bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Assessment of Noise Amplitude Generated by Toys
Authors: Mahboubi Hossein , Oliaei Sepehr , Badran Karam , Kiumehr Saman , Djalilian Hamid R.
Published: February 2015

Objective

To systematically quantify the amplitude of noise generated by toys intended for young children.

Method

From 2008 to 2011, greater than 200 toys intended for children under 5 years were screened for loudness. The toys with sound output of >80 dB were retested in a sound‐proof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker.

Results

Ninety different toys were analyzed. Mean noise amplitude peak at the speaker level was 99.5 dBA ± 8.1 SD (range, 80‐121 dBA) and at 30 cm away from the speaker was 79.7 dBA ± 11.1 SD (range, 60‐109 dBA). Eighty‐one (90%) had more than 90 dBA noise amplitude at speaker level while 16 (22%) had more than 90 dBA noise amplitude at 30 cm distance. The mean noise amplitude of the loudest toys significantly decreased during the studied period (P <. 001). There was no significant difference in mean noise amplitude of different toys specified for different ages.

Conclusion

Our findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise‐induced hearing loss in this age group. Parents should be warned about the consequences of purchasing loud toys.
Utility of MRI in Workup of Pediatric Central Sleep Apnea
Authors: Woughter Meghan , Baldassari Cristina
Published: February 2015

Objective

1) To determine the incidence of central nervous system pathology on magnetic resonance imaging (MRI) scans in children with central sleep apnea (CSA). 2) To assess whether certain factors such as abnormalities on neurologic examination impact the yield of MRI in evaluation of CSA.

Method

A retrospective chart review was conducted at a tertiary pediatric hospital over 10 years. Inclusion criteria were patients 6 months to 18 years of age who underwent both full‐night polysomnogram (PSG) and head MRI. Children with central apnea index (CAI) greater than 1 were considered to have CSA.

Results

Thirty‐six children were included. Sixteen patients were boy (44.4%), and the mean age was 43.2 ± 52.2 months. Twenty children (55.6%) had CAI greater than 1. Fourteen children (38.9%) had evidence of pathology on MRI, with the most common finding (n = 5) being arachnoid cyst. When patients with CSA were compared to those without CSA, there was no significant difference (P =. 23) in rates of abnormal head MRI. The presence of OSA on PSG did not predict (P =. 54) pathologic findings on MRI. In CSA patients, the presence of either developmental delay or an abnormal neurologic exam improved the diagnostic yield of MRI.

Conclusion

CAI greater than 1 did not predict the presence of pathology on head MRI. Thus, the routine use of MRI in evaluation of CSA is not recommended. Further research is necessary to determine if there are other diagnostic tests that can be utilized in evaluation and management of pediatric CSA.
Use of Sound Devices by Teenagers
Authors: De Nobrega Manoel , Alcântara Everson F. , Moraes Gerson L. , Passos Maria Aparecida Z. , Vitalle Maria Sylvia D.S. , Cintra Isa D. P.
Published: February 2015

Objective

To verify the use of electronic device (iPods, MP3s, cell phones, and PCs) by teenagers who are students in public schools of São Paulo, Brazil.

Method

Carried out in a school in São Paulo/Brazil in 2011 and involving students from 10 to 17 years. The sample answered a questionnaire containing questions which referred to electronic devices: type of phones (external, internal, and occlusive), times and places used, elevated volume. Chi‐square was done and considered P <. 05.

Results

Among the 249 teenagers studied, 55.8% were girls, the average age was 12.6 years (±1.42 years). Use of phones: 89.9% girls and 73.6% boys (P =. 01). Type: 17% external, 18.9% internal, and 64.1% occlusive. Time of usage: cell phone, ‐ >1 h/d by 26.4% girls and 38.3% boys (P =. 03); iPod/MP3, ‐ >1 h/d by 26.4% girls and 18.5% boys (P =. 06). Related to the places: 50% streets, 87% home, 45% car, 31% subway, 47% bus, and 21% park. Elevated volume in cell phone: 28% by girls and 35.8% by boys (P =. 83); in iPod/MP3, 16.7% and 25.9% (P =. 06) for girls and boys, respectively.

Conclusion

The elevated percentage of teenagers using electronic devices in an inadequate way points to the necessity of concerning the topic as a way to avoid risks and future auditory loss.
Weight Changes Immediately following Tonsillectomy
Authors: Patel Anju K. , Bababekov Yanik , Mader Nicholas S. , Vecchiotti Mark A. , Scott Andrew R.
Published: February 2015

Objective

To evaluate weight change in the pediatric population after tonsillectomy and identify associated risk factors for weight loss.

Method

A retrospective medical record review of all patients 12 years of age and younger who underwent tonsillectomy at a tertiary care center from January 2008 to November 2011 was conducted. Patient characteristics, preoperative and postoperative weight, indication for surgery, surgical technique, and perioperative complications were recorded.

Results

In total, 152 patients met inclusion criteria based on complete medical records and postoperative follow‐up. Weight was recorded preoperatively (mean of 30 days prior to surgery) and between 2 and 6 weeks postoperatively (mean of 24 days) using the same clinic scale. There was a total of 95 (62.5%) patients with ages ranging from 0 to 5 years (group A) and patients with ages ranging from 57 (37.5%) 6 to 12 years (group B). Regression analysis estimated the mean and distribution for weight change in each age group. At 21 days postoperatively, groups A and B experienced percentage weight changes of 1.7% and −1.2%, respectively (P <. 03).

