bluuebunny/crossref_metadata_2025 huggingface dataset:
The EarLens Photonic Transducer: Extended Bandwidth
Authors: Perkins Rodney C. , Fay Jonathan , Nilsson Michael J. , Puria Sunil , Levy Suzanne P. C.
Published: September 2011

Objective

Light pulses transmitted through the external auditory canal are captured by a photodetector on a tympanic membrane contact transducer creating a current, which activates a micro‐motor. The hypothesis that an extended bandwidth (10 kHz) contact transducer residing on the tympanic membrane will improve speech understanding in noise is tested.

Method

Reception thresholds of sentences (RTS) were measured with target speech at ‐45° and two talkers at +45°, simulating a photonic transducer on (1) normal and (2) hearing‐impaired subjects. HINT sentences and masking speech materials were recorded at 24‐kHz bandwidth and low‐pass filtered at 4, 6, 8, and 10 kHz.

Results

For normal hearing subjects (n = 12), the mean RTS was ‐17.4, ‐19.1, ‐19.3, and ‐20.7 dB for 4, 6, 8, and 10 kHz respectively. For hearing impaired subjects (n = 12), the RTS unaided full bandwidth was ‐10.0 dB and ‐10.0, ‐11.9, ‐12.2, and ‐12.4 dB for aided 4, 6, 8, and 10 kHz respectively. The results indicate significant improvements of 3.3 dB (P <. 001) in normal hearing and 2.4 dB (P =. 02) for hearing impaired subjects for the 10 kHz vs the 4 kHz bandwidths. Initial measurements with the IDE‐approved photonic hearing device are consistent with the simulation study.

Conclusion

The results suggest that acoustic cues above 4 kHz in a hearing device can greatly enhance the ability to hear target speech in noisy environments. This opens up possibilities for a unique hearing system using only light to transmit sound to vibrate the tympano‐ossicular system.
The Efficacy of a Vibrotactile Neurofeedback Training in Stance and Gait Conditions for the Treatment of Balance Deficits
Authors: Basta Dietmar , Ernst Arne
Published: September 2011

Objective

Conventional vestibular rehabilitation strategies mostly require a long lasting intensive training and are not successful in many patients. Newly developed neurofeedback training procedures seem to be more effective. The present study was aimed at investigating the efficacy of a new vibrotactile neurofeedback method for the treatment of vestibular disorders.

Method

One hundred and five patients with a peripheral or central vestibular disorder performed neurofeedback training in stance and gait tasks with the Vertiguard‐RT device (2 weeks, 10 min/d). The patients received a feedback signal at the hip in that direction, which showed a higher body sway than the preset threshold.

Results

The mean reduction of sway was 30.0% in pitch and 31.0% in roll direction. Significant improvements were also observed in platform stability measurements (composite score of the Sensory Organization Test) and in the Dizziness Handicap Inventory/Vertigo Symptom Scale. No significant changes occurred in the double blinded placebo group.

Conclusion

The present data shows that the vibrotactile neurofeedback method improves the balance in everyday‐life conditions significantly with minimal efforts for the patients. The method seems to be well suited for home or group training since the tasks are easy and all relevant values are stored in a small body‐worn device.
The Efficacy of Ear Canal Irrigations with Isopropyl Alcohol
Authors: Silverstein Herbert , Van Ess Mark J. , Wycherly Benjamin , Alameda Yadiel A.
Published: September 2011

Objective

To assess the efficacy and safety of 70% isopropyl alcohol (IPA) as a weekly irrigant to reduce cerumen accumulation, using a unique closed tip irrigator bottle.

Method

Prospective crossover study. Forty ears randomly divided into 2 groups. Group 1 instilled IPA weekly for 2 months, followed by 2 months of no cleaning. Group 2 did the opposite. Cerumen occlusion graded 0 to 4 (0%, 25%, 50%, 75%, 100%) followed by cerumenectomy at 0, 2, and 4 months.

Results

The mean grade at the initial evaluation in Group 1 was 3.1 (range, 2‐4) and in Group 2 was 3.3 (range, 3‐4) (P =. 33). After the first 2 months, there was a significant difference between those who used the IPA (Group 1) vs those who did not (Group 2) (P <. 0002). There was also a significant difference within both groups between using the IPA for 2 months and not cleaning for 2 months (P <. 02 Group 1, P <. 01 Group 2). All subjects tolerated IPA with no complaints or side effects, and there were no cases of canal irritation.

Conclusion

Weekly irrigation with 70% IPA is safe and reduces the accumulation of cerumen in the external auditory canal. Routine use of IPA may decrease the number of patient visits for cerumen related issues.
The New Baha Implant: A Prospective Osseointegration Study
Authors: D’Eredita Riccardo
Published: September 2011

Objective

Assess stability of a new design titanium implant (Cochlear Baha BI300) in bone anchored hearing aid (Baha) recipients over time in a prospective, nonrandomized, one‐group study at a tertiary care institution.

Method

Twelve patients who underwent one‐stage Baha surgery over 4 months have been analyzed. Implant stability was measured with Implant Stability Quotient (ISQ) measurement tests. Patients were tested at surgery and every week after, for 1 year. Two‐tailed Student test was calculated for all comparisons. P <. 05 was considered significant.

Results

The new implant showed a steep increase of ISQ values over the first 2 weeks and reached stable ISQ values 3 weeks after surgery. No significant difference on ISQ values was evident between children and adults. Complete healing time was obtained in 8 days on average (range, 7‐12 days; median, 7.6). Neither implant extrusion nor skin revision surgery was observed in our patients during the first year of follow‐up.

