bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role and Function of the Vegf Pathway during Palate Development
Authors: Jacobs Britni H. , Goudy Steven L. , Hill Cynthia A.
Published: September 2014

Objectives:

(1) Define the evolution of palatal vascularization during palatal shelf formation and effects of vascular endothelial growth factor (Vegf) deletion in the cranial neural crest. (2) Determine downstream mediators of Vegf signaling.

Methods:

Conditional deletion of Vegf using Wnt1‐Cre; Vegf F/F mice (VegfCKO) led to a cleft palate phenotype. PECAM staining was used to determine vascular patterning in the VegfCKO developing palate daily from E13.5 to E16.5 compared to controls. The VegfCKO palate shelves at E13.5 and E14.5 were analyzed using quantitative PCR (qPCR) to assess mediators and targets of Vegf signaling.

Results:

VegfCKO had aberrant vascular branching via PECAM staining in comparison to controls. In E13.5 VegfCKO mice, there were no significant differences in mediators and targets of VEGF signaling measured by qPCR. However, at E14.5, VegfCKO palates demonstrated significant reductions in pyruvate dehydrogenase kinase (PDK4) (P =. 045), which is a glycolytic gene, and stromal cell‐derived factor 1 (SDF1) (P =. 036), which induces endothelial migration.

Conclusions:

Vegf was required for palatal vascularization and palatal elongation. During palatal development Vegf was upstream of SDF1, a cytokine necessary for endothelial progenitor cell recruitment and migration. Vegf also modulates glycolysis through variations in PDK4, a protein involved in glucose metabolism.
Safety and Perioperative Complications in Pediatric Otologic Surgery
Authors: Roxbury Christopher , Yang Jingyan , Salazar Jose H. , Goldstein Seth , Abdullah Fizan , Shah Rahul K. , Boss Emily F.
Published: September 2014

Objectives:

There is a paucity of data regarding postoperative complications associated with pediatric otologic procedures. We describe safety and postoperative sequelae of these procedures using data from the largest quality improvement initiative in pediatric surgery, the American College of Surgeons National Surgery Quality Improvement Program‐Pediatric (NSQIP‐P). This study is the first to assess safety of pediatric otologic surgery using NSQIP‐P data.

Methods:

We identified children who underwent outpatient otologic surgery using current procedural terminology codes. Variables of interest included patient demographics and 30‐day unplanned postoperative events including reoperation, readmission, and wound complication. Adverse event rates were determined and prevalence of events was compared by procedure type and within patient subgroups.

Results:

Of 37,319 pediatric surgical cases, 2410 were otologic procedures. The most common procedure was tympanoplasty (N = 836, 34.7%), followed by myringoplasty (N = 741, 30.7%), tympanomastoidectomy (N = 630, 26.1%), and cochlear implantation (N = 464, 19.3%). There were 7 reoperations (0.3%), 30 readmissions (1.2%), and 17 wound complications (0.6%). Cochlear implantation had the highest readmission and reoperation rates (12/464, 2.6% and 3/464, 0.7%) of the procedures studied, followed by tympanomastoidectomy (8/630, 1.3% and 3/630, 0.5%). There was not enough power to determine statistical significance of patient characteristics that increased risk of adverse event.

Conclusions:

Pediatric otologic procedures are commonly performed and have extremely low rates of postoperative 30‐day complications. Although NSQIP‐P is a powerful, nationally recognized quality platform, optimization is necessary for assessment of meaningful procedure‐specific outcomes in pediatric otologic surgery. Analysis of pooled NSQIP‐P data across future years may guide determination of predictive factors for an adverse event.
Treatment of Bilateral Severe Bronchomalacia with 3‐Dimensionally Printed Patient‐Specific External Bronchial Splints
Authors: Morrison Robert J. , Nasser Hassan B. , Jensen Daniel R. , Park Albert H. , Ohye Richard G. , Hollister Scott J. , Green Glenn E.
Published: September 2014

Objectives:

(1) Describe the treatment options for severe bronchomalacia. (2) Learn about a novel technology for treatment of severe bronchomalacia using a 3‐dimensionally (3D) printed patient‐specific external bronchial splint.