Conclusion

Immediately following tonsillectomy, pediatric patients experience varying degrees of weight loss. This depends primarily upon age but may be mitigated by other factors. Patients age 6 years and above have predicted weight loss in the immediate postoperative setting, while younger children maintain or surpass their preoperative weight by the 21‐day interval.
Access to the Maxillary Sinus via Canine Fossa Trephination
Authors: Tan Neil C. , Hanna Brendan , Bassiouni Ahmed , Cleland Edward , Jardaleza Camille , Wormald Peter J.
Published: February 2015

Objective

1) To assess how much of the maxilary sinus could be accessed through a 5‐mm endoscopic canine fossa trephination (eCFT) in a cadaveric model. 2) Review the clinical benefits as well as co‐morbidities associated with this procedure.

Method

A cadaveric study involving 6 fresh‐frozen heads that underwent endoscopic sinus surgery giving 12 sides. eCFT was performed and heads were registered with an image guidance system (IGS). Access to predetermined points in the sinus was assessed by whether the registration probes could reach corners of sinus as demonstrated on the IGS.

Results

Instrumentation access through an eCFT allowed for 89.6% (range, 75%‐100%) of corners within the maxillary sinus to be reached as demonstrated on the IGS. The 0° probe was capable of accessing 97.9% of the posterior face. The anterior face was more difficult to access with only 81.3% of points being reached.

Conclusion

eCFT is a simple procedure that should be added to the repertoire of the modern endoscopic sinus surgeon. It allows for excellent surgical access to the maxillary sinus, far above what is accessible through the natural ostium alone. Refinements in technique report significantly decreased complication rates when compared to Caldwell‐Luc.
Allergen Extract Compatibilities
Authors: Rekkerth Donna J. , Grier Thomas J.
Published: February 2015

Objective

1) Assess the relative stabilities of extracts at various dilutions and define target allergen recoveries in defined mixtures. 2) Identify stable, risky, and incompatible extract combinations. 3) Recognize the effects of glycerin, time to and temperature on the stability of immunotherapy treatment vials. 4) Design optimal extract mixtures.

Method

Examination of target allergen recoveries in extract mixtures at maintenance vial strengths, using laboratory methods (IgE ELISA inhibitor and IgE Immunoblotting) known to be sensitive to changes in overall extract composition, specific allergen concentrations, and total allergen concentrations or extract potencies, 2000 present.

Results

Degradation of some allergens in dilutions or mixtures can be influenced by several factors, including endogenous hydrolytic enzymes, final glycerin concentrations, presence of stabilizers such as human serum albumin, storage times in the refrigerator, and elevated temperature exposures. A working knowledge of the stabilities and compatibilities of various allergens in extract mixtures is essential to optimal formulation of patient vials for subcutaneous immunotherapy. A mixing recommendation chart was created for use in the allergy clinic as a guide to ensure allergen extract compatibility.

Conclusion

Degradation of allergens in dilutions or mixtures can be influenced by several factors, including presence of endogenous hydrolytic enzymes, final glycerin concentrations, presence of stabilizers such as human serum albumin, storage refrigerator times, and elevated temperature exposures.
Alternate Sliding Technique for a Nasal Septum Perforation
Authors: Ushio Munetaka , Kondo Kenji , Baba Shintaro , Kanaya Kaori , Tamaruya Noriko , Ino Kenji , Yamasoba Tatsuya
Published: February 2015

Objective

A critical point for successful surgical closure of the perforation of a nasal septum is the simultaneous achievement of both sufficient blood supply to the closure site and reduced tension of the flaps. We describe a modified surgical technique, the “alternate sliding technique,” to manage this difficulty.

Method

The procedure starts with the elevation of bilateral mucosal flaps under an endoscopic view. A releasing incision is made across the nasal floor on 1 side and across the lateral cartilage on the other side. The flaps are slid up‐ and downward, respectively. The perforation is then sutured.

Results

Nasal septum perforation was successfully fixed with the first surgery in 6 of the 8 patients. Among them, reperforation was not observed during postoperative follow‐up of 3 to 18 months. The symptoms complained of before surgery fully resolved. A patient who had taken corticosteroids for several years and another who had had multiple perforations required the additional closure of a small perforation in our clinic.

Conclusion

Our alternate sliding technique facilitates a better blood supply from the bipedicled attachment. Each suture is lined by a mucosal flap of the other side. These minimize the risk of reperforation. Our technique is applicable for small to medium perforations.
Can Lacrimal Sac Washout Predict Outcomes of Endoscopic DCR?
Authors: Chin David , Harvey Richard J. , Wilcsek Geoff , Sacks Raymond
Published: February 2015

Objective

High success rates for endoscopic dacryocystorhinostomy (END‐DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END‐DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure.

Method

Retrospective review of END‐DCRs performed at a tertiary referral center. Partial and complete NLDO were defined by the presence or absence of flow into the nose with lacrimal sac washout (SWO), respectively. Intraoperative findings including thickness of bone, level and state of the common canaliculus, state of inflammation, and contents of the lacrimal sac during END‐DCR were recorded. For patients with at least 3 months follow‐up, the outcome of resolution of epiphora (none/partial/complete), postop Jones 1 (J1; positive/ negative) and endoscopy of the neo‐ostium (closed/partially or fully‐open) were defined.

Results

A total of 245 primary END‐DCRs were reviewed (mean age, 63.6 ± 5.3 years, 70% women). Based on SWO, the groups were defined as 39.6% and 60.4% complete NLDO. Overall improvement in epiphora was 95.5%. In cases where symptoms improved, absence of flow into nose on SWO was associated with a higher rate of complete resolution (93.6% vs 84.9%, RR 1.102 [1.001, 1.213]). The ostia were fully open in 93.9% and postop J1 was positive in 97.1% of patients and were not different between groups.