Conclusion

In our hands this new implant revealed stability and fast integration. The data from the present study suggest the new implant may be suitable for early loading protocols.
Maximum Extremes in Otolaryngology Resident Surgical Case Numbers
Authors: Rosenberg Tara L. , Franzese Christine B.
Published: September 2011

Objective

1) Understand the significance between the mean and maximum case numbers for surgical procedures among otolaryngology residents nationwide. 2) Understand potential weaknesses of the ACGME resident case log system and possible errors contributing to case inflation. 3) Understand when excessive case load transforms education into service.

Method

Retrospective review of otolaryngology resident national data reports from the ACGME resident case log system for 6 academic years (2004‐2010). Maximum, mean, and standard deviation about the mean for total number of cases and for specific surgical procedures were compared. Tracked CPT codes, “unbundling,” and mechanisms for data entry were reviewed.

Results

The total case numbers for residents graduating from 2005 to 2010 remained fairly constant and ranged from a mean of 1699.5 ± 424.2 in 2007 to 1772.2 ± 517 in 2010. The maximum value for total number of cases increased from 3559 in 2007 to 4857 in 2010, and these values surpass the mean by 5 to 6 standard deviations in most years. Comparison of case numbers for other procedures such as parotidectomy, thyroidectomy, mastoidectomy, and endoscopic sinonasal surgeries, among others, yielded similar results.

Conclusion

Large differences between mean and maximum case numbers for resident surgical procedures exist and are expanding. Educational benefit derived from such excessive case load, if accurate, is unclear. Critical examination of the ACGME resident case log system and investigation of resident case log documentation habits are needed to improve accuracy.
Visualization of Endolyphatic Hydrops in Patients with Ménière’s Disease by Locally Enhanced Inner Ear MRI: Correlation with Audiovestibular Function
Authors: Gürkov Robert , Louza Julia , Strupp Michael , Flatz Wilhelm , Krause Eike
Published: September 2011

Objective

The pathophysiologic role of endolymphatic hydrops in Ménière’s disease is still unresolved. The aim of this study was to determine whether the degree of endolymphatic hydrops as it is detected in vivo in patients with definite Ménière’s disease correlates with audiovestibular function.

Method

In this prospective study, 37 patients with definite Ménière’s disease were examined with intratympanic contrast enhanced temporal bone MRI. The degree of hydrops was then compared with hearing levels, SP/AP ratios, interaural amplitude ratios of vestibular evoked myogenic potentials and horizontal semicircular canal paresis.

Results

There was a significant correlation between the degree of hydrops on the one hand and the averaged hearing level at 0.25 to 1 kHz and 0.5 to 3 kHz (r = 0.71, P <. 01) and the vestibular evoked myogenic potential interaural amplitude ratio (r = ‐0.44, P <. 05) on the other hand. A trend toward a correlation was found between the hydrops and the caloric response; no correlation was found between the hydrops and the SP/AP ratio.

Conclusion

The degree of endolymphatic hydrops correlates with a progressive loss of auditory and sacculus function in patients with Ménière’s disease.
Water‐Soluble Coenzyme Q10 in Chronic Hearing Loss
Authors: Guastini Luca , Crippa Barbara , Mora Francesco , Salzano Francesco‐Antonio , Mora Renzo , Santomauro Valentina
Published: September 2011

Objective

Q‐TER is a multicomposite water‐soluble formulation of CoQ10; in particular, Q‐TER consists of a mixture of maltodextrin, acting as a carrier, of CoQ10 molecules of sucrester, which serves as bioactivator. The purpose of this study was to evaluate the efficiency of Q‐TER in subjects with chronic sensorineural hearing loss.

Method

A total of 80 patients affected by chronic sensorineural hearing loss were included. The patients were divided, at random, into 2 numerically equal groups (A and B). Group A underwent therapy with Q‐TER, 160 mg, once a day for 30 days; group B received placebo, once a day for 30 days.

Results

Before, at the end, and 6 months after the end of the treatment, all patients underwent: pure tone audiometry, transient evoked otoacoustic emissions (TEAOE) and otoacoustic products of distortion (DPOAE), auditory brainstem response and speech audiometry. Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant (P <. 05) improvement of the audiometric thresholds at the 1.000, 2.000, 4.000, and 8.000 Hz. This improvement was confirmed by the data obtained with the speech audiometry and in the last check. We found no significant differences in the others parameters and in group B.

Conclusion

It is quite early to be enthusiastic. There must be more studies with controlled results. However, this kind of therapy for chronic hearing loss seems to be interesting, especially to stop hearing decay. It is also remarkable that good results are found one month after the beginning of the treatment.
Anatomic Variants on Congenital Computed Tomography in Congential Aural Atresia
Authors: Dedhia Kavita , Egloff Ann Marie , Branstetter Barton , Yellon Robert F.
Published: September 2011

Objective

Report incidence of anatomic variants in temporal bone CT scans with congenital aural atresia (CAA) or external auditory canal stenosis (EACS). Anatomic variants include: inferiorly displaced tegmen, malleus/incus complex (MIC) directly lateral to stapes, facial nerve obstruction at oval window (OW) and middle ear, middle ear area, incudostapedial (IS) joint angle.

Method

Prospective anatomic study of 134 CT scans (102 children, 32 bilateral) of CAA/EACS, graded by a blinded neuroradiologist. Both Jahrsdoerfer and absence or presence of new/refined anatomic considerations were graded. There were 32 atresiaplasty and 70 nonsurgical patients. Surgical and audiological data were reviewed retrospectively for anatomic correlations related to outcomes.

