergic rhinitis (AR) and identify any factors influencing their awareness of the guidelines. (2) Assess their diagnosis, treatment protocol, and understanding of co‐morbidities of AR.

Methods:

A cross‐sectional questionnaire‐based study was performed between November 2012 and July 2013. One hundred one GPs from 23 practices completed questionnaires as part of educational briefing with a response rate of 97% (101/104). One hundred copies met the criteria.

Results:

Only 7 out of 100 GPs (7%) were aware of the Allergic Rhinitis and its Impact on Asthma (ARIA) or related AR guidelines; therefore, the prevalence of awareness of the guidelines is 0.07 (95% confidence interval 0.03 to 0.14). A further 13% (13/100) knew of local guidelines which were not for AR. Most GPs knew the treatment for mild and moderate‐severe AR (93% and 77% respectively). A higher percentage of GPs with previous ear, nose, and throat (ENT) experience (97% and 84% for mild and moderate‐severe respectively) were aware of the treatment. Forty‐one percent of GPs did not know the link between AR and asthma. A significant number of GPs with previous ENT experience (P <. 05) knew the co‐morbidities: 89% (33/37), compared to 68% (43/63) of those without ENT experience; they were also more aware of the link with asthma: 65% (24/37) compared to 56% (35/63) of those without ENT experience.

Conclusions:

Education of GPs, including more ENT experience and workshops, is required to increase awareness of the guidelines. These will improve management of AR.
Chronic Rhinosinusitis and Mood Disturbance
Authors: Erskine Sally , Philpott Carl M.
Published: September 2014

Objectives:

This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS). The aim of this analysis is to determine the number of patients consulting with their family physician about anxiety or depression among those with CRS and controls.

Methods:

CRES is a mixed methods study of patients with CRS including qualitative interviews and study‐specific questionnaires. This analysis considers only the questionnaires. These included comprehensive questions about demographic and socioeconomic factors and past medical history as well as SNOT‐22 (nasal symptom score) and SF‐36 (quality of life tool). Questionnaires were distributed to patients with CRS attending general ENT and rhinology clinics within the National Health Service and private sector and to a control population across many centers in the United Kingdom from 2004 to 2013.

Results:

A total of 1519 participants, including 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Self‐reported consultation with family physician for depression was 9 out of 57 (15.8%), 132 out of 659 (20.0%), 142 out of 577 (24.6%), and 36 out of 226 (15.9%), respectively. P <. 02 for differences between participant subgroups. For anxiety: AFRS 10 out of 57 (17.5%), CRSwNP 105 out of 659 (15.9%), CRSsNP 130 out of 577 (22.5%), controls 39 out of 236 (16.5%), P =. 04 between groups.

Conclusions:

There are differences in rates of consulting with family physicians for depression and anxiety disease between those with different types of CRS and controls; those with CRS without polyps were most likely to have consulted. This may influence management strategies for patients with different nasal pathologies.
Contemporary Management of Frontal Osteomyelitis
Authors: Kejner Alexandra E. , Guillot Lori M. , Woodworth Bradford A.
Published: September 2014

Objectives:

Frontal sinus osteomyelitis is a severe complication that can result from chronic rhinosinusitis, from trauma, or as a complication of reconstruction or obliteration of the frontal sinus. The objective of the current study is to evaluate the contemporary management of frontal sinus osteomyelitis in light of recent pervasive advancements in endoscopic experience.

Methods:

Review of a prospectively collected database of patients with frontal sinus pathology was performed from 2008‐2013, and data from individuals with frontal sinus osteomyelitis were collected regarding demographics, etiology, surgical technique, adjunctive medical treatments, complications, and clinical follow‐up.

Results:

Eleven patients (average age, 43.6 years; range, 8‐84 years) were included in the study. An open approach was used in 5 patients (2 osteoplastic flaps, 2 Reidel procedures, 1 cranialization). Four patients underwent completely endoscopic approaches (2 Draf IIB, 2 Draf III), while 2 individuals had combined procedures (Lynch/Draf III, osteoplastic flap/Draf III). Osteomyelitis was secondary to complications from previous surgery (n = 6) and acute/chronic rhinosinusitis (n = 5). An open approach was used in all cases of osteomyelitis that formed as a result of prior surgery. All patients received 6 weeks of intravenous antibiotics. Average clinical follow‐up was 8 months with no revision procedures.