Conclusion

END‐DCR is highly successful for both types of NLDO. Preoperative absence of flow into nose on SWO was associated with slightly higher chance of complete resolution.
Cerebrospinal Fluid Leak following LeFort I Osteotomies
Authors: Kroeker Andrew , Edwards Sean , Sullivan Steven , McKean Erin M.
Published: February 2015

Objective

1) Describe an unusual complication of cerebrospinal fluid leak (CSF) following orthognathic surgery through LeFort I osteotomies. 2) Understand the mechanism and incidence of injury and techniques of endoscopic repair. 3) Review the literature regarding skull base defects and CSF leaks following maxillofacial advancement.

Method

Case report, single patient, 2012, literature review.

Results

An 18 year‐old morbidly obese woman presented to the oral maxillofacial surgery clinic with complaints of malocclusion. She underwent bilateral LeFort I osteotomies and was discharged on POD1. She represented 3 days later with headache and nausea. A head CT demonstrated pneumocephalus and a fracture of the dorsal aspect of the right sphenoid sinus causing a communication with the prepontine cistern. The patient subsequently underwent endoscopic repair by the otolaryngology and neurosurgery services, using a vascularized pedicled mucosal nasoseptal flap. She was discharged from the hospital on post‐ operative day 7 and since has had an uneventful recovery.

Conclusion

Postoperative recognition of CSF leak is imperative in order to ensure timely repair and to prevent further complications. Identification of surgical techniques and patient‐specific factors contributing an increased risk of postoperative CSF leak is vital. Given the prior intranasal and palatal surgery, various preoperative reconstruction options must be considered.
Changes of the Histological Features in Nasal Polyps
Authors: Kim Su Jin , Shin Seung Youp , Lee Kun Hee , Kim Sung Wan , Cho Joong Saeng
Published: February 2015

Objective

Depending on the inflammatory cell infiltration, nasal polyps can be categorized as eosinophilic type or non‐eosinophilic type. There is a geographical difference in the prevalence of a certain pathological type of polyp. More than 80% of polyps in Western people are the eosinophilic type, while this type is rarely found among Eastern people. The periodical change in the prevalence of histological types of polyps was evaluated in this study.

Method

Two hundred total patients, each confirmed to the polyp biopsy, were enrolled between 1993 and 2010. Specimens were fixed in formalin, then made to a paraffin block and H&E stained slide, which was reviewed by 2 authors. The number of eosinophils per high power field (HPF) and other cellular, epithelial, and stromal markers were reviewed.

Results

We compared the nasal polyp eosinophil count by periods, the average eosinophil count/HPF increased from 7.22 (±1.695) in 1993 to 20.44 (±3.635) in 2010 (P =. 001). Eosinophilic polyp (showing over 5 eosinophils/HPF) increased significantly from 26% in 1993 to 52% in (P =. 000 ‐> P <. 001). Among other histologic markers, lymphocytes, basement membrane thickening, and gland hypertrophy showed significant difference.

Conclusion

After comparative studies between histopathologic findings of nasal polyps from 1993 and 2010 respectively, the percentage of eosinophilic nasal polyp, known to be rare among Asians, including Koreans, have increased significantly.
Chronic Rhinosinusitis and Lacrimal Obstructive Disease
Authors: Matos Teresa O. , Angelo Pedro S. , Ribeiro Helena G. , Costa Tiago , Subtil João , Dinis Paulo Borges
Published: February 2015

Objective

To investigate if chronic inflammatory sinus disease has a pathogenic role in the obstructive pathology of the neighboring lacrimal system, including obstruction alone and chronic or recurring dacryocystitis.

Method

One hundred patients were selected for endoscopic DCR because of persistent epiphora and/or chronic or recurrent dacryocystitis. Their sinus CT scans were evaluated using the Lund‐Mackay score.The nonoperated side and a further group of 30 head trauma patients were the control groups.

Results

No statistically significant differences were found in either presence or absence, or even disease extension or location, of image defined inflammation of the sinuses and obstructive pathology of the lacrimal system, including chronic or recurring dacryocystitis. DCR sides and patients do not have higher scores of sinonasal disease than nonsurgical sides or normal subjects.

Conclusion

These results lead to the conclusion that chronic inflammatory sinus disease is a comorbidity that very likely does not play a pathogenic role in any form of obstructive disease of the lacrimal system.
Clinical Trend of Churg‐Strauss Syndrome in Japan
Authors: Arai Chiaki , Iimura Jiro , Wada Kota , Uno Kosuke , Edamatsu Hideo , Moriyama Hiroshi , Ota Fumikazu
Published: February 2015

Objective

There are a lot of reports that LTRA internal use, steroid medicine, and weight loss are associated with the onset of CSS. Because we experienced 2 cases of CSS that occurred during treatment of eosinophilic sinusitis this time, in addition, we consider some discussion from the literature.

Method

We examined retrospectively 2 eosinophilic sinusitis patients, one with asthma and the other with allergic rhinitis. After these operations, we added wash‐out sinuses and prescribed LTRA and nasal steroids. Depending on the state of intranasal findings, we gave steroid medicine.