Results

Prevalence of anatomical variants: inferiorly displaced tegmen X (X%), MIC directly lateral to stapes Y (Y%), facial nerve obstructed access to oval window Z (Z%), and middle ear B (B%). Large MIC obstructing stapes access (5/7 patients) with increased intra‐operative difficulty. Mean middle ear area DD (range, 0.07 to 0.86mm2) and mean IS joint angle FF (range, 50°‐147°). Trend toward improved outcomes with: normal tegmen, facial nerve favorable to OW, or non‐obstructing MIC. No statistically significant clinical correlations for anatomic factors including Jahrsdoerfer grading.

Conclusion

Large obstructing MIC increases the difficulty of atresiaplasty. There is a trend showing improved outcomes with normal tegmen, facial nerve favorable to oval window, or nonobstructing MIC. A larger atresiaplasty cohort is needed since the number of cases was insufficient to demonstrate statistical significance. Nonetheless, the frequency of these new/refined anatomic variants has been more clearly delineated. The presence of these anatomic variants may possibly influence the decision for or against atresiaplasty.
Free Tissue Transfer for Cranio‐orbitofacial Defects
Authors: William John Caroline M. , Schaheen Basil , Krein Howard , Curry Joseph , Heffelfinger Ryan
Published: September 2011

Objective

1) Examine the outcomes and complications from a single institution experience with free tissue transfer for craniofacial defects involving the orbit. 2) Discuss an algorithm for free flap reconstruction of the orbit and peri‐orbital structures.

Method

A review of 42 patients who underwent free flap reconstruction for orbital or peri‐orbital defects between September 2006 and January 2011 was performed at a tertiary care facility. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow‐up.

Results

Forty‐four cases were identified; thirty‐five required orbital exenteration. Periorbital defects included those resulting from significant soft tissue or bony removal from the midface, scalp, or skullbase. We present an algorithm for management of such defects. Free flaps used included anterolateral thigh (31), radial forearm (10), latissimus (2), and rectus abdominus (1). Additional reconstructive techniques were performed concurrently in 23 cases, and 4 patients required revision procedures. Fifteen (36%) patients experienced a complication with flap loss occurring in 2 (4.8%). Mean hospital stay and duration of follow‐up were 9.9 days and 13 months, respectively.

Conclusion

Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The anterolateral thigh provides a versatile option to reconstruct the many cranio‐orbitofacial defects encountered.
Outcomes of Balloon Dilation of Pediatric Subglottic Stenosis
Authors: Howell Rebecca Jackson , Whigham Amy S. , Zalzal George H. , Pena Maria T. , Choi Sukgi S. , Preciado Diego A.
Published: September 2011

Objective

1) Report outcomes of balloon dilation in the endoscopic management of pediatric SGS. 2) Determine the role of balloon dilation in both primary vs adjuvant therapy.

Method

Retrospective review of treatment with noncompliant, high‐pressure balloons for SGS in the past 2 years at a tertiary pediatric hospital. Fifty‐one dilations in 28 children with SGS were performed. Mean age was 39.2 months. Mean SGS grade was 2.40.

Results

Overall, 18 (64.2%) had successful balloon treatment. Fifteen children had primary and 13 had secondary balloon dilation. Those with primary, 10 (66.6%), were able to avoid open reconstruction/tracheotomy, and 5 were temporized (36 days average) until definitive open reconstruction. Those with secondary, 9 (69.2%), were able to decannulate. Eight of 10 failed balloon dilations had concomitant airway pathologies, compared with only 6 of 12 where treatment was successful (P =. 02). There was no statistical association in successful vs failed treatment by age (49.6 vs 29.3, P =. 43), degree of stenosis (2.39 vs 2.60, P =. 41), presence of lung disease (33.3% vs 70%, P =. 07) or soft nature of stenosis (61.1% vs 40%, P =. 28).

Conclusion

Balloon dilation plays an important role in the primary or adjuvant management of pediatric SGS. Presence of concomitant airway lesions is significantly associated with balloon dilation treatment failure. Meticulous surveillance of the dilated airway is necessary given this failure rate.
Patient and Family Satisfaction in a Pediatric Otolaryngology Clinic
Authors: Zopf David A. , Thorne Marc C.
Published: September 2011

Objective

Identify factors related to patient and family satisfaction in an academic pediatric otolaryngology clinic. Suggest strategies to improve patient and family satisfaction in this setting.

Method

Review of an ongoing continuous quality improvement (CQI) effort. Patients/families were surveyed following each visit between May and December 2010. Linear and multiple linear regression were used to evaluate relationships between wait times in the reception area and examination room, assessment of the provider, and clinic volume with overall satisfaction.

Results

During the study interval, 754 clinical encounters in the pediatric otolaryngology clinic resulted in 528 responses for a response rate of 70%. Linear regression showed a significant relationship between each of the independent variables and overall satisfaction, with the greatest variance in overall satisfaction explained by satisfaction with the provider, followed by wait time in the examination room, wait time in the reception area, and clinic volume (r2 0.53, 35, 26,. 01, respectively). Multiple linear regression showed that clinic volume was not associated with overall satisfaction independent of the other variables.

