bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Revision Adenoidectomy Rates by Technique
Authors: Sapthavee Andrew , Billings Kathleen , Penn Edward
Published: February 2015

Objective

No studies are available comparing revision adenoidectomy rates between patients who underwent suction coagulator or powered‐shaver (microdebrider) techniques at their initial surgery. Our objective is to compare revision adenoidectomy rates between these 2 instrument groups. This information may be able to guide technique selection and assist training resident otolaryngologists.

Method

This study is a retrospective chart review of patients who underwent revision adenoidectomy at Children’s Memorial Hospital in Chicago, Illinois, from June 2007 through December 2011. The patients were divided into 2 groups based on technique of adenoidectomy used at the time of initial surgery, and the regrowth rate analyzed.

Results

During the 4.5‐year study period, 7399 adenoidectomies or adenotonsillectomies were performed. A total of 94 revisions were performed (1.27%). Microdebrider was used in 4071 adenoidectomies, and the remaining 3328 cases were performed with mainly electrocautery, and less often curette or coblator. Total revisions done with the microdebrider at initial surgery during the time period was 33 (0.81%). Total revisions done with the suction bovie at initial surgery was 46 (at least 1.38%). The mean age at presentation for primary adenoidectomy was 2.85 years. The average interval until revision adenoidectomy was 29 months. These data will be further analyzed statistically.

Conclusion

Symptomatic regrowth of adenoid tissue is rare. There was a trend toward a lower rate of adenoid regrowth requiring revision surgery in those who underwent microdebrider versus suction bovie adenoidectomy initially. Revision adenoidectomy occurs at a rate of 1.3% overall, while the revision rate with the microdebrider technique is 0.8%.
Adenotonsillar Surgery and Guidelines in Italy
Authors: Motta Gaetano , Testa Domenico , Spadera Lucrezia , Landolfo Pasquale Gianluca , Massimilla Eva Aurora , Motta Sergio
Published: February 2015

Objective

1) Ascertain the impact that guidelines on (adeno)‐tonsillectomy have had on the clinical behavior of ENT specialists in Italy. 2) Evaluate the indications—inclusion criteria—for adeno‐tonsillar surgery in children, adopted by ENT specialists, particularly referring to comorbidities.

Method

A multicentric study including 14770 children undergoing (adeno)‐tonsillectomy in 2002, 2004, 2006, and 2008 was conducted in 14 Italian otorhinolaryngological units. Data regarding indications and surgical procedures were gathered using a predesigned questionnaire and elaborated with analysis of variance, taking P value <.05 as the threshold for statistical significance.

Results

Over the 4‐year study period, the incidence of the analyzed interventions did not significantly change (P value >.05), with adenotonsillectomy comprising the most commonly performed (64.1%). No significant variations in the indications for these operations were observed, except for adenotonsillectomy in children having 5 or more feverish episodes in the preceding year without nasal obstruction (decreased: P =. 010). The coexistence of feverish episodes and nasal obstruction was the most frequent surgical indication (65.2%). We also found a high preoperative incidence of middle ear inflammations (43.3%), recovered or improved persistently in 88.5% of the cases after surgery.

Conclusion

Italian guidelines were not implemented by ENT units involved in the survey; in most cases the indications for adeno‐tonsillectomy are based on the overall clinical presentation rather than on a single symptom. The need to review the Italian guidelines is evident.
Characteristics of Patients Undergoing Supraglottoplasty
Authors: Garritano Frank G. , Carr Michele M.
Published: February 2015

Objective

1) To examine the characteristics of patients undergoing supraglottoplasty for the treatment of laryngomalacia. 2) To better understand the features of laryngomalacia that may predispose patients to the need for future supraglottoplasty.

Method

Retrospective case series evaluating patients who underwent supraglottoplasty for laryngomalacia at our academic tertiary care children’s hospital between 2005 and 2012 and examining their demographic information, medical comorbidities, symptoms, indications for surgery, operative findings and procedure, site of laryngeal obstruction, operative techniques, and surgical success rates.

Results

Fifteen patients with laryngomalacia underwent seventeen procedures. The most common indications for supraglottoplasty were persistent stridor (93.3%), difficulty feeding (53.3%), and failure to thrive (33.3%). The most common comorbidities were gastroesophageal reflux (86.7%) and cardiopulmonary disease (40%). Operative findings included shortened aryepiglottic folds in 14 patients (93.3%), retropositioned epiglottis in 14 (93.3%), and prolapsed arytenoids in 4 (26.7%). Thirteen patients (86.7%) underwent division of the aryepiglottic folds and 4 underwent ablation of arytenoid mucosa (26.7%). Of the 14 patients who had followed up at the study conclusion, 13 (92.9%) had symptom improvement and 9 (64.3%) had complete resolution of their symptoms.

Conclusion

Supraglottoplasty is an effective treatment for laryngomalacia. Outcomes in our patients are similar to those reported in prior literature. The findings of shortened aryepiglottic folds and a retropositioned epiglottis appear to be disproportionately represented in our cohort of patients undergoing supraglottoplasty.
IgE in Infants with Laryngomalacia: Risk for Asthma
Authors: Abdel‐Aziz Mahmoud F.
Published: February 2015

Objective

To evaluate a possible predictive value for developing asthma later on in infants with laryngomalacia by measuring specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens.