Results

We performed wash‐out sinuses, LTRA internal use, and nasal steroids as postoperative treatment with both cases, and, at the exacerbation of intranasal findings, the intranasal findings improved by administration of steroid medicine. When we took steroid medicine, we did not do it with fixed quantity and the administration method that we did it and reduced. CSS was diagnosed by mononeuritis multipleand polyarthritis and purpuric onset subsequently. We suggested the possibility that LTRA internal use was associated with the onset of the CSS.

Conclusion

LTRA internal use, steroid medicine, and weight loss may be associated with the onset of the CSS, and it is important to discontinue a causing agent when the otolaryngologist who frequently prescribes these drugs grasps overall status, and suspects CSS.
Comparison of CT and Pathophysiologic Recovery in Sinusitis
Authors: Lee Ki‐Il , Chung Young‐Jun , Mo Ji‐Hun , Lee Sang Joon , Chung Phil‐Sang
Published: February 2015

Objective

To investigate and understand the difference between clinical and pathophysiologic recovery according to recovery periods in the rabbit sinusitis model.

Method

A synthetic sponge was inserted into the right‐side nasal cavities of 15 rabbits. After 2 weeks, the maxillary sinu‐sitis was induced and confirmed by computed tomography (CT) scan. The opacification in CT scan was graded. Then the mucosa was harvested from the maxillary sinus. Ciliary beat frequency (CBF) was measured for evaluating mucosal function. Light microscopic, scanning and transmission electron microscopic (SEM & TEM) examinations were performed. Histopathologic findings in microscopic examinations were scored in a semi‐quantitative measure. Each examination was performed at the time of reopening of maxillary sinus ostium, 4 weeks and 8 weeks after reopening of maxillary sinus ostium.

Results

The sinus opacification in CT scan and ciliary regeneration in SEM showed significant improvement 8 weeks after reopening of maxillary sinus ostium. But CBF, tissue inflammation score and ciliary wave disorder were not improved significantly 8 weeks after reopening of maxillary sinus ostium.

Conclusion

Clinical, functional, and histopathologic recoveries from sinusitis require different periods of time. Incomplete functional and histopathologic recoveries can be the cause of relapse or recurrence of sinusitis. Therefore, close follow‐up will be necessary after clinical resolution of sinusitis.
Concha Bullosa Mucopyocele Presenting as a Nasal Mass
Authors: Oakley Gretchen M. , Meier Jeremy D. , Error Marc E.
Published: February 2015

Objective

1) Describe the rare case of an adolescent with a concha bullosa mucopyocele presenting as a nasal mass. 2) Review the existing literature discussing mucopyocele of a concha bullosa.

Method

Case report of a 14‐year old girl presenting to the emergency department with localized right‐side facial pain, pressure, and headaches. The patient had no rhinorrhea, was afebrile, and had a normal white blood cell count and c‐reactive protein.

Results

Sinus CT showed a right‐side intranasal mass with destruction of middle turbinate bone. MRI revealed post‐obstructive fluid throughout the maxillary, ethmoid, and frontal sinuses. The patient was taken to the operating room for biopsy of the presumed mass and drainage of the sinuses. A large, bulging middle turbinate was found on nasal endoscopy and incision into the turbinate revealed a purulent concha bullosa. The concha bullosa was opened and unilateral maxillary antrostomy and anterior ethmoidectomy performed. Literature discussing concha bullosa mucopyocele is limited to only a few case reports.

Conclusion

This describes an unusual case of an adolescent girl with a concha bullosa mucopyocele presenting as an obstructing mass of the middle meatus without signs or symptoms of infection. Although rare, an infected concha bullosa can cause significant problems by obstructing the entire osteomeatal complex.
Endonasal Neuroendoscopy
Authors: El‐Guindy Ahmed S.
Published: February 2015

Objective

To provide a detailed description of the extended endoscopic endonasal approach to the ventral skull base, evaluate its advantages and limitations and to understand better the complex anatomic relationships of the structures involved in the approach from an endoscopic endonasal perspective.

Method

Anatomic dissection study from January 2011 to October 2011. Materials: Three fresh, latex‐injected cadaver heads were dissected. Setting: Dissection laboratory, Tanta University School of Medicine. Intervention: An endoscopic endonasal approach was performed on midline skull base. Outcome measurements: Anatomic relationships of endonasal endoscopic skull base approach.

Results

The extended endoscopic endonasal approach allows surgeons to access the entire ventral midline skull base from the crista galli to foramen magnum. A complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 cranial nerves is obtainable. The major potential advantage of the extended endoscopic endonasal approach to skull base is that it provides a direct anatomic route to the lesion without traversing any major neurovascular structures, obviating brain retraction. The disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with a potential for cerebrospinal fluid leakage and meningitis.

Conclusion

The extended endoscopic endonasal approach allows surgeons to access the entire ventral midline skull base from crista galli to foramen magnum and deal with a diverse array of intra‐ and extradural lesions through a rostro‐caudal trajectory.
Endoscopic Surgery for Cerebrospinal Fluid Rhinorrhea
Authors: Chen Feng , Gao Xia
Published: February 2015

Objective

To evaluate the clinical effect of endoscopic surgery for cerebrospinal fluid (CSF) rhinorrhea and discuss the best treatment.

Method

Records of 52 patients aged 19 to 60 years with a mean age of 41.9 years treated by endoscopic surgery in our department between June 2002 to May 2010 were analyzed retrospectively. Eighteen were spontaneous, 34 were traumatic or iatrogenic. Middle turbinate mucosa, fascia lata, and abdominal fat were used in the leak repair. The CSF fistula were closed by the combined multilayer “underlay,” “overlay” or “bath‐plug” techniques.