Conclusion

Variations in satisfaction with the provider accounted for the greatest amount of variance in overall satisfaction. The identification that variation in examination room wait times explained a larger portion of the variance in overall satisfaction has led to efforts to minimize this aspect of the patient and family experience.
Pediatric Diadochokinetic Rates: Establishing a Normative Database
Authors: Maturo Stephen C. , Hill Courtney , Hartnick Christopher J. , Bunting Glenn
Published: September 2011

Objective

1) Establish the first comprehensive pediatric normative database for diadochokinetic rates (DDK) using the Voice Evaluation Suite, a computerized voice analysis program. 2) Analyze normal DDK rates for age and gender differences.

Method

Observational design analyzing DDK rates on 335 children ages 4 to 18 years with normal voices. Data was collected over a 6‐month period from July to December 2010 in a pediatric otolaryngology clinic. Main outcome measures included age, gender, Pediatric Voice Related Quality of Life screening, and DDK rates.

Results

The mean DDK rates of each age and gender are presented. There was no statistically significant difference between boys and girls of the same age (P <. 05). There was a statistically significant difference in children ages 4 to 11 years when compared with children ages 12 to 18 years (P <. 001).

Conclusion

Pediatric DDK rate is similar between boys and girls of the same age. Faster DDK rates are seen in children over 12 years of age, regardless of gender, when compared with those children younger than 12 years. The normative data presented represents the most comprehensive DDK database in the English language.
Predictors of Tonsillectomy after Previous Adenoidectomy for Upper Airway Obstruction
Authors: GovAri Eliav , Mills Jonathan , Basler Keith
Published: September 2011

Objective

1) Characterize risk factors for subsequent tonsillectomy in pediatric patients undergoing primary adenoidectomy for upper airway obstruction.2) Compare rates of subsequent tonsillectomy between adenoidectomy patients with and without upper airway obstruction.

Method

A retrospective cohort of patients undergoing adenoidectomy without tonsillectomy at the University of Missouri between 1995 and 2010 was examined using billing records and selected chart review. A nested case‐control study with detailed chart review was then conducted to determine predictors of subsequent tonsillectomy in patients with upper airway obstruction.

Results

Of 1291 patients identified in the retrospective cohort, 7.8% later underwent tonsillectomy. Using a fitted multiple logistic regression model, age less than 3 years (P =. 027), female sex (P <. 0001), and upper airway obstruction (P =. 001) were all found to be significant predictors of subsequent tonsillectomy. In the nested case‐control study, potential predictors investigated included adenoidectomy indications, symptoms, smoke exposure, weight, comorbidities, and adenoid and tonsil size at the time of adenoidectomy. Of these, only tonsil size was significant, with each increase in size of 1 (eg, from 2+ to 3+) associated with an increased odds of future tonsillectomy of 2.5 (P =. 01).

Conclusion

Patients undergoing adenoidectomy for upper airway obstruction are at increased risk of subsequent tonsillectomy when compared with those with other indications. Within this subgroup of patients with upper airway obstruction, young age, female sex, and large tonsil size may further increase the risk of subsequent tonsillectomy after previous adenoidectomy.
Socioeconomic Factors in Pediatric Neck Abscesses
Authors: Johnson Romaine F. , Jiang Zi Yang
Published: September 2011

Objective

Socioeconomic status has been associated with increased risk of developing some infectious diseases. Our objective was to study the relationship of socioeconomic status in children with neck abscesses to see if potentially a similar relationship exists.

Method

We studied a population of children with neck abscesses at a tertiary care pediatric hospital in Dallas, Texas. The patients’ demographic, clinical, and economic data were analyzed to see if socioeconomic status was different when compared to Texas and US averages. Controls for population and hospital averages were instituted.

Results

200 children with cervical neck abscesses were analyzed. The median household income of the cohort was calculated to be less than US and Texas averages based on US census data. Forty‐eight percent were enrolled in Medicaid at the time of presentation. Twenty‐one percent were uninsured or self‐payers. These proportions were higher when compared with the United States and the state of Texas, although in line with the hospital’s payer mix. The rate of pre‐admission antibiotic usage and duration of illness before seeking treatment did not vary significantly among the patients studied.

Conclusion

Children with neck abscesses in this cohort tended to live in areas with lower household incomes. The payer mix was different when compared with the US and Texas but not the study hospital. Insurance status did differ in initial medical care choice (PCP vs ER) but not overall outcomes.
Treatment of Pediatric Obstructive Sleep Apnea beyond Tonsillectomy and Adenoidectomy
Authors: Friedman Michael , Maley Alex , Taylor David , Kelley Kanwar , Pearson‐Chauhan Kristine , Hoehne Colleen
Published: September 2011

Objective

1) Compare the efficacy of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone in the treatment of pediatric OSAHS. 2) Compare the morbidity of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone.

Method

Randomized single‐blind controlled study of 60 pediatric patients treated between January 2009 to January 2010 at a tertiary care center. Patients were randomized into 2 groups: adenotonsillectomy alone (group I) and adenotonsillectomy with pharyngoplasty (group II). Endpoints included: pre‐ and postsurgical AHI, number of cures, pain levels, and change in OSA‐18.

Results

Sixty patients were enrolled and 52 patients completed the study (group I n = 27, group II n = 25). The mean age, BMI, and baseline AHI did not differ significantly between the two groups. The change in AHI from pre‐ to postsurgery was not found to be significant between the 2 groups (P =. 337). No significant differences were found in the number of cures (P =. 709). There was no significant difference between groups for OSA‐18 score (P =. 478). Pain outcomes measured on postoperative days 1 to 7 using VAS did not reveal a significant difference in pain levels.