Method

Sixty‐four children having congenital laryngeal stridor “laryngomalacia” before 18 months of age were followed prospectively until early school age. Serum levels of food and inhalant allergen‐specific IgE antibodies were determined at presentation, using the CAP system IgE FEIA (Pharmacia, Uppsala, Sweden). At 6 to 8 years, the children were evaluated for asthma and allergic manifestations.

Results

Asthma was present in 24 (37.5%) children at school age. Food‐specific IgE antibodies of ≥ 0.35 kU/L were found in 27 (42%) infants, but only specific IgE to wheat and to egg white at the level of ≥ 0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of ≥ 0.70 proved to be significant. Inhalant allergen‐specific IgE of ≥ 0.35 kU/L was found in 16 cases (25%) and was significantly predictive of asthma.

Conclusion

Presence of specific IgE of ≥ 0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in those infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations.
Immunity in Children with Chronic Tonsillitis
Authors: Danilov Lucian , Diacova Svetlana , Ababii Ion , Maniuc Mihail , Vinogradova Tatiana , Ababii Polina
Published: February 2015

Objective

1) To explore some aspects of systemic immunity reactions in chronic tonsillitis. 2) To compare systemic immunity reactions in chronic tonsillitis in children and adults.

Method

Prospective study design in 2011. Subjects: 24 children and 13 adults with chronic tonsillitis. Setting: Otolaryngology department, Moldova. Outcome measures: C reactive protein, antistreptolysin O, absolute and relative amount of B lymphocytes, immunoglobulins–A, M, G, circulatory immune complexes, interleukins IL‐4, IL‐8, IL‐1β in blood serum.

Results

Interleukin‐8 is 6.5 times higher in children than in adults (P =. 047), interleukin‐1β is 17.4 times higher (P =. 045). Level of serum IgA in adults is higher than in children (P =. 038), antistreptolysin–O titre is 1.4 times higher.

Conclusion

Study of interleukin‐1β and interleukin‐8 is useful in understunding the etiopathogenetic mechanism of chronic tonsillitis in children. Nonspecific immune factors play an important role in immune response in chronic tonsillitis in children, while in adults the main role is held by specific immune response.
Reinnervation for Vocal Fold Paralysis: Results in Children
Authors: Setlur Jennifer , Bunting Glenn W. , Ballif Catherine , Hartnick Christopher J.
Published: February 2015

Objective

1) Exhibit long‐term follow‐up results of patients with unilateral vocal fold immobility who underwent ANSA reinnervation of the recurrent laryngeal nerve. 2) Demonstrate the appropriate studies that should be performed at the time of follow‐up.

Method

Retrospective review in a tertiary care otolaryngology practice. Four patients with symptomatic unilateral vocal fold paralysis who underwent recurrent laryngeal nerve reinnervation by a single surgeon were reviewed between September 2005 and December 2011. Postoperative measurements were obtained, both subjective (voice questionnaire) and objective (acoustic measurements and aerodynamics).

Results

The study group included 3 girls and 1 boy ages 2 to 12 years. Mean follow‐up time was 4.25 years. Causes for vocal fold paralysis were cardiac surgery (3) and skull base neoplasm (1). Voice questionnaire results (0 = severely abnormal, 100 = normal) were 100 in 2 patients, 98 in 1 patient, and 96 in 1 patient indicating a high level of satisfaction postoperatively in all patients. Mean maximum phonation time was 7.7 seconds, mean s/z ratio was 2.15, and mean subglottal pressure was 8.8 cm H2O.

Conclusion

Children who undergo ANSA reinnervation of the recurrent laryngeal nerve have normal or near normal subjective voice scores. Objective scores may not reflect the same change. In this population, it may be beneficial for the practitioner to rely upon subjective measures rather than objective measures to determine treatment success.
Rib Reconstruction of Absent Mandibular Condyles in Children
Authors: Goerke Derek , Sampson Daniel E. , Tibesar Robert , Sidman James D.
Published: February 2015

Objective

1) Describe pediatric costochondral graft reconstruction of the absent mandibular condyle. 2) Report the short‐term and long‐term outcomes and complications associated with performing this procedure in young children.

Method

All children treated for an absent mandibular condyle with a costochondral graft from 2002 to 2011 at Children’s Hospitals and Clinics of Minnesota were identified and a retrospective chart review was performed. Outpatient charts, hospital records, and operative reports were reviewed.

Results

Ten patients aged 3 to 11 years old were identified. The most common diagnosis in 7 out of 10 patients was oculo‐auriculo‐vertebral syndrome. Three of the patients had a tracheostomy, of which one was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 out of 10 patients. Five patients have required no further surgeries to date, with a mean follow‐up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years whereas resorption occurred after an average of 2.5 years.

Conclusion

Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short‐term results show particular improvement in function and mandibular alignment. The mean follow‐up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population.
Hange‐Shashin‐To Gargle against Radiation‐Induced Mucositis
Authors: Yamashita Taku , Matsunobu Takeshi , Tanaka Yuya , Araki Koji , Tomifuji Masayuki , Shiotani Akihiro
Published: February 2015

Objective

Chemoradiation has been recognized as one of the standard therapies for head and neck cancer. However, recent intensified chemoradiation can cause serious adverse events and influence treatment completion. We investigated the effect of Hange‐Shashin‐To, an herbal medicine, against chemoradiation‐induced mucositis in the context of the completion of chemoradiation.