Results

The cribriform plate was the most common site of the leak (21/52), followed by the sphenoid sinus (17/52), anterior ethmoid sinus (7/52), posterior ethmoid sinus (4/52), and frontal recess (3/52). Defects ranged in size from 5 to 35 mm (mean, 9.7 ± 3.5mm), 13 cases were >10 mm. Forty‐two cases (80.8%) were repaired successfully at the first transnasal endoscopic surgery, 6 cases succeeded at the second attempt, and 4 cases at the third attempt. The first attempt success rate of patients with large size (>10 mm) leaks (61.5%) was significantly lower than that of patients with small size (<10 mm) leaks (87.2%). One patient had postoperative intracranial infection and one patient had postoperative hydrocephalus. All patients were followed‐up for 6 months to 3 years (mean 1.2 years), and no recurrence was found.

Conclusion

Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. Location and size of leak and repair material affect surgical outcome. Abdominal fat is a good repair material to stop the leak for patients with larger (>10 mm) leaks.
Epidemiology of Sinonasal Cancers in the City of São Paulo
Authors: Bezerra Thiago , Michels Fernand , Soter Ana C. , Pinna Fabio D.R. , Godoy Maria Dantas , Latorre Maria do Rosario , Voegels Richard L.
Published: February 2015

Objective

Evaluate epidemiology of nose and paranasal sinus cancer in the city of São Paulo.

Method

This was a study based on population cancer registry data of São Paulo from 1997 to 2006. We extracted data of 628 patients (CID‐10 C30, C31.x) from a total of 388.950 diagnosed with cancer among all tumors. We aggregated data into the morphologic groups according to ICD‐O.

Results

The overall estimated incidence of nose and sinus tumors was 0.6 out of 100,000 and it was higher in men (0.7/100,000 vs 0.5/100,000). They are more frequent among fifth and eighth decades. The most common site was maxillary sinus (37.1%) followed by nasal cavity (33.3%). Isolated diagnosis of other sinus cancer was very rare and the most common was from ethmoid sinus (2.5%) The most common morphologic groups were squamous cell (followed by adenoid cystic carcinoma and esthesioneuroblastoma). The epidemiology of each site and each morphology were analyzed in detail.

Conclusion

Sinonasal cancers in São Paulo have an incidence comparable to described previously. The analysis of sinonasal cancers from reliable population based registry was not commonly reported and this information can provide us more knowledge about this disease, besides the large case series of large health services.
Inferior Turbinate Surgery for Severe Allergic Rhinitis
Authors: Kojima Yusuke , Tsuzuki Kenzo , Oka Hideki , Takebayashi Hironori , Sakagami Masafumi
Published: February 2015

Objective

Inferior turbinate surgery, an outpatient surgery, is used to treat severe allergic rhinitis that is unresponsive to medication. The purpose of this study was to determine the clinical effects of outpatient inferior turbinate surgery (OITS) on patients with severe allergic rhinitis.

Method

Between January 2008 and December 2011, we performed OITS bilaterally under local anesthesia for 216 patients with severe allergic rhinitis. Two kinds of cautery device, high‐frequency electrocautery and argon plasma coagulation, were used. Nasal symptoms and intranasal findings were evaluated pre‐ and postoperatively at 3 months or more after OITS.

Results

On average, scores for sneezing, nasal discharge, and nasal obstruction significantly improved from 1.3 to 0.8, from 1.7 to 1.1, and from 2.6 to 1.2 (P <. 001, n = 216), respectively. Overall, improvement of symptoms was found in 73% (157/216 patients) postoperatively. Congestion of inferior turbinates also improved in 74% (160/216 patients).

Conclusion

These data indicate that the OITS had an effect on more than 70% of patients with severe allergic rhinitis.
Mini‐Nasoseptal Flap for Recalcitrant Sphenoid Sinusitis
Authors: Thompson Christopher F. , DeConde Adam S. , Chiu Alexander G. , Suh Jeffrey D.
Published: February 2015

Objective

To describe the use of a modified nasoseptal flap for select cases of chronic sphenoid sinusitis.

Method

Description and illustration of the surgical technique and indications for the modified nasoseptal flap for chronic sphenoid sinusitis. We report 3 cases of recurrent sphenoid fungal sinusitis treated with revision endoscopic sinusotomy and a mini‐nasoseptal flap.

Results

The mini‐nasoseptal flap was used successfully in all cases without evidence of restenosis in the follow‐up period. There were no complications related to flap harvest or inset.

Conclusion

Inflammatory sphenoid lesions such as fungal balls may increase the risk of postoperative ostial stenosis especially in cases when postoperative surveillance or debridement is difficult or impossible. The mini‐nasoseptal flap may expedite healing and decrease the risk of restenosis after sphenoid sinusotomy by avoiding cicatricial scarring.
Mometasone Furoate for Adenoidal Hypertrophy in Adolescents
Authors: Sahin‐Yilmaz Asli , Celebi Saban , Yilmaz H. Baki , Oysu Cagatay
Published: February 2015

Objective

1) To find out whether the symptoms attributable to adenoid hypertrophy in adolescents may be treated with intranasal mometasone furoate (MF) application. 2) To learn if adenoid hypertrophy in adolescents may decrease in size with intranasal MF.

Method

A prospective, double‐blind, randomized, crossover study was conducted in 28 subjects (12‐18 years) with adenoidal hypertrophy. Subjects used intranasal MF or placebo for a duration of 6 weeks with a washout period of 3 weeks. Subjective symptoms and adenoid size were evaluated.