Conclusion

With short‐term follow‐up, the addition of pillar closure to traditional adenotonsillectomy did not significantly improve sleep parameters as measured by polysomnogram or in quality of life as measured using the OSA‐18. It is unknown if pharyngoplasty will have long‐term benefits in preventing progression of OSA.
Viral Profile in Chronic Adenotonsillar Diseases
Authors: Anselmo‐Lima Wilma T. , Arruda Eurico , Paula Flavia , Tamashiro Edwin , Proenca‐Modena Jose Luis , Valera Fabiana C. P. , Buzatto Guilherme P.
Published: September 2011

Objective

Although there is a known role of virus in acute upper respiratory infections, few studies have explored the relationship between chronic diseases of Waldeyer’s ring and viral infections. This study aimed to analyze the presence of the main respiratory viruses in patients with chronic adenotonsillar diseases.

Method

Nasal lavage and peripheral blood from 60 children with chronic adenotonsillitis or adenotonsillar hypertrophy were analyzed by RT‐PCR for bocavirus, adenovirus, rhinovirus 1 and 2, enterovirus, respiratory syncytial virus, parainfluenza virus type 1 and 3, influenza virus A and B, and human coronavirus.

Results

Virus infection was found in 66% of nasal lavage samples (40/60). The most prevalent virus was adenovirus (33.3%), followed by rhinovirus (30%), bocavirus (10%), enterovirus (8.3%), respiratory syncitial virus (5%), and influenza virus (5%). Parainfluenza virus and coronavirus were not detected in any sample. Co‐infection was present in 24% of patients (14/60), especially adenovirus (9/14) and bocavirus (8/14). In peripheral blood, none of the patients had virus genome detected.

Conclusion

The high prevalence of local genomic viruses in chronic adenotonsillar diseases may reflect a tissue persistence or virus latency, and may be an important etiology that could trigger inflammatory mechanisms involved in chronic diseases of the Waldeyer’s ring.
A Blinded Randomized Controlled Trial on the Efficacy of Postsurgical Debridement of Sinus Cavities on Wound Healing following Endoscopic Sinus Surgery
Authors: Naidoo Yuresh , Wen David , Pow Vincent , Wormald Peter J.
Published: September 2011

Objective

Ascertain whether early debridement, with its related costs and patient discomfort, limits adhesion formation as evaluated by a blinded observer, via video‐endoscopy at 3 months post‐surgery.

Method

A blinded RCT of patients undergoing primary bilateral sinus surgery at a tertiary referral hospital. One side of the nose was randomized to receive debridement postoperatively. The sinus cavities were videotaped at 3 months, and 2 surgeons blindly evaluated each side.

Results

No significant difference in the 2 sides was found in terms of adhesion and patency rates.

Conclusion

Regular and frequent debridement following sinus surgery might not be as crucial as previously thought to prevent adhesion formation and improve wound healing. However, removal of crusting does seem to improve patients perception of malodor and nasal obstruction in the immediate postoperative period.
Antimicrobial Activity of SinuSurf
Authors: Adappa Nithin D. , Kofonow Jennifer
Published: September 2011

Objective

1) Determine the antimicrobial potential of a novel topical sinonasal surfactant, SinuSurf. 2) Evaluate whether the addition of SinuSurf™ with mupirocin or gentamicin creates an additive/synergistic effect on recalcitrant chronic rhinosinusitis (CRS) pathogens such as methicillin‐resistant Staphylococcus aureus (MRSA) and Pseudomonas aurginosa (PA).

Method

MRSA and PA01 cultures were grown in 96‐well plates containing 10‐fold serial dilutions of mupirocin (1x = 150ug/ml) or gentamicin(1x = 80ug/ml), diluted in normal saline with or without the addition of SinuSurf. Colony forming units (CFUs) were determined 20 hours later.

Results

In the absence of antibiotics, SinuSurf evinced a 6 log reduction in CFUs for PA and 3 log reduction for MRSA. At the clinically used concentrations of respective antibiotics (80 ug/ml gentamicin, 150 ug/ml mupiricin) no growth was evident. In combination with SinuSurf, mupirocin at 1:10 dilution demonstrates complete eradication not seen with mupiricin alone. Similarly, SinuSurf in conjunction with gentamicin at 1:100 dilution demonstrates no growth while gentamicin alone at that dilution yielded growth. Furthermore, addition of SinuSurf resulted in a 5 log reduction in CFUs at a 1:100 dilution of mupirocin and 1:1000 dilution of gentamicin.

Conclusion

Bacterial biofilms have recently been demonstrated in the sinonasal cavities of CRS patients and implicated in recalcitrant disease. Bacteria in the biofilm state require 100X to 1000X concentrations of antibiotics for effective therapy. Our data demonstrate the addition of SinuSurf increases the effective in vitro concentration of antibiotics significantly.
Characterization of Bacterial Community Diversity in Chronic Rhinosinusitis Infections Using Novel Culture‐Independent Techniques
Authors: Salib Rami , Stressman Franziska A. , Bruce Kenneth , Chan Samuel , Harries Philip G. , Howarth Peter , Rogers Geraint B.
Published: September 2011

Objective

Chronic rhinosinusitis (CRS) is a common condition involving a microbial component. Only a small fraction of the total range of bacterial species present in CRS is detected through conventional culture‐dependent techniques. We aimed to characterize the bacterial diversity in CRS samples using the novel molecular technique TRFLP.

Method

Through 16S ribosomal RNA (rRNA) gene clone sequencing and Terminal Restriction Fragment Length Polymorphism (TRFLP) analysis, the bacteria present in 70 clinical samples from 43 CRS patients undergoing endoscopic sinus surgery were characterized.