Conclusions:

Endoscopic, endoscopic‐assisted, and open approaches were used successfully in the current series of patients with osteomyelitis of the frontal bone. While the advent of endoscopic techniques allows an additional surgical treatment option, it is important to select patients appropriately as open procedures continue to have a role in the treatment algorithm.
Applicant Opinions of Task Simulation Exercises as Part of the Otolaryngology Resident Interview Process
Authors: Giliberto John P. , Myer Charles M. , Hendricks Brian L. , Myer Charles M.
Published: September 2014

Objectives:

(1) Characterize opinions of applicants participating in simulation during an otolaryngology interview process. (2) Describe the effect of task simulation on applicant impression of the host program. (3) Evaluate correlation between objective simulation performance and traditional rank order methods.

Methods:

Applicants completed pressure equalization tube (PET) insertion on a simulator following an instructional presentation. A published global rating scale (GRS) was completed by the resident proctor and time to completion was recorded. Applicants were informed that scores were not used in final rank order list. After the interview an online survey was sent to the applicants.

Results:

Forty‐eight applicants completed PET simulation. Survey response rate was 81% (39/48). Inclusion of a simulation exercise during interviewing positively changed the opinion of 21% (8/38) of the applicants, with 1 negative response. The majority of respondents (88%) had no negative response to inclusion of simulation if GRS scores are not included in ranking process. If GRS results are used for ranking, respondents felt it was more fair if the task was non‐novel versus novel (54% vs 23%). The inclusion of GRS results in ranking engendered negative opinions of the program (28% non‐novel task, 46% novel task). Mean GRS score for applicants was 16 ± 0.98. Time to completion and GRS score were correlated (P <. 01), but neither GRS score (P =. 91) nor time to completion (P =. 31) were correlated to rank order.

Conclusions:

Simulated task performance may provide complementary information to that of traditional interviews. Inclusion in ranking may negatively affect resident perception of the program, notably if the task is novel.
Early versus Delayed Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: Impact on Health Care Utilization
Authors: Benninger Michael S. , Holy Chantal E. , Sindwani Raj , Hopkins Claire
Published: September 2014

Objectives:

Using a patient cohort with chronic rhinosinusitis (CRS) refractory to medical management, evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization.

Methods:

The MarketScan CCAE database was queried. Patients with ESS in 2010 and complete medical history from 2004 to 2012 were identified. Diagnoses of CRS or polyposis prior to 2005 as well as ESS prior to 2010 were exclusion criteria. Patients were characterized by time interval of first CRS diagnosis to ESS and grouped as follows: (1) <1 year (N = 888); (2) 1‐2 years (N = 267); (3) 2‐3 years (N = 300); (4) 3‐4 years (N = 414); and (5) 4‐5 years (N = 649). Outpatient visits/procedures and prescriptions associated with CRS were analyzed for all groups at the following time points: year immediately preoperative, year 1 postoperative, and year 2 postoperative.

Results:

Patients in all groups showed significant decline in health care utilization following surgery. Groups 1 and 2 had significantly fewer health care needs pre‐ and postoperatively compared to Group 5. Specifically, Group 1 had an average of 3.45 visits (95% confidence interval [CI]: 3.31‐3.58) and 2.92 filled prescriptions (95% CI: 2.71‐3.14) preoperatively versus Group 5 (visits: 4.57 (95% CI: 4.37‐4.78); prescriptions: 4.69 (95% CI: 4.33‐5.05)). At year 2 postoperative, Group 1 had 0.92 visits (95% CI: 0.74‐1.10) and 0.82 prescriptions (95% CI: 0.67‐0.96) versus Group 5, with 1.78 visits (95% CI: 1.45‐2.11) and 2.06 prescriptions (95% CI: 1.73‐2.39).