Methods:

A 16‐month‐old patient previously underwent tracheostomy for severe bronchomalacia but had been unable to be discharged home since birth because of persistent high ventilatory requirements (PEEP 20). Despite high ventilatory settings and intravenous sedatives, respiratory events required prolonged intensive care unit (ICU) care and intermittent comas. Endoscopic examination demonstrated focal bilateral mainstem bronchomalacia. DICOM CT images of the patient's airway were imported into a computer‐aided modeling program and custom 3D external bronchial splints were created utilizing image‐based Boolean design. The splints were 3D printed using poly‐L‐caprolactone. Institutional Review Board and Food and Drug Administration emergency‐use exemption was granted and the patient was implanted with the custom devices.

Results:

Subsequent bronchoscopy revealed patency of both mainstem bronchi and normal ventilatory variation in both lungs. Peak end‐expiratory pressure (PEEP) was immediately weaned from 20 to 10 mm Hg and tidal volumes immediately improved from 5 to 10 cc/kg. The patient is actively being weaned from ventilator support. Respiratory parameters, endoscopy, and dynamic imaging are being actively studied during the patient's recovery.

Conclusions:

This patient demonstrates a clinical scenario of bilateral bronchomalacia who had exhausted conventional treatment options but necessitated prolonged ICU‐level support. The creation of 3D‐printed external bronchial splints has alleviated the critical nature of the bronchomalacia and represents the first time this technology has been used in a patient with bilateral disease.
Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children
Authors: Marom Tal , Alvarez Pedro E. , Jennings Kristofer , Patel Janak A. , McCormick David , Chonmaitree Tasnee
Published: September 2014

Objectives:

(1) Analyze the clinical characteristics of upper respiratory infections (URIs) complicated by acute bacterial sinusitis (ABS) in young children. (2) Describe the bacteria and viruses isolated in nasopharyngeal specimens in children with ABS.

Methods:

We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (aged 6‐35 months at enrollment), who were followed up for one year to capture all URI episodes and complications. At the initial URI visit (median day = 4), nasopharyngeal samples were obtained for bacterial cultures and viral studies. The study was conducted at the University of Texas Medical Branch, Galveston, during 2003‐2007.

Results:

Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. The average age was 18.8 ± 7.2 months; white children were more likely to have ABS episodes than blacks (P =. 01). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS (P =. 01). Bacterial cultures were positive in 82/83 (99%) available samples; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with ABS risk (P =. 04 for both).

Conclusions:

ABS complicates 8% of URIs in children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M catarrhalis during URI are positively correlated with ABS risk.
Antigen‐Specific Immunoglobulin Production in Ethmoid Mucosa in Refractory Chronic Rhinosinusitis with Nasal Polyps
Authors: Matsune Shoji , Wakayama Nozomu , Yamaguchi Satoshi , Sekine Kuwon , Ishida Mariko , Yoshioka Yuma , Okubo Kimihiro
Published: September 2014

Objectives:

For the past few decades, endoscopic sinus surgery (ESS) combined with medication therapy has improved the prognosis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, we sometimes encounter refractory CRSwNP complicated with nonatopic asthma and tremendous eosinophil infiltration in nasal polyps. Recently, enterotoxin of Staphylococcus aureus (S aureus) and fungi have been thought to contribute to the pathology of refractory CRSwNP, while its pathophysiology in detail is still controversial. Aim of study: In order to elucidate the pathology of refractory CRSwNP, antigen‐specific IgEs and IgGs to enterotoxin of S. aureus (SAE‐A, B) and fungi in ethmoid sinus mucosa, in addition to IgE and IgG analysis in blood serum and skin tests, were studied in operation cases with CRSwNP.

Methods:

Total IgE and IgG and SAE‐A, B, Aspergillus, Candida and Alternaria‐specific IgEs and IgGs production in ethmoid sinus mucosa were analyzed and compared to such data in blood serum and the results of skin tests in operation cases with CRSwNP in our university hospital. Ethmoid sinus mucosa was obtained during operation and kept in liquid nitrogen followed by mashing in 1 mL phosphate‐buffered saline (PBS). After centrifugation of this PBS, the supernatant was harvested in each case to analyze total and antigen‐specific IgEs and IgGs based on the weight correction of each sample.