Results

Bacterial TRFLP profiles were generated for 70 from 73 samples, and a total of 48 separate bands were detected. Species belonging to 34 genera were identified as present by clone sequence analysis. Of the species detected, those within the genera Pseudomonas, Citrobacter, Haemophilus, Propionibacterium, Staphylococcus, and Streptococcus were found to be numerically dominant, with Pseudomonas aeruginosa being the most frequently detected species.

Conclusion

This study has validated the use of the culture‐independent molecular technique TRFLP in sinonasal samples. Preliminary characterization of the microbial diversity in CRS suggests a complex range of common and novel bacterial species within the upper airway in CRS, providing further evidence for the polymicrobial etiology of this disease.
Chitosan Packing for Epistaxis in Coagulopathy Set‐up
Authors: Shikani Alan H. , Al‐Qudah Mohannad A. , Kourelis Konstantinos G.
Published: September 2011

Objective

The management of refractory epistaxis in the context of coagulation disorders can be challenging for the physician and agonizing for the patient. This study investigates the efficacy of chitosan, a hemostatic polysaccharide that forms a coherent seal when it comes in contact with red blood cells, on these difficult‐to‐treat cases.

Method

The study population comprised 35 patients with bleeding diathesis (warfarin administration in 10 cases, antiplatelets in 18, both anticoagulants in 6, thrombocytopenia in 1) and persistent epistaxis despite aggressive tamponade. Treatment consisted of outpatient placement of a light packing with chitosan dressing supported by a polyvinyl acetal sponge for 48 hours.

Results

Immediate control of epistaxis was successfully achieved on an outpatient basis in 32 patients (91%) within a mean time of 3.5 minutes. Three patients (9%) continued to bleed despite the chitosan pack and required further treatment (two had repacking and one had electro‐coagulation of the spheno‐palatine artery). Upon packing removal, mild self‐limited sero‐sanguinous oozing was noted in 17 cases (48%). On the 1‐week follow‐up, no rebleeding was reported.

Conclusion

Chitosan‐based nasal packing is an effective outpatient method for the management of refractory epistaxis in the setting of coagulopathy due to its unique hemostatic properties, which are independent of clotting factors and/or platelets.
Do Nasal Muscles Really Work during Nasal Breathing?
Authors: Bettega Silvio , Bettega Marcelo
Published: September 2011

Objective

Determine the role of nasal muscle function in healthy patients and patients with nasal septum deviation who underwent surgical treatment.

Method

Forty‐five patients were divided into 2 groups: Group A (n = 16), with no septum deviation and no nasal obstruction; Group B (n = 29), with both. Electromyographic (EMG) activities of nasal muscles were evaluated. Group A was the control, and Group B underwent surgery. Patients were evaluated before and after surgery.

Results

No abnormal finding was found in any of the nasal muscles of the control group. There was less EMG activity during normal breathing compared with forced breathing in both groups. In group B, there was a decrease in EMG activity 30 days after surgery (33.17% on normal breathing and 49.04% on forced breathing) as well as 90 days after surgery (27.21% on normal breathing and 36.14% on forced breathing).

Conclusion

The decrease in electromyographic activities of nasal muscles after removal of an obstructive factor as septum deviation, correlates with the hypothesis that nasal muscles are important during nasal breathing.
Intraoral Approach to Chin Augmentation
Authors: Aynehchi Behrad B. , Parhiscar Afshin , Burstein David H.
Published: September 2011

Objective

Silicone augmentation mentoplasty is a common procedure with consistent results in properly selected patients. While many plastic surgeons employ external approachs, the intraoral method affords acceptable aesthetic outcomes while avoiding an external scar. To date, a series of this magnitude involving the intraoral route has yet to be reported.

Method

A total of 125 patients underwent chin augmentation with silicone implants between 2004 and 2010. Among these implants, 105 were placed transorally. 85 patients were followed for at least one year. Demographic information, indications, patient satisfaction questionnaire results, and complications were recorded.

Results

All implants yielded satisfactory results with no displacement, infection, tissue reaction, lower lip incompetence, or mental nerve injury. In addition, no intraoral contamination of implants occured. Two cases of superficial mucosal irritation at suture sites were observed and resolved without consequence. Symmetry, projection, and overall balance of facial components were excellent as well. Although all patients were satisfied with the functional and aesthetic results, 20% stated they would like further augmentation. Patients were extremely satisfied with the lack of an external scar.

Conclusion

Silicone augmentation mentoplasty is a relatively simple, reliable, and aesthetically pleasing procedure associated with minimal morbidity. Based on our series, with the avoidance of excessively large implants, the intraoral technique is recommended for its lack of complications and circumvention of an external scar.
Effects of Anatomy and Particle Size on Nasal Sprays
Authors: Frank Dennis , Pawar Sachin , Rhee John S. , Kimbell Julia S.
Published: September 2011

Objective

Compare spray penetration past the nasal valve (NV) predicted for particle sizes at varying spray speeds using a computational fluid dynamics (CFD) model of the human nasal cavity with septal deviation on the left side and inferior turbinate hypertrophy on the right.

Method

Simulations using Fluent (ANSYS, Inc, Lebanon, New Hampshire) were carried out for 10 µm, 20 µm, 50 µm, or particle sizes following a Rosin Rammler Particle Size Distribution (RRPSD) ranging from 10‐110µm. Spray speed was 1 m/s, 3 m/s, or 10 m/s; steady state inspiratory airflow rate was 15.7 L/min.