Conclusions:

Patients treated surgically early in the diagnosis of CRS have lower health care needs than patients treated after many years of failed medical management.
The Effect of Surgical Approach on Outcomes following Pituitary Tumor Resection
Authors: Goyal Parul , Villwock Jennifer A. , Villwock Mark R. , Deshaies Eric
Published: September 2014

Objectives:

The goals of pituitary tumor resection include normalizing endocrine function, relieving mass effect, and minimizing risk of recurrence. This study sought to determine the effect of surgical approach “transsphenoidal or transfrontal” on outcomes.

Methods:

Retrospective review of the 2008‐2011 Nationwide Inpatient Sample for patients undergoing pituitary lesion resection. Hospital and patient demographics and outcomes were compared between transfrontal and transsphenoidal surgical approaches.

Results:

A total of 8543 admissions for resection of pituitary lesions met our inclusion criteria. Most (>90%) were treated transsphenoidally. The transfrontal approach was most frequent in the young (<35 years) and in the South. Transfrontal resection led to significant increases in mortality and complications including central diabetes insipidus, iatrogenic panhypopituitarism, and intracerebral hemorrhage. Multivariate analysis found transsphenoidal resection reduced hospital costs and length of stay by over 50%; low‐volume hospitals increased cost and length of stay. There was an increased rate of transfrontal approaches at low‐volume centers.

Conclusions:

Multiple factors influence outcomes of pituitary tumor resection. Case specifics, including tumor location and size, influence approach and lead to a selection bias that cannot be controlled for in the present study. The prevalence of transfrontal resections at low‐volume centers may indicate that surgeon familiarity rather than contraindication to transsphenoidal surgery serves as the basis for surgical planning.
The Effect of Vibrissae on Subjective and Objective Measures of Nasal Obstruction
Authors: Stoddard David G. , Pallanch John F. , Hamilton Grant S.
Published: September 2014

Objectives:

(1) Recognize the impact of nasal vibrissae on subjective and objective measures of nasal obstruction. (2) Apply presented data to make informed recommendations to patients regarding vibrissae reduction as an adjunct or alternative to other treatments for nasal obstruction.

Methods:

In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae concentration and treated with a topical decongestant. Subjects were then asked to subjectively assess nasal breathing using the NOSE instrument prior to undergoing rhinomanometry. Nasal vibrissae were then trimmed, and participants repeated the subjective and objective assessments. Pre‐ and post‐intervention outcomes including NOSE values, airflow, and resistance were compared using statistical analysis.

Results:

Statistically significant improvement was noted in subjects’ NOSE assessment of nasal obstruction (80% average improvement, P <. 001) and 2 of 4 questionnaire outcomes (P =. 016,. 083, P =. 031, and P =. 25). Statistically significant improvements occurred in objective measurement of inspiratory: flow (P =. 009); effective total resistance (P =. 003); and average vertex (maximum) resistance (P =. 029). Patients with moderate or severe vibrissae at baseline were noted to have more improvement in subjective and objective obstruction assessments than patients rated mild.

Conclusions:

In these 30 subjects, strong statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with more dense vibrissae. These data suggest consideration of reduction of vibrissae density in patients complaining of nasal obstruction. Furthermore, the role of nasal vibrissae should be considered in any study examining the impact of medical or surgical interventions on nasal obstruction.
Endoscopic Anterior Skull Base Resection: University of Miami Experience
Authors: Hachem Ralph Abi , Sargi Zoukaa B. , Rivera Andrew M. , Wood John W. , Grobman Ariel B. , Casiano Roy R.
Published: September 2014

Objectives:

To report: (1) Oncological safety of endoscopic technique using disease free survival and a Kaplan Maier analysis for malignant tumors and recurrence rate for benign tumors; (2) Type of reconstruction of large anterior skull base defects and rate of postoperative cerebrospinal fluid leak; (3) Postoperative major (cranial and orbital) and minor complications.

Methods:

Retrospective chart review identifying patients undergoing endoscopic anterior skull base resection for malignant and benign tumors at a tertiary care medical center between September 1997 and June 2013.