Results and Conclusions:

In the skin tests, positive reaction was often observed only to Candida 48 hours after injection. While local fungi‐specific IgEs were little, local SAE‐A,‐B‐specific IgEs were apparently positive and local total IgE level was elevated. Candida specific Ig G and/or SAE‐A, ‐B specific IgE dependent reactions may play important roles in the pathophysiology of refractory CRSwNP.
Association between Physiologic Parameters and Anatomic Location in Spontaneous Cerebrospinal Fluid Leaks
Authors: Shargorodsky Josef , Xie Yanjun , Solomon David , Ishii Masaru , Gallia Gary , Reh Douglas D. , Lane Andrew P.
Published: September 2014

Objectives:

Although a relationship between elevated cerebrospinal fluid (CSF) pressure and spontaneous CSF leaks has been reported, analyses by anatomic sub‐site are lacking. This study seeks to elucidate the association between physiologic parameters and CSF leak location.

Methods:

Prospective case series of patients undergoing endoscopic endonasal repair of spontaneous CSF leak between 2004 and 2013. All participants had a lumbar drain placed for 24‐hour continuous preoperative pressure monitoring, and 24 hours of continuous monitoring starting 48 hours after the repair. In addition to patient characteristics, mean and peak CSF pressures by anatomic location were calculated and compared.

Results:

Twenty‐five patients underwent perioperative CSF pressure monitoring, with a mean follow‐up of 526 days. Nine patients had CSF leaks along the cribiform plate, 4 in the ethmoid roof, 8 in the sphenoid, 2 in the posterior table of the frontal sinus, and 2 with multiple leaks. Patients with cribiform leaks had the lowest mean body mass index (BMI) and prevalence of obstructive sleep apnea (22.2%), while those with multiple sites of leak had the highest mean BMI and prevalence of obstructive sleep apnea (50%). Patients with frontal sinus leaks had the highest postoperative mean (14.47 mmHg) and peak (42.5 mmHg) CSF pressures, while ethmoid roof had the lowest mean (0.43 mmHg) and peak (16.45 mmHg) CSF pressures.

Conclusions:

CSF pressure and other physiologic characteristics differ among patients with spontaneous CSF leaks by anatomic location. Understanding these differences may enable treatment approaches tailored by leak site, thereby improving repair outcomes.
Binary versus 5‐Point Likert Scale in Assessing Otolaryngology Trainees in Endoscopic Sinus Surgery
Authors: Awad Zaid , Taghi Ali S. , Sethukumar Priya , Ziprin Paul , Darzi Ara , Tolley Neil S.
Published: September 2014

Objectives:

(1) Examine the discriminant validity of 2 validated assessment tools in endoscopic sinus surgery (ESS) training. (2) Compare the binary versus the 5‐point Likert‐scale tools in ESS assessment.

Methods:

A cross‐sectional study was conducted from February‐August 2013. All otolaryngology trainees in the North‐London training program were assessed while performing ESS on sheep heads, which previously showed face and content validity. Performance was rated by 2 blinded assessors using 2 validated tools: The Inter‐Collegiate‐Surgical‐Curriculum‐Project tool, which utilizes a binary system and is used throughout the UK surgical training system, and the John Hopkins 5‐Point Likert scale ESS tool. The tools’ construct validities were tested by comparing performance of experts and novices. The tools were also tested by correlating task‐specific and global skills ratings with overall performance level.

Results:

The binary tool showed higher inter‐rater reliability than the Likert scale, both in task‐specific (Kappa: 0.89 versus 0.62) and global skills (Kappa: 0.79 versus 0.68) rating. Both tools discriminated between different levels of expertise in global and task‐specific skills (Kruskal‐Wallis: P <. 001 for all). But pairwise comparison showed that Likert scale tool was a better discriminator between novices and trainees, globally (P =. 016 versus P <. 271) and task‐specifically (P =. 049 versus P =. 449). Likert scale tool also correlated better with overall performance globally (r = 0.903 versus 0.741) and task‐specifically (r = 0.833 versus 0.802).