Results

Simulations predicted at least 2 times higher NV penetration on the right side (hypertrophic turbinate) than the left (septal deviation) for most particle sizes and spray speeds. Simulated penetration of 10 µm particles at 1 m/s was 100% with none escaping via the nasopharynx. At 3 and 10 m/s, more simulated 10µm particles escaped the nose than other sizes. Maximum penetration of RRPSD, 20µm, and 50µm particles was predicted to be 15%, 35%, and 12% on the left side, and 52%, 58%, and 56% on the right, respectively, occurring at 1m/s for RRPSD and 50 µm, and 3 m/s for 20 µm.

Conclusion

In the presence of a septal deviation, sprays containing 10 µm particles may have better penetration past the NV. Additionally, increasing spray speed (above 3m/s) appears to limit spray penetration, suggesting that patients should be discouraged from spraying medications forcefully, as this could limit penetration of the drug.
Evolution of the Draf III Procedure: Mucosal Grafting Technique
Authors: Conger Bryant T. , Riley Kristen , Woodworth Bradford A.
Published: September 2011

Objective

The Draf III procedure is an advanced surgical option for frontal sinus disease refractory to endoscopic frontal sinustomy and also delineates the anterior limit of skull base tumors during endoscopic resection. Our objective was to evaluate outcomes of a novel strategy utilizing mucosal grafts to decrease postoperative closure.

Method

Patients with frontal sinus pathology requiring a Draf III procedure were prospectively enrolled in the study. Demographics, reason for the procedure, percent graft viability, and complications were recorded. The primary outcome measure was anterior‐posterior (AP) diameter at 3 months.

Results

Mucosal grafting technique was performed during 19 Draf III procedures from August 2008 to November 2010. Seventeen patients (average age 54 years) were available for endoscopic measurement at 3 months with an average postoperative follow‐up of 13.5 months (4‐24). Reasons for the procedure included tumor (n = 9), frontal ostium stenosis (n = 7), and trauma (n = 1). Fourteen patients (83%) had complete mucosal graft viability. Average intraoperative AP diameter was 12.3 mm. All patients maintained a patent combined frontal sinus ostium for the duration of follow‐up with an average diameter of 10.9 mm at 3 months and no closure >25% of intraoperative size.

Conclusion

Cicatricial stenosis and osteoneogenesis are common following the Draf III procedure in up to 50% of individuals. The present study demonstrated that the mucosal grafting technique decreases Draf III stenosis when compared with historical series and should be considered a routine strategy for preventing postoperative closure.
Intracranial Abscess from Acute Sinusitis without Craniotomy
Authors: Crozier Emily E. , Brenski Amy C. , McClay John E.
Published: September 2011

Objective

To evaluate the success of treatment of intracranial abscess occurring from acute sinus disease without utilizing craniotomy.

Method

Retrospective chart review based at a tertiarty care children’s medical center. Children were evaluated from 1995 to 2010 with intracranial abscess formation from acute sinusitis. The main outcome measures were treatment modalities for acute intracranial and sinus disease.

Results

Twenty‐five children were evaluated from 1995 to 2010 with acute sinusitis resulting in brain abscesses. Over the first 10 years, 15 were treated successfully with an intracranial procedure and sinus surgery. Over the past 5 years, 10 cases of intracranial abscess were encountered, with 5 out of 10 treated successfully without the need for craniotomy. 4 out of 5 had small epidural abscesses treated with endoscopic sinus surgery and intravenous antibiotic, and 1 out of 5 had a small epidural and subdural abscess treated with medical therapy alone.

Conclusion

Medical management of intracranial abscess along with medical or surgical treatment of acute sinusitis may be a viable option for certain children with small epidural abscesses caused by acute sinusitis.
Management of Refractory Nasal Polyposis in Samter’s Triad
Authors: Shikani Alan H. , Basaraba Randall , Kourelis Konstantinos G. , Leid Jeff G.
Published: September 2011

Objective

Rhinosinusitis and polyposis in Samter triad is difficult to treat, commonly recurring despite sinus surgery, antibiotics, and/or nasal steroids. Systemic steroids are limited by side effects. The present study assesses the efficacy of a gel placed into the sinuses, releasing steroids and antibiotics, along with topical nebulization of the same medications.

Method

Ten Samter patients with recurrent rhinosinusitis after sinus surgery received weekly intra‐sinus placement of a hydroxycellulose gel‐releasing mometasone and antibiotics, along with endoscopic sinus debridement, for 6 weeks. Outcome was evaluated by Lund‐Kennedy (LK) endoscopic and symptom scales immediately, 3 weeks, 6 weeks, and 10 weeks after the beginning of the protocol.

Results

Both LK symptoms and endoscopic scores showed a progressive and statistically significant decline throughout the course of therapy, reaching at the end of treatment 56% (P =. 003) and 59% (P =. 004) improvement of pretreatment values, respectively. At 1 month posttreatment, mild relapse was noted.

Conclusion

A topical membrane therapy regimen consisting of gel‐releasing corticosteroids and antibiotics, along with topically nebulized corticosteroids and antibiotics, regular saline hydrotherapy, and sinus debridement, improves symptoms and endoscopic findings in recurrent Samter sinonasal polyposis.
Novel Irradiated Axial Rotational Flap Model in the Rodent
Authors: Luginbuhl Adam , Pribitkin Edmund A. , Curry Joseph , HeffelfingerModest Ryan , Modest Mara C.
Published: September 2011

Objective

Create a local flap model in the rodent mimicking the rotational flaps used in head and neck reconstruction, secondarily to see if irradiation of this model will result in flap failure and necrosis.