Results

At the initiation of the study, there was no significant difference between the mean symptom scores for any of the sinonasal symptoms between the 2 treatment groups. Placebo users had no statistically significant reduction in their sinonasal symptoms (P >. 05 for all) other than snoring (P =. 011). MF users had a statistically significant reduction in all symptoms (P <. 05 for all) other than coughing (P =. 527). There was a significant difference between the 2 treatment groups in the mean posttreatment scores for total subjective symptom scoring and rhinorrhea (P =. 031, P =. 012 resp). There was no significant difference in baseline endoscopy scores between the 2 treatment groups (P =. 317). There was a significant reduction in nasal endoscopy scores in the MF group compared to placebo group (P =. 034).

Conclusion

MF may have some advantage over placebo for the symptoms attributable to adenoid hypertrophy in adolescents. Intranasal MF decreases the size of the adenoid hypertrophy in this group of patients.
New Technique for the Endoscopic Treatment of CSF Fistulas
Authors: Chaparro Morante Juan C. , Venegas Monica Hidalgo , La Borda Alberto Trelles Polo Y.
Published: February 2015

Objective

1) Report our experience in surgical treatment for closure of CSF fistulas of different etiologies, with a new endoscopic technique without invasive surgery. 2) Improve the treatment of CSF leakage, thus avoiding craniotomy and its sequelae.

Method

We present 5 cases of adult patients with CSF fistula treated by endoscopic surgery from July to December 2011 using cartilage and mucoperichondrium tragal graft, resorbable thread as a guide and sterile sponge, previus revivig edges. Overlay technique was used and nasal packing was for 5 days. Endoscopic controls were carried out.

Results

In all surgery cases closure of the fistula was observed at 6 weeks. There were no recurrences and no reoperationes were necessary. All patients improved their symptoms without reoccurring liquorrhea.

Conclusion

Endoscopic closure of CSF fistulas with the technique of cartilage graft has proved a very safe method for this type of defect in the skull base as well as being reliable, secure, and free of sequelae known as craniotomies.
Nitric Oxide Synthase in the Nasal Mucosa
Authors: Yoda Shigetoshi , Fukushima Hisaki , Shibata Dai , Akisada Takeshi , Harada Tamotsu
Published: February 2015

Objective

The amount of nitric oxide (NO) in the nasal cavity is significantly higher in allergic rhinitis patients than in healthy individuals. The purpose of this study was to identify NO synthase (NOS) isoforms (NOS‐1, NOS‐2, and NOS‐3) and examine their localization, gene expression, and protein expression in allergic rhinitis model mice.

Method

Male BALB/c mice were intraperitoneally administered Cryptomeria japonica 1 (Cryj1) and adjuvant (primary immunization) 3 times; thereafter, Cryj1 was administered daily into the nasal cavity (secondary immunization). The expression of NOS‐1, NOS‐2, and NOS‐3 in the nasal mucosa was investigated using real‐time polymerase chain reaction, and Western blot analysis.

Results

The expression of NOS‐1 mRNA was significantly decreased, and NOS‐2 and NOS‐3 mRNA levels were significantly increased in the allergy group compared to the control group. Protein expression of NOS‐1 was significantly decreased and that of NOS‐2 was significantly increased in the allergy group compared with the control group, but no significant difference was noted in the levels of NOS‐3 protein.

Conclusion

This study shows that not only NOS‐2 but also NOS‐1 and NOS‐3 are involved in the pathogenesis of allergic rhinitis.
Optimal Approach to the Sphenoid Sinus: The Missed Guide
Authors: Younes Ahmed , Alhamshary Ahmed S. , Romeh Hossam I. , Albirmawy Osama A.
Published: February 2015

Objective

To formulate an updated applicable algorithm for selection of the optimal surgical approach to the sphenoid sinus.

Method

Retrospective review. The records of 63 patients who had undergone surgery for sphenoid sinus lesions, at Otolaryngology Department, Tanta University, between 2000 and 2009 were reviewed. Four different surgical approaches were identified: Endoscopic transnasal sphenoidotomy (TNS), endoscopic transethmoidal sphenoidotomy, endoscopic transpterygoid sphenoidotomy, and endoscopic transnasal sphenoidotomy with posterior septectomy. The approaches were compared in: mean age, preoperative imaging data, pathological diagnosis, percentage of revision procedures, and surgical complications.

Results

TNS was the most commonly used approach (65%). Endoscopic transethmoidal sphenoidotomy was the second approach (25%). Endoscopic transpterygoid sphenoidotomy was used in 3%. It was used for management of lateral sphenoid recess lesions. Endoscopic transnasal sphenoidotomy with posterior septectomy was used in 6% for sellar, parasellar, and clival lesions. No major complications were committed.

Conclusion

Selection of the appropriate approach to the sphenoid depends mainly on the disease extent displayed by preoperative imaging. The endoscopic transnasal approach was suitable for management of isolated sphenoid sinus lesions. Eendoscopic transethmoid approach was used for management of pansinus involvement. The endoscopic transpterygoid approach was used for dealing with lesions of the lateral sphenoid recess and the endoscopic transnasal sphenoidotomy with posterior septectomy was used for management of sellar, parasellar, and clival lesions.
Orbital Complication of a Paranasal Sinus Actinomycosis
Authors: Pimentel Joao C. , Escada Pedro A. , Cavilhas Pedro
Published: February 2015

Objective

1) Describe the first reported case of paranasal sinus actinomycosis associated with an orbital complication. 2) Describe other unusual features of the case: the occurrence of the infection in an immunocompetent pregnant patient, the involvement of the ethmoid sinus, the safety of a surgical treatment in a 15‐week pregnant patient.