Conclusions:

While the binary assessment tool may show higher inter‐rater reliability and is easier to complete, the Likert scale, when each level is well defined, showed good agreement and better construct validity, which can be useful when monitoring progress in training.
Chlorogenic Acid: A Potential Activator of Dysfunctional Mucus Transport in Chronic Rhinosinusits
Authors: Illing Elisa A. , Dean Nichole , Dunlap Quinn , Skinner Daniel , Zhang Shaoyan , Woodworth Bradford A.
Published: September 2014

Objectives:

Salubrious effects of the green coffee bean are purportedly secondary to high concentrations of chlorogenic acid (CA). CA has a molecular structure similar to bioflavanoid polyphenols known to activate transepithelial Cl‐ transport in sinonasal epithelia. In contrast to bioflavonoids, chlorogenic acid is freely soluble in water. The objectives of this study are to evaluate the Cl‐ secretory capability of CA and potential as a therapeutic activator of mucus clearance in sinus disease.

Methods:

CA was tested on primary murine nasal septal epithelial (MNSE) [CFTR+/+ and transgenic CFTR‐/‐] and human sinonasal epithelial(HSNE) [CFTR+/+ and F508del/F508del] cultures under pharmacologic conditions in Ussing chambers to evaluate effects on transepithelial Cl‐ transport. Changes in airway surface liquid depth and CFTR mRNA transcription were also measured.

Results:

CA stimulated transepithelial Cl‐ secretion [(change in short‐circuit current(^†ISC)] in MNSE (13.11 ± 0.9 vs 0.1 ± 0.1, P <. 05) and HSNE (34.3 ± 0.9 vs 0.0 ± 0.1, P <. 05). The drug had a slow onset with peak effect at 15 minutes after application. Administration of the CFTR blocker INH‐172 significantly reduced ISC (MNSE −16.4 ± 1.0 vs −9 ± 0.9 and HSNE (−44.6 ± 1.0 vs 34.1 ± 0.3, P <. 05), indicating effects of the drug are likely mediated through CFTR. CA‐mediated Cl‐ secretion was absent in CFTR‐/‐ MNSE and F508del/F508del HSNE, confirming CFTR dependency. A modest increase in ASL depth was noted with 1 hour incubation (9.4 vs 8.3 µm). The compound did not alter CFTR mRNA levels when analyzed by quantitative reverse transcription polymerase chain reaction.

Conclusions:

CA is a water‐soluble agent that promotes CFTR‐mediated Cl‐ transport in sinonasal epithelium. Further in vivo evaluation as a therapeutic activator of mucus clearance is planned.
Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis
Authors: Kingdom Todd T. , Gitomer Sarah A. , Sillau Stefan H. , Katial Rohit K. , Ramakrishnan Vijay R.
Published: September 2014

Objectives:

(1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predict disease severity in CRSwNP.

Methods:

Patients with CRSwNP treated at an academic hospital specializing in respiratory and allergic disease from 2008 to 2010 were included in this study. Clinical information was collected retrospectively. Sinus computed tomography (CT) scans were scored by a single author according to the Lund‐Mackay (LM‐CT) system, and surgical specimens were evaluated by a single author for degree of tissue eosinophilia. Statistical analysis was performed with t test, chi‐squared test, Fisher's exact test, and multiple regression models.

Results:

Seventy CRSwNP patients were included. They had a mean LM‐CT score of 16.7, 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. There was no significant correlation between tissue and serum eosinophil counts (P =. 97). There was a significant positive correlation between CT score and peripheral eosinophil level (P <. 05). Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms (P =. 91), or Lund‐Mackay scores (P =. 25), nor did it correlate with presence of asthma, but it may be elevated in aspirin‐sensitive patients (P =. 09). Patients with mild asthma had significantly more tissue eosinophils when compared to patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics.

Conclusions:

Higher serum eosinophil levels may indicate worse mucosal disease as measured on CT scan, but neither serum nor tissue eosinophilia predicted disease severity in our population CRSwNP patients.
Combined Rhinosurgical and Neurosurgical Management of Intradural Angiofibromas
Authors: Naraghi Mohsen , Saberi Hooshang , Boroojerdi Masoud
Published: September 2014

Objectives:

Although intracranial extension of angiofibromas is not uncommon, intradural penetration is rare. Management of such rare tumors is a challenging issue in skull base surgery, necessitating tumor removal via combined approaches in most cases. In this paper we present our experience for management of extensive intradural angiofibromas.