Method

A 3 × 8 cm flap was designed over the right side of the abdomen pedicled off of the inferior epigastric. Left side of the abdomen a 3 × 8 cm defect at 60 degrees from midline was created and the flap was inset. On POD #7 area of necrosis was analyzed.

Results

Eight rats were irradiated with 40 gy in 4 divided doses over 8 days. Field of radiation was restricted to an 8 × 10 cm across the abdomen. One month elapsed for the irradiated group prior to surgery. The control group consisted of 5 rats without radiation. Seven rats in the radiation group completed the study. One rat was sacrificed because of self‐mutilation after surgery. Four out of 7 (57%) rats in the irradiated group had necrosis of the distal flap ranging from 1 to 6 cm from the distal edge. No necrosis was seen in the control group. Histology revealed collagen and vascular changes in the irradiated skin.

Conclusion

The irradiated rat model of an axial rotational flap is consistent with what is seen in previously irradiated patients that develop skin necrosis after reconstruction with local rotational flaps.
Outcomes of a Novel Titanium Nasal Implant for Nasal Valve Dysfunction
Authors: Cunningham Aileen , Fayad George G.
Published: September 2011

Objective

1) Analyze an initial cohort of UK patients undergoing surgery for nasal valve dysfunction with a novel titanium nasal implant, the Breathe‐Implant à Wengen. 2) Assess surgical outcomes, operative complications, subjective symptom improvement, and patient satisfaction with this new procedure in order to improve current practice and inform future patients.

Method

Retrospective case note evaluation collated demographic details, indications, examination findings, imaging reports, operative details, length of follow‐up, surgical outcomes, and complications. Patients were contacted by telephone to complete a postoperative symptom evaluation questionnaire consisting of 4 procedure specific questions and a modified Glasgow Benefit Inventory (GBI) consisting of 11 questions.

Results

Twenty‐three patients underwent the procedure since 2009. Seventeen patients had nasal obstruction as the primary indication for surgery. Mean follow‐up 3.6 months (range, 1‐9 months). One patient had persistent postoperative nasal obstruction requiring further surgery. A total of 18 patients completed the questionnaire. Patient evaluation of postoperative nasal obstruction was found to be mean score of 1.5 (scale of 0 = no obstruction and 10 = complete nasal obstruction). Cosmetic appearance following insertion of the implant was reported as worse in 8 patients. A total of 72% reported that they would undergo the procedure again, and 83% felt that the operation made their overall life better.

Conclusion

This unit is the first in the UK to use this device for nasal valve dysfunction. Our preliminary outcome data has found low complication rates and high patient satisfaction with improved symptoms and quality of life. However, cosmetic outcomes are an important issue to discuss with all potential Breathe‐Implant patients.
Prevalence of Rhinovirus RNA in Patients with Chronic Rhinosinusitis
Authors: Valera Fabiana , Arruda Eurico , Paula Flavia , Tamashiro Edwin , Anselmo‐Lima Wilma T. , Proenca‐Modena Jose L.
Published: September 2011

Objective

The real impact of virus infection in the perpetuation of chronic rhinosinusitis (CRSsNP) and nasal polyps (CRSwNP) is still to be established. The purpose of this study was to evaluate the prevalence of rhinovirus RNA in nasal lavage from patients with CRSwNP and CRSsNP, without acute exacerbations.

Method

Nasal and sinusal (maxillary) lavages were collected from a total of 36 patients with CRSwNP and CRSsNP, during ESS procedure, from July 2008 to August 2010. The RNA of human rhinovirus was evaluated through RT‐qPCR using TaqMan primers specific to human rhinovirus sp.

Results

Rhinovirus RNAs were found in 19 (51.35%) of the samples. Correlation between nasal and sinusal lavages was of 61%. There was no correlation between rhinovirus prevalence and seasonality. Rhinovirus was present in 6 out of 13 samples of CRSsNP (46%) and 12 out of 23 samples of CRSwNP (52%). Lund Mackay score ranged from 2 to 8 (mean 4.4) among CRSsNP patients and from 8 to 24 (mean 14) among CRSwNP patients. Mean Lund‐Mackay score was similar between patients with or without rhinovirus, both for CRSwNP (16.9 vs 17.3, respectively) and CRSsNP (5.4 vs 3.5, respectively).

Conclusion

There is a very high prevalence of rhinovirus RNA in nasal lavages from patients with CRSsNP and CRSwNP.
Prognostic Factors Associated with Revision Surgery in Allergic Fungal Sinusitis
Authors: Wang Eric W. , Crosby Brittany , Carroll William R. , Schlosser Rodney J. , Nguyen Shaun A.
Published: September 2011

Objective

1) Examine the efficacy of FESS combined with aggressive postoperative medical management in the treatment of allergic fungal sinusitis (AFS). 2) Determine prognostic factors associated with disease recurrence and the need for subsequent revision surgery in a population of AFS patients.

Method

A retrospective case control study examined demographic and disease‐related characteristics and adjuvant therapies in patients undergoing combined surgical and medical treatment of AFS in a single tertiary academic center. Exclusion criteria included follow‐up of less than 6 months. The dependent variable was revision surgery. Average follow‐up was 29.4 months.

Results

Eighty consecutive AFS patients from 2002 to 2009 were identified and 62 patients did not require revision surgery (78%).

Conclusion

AFS can be effectively controlled with multimodality therapy. Compliance with postoperative medical therapy and topical steroid use are prognostic factors associated with treatment success, decreasing the rate of revision surgery to 13%. African‐American race and prior surgeries are prognostic factors associated with revision surgery, suggesting more aggressive disease.