Method

Case report of a 25‐year‐old woman, 15 weeks pregnant. Disease studied: Ethmoid sinus actinomycosis complicated by an subperiosteal orbital abscess. Setting: Tertiary referral university hospital. Intervention: Intravenous antibiotic therapy associated with a surgical treatment under general anesthesia. Outcome measurement: Safety and efficacy of the treatment.

Results

The patient was admitted for treatment of the complicated rhinosinusitis. She immediately started intravenous antibiotic therapy with amoxicillin and clavulanic acid and a surgical drainage under general anesthesia was indicated. Risks for the patient and for the fetus were discussed and the informed consent was obtained for the anesthetic and for the surgical procedures. A combined external and transnasal endoscopic approach was performed to treat the infection. Actinomyces meyeri was isolated. The patient improved and was discharged after 14 days of medical treatment. Eight months after surgery the patient and her newborn are both well and no sequelae were registered.

Conclusion

Actinomycosis of the paranasal sinus can involve primarily the ethmoid sinus, do not have a history of dental procedures or trauma, and result in orbital complications. Standard medical and surgical therapies for complicated rhinosinusitis are safe and effective, even in a pregnant patient.
Pan‐American Clinical Guideline on Rhinosinusitis
Authors: Dibildox‐Martinez Javier , Mayorga Butron Jose L. , Macías Fernández Luis A. , Casiano Roy R. , Carrau Ricardo L. , Javer Amin R. , Gordon Bruce R.
Published: February 2015

Objective

This evidence‐based clinical practice guideline (CPG) aims to improve clinical decision making of general practitioners and specialists in the treatment of acute and chronic rhinosinusitis in adults. Support clinicians in clinical decision making for medical treatment with target in the pathophysiological process and evidence‐based efficacy, safety, and tolerability.

Method

The Pan‐American Association of Otorhinolaryngology and Head and Neck Surgery, in partnership with the Ibero American Agency for Development and Assessment of Health Technologies, developed a clinical practice guideline on medical management of acute and chronic rhinosinusitis in adults. This document provides punctual evidence‐based recommendations for primary care physicians and otolaryngologists on the medical management of these conditions and complies with evidence‐based medicine fundamentals and with well‐validated guidelines methodology as recommended by the National Institute for Clinical Excellence, the National Institutes of Health, and The Scottish Intercollegiate Guidelines Network.

Results

This document provides from A Grade to D Grade clinical recommendations for treatment of these conditions. The Guideline Development Group made recommendations based on well‐designed, randomized controlled trials and systematic reviews. Some clinical questions could not be answered by high quality research and for these questions a Panel Delphi was conducted to provide clinical guidance. Overall there is a need for well‐designed RCTs and economic assessments to answer most of the gaps of knowledge for the treatment of acute and chronic rhinosinusitis.

Conclusion

This clinical practice guideline provides guidance for the medical treatment of adults with acute and chronic rhinosinusitis.
Rhinosinusitis in the Immunocompromised Cancer Population
Authors: Jackson Ryan S. , Phommachanh Viengsouk , Keeler Jarrod A. , Pechter William , Greene John N. , Padhya Tapan , Tabor Mark H.
Published: February 2015

Objective

The microbiology of acute and chronic sinusitis in the general population is well documented, however, this is not well characterized in vulnerable subgroups. Our primary aim is to evaluate the paranasal sinus microbiology of immunocompromised patients at a tertiary cancer center.

Method

Following institutional review board approval, records at Moffitt Cancer Center were retrospectively reviewed using ICD‐9 codes for in‐hospital treatment of sinusitis while undergoing concurrent oncologic therapy. All patients had nasal endoscopy with aerobic middle meatal culture. Demographics, type of malignancy, leukocyte count, glycemic status, and culture results were recorded.

Results

Eighty patients were identified from June 2000 to April 2009. Malignancies included leukemia (63%), lymphoma (22%), multiple myeloma (5%), carcinoma (5%), and sarcoma (4%). One patient (1%) had common variable immunodeficiency. A total of 102 sinus cultures were collected. Of those, 59 (58%) were interpreted as no growth (n = 20) or usual respiratory flora (n = 39). Of the 46 positive cultures, 58 organisms were isolated. There were 16 fungi (28%), 12 coagulase‐negative Staphylococcus (20%), 9 methicillin‐sensitive Staphylococcus aureus (16%), 8 methicillin‐resistant Staphylococcus aureus (14%), 6 Pseudomonas species (10%), 3 Moraxella catarrhalis (5%), and 4 other gram‐negative bacilli (7%) isolated.

Conclusion

Pathogens identified in this population differ from published data examining the general population. There is an increased percentage of negative cultures, fungi and coagulase negative staphylococcus. We found fewer streptococcus pneumonia species. We attribute this change in flora to frequent empiric treatment of this population with broad‐spectrum antibiotics.
Stratus Relieva: Treatment for Chronic Rhinosinusitis
Authors: Baptista Peter M. , de Abajo Jorge , Fernandez Secundino , Barona Luz
Published: February 2015

Objective

Patients with chronic rhinosinusitis resistant to systemic treatment have as an alternative endoscopic nasal surgery. The Relieva Stratus system has allowed local treatment in paranasal cavities, avoiding an aggressive surgery and high corticoesteroids systemic treatment. We describe our experience with the system in the first six patients.