Results:

Preliminary analysis shows that 34 patients underwent transnasal endoscopic resection for malignant disease and 2 patients for benign disease. The median follow‐up was 30 months. Olfactory neuroblastoma was the most common pathology. There were 3 major and 5 minor complications. Three patients recurred locally resulting in a local control rate of 90.9%. The overall mortality rate was 18%, and the disease specific mortality was 3%. Reconstruction of the skull base defect was done using acellular dermis as a sole graft with a success rate of 97% and a cerebrospinal fluid leak in 1 case.

Conclusions:

Endoscopic anterior skull base resection for benign or malignant disease is a safe and valid alternative compared to standard approaches. It is gaining more popularity, and with increasing surgical expertise, the indications of this procedure are expanding.
Endoscopic Balloon Dacryocystorhinostomy
Authors: McLaughlin Kevin E.
Published: September 2014

Objectives:

(1) Describe new endoscopic balloon technique for dacryocystorhinostomy. (2) Review preliminary outcomes of endoscopic balloon DCR.

Methods:

This study has 2 parts. The first entails a cadaver study looking at feasibility of applying balloon dilation technology to nasolacrimal duct obstruction. Five cadavers (10 sides) were used to confirm the technique. All 10 nasolacrimal ducts were successfully cannulated and dilated with a 5 × 16 mm balloon via a 70° guide. The second part of the study details our preliminary experience using this technique in patients referred to a tertiary rhinology clinic for nasolacrimal duct obstruction.

Results:

A total of 5 patients have enrolled in our prospective study. All patients were successfully cannulated. Follow‐up ranges from 1 to 6 months. Resolution or decrease of preoperative epiphora has been noted in all 5 patients.

Conclusions:

Transnasal endoscopic balloon dilation of the nasolacrimal duct system may be a possible therapeutic option for the treatment of nasolacrimal duct obstruction. Furthermore, this may be a particularly attractive option for patients who are not candidates for a general anesthetic or cannot be taken off of anticoagulant medication. Further study is warranted.
Endoscopic Endonasal Removal of Advanced Sinonasal Inverted Papilloma
Authors: Hinohira Yasuyuki , Kyo Yoshiyuki , Watanabe So
Published: September 2014

Objectives:

(1) Demonstrate our endonasal procedure to totally remove advanced sinonasal inverted papilloma (SIP). (2) Show the successful outcome in the long‐term follow‐up study.

Methods:

A retrospective study. Forty‐six sides of the 45 patients with SIP were operated on for the last 13 years. Nineteen of the 45 patients showing advanced stage (III:17 and IV:2 in Krouse's staging) were enrolled in this study. They consisted of 11 men and 8 women, and the age ranged from 28 to 92 years old. Endoscopic endonasal sinus surgery with aid of supplementary techniques described below was performed in all patients.

Results:

Extranasal methods were not required in this study. Transinferior turbinate approach to the anterior part of the maxillary sinus was applied to 5 of the 11 patients where SIP originated from the maxillary sinus. Endonasal medial maxillectomy was added to 2 of the 5 patients because of the inferior turbinate invasion. Draf type IIb or III procedure was applied to 4 of the 5 patients in whom the frontal sinus was involved. In 2 patients who showed the sphenoid sinus invasion, transseptal approach was used. During the 15 to 122 months follow‐up period, recurrence was seen in 2 patients in whom simple ESS procedure had been performed in the maxillary sinus.

Conclusions:

Our endonasal removal procedure for advanced SIP is acceptable, and may be alternative to extranasal methods, although longer follow‐up study is required.
The Endoscopic Modified Lothrop: Lessons Learned during a 17‐Year Experience
Authors: Leavitt Kathryn A. , Rasband‐Lindquist Allison N. , Robinson Ann B. , Beahm D. David , Hoover Larry A.
Published: September 2014

Objectives:

Participants should be able to: (1) Recognize factors contributing to failure; (2) Describe techniques required for a safe/successful surgery; (3) Implement postsurgical medical treatment enhancing long term outcome.