Method

Subjects were 10 head and neck cancer patients who underwent whole neck irradiation between May and November 2011. The patients gargled with 2.5 g Hange‐Shashinto‐To mixed with tap water 3 times a day during and after chemoradiation period, prohibiting eating and drinking for 30 minutes after the gargling.

Results

Two patients started gargling with Hange‐Shashin‐To after grade III mucositis appeared, and the other 8 began it on the commencing date of chemoradiation. In 1 of the former 2 patients, the mucositis improved until grade I despite continued chemoradiation. Although the other remained grade III until the end of radiation, the gargling was useful for treatment completion without interruption. Of the latter 8 patients, 6 had grade I and 2 had grade II as the worst mucositis level in the chemoradiation period. Grade III or IV mucositis was not observed in this case series.

Conclusion

Our results suggest that Hange‐Shashin‐To can alleviate mucositis from chemoradiotherapy and contribute to treatment completion without interruption. Although further studies in a large number of patients are needed to confirm our findings, Hange‐Shashin‐To may be a useful adjunctive therapy in chemoradiation for head and neck cancer.
An Uncommon Case of Facial Trauma
Authors: Trozzi Marilena , De Vincentiis Giovanni , Sitzia Emanuela , Carretti Marco , Bottero Sergio
Published: February 2015

Objective

Present a rare case of a massive posttraumatic nasal swelling hiding a complication of an undiagnosed nasal dermoid sinus cyst in a 3‐year‐old boy. Emphasize that the clinical history, careful assessment, and especially accurate imaging are essential for accurate diagnosis and the proper treatment to be applied.

Method

A 3‐year‐old boy was admitted to our hospital because of swelling of the fronto‐nasal regions following a nasal trauma occurring 5 days earlier. X‐rays of the nasal bones in the lateral side were negative for fracture. Given the noteworthy facial deformation we opted for a hospitalization for further study.

Results

Bone‐image CT and 3D‐CT revealed bone defects within the frontal skull base. MRI demonstrates that a dermoid cyst centered in a bone defect was in contact with the dura of the frontobasal area, and a dermal sinus extending to the frontonasal skin could also be detected. Only then we observed the midline pit on the nasal dorsum initially attributed to the outcomes of recent trauma. Surgical resection was performed by frontobasal craniotomy. The dermal sinus was followed subcutaneously into the orifice of the nasal skin. A small skin incision was made and the sinus was then totally removed.

Conclusion

Radiological imaging is crucial for defining diagnosis, but observation of disproportion between sign and medical history that it has been possible to direct toward the correct study and the appropriate therapy to be performed.
Effect of Endoscopic Sinus Surgery on Pulmonary Function of Chronic Rhinosinusitis with Asthma
Authors: Asako Mikiya , Tomoda Koichi
Published: February 2015

Objective

To evaluate the postoperative pulmonary function of chronic rhinosinusitis associated with nasal polyps and asthma.

Method

A retrospective analysis was performed on 34 patients with/without chronic bronchial asthma who underwent ESS for medically refractory chronic rhinosinusitis with polyp. Patients received comprehensive asthma care before and after ESS (mean, 19.3 and 23.1 months, respectively). Twenty patients were not clearly diagnosed with asthma, 10 patients had mild to severe persistent aspirin‐tolerant asthma, and 4 patients had moderate to severe persistent aspirin intolerant asthma. Outcomes analyzed included pre‐ and post‐ESS individual and group mean upper airway symptom scores, Lund‐Mackay CT scores, and pulmonary function test results.

Results

All groups showed a significant increase in pulmonary function 1 month after ESS (P <. 01). The various index biomarker in the pulmonary function is useful for evaluating lower airway condition. V50 and V25/Ht are the most accurate reflection markers of the bronchiolar constriction. There were significant increases in the V50 and V25/Ht before and after the sinus surgery in both the AIA and ATA groups (P <. 05). ATA group is more increased of the pulmonary function than AIA group after ESS, in addition, non‐asthma diagnosis group is also increased in the pulmonary function after surgery.

Conclusion

Our data indicate that patients with CRS/WP compose clinically the group of bronchiolar constriction.
EGCG Regulates Mucin by p38 MAPK/MMP‐9 Pathway in Asthma
Authors: Kim Young‐Da , Bae Chang Hoon , Song Si‐Youn , Lee Heung‐Man
Published: February 2015

Objective

Mucus plays an important role in protecting human airways from external environments by entrapping inhaled foreign particles and bacteria, and clearing them from the airways by ciliary movement. Epigallocatechin‐3‐gallate (EGCG) is a major component of green tea extract and known to provide numerous functions, such as anti‐oxidant effect, anti‐tumor effect, anti‐ diabetic effect, and anti‐inflammatory effect. However, the precise mechanism of action about anti‐inflammatory effect of EGCG is not fully defined.

Method

The effect of EGCG on phorbol 12‐myrisate 13‐ acetate (PMA)–induced MUC5B expression and signaling pathways were investigated in human NCI‐H292 airway epithelial cells, human nasal epithelial cells, and in asthma model of mice.

Results

PMA‐induced MUC5B mRNA and protein levels were significantly decreased after treatment with EGCG. PMA increased phosphorylation of p38 MAPK and this was significantly decreased after pretreatment with EGCG. PMA induced MMP‐9 overexpression and this was significantly attenuated by pretreatment with EGCG or specific inhibitor for p38 MAPK (SB203580). And EGCG inhibited PMA‐induced MMP‐9 protein activities in gelatin zymography. PMA induced MMP‐9 and MUC5B over‐expression in human nasal epithelial cells and this was significantly attenuated by pretreatment with EGCG.