Methods:

Six cases were male patients, 5 between 15 and 19 years old, presenting with nasal obstruction and epistaxis and proptosis. One of them was an aggressive recurrent tumor in a 32‐year‐old patient. They were scheduled for combined approaches with assistance of image‐guided endoscopic surgery.

Results:

Six cases underwent combined transnasal, tramaxillary, and craniotomy approaches with assistance of image‐guided endoscopic surgery. Craniotomy preceded rhinologic approach in 3. CSF leak and skull base defect was repaired by temporalis muscle flap and pericranial flap in 4 and fascia lata in 2. One postoperative leak was repaired with fascia lata transcranially. Otherwise the course was uneventful in all cases.

Conclusions:

The intradural intracranial extensions of angiofibroma require meticulous approach in terms of surgery because of their greater risk for complications during the dissection. Carotid rupture and brain damage are 2 catastrophic complications which should be kept in mind. In cases with extensive intradural involvement of the middle cranial fossa by angiofibroma, craniotomy with intradural approach could help to decrease complications.
Correlation between Nasal Nitric Oxide and Quality‐of‐Life Improvements after Sinus Surgery
Authors: Fu Chia‐Hsiang , Lee Ta‐Jen , Huang Chi‐Che , Hang Po‐Hung
Published: September 2014

Objectives:

Analyze the correlation between preoperative nasal nitric oxide (nNO) level, its postoperative change, and symptom scores in patients with chronic rhinosinusitis (CRS).

Methods:

We collected pre‐ and postoperative 3 and 6 months nNO level for patients who received bilateral endoscopic sinus surgery. They were classified according to existence of nasal polyps (NPs) and allergy test. Subjective symptoms were provided as Sino‐Nasal Outcome Test‐22 (SNOT‐22) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Associated medical parameters were analyzed.

Results:

Fifty‐four patients completed the follow‐up, including 16 CRS without NPs (CRSsNPs) and 38 CRS with NPs (CRSwNPs). Allergic patients had higher preoperative nNO level (P =. 042), but existence of NPs didn't make any difference. The nNO level correlated well with computed tomography score (P =. 001), endoscopy score (P <. 001), and current smoking (P =. 038). Baseline nNO correlated with postoperative 3‐month improvement in nose blowing (P =. 029) and nasal discharge (P =. 007) in CRSwNPs. In nonallergic patients, higher baseline nNO had better improvement in olfaction (P =. 039) and nasal discharge (P =. 035). Postoperative 3 month nNO change had significant correlation with improvement of olfaction only in CRSwNPs (P =. 036). The nNO change in postoperative 6 month had no correlation with any individual symptom score change in either group.

Conclusions:

Baseline nNO was significantly correlated to some of the symptom improvements in CRSwNPs and nonallergic group within 3 months postoperatively. Postoperative 3 month nNO change related to olfaction improvement in CRSwNPs group; however, no significant correlation could be detected in the 6‐month period after surgery.
Correlation between Rhinomanometry and NOSE Scale and Measurement of Therapeutic Success in Nasal Obstruction
Authors: Sánchez Hugo Lara , Álvarez Nuño Candelas , Sañudo Elisa Gil‐Carcedo , Iscar Agustín Mayo , Valdezate Luis Ángel Vallejo , María Luis
Published: September 2014

Objectives:

Active anterior rhinomanometry (AAR) and the Nasal Obstruction Symptom Evaluation (NOSE) scale are instruments for measuring nasal obstruction (NO). The study aimed to measure therapeutic success in the patients with NO by AAR and NOSE scale and establish the correlation between AAR and NOSE scale and between NOSE scale and visual analogue scale (VAS).

Methods:

Cohort study of patients with NO, on whom we performed an AAR, the NOSE scale, and the VAS at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty, or septoplasty and turbinoplasty). The nasal flows obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed.

Results:

A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with AAR and the subjective scales (P =. 0001). In patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P =. 1363). The correlation between the AAR, the NOSE scale, and VAS was measured, removing the effect of the intervention, finding only a strong correlation between the NOSE scale and VAS (r =. 83327).