Methods:

Results with the endoscopic Modified‐Lothrop were reviewed. Although the success rate is good for revision sinus surgery (90%), factors contributing to failure such as allergy, mucosal reactivity, and scar formation were investigated. The senior author's series of 104 endoscopic modified Lothrops completed between January 1997 and October 2013 were reviewed for patency of the frontal floor drainage, mucosal condition, and symptomatology. The Lothrop procedure was first reported in 1914 using an external incision. Draft in 1991, Close in 1994, and Gross in 1995 described the endoscopic modified Lothrop. All patients selected for this procedure had failed medical treatment of nasal saline and antiseptic irrigations, topical steroids, and appropriate antibiotics. Nearly all of these patients had also failed standard endoscopic sinus procedures at least once.

Results:

Image guidance has improved the precision and safety of this operation. Three of the first 5 procedures performed without image guidance failed. Of the succeeding 99 procedures performed with image guidance, 96% were successful in maintaining open frontal drainage and resolving most symptoms with a prolonged follow‐up (mean 42 months).

Conclusions:

The endoscopic modified Lothrop is a technically difficult procedure. When performed under the supervision of an experienced endoscopic surgeon with image guidance and modern endoscopic irrigated curved drills, it can be performed safely and effectively when standard endoscopic procedures fail.
Endoscopic Resection of Anterolateral Maxillary Sinus Inverted Papillomas
Authors: Dean Nichole , Illing Elisa A. , Woodworth Bradford A.
Published: September 2014

Objectives:

Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell‐Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes concerning the endoscopic surgical resection of anterolateral maxillary sinus IPs.

Methods:

A prospective review of patients presenting with maxillary sinus IPs pedicled on the anterior and/or lateral walls was performed. Demographics, pedicle location, operative technique, pathology, complications, recurrence, and postoperative follow‐up were evaluated.

Results:

Over 6 years, 35 patients (avg. age 56) underwent EMM for maxillary sinus IPs located on the anterolateral maxilla. Most patients (69%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70° endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell‐Luc approaches were required. Pathologic dysplasia was identified in 8 subjects, and 3 had carcinoma. There were no recurrences with a mean disease‐free interval of 27 months (6‐72 months).

Conclusions:

In the present study EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location previously considered accessible only with external procedures.
Ethmoid Drug‐Eluting Catheter for Nasosinusal Polyposis: Results after a Randomized Controlled Trial
Authors: Plaza Guillermo , Espitia Elizabeth A. , Hernández‐García Estefanía , Eisenberg Gustavo , García‐Peces Victoria , Montojo Jose , Pascual Maria Urbasos
Published: September 2014

Objectives:

Assess the safety and efficacy of a drug‐eluting catheter to be inserted into the ethmoid sinuses during endoscopic sinus surgery to elute triamcinolone in patients with CRSwP (nasosinusal polyposis).

Methods:

Prospective, randomized, controlled, double‐blind, clinical trial using intrapatient control design. The study enrolled 40 patients with CRSwP undergoing endoscopic sinus surgery. In every case, after polypectomy was done to expose the ethmoid bulla, a drug‐eluting catheter to elute triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional total ethmoidectomy. Outcome measures were visual analogue scales, Rhinosinusitis Disability Index, endoscopy, and olfactometry assessment at baseline, 3, 6, and 12 months. Safety assessments included ocular examinations at baseline and 30 days. All CT imaging was done after more than 12 months of follow‐up.

Results:

After randomization was performed, unilateral devices were successfully placed in all patients and easily removed after 4 weeks. When comparing both nasal fossae in postoperative endoscopies at 6 and 12 months, the prevalence of edema, adhesions, and recurrent polyposis were statistically similar. Changes from baseline in patient‐reported outcomes were statistically relevant in both sides. No clinically important changes in intraocular pressure occurred. CT resolution of pathology was achieved in both sides, improving Lund‐Mackay scale, without significant differences.

Conclusions:

This trial provides clinical evidence on the safety and efficacy of a drug‐eluting catheter for use in patients with CRSwP. It achieves similar results compared to complete ethmoidectomy, without any major complications.
The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice: An Updated Study
Authors: Akst Lee M. , Haque Omar J. , Hillel Alexander T. , Best Simon R. , Altman Kenneth W.
Published: September 2014

Objectives:

(1) Understand evolving national trends in diagnosis and management of reflux disease. (2) Be able to analyze these by provider specialty.