Conclusion

The results of this study demonstrated that EGCG down‐regulates MUC5B expression through the p38 MAPK dependent MMP‐9 signaling pathway. These results suggest that EGCG may have protective effect on asthma through the regulation of mucin gene expression in airway epithelial cells. Furthermore, EGCG could be a novel therapeutic agent for controlling asthma.
Endoscopic Orbital Decompression: When and How?
Authors: Naseri Iman
Published: February 2015

Objective

1) Identify acute and chronic indications for orbital and/or optic nerve decompression. 2) Review known techniques for endoscopic orbital decompression. 3) Evaluate the necessity to include inferior orbital wall/orbital floor. 4) Compare and contrast the endoscopic technique in comparison to various open methods.

Method

Retrospective review of all patients that underwent endoscopic orbital decompression procedures between 2009 and 2011. Data analysis included review of perioperative clinical findings, operative technical details, radiology data, and outcomes.

Results

A total of 15 orbital decompressions were performed. All patients underwent endoscopic medial orbital wall decompression, 2 included the orbital floor. The majority of the patients had allergic fungal sinusitis as their primary diagnosis for surgical indication (n = 7, 47%). Neoplasms (n = 5, 33%) and Graves disease (n = 3, 20%) were the remaining diagnoses. Restricted ocular motility, proptosis, and diplopia were the most common presentations indicating surgery (n = 13, 11 and 8, respectively). Resolution of diplopia was observed in all patients, but delayed in Graves patients (2‐3 months). Proptosis improved in 7 patients (64%), without any significant difference among those including orbital floor.

Conclusion

The endoscopic technique for orbital decompression is a safe and less invasive alternative to currently used open approaches. Sufficient medial wall decompression may yield sufficient outcomes, precluding the need for including the orbital floor. Further objective outcomes data is needed to compare proptosis among various modes of endoscopic decompression techniques.
Laser Transcanalicular DCR
Authors: Meher Ravi , Raj Anoop
Published: February 2015

Objective

1) To find out the success rate of LASER transcanalicular DCR.

Method

Retrospective study from December 2008 to June 2011. Nasolacrimal duct obstruction causing epiphora. All the cases of laser transcanalicular DCR operated in the ENT department. These surgeries were performed by the author and co‐author of the same unit. Patency of the nasolacrimal fistula as determined by syringing.

Results

Forty‐two cases of laser DCR were performed in the above mentioned period. Age group varied from 8 to 58 years. Ony 31 cases were available for prolonged follow‐up. The remaining 11 cases could not be traced. Out of 31 cases, 21 cases had no problem and the rhinostomy site was patent on syringing. Success rate −67.7% (21 cases). Ten patients had blocked rhinostomy site ob syringing thus the failure rate −32.2% (10 cases). All the failure cases under revision DCR using laser with lacrimal intubation using silicon stents in 8 cases.

Conclusion

The failure of the laser transcanalicular DCR was because of occlusion of rhinostomy site by granulations, small opening, an and formation of synechiae. This was attributed to smaller opening made with laser, inadequate bony opening, formation of multiple openings in an attempt to enlarge the rhinostomy, or failure to identify correct rhinostomy site.
Polyp Recurrence Rate in Chronic Rhinosinusitis Phenotypes
Authors: Nakayama Tsuguhisa , Okushi Tetsushi , Asaka Daiya , Haruna Shin‐Ichi , Moriyama Hiroshi , Otori Nobuyoshi
Published: February 2015

Objective

We proposed that chronic rhinosinusitis (CRS) is classified by 4 phenotypes in the previous study. Three phenotypes in the 4 were well classified by nasal polyps and mucosal eosinophil count. In this study we investigated the difference of recurrence rate of nasal polyps after endoscopic sinus surgery between these three phenotypes.

Method

This study was a prospective collecting data and retrospective analysis. All patients were followed up for at least 180 days after endoscopic sinus surgery. We defined mucosal eosinophilia as over 80 eosinophils under high‐power magnification. Disease‐free survival curves were drawn using the Kaplan‐Meier method and compared using log‐rank test.

Results

A total of 264 of the 375 patients were enrolled in the study. The mean follow‐up period was 540.4 days. Polyp recurrence was significantly different between the 3 groups (P =. 016). Patients with cluster 4 (eosinophilic CRSwNP) had a higher polyp recurrence rate than cluster 2 (non‐eosinophilic CRSwNP; P =. 047) and cluster 1 (non‐eosinophilic CRSsNP; P =. 005). Cluster 1 and cluster 2 had no significant difference (P =. 362).

Conclusion

We demonstrated polyp recurrence rate was different between the three phenotypes.
Quality of Life in Chronic Rhinosinusitis
Authors: Remenschneider Aaron K. , Metson Ralph B.
Published: February 2015

Objective

1) Establish baseline characteristics of patients with chronic rhinosinusitis using a novel general quality of life instrument, the European Quality of Life 5‐Dimension survey (EQ‐5D). 2) Compare patients with chronic rhinosinusitis with healthy individuals and with patients with common chronic medical conditions.

Method

From February 2011‐2012, preoperative quality of life data were obtained from 225 patients with chronic rhinosinusitis prior to surgery at Massachusetts Eye and Ear Infirmary. Global function as well as to 5 distinct parameters (mobility, self‐care, activity, pain, anxiety) were compared against published values for healthy and disease controls.