Conclusions:

There is a higher treatment success in patients treated surgically. There is no significant correlation between AAR and NOSE scale and VAS. This is considered because the AAR and subjective scales are complementary and they measure different aspects of NO. Therefore, the AAR and the NOSE scale are helpful instruments to be used together for the diagnosis of NO and to measure objective therapeutic success and the feeling of satisfaction by the patient.
Cytologic and Functional Alterations of Nasal Mucosa in Smokers: Temporary or Permanent Damage?
Authors: Pagliuca Giulio , Rosato Chiara , Martellucci Salvatore , De Vincentiis Marco , Fusconi Massimo , De Virgilio Armando , Gallo Andrea
Published: September 2014

Objectives:

(1) Quantify the changes in the number of ciliated cells, ciliary beat frequency, and mucociliary transport of the nasal mucosa in smokers. (2) Evaluate if these cytologic and functional changes in smokers are permanent or reversible after smoking cessation.

Methods:

Ninety healthy volunteers recruited from the staff of A. Fiorini Hospital, Sapienza University of Rome, were enrolled in this study from September 2013 to January 2014. Volunteers were divided into 3 groups (smokers, nonsmokers, and ex‐smokers) composed of 30 subjects each. Cytological features of nasal mucosa and effectiveness of nasal mucociliary clearance were studied focusing on 4 parameters: 1) ratio between the number of ciliated cells and mucous‐secreting cells analyzed through microscopic observation of nasal scraping specimens; 2) in vitro evaluation of ciliary motility; 3) survival time of the ciliated cells analyzed by phase‐contrast microscopy; 4) nasal mucociliary clearance assessed by saccharin transit time test.

Results:

All parameters are significantly reduced in the group of smokers compared to the nonsmokers (P <. 05). However, there are no statistically significant differences between the nonsmoker and ex‐smoker groups (P >. 05).

Conclusions:

Cigarette smoking causes cytological modifications of nasal mucosa that influence the effectiveness of mucociliary clearance. Our study, although preliminary and conducted on a limited number of cases, suggests that these changes are not permanent and that nasal mucosa of ex‐smokers would recover normal cytologic and functional features.
Endoscopic Approach to Greater Palatine Artery to Control Recurrent Anterior Epistaxis
Authors: Butrymowicz Anna , Pinheiro‐Neto Carlos , Weisstuch Adam , Agarwal Jay
Published: September 2014

Objectives:

(1) Describe the anatomy of the incisive foramen. (2) Describe the endoscopic approach to the greater palatine artery. (3) Recognize the importance of the greater palatine artery as a cause of recurrent anterior epistaxis.

Methods:

Cadaveric and radiographic study of the incisive foramen; illustrative case series. Seventy computed tomography (CT) scans were reviewed, and measurements were made of the incisive foramina's distance to the anterior nasal spine and subnasale. An endoscopic approach to the incisive foramen was completed in 20 cadavers, and measurements of the distance from the anterior nasal spine to the incisive foramen were documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery.

Results:

Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Cadaveric measurements preliminarily correspond to radiographic measurements.

Conclusions:

Endoscopic cauterization of the greater palatine artery is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Preoperative evaluation of a CT scan can help aid a surgeon in determining the relative contribution of the greater palatine artery to the anterior septal blood supply, and guide surgical approach to control recurrent anterior epistaxis. Our case series corroborates the above.
Case Series and Systematic Review of IgG4‐Related Diseases in the Head and Neck
Authors: Mulholland Graeme B. , Jeffery Caroline C. , El‐Hakim Hamdy , Cote David
Published: September 2014

Objectives:

Immunoglobulin G4‐related disease (IgG4‐RD) is a poorly understood chronic inflammatory disorder affecting the middle aged and elderly that can present to the otolaryngologist. We aim to summarize the current literature by performing a systematic review as well as describe our institutional experience with 8 patients.

Methods:

Our search used Pubmed, Ovid, and Scopus using the keywords IgG4 related disease, head and neck, orbit, salivary glands, sialadenitis, Kuttner, angiocentric eosinophilic fibrosis, submandibular, lacrimal, thyroid, dacryoadenitis, nasal, sinus, paranasal, and Mikulicz's. Original research and review articles published in English from 1964 to 2013 whose major topic was IgG4‐RD affecting the head and neck were included. Data regarding the various presentations and management of IgG4‐RD were summarized. Additionally, we present our own experience with a series of 8 patients diagnosed with this condition.