Methods:

National Ambulatory Medical Care Survey (NAMCS) data for time periods 1998‐2001, 2002‐2005, and 2006‐2009 were reviewed for number of visits, provider type, and prescriptions provided.

Results:

Addition of 2 more 4‐year periods to previously reported data demonstrates increasing ambulatory visits for reflux across all races, sexes, and age groups. In 2006‐2009, there were 15,750,000 visits for reflux, representing 6.9 visits per 100 people on a population basis. Overall visits increased across each sequential time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, reflux visits increased from 1998‐2001 to 2002‐2005 but then decreased in 2006‐2009; percentage of reflux visits to otolaryngologists fell from 4.4% in 2002‐2005 to 2.9% in 2006‐2009. Approximately two‐thirds of reflux visits were among internal medicine and family practice providers. Among the 3 study periods, number of reflux prescriptions increased 233% with continuing trends toward increased proton pump inhibitor and reduced H2 antagonist use.

Conclusions:

Number of ambulatory visits for reflux continues to increase over time, across all demographic subgroups studied. Otolaryngologists are the only specialty who saw a decrease in overall reflux visits from 2002‐2005 through 2006‐2009; this may reflect real change in practice patterns, change in coding strategies or uncertainty in firmly establishing a reflux diagnosis. Understanding trends in this increasingly prevalent disease may focus attention on more precise diagnosis and improved treatment.
The Loop‐Type Maxillary Artery and Its Relationship with the Lateral Pterygoid Muscle
Authors: Salas Juan E. , Garza Luis M.
Published: September 2014

Objectives:

Determine the relationship between a loop‐type configuration of the third portion of maxillary artery and its position according to the inferior belly of the lateral pterygoid muscle.

Methods:

A descriptive transversal study in preserved cadaver head specimens, conducted between August and December of 2013, on a total of 23 hemi‐heads of Latin American origin, in which the second and third portions of the maxillary artery were dissected through an endoscopic transmaxillary approach to the pterygopalatine and infratemporal fossa.

Results:

A total of 23 maxillary arteries were dissected, of which 7 (30.4%) were found to be superficial to the inferior belly of the lateral pterygoid muscle (LPMib) and 16 (69.6%) were found to lie deep. A total of 16 arteries (69.5%) were found on a loop‐type configuration, and 7 (30.5%) were found on an ascending configuration. The loop type was found deep to the LPMib in 13 (81.3%) of the cases and superficial in 3 (18.8%) of them. The results were analyzed with Fisher's exact test with a P value of. 091.

Conclusions:

This study shows a tendency in the Latin American population to have maxillary arteries deep to the LPMib in loop configuration, which emphasizes the need to stay close to the pterigomaxillary fissure during surgical dissection when aiming to find the main trunk of this vessel in its transition point between its second and third portions. Although the results are promising, the results need to be confirmed in a larger sample.
Management of CRSwNPs Surgically
Authors: Masterson Liam M. , Egro Francesco M. , Bewick Jessica C. , Hopkins Claire , Philpott Carl M.
Published: September 2014

Objectives:

Long‐term follow‐up of 1045 patients with chronic rhinosinusitis with nasal polyposis (CRSwNPs) in the national Sinonasal Audit demonstrated that at 5 years 20.6% of patients had undergone revision surgery. The aim of this study was to see if the Chronic Rhinosinusitis Epidemiology Study (CRES) data reflected a continued burden of revision surgery in patients with CRSwNPs.

Methods:

A prospective questionnaire‐based study at 30 sites around the UK of patients with CRS presenting to secondary care between October 2007 and September 2013. This paper presents a specific analysis of patients with CRS who reported undergoing sinus surgery.