Results

General quality of life as measured using the EQ‐5D visual analog scale revealed that patients with chronic rhinosinusitis had significantly lower scores when compared with age matched controls: 72.48 ± 17.22 vs 78.75 ± 14.92 (P <. 01), 95% CI (–8.41 to −4.14). Patients with chronic rhinosinusitis also scored worse on pain/discomfort and anxiety/depression when compared to both healthy controls and individuals with diabetes or cardiovascular disease. (P <. 05). Mobility, self‐care, and activity level were not significantly impaired in patients with chronic rhinosinusitis.

Conclusion

Patients with chronic rhinosinusitis have impaired quality of life when compared with healthy controls. Pain/ discomfort and anxiety/depression are significantly worse when compared with healthy patients and those with other co‐morbidities. As a new and powerful quality of life tool, the EQ‐5D appears consistent with previously studied instruments for chronic rhinosinusitis.
Radiofrequency and Microdebrider Turbinate Reduction in Sheep
Authors: Meier Josh , Faquin William , Cunningham Michael J.
Published: February 2015

Objective

1) To compare the histologic and volumetric effects of bipolar radiofrequency ablation (RFA) and microdebrider turbinate reduction in a sheep model. 2) To evaluate the response of nasal mucosa in sheep to Compound 48‐80 (Sigma), a histamine‐releasing agent. 3) To further develop a sheep model of endonasal surgery.

Method

To induce nasal hypertrophy, 2 sheep received Compound 48‐80, and 2 sheep were controls. The right middle turbinate was treated with RFA, the left turbinate with microdebrider. In each group, 1 sheep was sacrificed immediately, the other at 3 weeks. Acoustic rhinometry, endoscopic photography and histologic analysis were performed.

Results

Endoscopic treatment of the sheep turbinates was feasible with standard endoscopic telescopes and equipment. There were similar increases in nasal volumes between the microdebrider and RFA groups immediately and at 3 weeks. Histologic analysis revealed that the RFA device resulted in a qualitatively increased amount of mucosal damage when compared to the microdebrider. At 3 weeks there was more squamous metaplasia in the RFA group. Endoscopic evaluation revealed similar effects in turbinate reduction between the two groups. Compound 48‐80 resulted in the expected decrease in nasal volume and increase in nasal secretions in one of two sheep.

Conclusion

This pilot study suggests that the heat‐independent method of the microdebrider results in less mucosal injury and squamous metaplasia than RFA. Both methods result in turbinate reduction and increases in nasal volume. Continuation of this pilot study is planned to further define these modalities and the effects of Compound 48‐80.
Role of mRNA Expression in the Nasal Polyp Pathogenesis
Authors: Gungor Atila , Tufan Ersoy , Salihoglu Murat , Yilmaz Ismail , Baloglu Huseyin
Published: February 2015

Objective

Nasal polyposis (NP) not only has a significant impact on the life quality of patients but also affects 2.11% of the population is a chronic inflammatory disease of the upper airway. The aim of this study is to evaluate and understand nasal polyp pathogenesis.

Method

Healthy mucosa and polyp samples were taken from 27 patients with nasal polyposis who underwent FESS. Total RNA was extracted from samples and converted to cDNA. Expressions of five given genes namely CC10, DMBT1, LTF, STAT, PIP were detected using QRT‐PCR technique. GAPDH gene were used for normalization.

Results

While there was no significant change in CC10 expression levels, we observed significant increase in the expressions of DMBT1, LTF, STAT and PIP compared to polyp tissue with healty mucosa.

Conclusion

We observed significant changes in the expressions of DMBT1, LTF, STAT and PIP genes which are kniwn with anti‐inflammatory, antimicrobial, immunomodulatory, and antineoplastic properties.
Rotation Flaps after Draf Procedures: A Cadaver Study
Authors: DeConde Adam S. , Vorasubin Nopawan , Thompson Christopher F. , Suh Jeffrey D.
Published: February 2015

Objective

To describe the anatomy and application of local mucosal flaps to reduce cicatricial scarring of the frontal recess after Draf IIB and Draf III procedures.

Method

Description and illustration of the surgical technique of 2 local mucosal flaps after Draf IIB and III procedures in a cadaveric model.

Results

Two distinct local rotation flaps can be successfully used after Draf IIB and Draf III procedures. 1) Prior to superior middle turbinectomy, a medially based mucosal flap is elevated from the medial aspect of the middle turbinate to the nasal septum. This flap is then placed on the posteromedial raw bone of the frontal recess after the Draf IIB. 2) Bilateral posteriorly based flaps are elevated off of the anterosuperior septum prior to the septectomy in a Draf III procedure. After the drillout is performed, the mucosal flaps are rotated to cover the frontal sinus posterior table.

Conclusion

Use of local mucosal flaps to provide primary healing after Draf IIB and Draf III procedures is technically feasible and may decrease the risk of restenosis after frontal sinus surgery.
Long‐term Effect of CN XII Stimulation for Obstructive Sleep Apnea
Authors: Woodson B. Tucker , De Vries Nico , Netzer Aviram , Lin Ho‐Sheng , Van De Heyning Paul
Published: February 2015

Objective

Compared to traditional OSA surgeries that modify skeletal and soft tissues, hypoglossal nerve stimulation alters physiology to maintain upper airway patency. To evaluate long‐term stability of CN XII stimulation, AHI and nerve stimulation parameters were assessed and compared.