Method

Four patients suffering ethmoid and 2 with frontal chronic rhinosinusitis have been included. The Stratus catheter was implanted endoscopically under general anesthesia in combination with balloon sinuplasty technique for either the maxillary or the frontal sinus. Triamcinolone was used for local delivery. Stratus was removed in office 4 week later.

Results

Stratus Relieva was implanted in patients with chronic inflammation of the ethmoid or frontal sinus. No major complications were observed. Four catheters were implanted in the ethmoid bulla and 2 in the frontal sinus. They were removed in office under local anesthesia. Intraoperaory bleeding was minimal. Patients described no foreign object sensation after surgery. We observed good evolution in all patients but one, in which Stratus Relieva was performed. This patient persisted with chronic inflammation of the maxillary and ethmoid sinus and functional endoscopy surgery was performed as alternative for definitive treatment.

Conclusion

Results with this device are promising although longer observation period is needed. It is possible that the patient that did not show an improvement of disease may have not been an adequate candidate for this surgery. Therefore, we consider that appropriate selection of patients is necessary for a good outcome.
Sublingual Immunotherapy for Allergic Rhinitis
Authors: Zhang Edward Z. , Fook‐Chong Stephanie , Leong Jern‐Lin
Published: February 2015

Objective

To study the efficacy and safety of sublingual immunotherapy (SLIT) based on the original American Academy of Otolaryngic Allergy (AAOA) Consensus dosing protocol for treatment of allergic rhinitis (AR).

Method

Patients undergoing SLIT for more than 12 months between 2007 to 2010 were prescribed escalation (over 3 months) and maintenance doses as recommended by AAOA. Sinonasal‐Outcome‐Test‐20 (SNOT‐20) questionnaire scores were used for calculations of repeated measures analysis of variance (ANOVA) with contrast testing to define trends.

Results

Data from 15 men and 6 women with a mean follow‐up duration of 17.57 months were analyzed. Fourteen patients had minor side effects including AR exacerbation (5 cases), itching (8), rash (2), diarrhea (1), and palatal ulcer (1). None required admission or treatment discontinuation. ANOVA testing revealed a significant linear decreasing trend in rhinological (F1,13 = 11.2), ear/facial (F1,13 = 5.4), sleep (F1,13 = 6.9), psychological (F1,13 = 13.1), and overall SNOT‐20 (F1,13 = 14.5) scores. Our results show overall SNOT‐20 scores improving by 31% from baseline within 3 months initiation of therapy, and continued to improve progressively during the maintainance phase up to 69%. Domain scores analyzed showed greatest improvements in ear/facial symptoms (up to 86%) and psychological function (up to 77%). Rhinologic and sleep function scores also showed impactful improvements of up to 56% and 61%, respectively.

Conclusion

This is the first published paper to study and demonstrate the safety and efficacy of SLIT based on AAOA consensus dosing protocol. A standardized regime will allow more meaningful comparison between studies.
Successful Surgery in Pediatric Chronic Nasal Obstruction
Authors: Pepe Graciela , Parras Jorge , Morel Pablo
Published: February 2015

Objective

1) To validate a minimally invasive surgical approach including endoscopic fiberdiodelaser‐assisted turbinoplasty, RFQ adenoidectomy, and sinus washes, as a first‐line treatment for children with chronic nasal obstruction and noncomplicated recurrent sinusitis that failed at maximal medical treatment.

Method

A prospective study of 50 children aged 3 to 13 years with persistent sinonasal symptoms was conducted in a tertiary private setting. Surgery under general anesthesia was done. The survey included NOSE instrument, child behavior, use of sinonasal medication and parent satisfaction at entry, 1, 6, and at least 24 months after surgery.

Results

Significant improvement in NOSE score was observed 1 month after the procedure, and remains unchanged after 6 and 24 months of follow‐up. Basal NOSE 92.5% ± 9.4 vs NOSE 1 month 7.2 % ± 12, NOSE 6 month 8.3 ± 15.2; 24 months 6.3 ± 10.3 (ANOVA P =. 0001). Patients used significantly less sinonasal medications. None remained with altered behavior (P. 001 McNemar’s test). Parent satisfaction was very high (Likert scale) with 95.8% at 6 months and 93% at 24 months.

Conclusion

Laser‐assisted turbinoplasty RFQ adenoidectomy and sinus washes are a successful approach for treating pediatric chronic nasal obstruction and sinusitis.
The Allergen‐Glycerin Balance
Authors: Rekkerth Donna J. , Grier Thomas J.
Published: February 2015

Objective

1) Review challenges monitoring allergen and glycerin levels in patient vials. 2) Describe the allergen and glycerin content of treatment board vials. 3) Demonstrate use of an algebraic calculator for determining the final glycerin concentrations. 4) Describe table comparing allergen levels in maintenance vial mixtures.

Method

Convenient tools have been created to simplify calculation of final glycerin concentrations present in buildup and maintenance immunotherapy mixtures, and the final allergen doses administered relative to current immunotherapy practice parameter recommendations. Information was studied from 2005‐present.

Results

A limited tolerance to elevated glycerin levels can prompt reductions in injection volume (and allergen dose) for patient safety and compliance. The IDT and MQT algorithms introduce a variety of allergen and glycerin levels to patient vials that can be difficult to monitor or calculate easily.

Conclusion

The effectiveness and safety of subcutaneous immunotherapy is linked directly to patient tolerance of both allergen loads and glycerin levels. Convenient tools have been created to simplify calculation of final glycerin concentrations present in buildup and maintenance immunotherapy mixtures, and the final allergen doses.