Results:

A total of 651 patients with CRSwNPs, 553 with CRSsNPs, and 45 with AFRS were included in the CRES. 365 (57%) of patients with CRSwNPs/AFRS reported undergoing endoscopic nasal polypectomy (ENP) in which 175 (25% or 48% of surgical cases) reported having received more than one ENP. The mean number of ENPs per patient in the revision group was 3.3 with a range of 2 to 30. Only 27.9% of patients reported concurrent endoscopic sinus surgery (n = 102). For comparison, patients with CRSsNPs reported ESS in 13% of cases with only 17% of those surgical cases reporting multiple procedures (chi‐squared P <. 001).

Conclusions:

This study demonstrated a significantly higher burden of both primary and revision surgery to the health care system for patients with CRSwNPs. Extrapolation of these findings to the HES data for 2011 and 2012 would suggest a bill of approximately £5.3 million per year spent on revision surgery.
Management of the Orbit during Endoscopic Sinonasal Tumor Resection
Authors: Christianson Brandon L. , Harrow Brian , Perez Carlos , Batra Pete S.
Published: September 2014

Objectives:

The primary aim of the study was to evaluate intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors.

Methods:

Retrospective chart review and prospective imaging assessment was performed of 215 cases managed at a tertiary care referral center between July 2009 and December 2012.

Results:

A total of 41 patients met predetermined criteria for inclusion. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign pathologies, respectively. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) most commonly demonstrated lamina papyracea erosion (78.1%), followed by extension into the periorbita (43.9%), lacrimal system (24.4%), orbit (14.6%), and orbital apex (7.3%). Procedures performed to address orbital involvement included endoscopic resection of lamina papyracea (85.3%), dacryocystorhinostomy (DCR) (26.8%), optic nerve decompression (7.3%), and orbital exenteration (4.8%). Ophthalmologic involvement was required in 31.7% of cases; anterior orbitotomy (26.8%) and open DCR (17.1%) were the most common adjunct open procedures. Orbital complications most commonly included epiphora (7.3%) and diplopia (5.1%), with no cases of change in visual acuity or orbital hematoma. CT reliably predicted invasion of the lamina papyracea and lacrimal system (P <. 05), while MRI reliably predicted invasion of the periorbita (P <. 05). Irregular tumor margin along the periorbita on MRI was statistically significant (P <. 05) for ophthalmologic involvement.

Conclusions:

CT and MR imaging provide complementary information for assessment of tumor extension to the orbit. This typically requires endoscopic and adjunct open approaches for effective tumor extirpation and can be achieved safely with low rate of complications.
Measurement of Nasal Polyp Patient Symptomatology over Time Using the Sinonasogram: Initial Validation
Authors: Albergotti William G. , Lee Stella , Ferguson Berrylin J.
Published: September 2014

Objectives:

Chronic rhinosinusitis with nasal polyps is a common disorder that requires multiple methods to monitor disease burden. There is no validated questionnaire to monitor nasal polyp patient symptoms over time. We describe a novel 10‐item questionnaire (Sinonasogram) which is currently used in clinical practice to evaluate current and 4‐week symptoms that are common to patients with chronic rhinosinusitis.

Methods:

Twenty‐five consecutive patients with nasal polyps seen in a university setting were included in this retrospective review. Patients were included if they had multiple visits to clinic and filled out the Sinonasogram questionnaire at each visit. Nasal polyp score was graded on a (0‐5) scale. Statistical analysis was performed to determine correlation between changes in current, 4‐week, and total Sinonasogram score and changes in nasal polyp score and to determine internal consistency.

Results:

Twenty‐five patients were included for analysis with a total of 81 clinic visits. Changes in total and current Sinonasogram scores were significantly correlated with changes in nasal polyp scores (P =. 004, P =. 002). Individual symptom scores best predicting nasal polyp size were nasal obstruction, hyposmia, and anterior rhinorrhea (P <. 001, P <. 001, P <. 001). Cronbach's alpha test for internal consistency was 0.8244 for current Sinonasogram score and 0.8878 for 4‐week Sinonasogram score.

Conclusions:

The Sinonasogram is a valid tool for monitoring nasal polyp symptoms and can predict changes in nasal polyp size. Symptoms that were found to be most associated with nasal polyps were nasal obstruction, hyposmia, and anterior rhinorrhea.