Method

Data were reviewed from a prospective multicenter feasibility trial of an implantable hypoglossal nerve stimulation device (Inspire, Inspire Medical) that includes both stimulation and sensing leads and a programmable stimulation generator. Polysomnographic and device outcomes were available in 24 of 36 subjects at 12‐month follow‐up.

Results

Six‐ to 12‐month responder rate (a priori = 50% reduction in AHI) improved (10/24 to 12/24). AHI (baseline, 6, and 12 month) remained constant in responder (33.8, 8.8, 10.0 events/h, P <. 01) and nonresponder (48.9, 60.3, 44.1 events/hr, P < ns) groups. Three subjects were reclassified as responders and 2 as nonresponders from 6 to 12 months. Average nerve stimulation thresholds (sensation, function, and subdiscomfort) did not change from baseline to 12 months. Stimulation parameters (frequency, pulse duration, stimulation intensity but not amplitude (2.2 [0.7] vs 1.5 [0.4] Volt, P =. 01)) were similar in responder groups. No additional device‐related adverse events were recorded at 12 months.

Conclusion

Polysomnographic measures recorded at 6 months are maintained at 12 months following CN XII implant in the majority of patients. Average stimulation thresholds remain constant over 1 year. Results support that clinically significant improvements in AHI are maintained over the 6 to 12 month interval.
MMA and CO2 Laser MLG in Obstructive Sleep Apnea Syndrome: New Parameters of Success
Authors: Carpes Arturo F. , Colombini Nelson E. P. , Pinto Jose A.
Published: February 2015

Objective

To describe the results obtained by maxillomandibular advancement associated with CO2 laser midline glossectomy in the surgical treatment of moderate to severe obstructive sleep apnea syndrome, based on polysomnographic analysis of macrostructure and microstructure of sleep.

Method

From the period of February 2005 to December December 2008, 22 patients with moderate and severe OSAS,with or without maxillomandibular anteroposterior discrepancies from the Otorhinolaryngology–Head and Neck Surgery Nucleus of Sao Paulo were selected. These patients underwent MMA with CO2 Laser MLG. Evaluation included physical examination, cephalometric analysis, and polysomnographic data before and after surgery. The sleep study parameters used were: AHI, MD, minimum Sat O2, time of Sat O2 desaturation below 90%, sleep stages N1, N2, N3, and REM. The cephalometric parameters used were: SNA, SNB, PAS, PP2‐PP2. Evaluation of eventual differences in pre‐ and postoperative data were investigated with the appropriate statistical tools. The surgical treatment proved to be effective in 8 out of 22 of the cases (36.36%), according to international criteria of normality. On the other hand, for these patients the AHI was not the best parameter to evaluate the therapeutic success.

Results

The DM (60.18% of improvement), stage N3 (59.9% of improvement), and time of Sat O2 <90% measured in minutes (81.81% of improvement) demonstrated they were the best instrument for characterizing the laboratorial control of desease.

Conclusion

The surgical treatment perfomed with MMA associated with CO2 laser MLG was effective in treating patients with moderate to severe OSAS. The improvement using the most accepted parameter by the international community (AHI below 5) was 8 out of the 22 (36.36%). The AHI was not the most accurate instrument to evaluate the control of the desease. Although MD, stage N3, and time of Sat O2 below 90% measured in minutes demonstrated to be more appropriate indicators of surgical control of the desease. The time of Sat O2 <90% was the best parameter in the evaluation of the surgical treatment.
Otolaryngology Review Studies: Adherence to MA/SR Guidelines
Authors: Hicks Katherine E. , Malin Barry T. , Anand Akash G. , Gillespie M. Boyd , Day Terry A.
Published: February 2015

Objective

Many high‐impact medical journals have adopted methodological standards for conducting systematic reviews (SRs) and meta‐analyses (MAs). These standards have emerged via the convergence of guidelines advocated by the Cochrane Group, the Agency for Health Care Research and Quality, the Guidelines International Network, and other groups in an effort to further utilize evidence‐based medicine (EBM) in clinical practice. The overarching goal of this study is to assess the successful application of these standards across otolaryngology literature.

Method

Studies that employed formal SR/MA techniques and were published within the 16 highest impact general otolaryngology journals (up to December 1, 2011) were selected. Each study was graded by multiple reviewers using a scale based upon the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) criteria, including factors pertaining to database searches, study inclusion and exclusion criteria, data management, and bias minimization.

Results

Of the 84,284 studies published in the top 16 English‐language academic otolaryngology journals (up to 12/01/2011), 150 employed formal SR/MA techniques. Overall, 45% of these were devoted to head and neck topics, a much greater percentage than in any other otolaryngology subfield. Less than 0.2% of studies published in these journals employ SR/MA techniques, but this percentage has increased steadily over the past 10 years.

Conclusion

Currently, SRs and MAs are regarded as the methodological “gold‐standard” for clinical reviews. The prevalence of such studies within the otolaryngology literature is increasing, but opportunity exists for broader application of these approaches and greater adherence to contemporary methodological standards.
4D Dynamic‐MRI as Glossectomy Speech Assessment Tool
Authors: Murano Emi Z. , Xing Fangxu , Zhuo Jiachen , Woo Jonghye , Gullapalli Rao , Stone Maureen , Prince Jerry L.
Published: February 2015

Objective

Quantitative tools assessing functional outcomes after tongue cancer treatment are crucial for evaluation and comparison of surgical reconstruction techniques or chemoradiation protocols. Furthermore, tools measuring physiologic outcomes directly and specifically may lead to a better understanding of tongue adaptation control. We developed a 4D dynamic MRI to address these issues.

Method

This MRI tool included 2 components: 1) A static 3D high‐resolution MRI to identify structures spared from the surgery. 2) Dynamic cine‐ and tagged‐MRI scans at 26 frames/second to determine the tongue surface and measure point displacement during speech. Data were collected from 3 patients and 3 controls.

Results

The 3D segmentation of the residual muscles were compared to the controls. Twenty‐six 3D tongue volumes with surface deformation during the utterance of the word /asouk/ showed that patients adapt their tongue shape for /S/. The medial grooving seen in controls is deviated to the surgical side and the lateral sides of the anterior tongue make palatal and dental contact in patients. The 3D tagged MRI in patients showed asymmetrical displacement in several distinct parts of the tongue not seen in controls. The local distinct pattern suggests local adaptation for utmost speech performance. All patients had above 98% intelligibility scores.

Conclusion

This is the first study of 4D‐MRI relating residual tongue anatomy to 3D surface and internal kinematics during speech. This technique may provide a future predictive model for treatment options.
4‐Year Demographic Study of Laryngeal Carcinoma
Authors: Smith Matthew D. , Fleming Jason , Lew‐Gor Simione , Simcock Richard , Weighill John , Harries Meredydd L.
Published: February 2015

Objective

To investigate the presenting features of cases of laryngeal carcinoma to a large tertiary head and neck center over a 4‐year period.

Method

A retrospective cohort study was carried out on laryngeal cancer patients presenting to our head and neck center between 2007 and 2011. Information on sex, age, smoking status, presenting symptoms, tumor location, tumor staging, and histopathology was collected from the Somerset Cancer Registry, using hospital case notes for completion.

Results

A total of 105 cases presented during the study period, of which 88.6% were male. The mean age was 66.1 years (range, 37‐89). 89.6% of patients had a smoking history. The most common presenting symptom was voice change (79.1%), followed by throat pain (14.0%). 84.8% of tumors were glottic, with 15.2% supraglottic. 4.7% of tumors were diagnosed as stage‐0, 30.8% stage‐I, 22.4% stage‐II, 18.7% stage‐III, 9.3% stage‐IVA, 9.3% stage‐IVB, and 2.8% stage‐IVC. Twelve (11.4%) presented with nodal disease, and 3 with distant metastases (2.9%). On histopathology, 29.2% of tumors were well differentiated, 52.8% moderately differentiated and 18.0% poorly differentiated squamous cell carcinomas.

Conclusion

Advanced age, smoking history, and dysphonia remain the most common features of laryngeal carcinoma presentations. Detection of early disease is vital to improve prognosis. Results should help focus referral pathways and enable family physicians to most easily identify those at risk. Smoking cessation programs must continue to be a priority.
Castleman’s Disease Masquerading as a Large Paraganglioma
Authors: Shires Courtney B. , Loevner Laurie A. , Lewis Cameron , O’Malley Bert W. , Rassekh Christopher H.
Published: February 2015

Objective

1) To describe a case of Castleman’s disease with unusual clinical and radiographic presentation as a somatostatin‐positive mass in the poststyloid parapharyngeal space (PPS). 2) To review the literature, which does not report Castleman’s disease of the PPS, somatostatin‐positive disease, or disease resulting in cranial neuropathy.

Method

The clinical presentation, imaging features, surgical findings, and pathology slides were reviewed in the case of an adult patient with a parapharyngeal space mass. The literature on Castleman’s disease was reviewed as was that on somatostatin‐positive parapharyngeal space lesions. Permission was obtained from the patient to publish the findings.

Results

A 51‐year‐old male with 3 months of otalgia, hearing loss, and tinnitus underwent audiogram, revealing asymmetric hearing loss. Laryngoscopy showed a paretic true vocal cord. Magnetic resonance imaging (MRI) showed a 4.5‐cm poststyloid PPS mass displacing the carotid artery anterolaterally. Octreoscan scan showed a significant uptake. Angiogram showed prominent vascular blush and feeders from the occipital artery. The patient underwent preoperative embolization of arterial feeders to the mass. A transcervical approach was used to access and remove the mass. Final histopathology is consistent with Castleman’s disease. Our review of the literature did not identify previously reported cases of octreotide‐positive lymphoproliferative diseases.

Conclusion

This case demonstrates that poststyloid parapharyngeal masses in the medial portion of the parapharyngeal space may actually be lateral retropharyngeal nodes. Paragangliomas may also grow medially and present atypically and may be associated with vocal cord paralysis. This case is particularly unusual in that octreotide‐positive Castleman’s has never been reported.
Coblation for Laryngeal Papilloma in Adults
Authors: Zhang Qinfeng , Liu Delong , She Cuiping
Published: February 2015

Objective

To investigate the effect and feasibility of coblation for laryngeal papilloma in adults under suspension laryngoscope.

Method

A retrospective study of the effect of coblation for 21 cases of laryngeal papilloma in adults was done from April 2008 to September 2010, including 4 multiple and 17 single laryngeal papilloma. All cases were treated with CoblatorTM ReFlex #7070 under general anesthesia without tracheotomy.

Results

All the cases were treated in 1 session. Follow‐ups were performed from 17 months to 46 months after surgery with 2 cases of recurrence. The volume of bleeding loss during surgery varied from 1 mL to 10 mL, 2 mL on average, with no bleeding or other complications postoperatively.

Conclusion

Coblation under suspension laryngoscope for laryngeal papilloma in adults is an ideal method because of less bleeding and damage.
Comorbidity Measurement in Patients with Oral Cancer
Authors: Dedivitis Rogerio A. , Castro Mario A. , Aires Felipe T. , Bohn‐Pfuetzenreiter Nataniele P. , Pfuetzenreiter Elio G. , Ribeiro Daniel A.
Published: February 2015

Objective

To measure comorbidity in patients with oral or oropharyngeal squamous cell carcinoma.

Method

Prospective cohort study performed in 2 hospitals in Santos. A total of 116 adult patients treated for a newly diagnosed oral or oropharyngeal squamous cell carcinoma were evaluated on this study from 1996 to 2007. We measured comorbidity illness applying the some validated scales.

Results

After 4 years of follow‐up the mortality rate was 47.4%. Patients with high values in ACE‐27 and WUHNCI showed increased absolute risk of death in 25% and 31%, respectively. Of the 55 deaths in the period, 30.9% were due to other causes than cancer. Four indexes had predictive value on mortality due to other causes than cancer. Thus, patients who have high indexes on CIRS, KFC, ACE‐27, and WUHNCI had increased risk of death of 33%, 23%, 44%, and 51%, respectively. Thirty‐eight patients (69.1%) presented cancer‐related mortality. Only the WUHNCI presented significant difference capable of predicting mortality.

Conclusion

Comorbidity is an independent prognostic factor in patients with oral or oropharyngeal cancer. Higher values in ACE‐27 and WUHNCI showed increased absolute risk of death. WUHNCI were capable of predicting cancer‐related mortality. Patients who have high indexes on CIRS, KFC, ACE‐27 and WUHNCI had increased risk of death due to noncancer causes.
Correlation of Thyroid Cytology with Surgical Histology
Authors: Chen Nan , Schneider Rebecca , Taylor Stephen , Zitsch Robert P.
Published: February 2015

Objective

1) To assess the predictive value of thyroid cytology by fine needle aspiration (FNA) at our institution in detecting thyroid malignancy since the introduction of the Bethesda System. 2) To identify other potential predictors of malignancy.

Method

Records of patients who underwent thyroid FNA and subsequent surgery at University of Missouri between 2007 and 2012 were reviewed. Data collected included cytologic and pathologic diagnoses as well as potential predictors of malignancy and demographic data, including radiation exposure, radiologic findings of calcification and increased vascularity, age, and gender.

Results

A total of 378 cases were eligible for review. Of these, one‐third met inclusion criteria. Cytology characterized as malignant or benign were found to have high concordance with surgical pathology findings. The diagnosis atypia of undetermined significance (AUS) and its malignancy risk were observed 2 to 3 times higher than that prescribed by the Bethesda guidelines. The majority of cases with cytologic features of follicular neoplasm were found to be benign. However, a significant number of incidental cases of papillary microcarcinoma were observed within this group. Papillary thyroid carcinoma was identified in 60% of cases with features suspicious for malignancy.

Conclusion

While benign and malignant cytologies are highly predictive, there exists wide variation in the interpretation of uncertain categories. Malignancy risk associated with AUS ranges from 6% to 28% in the literature. These results suggest that trends developed from institution‐specific data may be more predictive in guiding post‐FNA management.
Epidermal Growth Factor Receptor Inhibition’s Effects on Invasion within Head and Neck Squamous Cell Carcinomas
Authors: Bewley Arnaud F. , Rasanen Kaiti , Basu Devraj , Herlyn Meenhard , Montone Kathleen
Published: February 2015

Objective

Targeted therapies can have mixed effects on cancer progression by limiting growth while simultaneously potentiating invasion and metastasis. Here we test the role of a mesenchymal‐like subpopulation (MLSP) of head and neck squamous cell carcinoma (HNSCC) cells in altering pattern of invasion (POI) during epidermal growth factor receptor (EGFR) inhibition.

Method

The contribution of MSLP cells to POI was evaluated in collagen‐embedded spheroids and patient‐derived xenografts (PDXs). MLSPs were identified by immunostaining for vimentin expression, E‐cadherin loss, and additional markers of epithelial to mesenchymal transition. Spheroids and xenografts undergoing anti‐EGFR treatment were evaluated for altered MLSP size, distribution, and invasion.

Results

MLSP cells were rare or absent in PDXs whose HNSCCs of origin contained less aggressive, pushing POIs. In contrast, abundant MLSP cells were seen in PDXs from tumors with highly infiltrative POIs. In collagen‐embedded spheroids, a pushing POI was mediated by collective migration of E‐cadherin‐positive cells, while infiltrative POIs arose from mesenchymal migration of MLSP cells. EGFR inhibition in spheroids produced a more aggressive POI by selectively targeting the epithelial subpopulation, which expressed higher levels of the receptor. Similarly, cetuximab treatment of xenografts enriched MLSP cells, which contributed to a more infiltrative invasion pattern in residual tumors.

Conclusion

Different HNSCC POIs arise from distinct migratory mechanisms used by E‐cadherin‐positive versus MLSP tumor cells. Cetuximab therapy potentiates the capacity of MLSP cells to produce an infiltrative POI. Anti‐EGFR therapy may therefore have disparate effects in altering progression of 2 HNSCC sub‐types, defined by presence or absence of MLSP cells.