Results:

One hundred twenty‐four articles met our inclusion criteria. IgG4‐RD most often presents as a mass lesion in the head and neck region. Common diagnostic features include: (1) elevated serum IgG4 level, (2) marked infiltration of exocrine glands by IgG4‐positive plasma cells with fibrosis, and (3) marked improvement with corticosteroid therapy. Early diagnosis and involvement of rheumatology is important in management.

Conclusions:

IgG4‐RD is a challenging nonsurgical disease that has multiple manifestations in the head and neck. It must be distinguished from various mimics including malignancy, systemic diseases, and infectious. Otolaryngologists should be aware of this condition and its management.
Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature
Authors: Khoueir Nadim P. , Nicolas Nicolas , Rohayem Ziad , Haddad Amine , Abou Hamad Walid M.
Published: September 2014

Objectives:

Systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature in order to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications.

Methods:

Literature was searched by 2 reviewers in online databases including PubMed and Embase with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. Reference sections of identified studies were examined for additional articles. We were only able to perform a meta‐analysis on the categorical outcomes using DerSimonian and Laird random effects models.

Results:

Ninety‐two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (Min = 20 mL; Max = 1482 mL). It was 414.6 mL (Min = 20 mL; Max = 1000 mL) and 774.2 mL (Min = 228 mL; Max = 1482 mL) respectively in the group with and without embolization. No conclusion could be taken because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval, 0.083‐0.117). It was 9.3% (95% confidence interval, 0.072‐0.115) for complications and 7.7% (95% confidence interval, 0.054‐0.101) for residual tumor.

Conclusions:

Endoscopic treatment is an evolving modality. It is considered today as the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.
Fungal Sinusitis: Fact or Fiction?
Authors: Katzer Cara M. , Bhalla Vidur , Horvat Rebecca T. , Tawfik Ossama W. , Beahm D. David , Robinson Ann B. , Hoover Larry A.
Published: September 2014

Objectives:

Participants should be able to: (1) Recognize chronic fungal sinusitis based on clinical examination and radiologic imaging; (2) Analyze the implications of nasal flora contents in suspected chronic fungal sinusitis patients; and (3) Implement surgical and medical treatment of chronic fungal sinusitis.

Methods:

A retrospective review of the senior author's patients from 1990 to 2014 was completed in which 50 immunocompetent patients thought to have evidence of fungal sinusitis were identified by the following criteria: Classic “high density” material seen on computed tomography (CT), fungal mycelium seen at surgery/fungal smears, and “Fig Newton” material visualized endoscopically in sinuses. Endoscopic surgery was performed on patients with emphasis to widely open sinuses and trim turbinates, allowing postoperative access to affected areas. Intraoperatively, material from sinus cavities was sent for microbiological and pathological analysis. Postoperatively, patients used saline irrigations to remove debris and potent topical steroids to reduce mucosal reactivity and edema. Antifungal agents were not employed. Regular debridements were carried out in the clinic until healing was complete.

Results:

Fungus was present in 29% of cultures/smears, while staphylococcus, pseudomonas, and other organisms were present in 44%. Nasal sinus mucosa returned to normal appearance in the majority of patients with topical treatment. Some patients with a strong allergy history had persistence of hypertrophic mucosa. A pulsed course of oral prednisone generally resolved this.

Conclusions:

Wide surgical drainage of affected sinus areas in combination with saline/acetic acid irrigations and topical steroids were successful in nearly all patients without the use of antifungal agents.
Health‐Related Quality of Life and Its Contributory Factors in Allergic Rhinitis Patients in Nigeria
Authors: Adebola Stephen O. , Abidoye Babatunde , Ologe Foluwasayo E. , Adebola Oyebola E. , Oyejola Benjamin A.
Published: September 2014

Objectives:

(1) Determine the health‐related quality of life (HRQoL) in allergic patients. (2) Identify contributory factors to patient well‐being.

Methods:

Cross‐sectional study by multistage sampling from October, 2013, to January, 2014. Kwara state has 16 local government areas with 3 senatorial districts, total land mass of 36,825 km2 with population of 2,591,555. Subjects: 132 consenting adults; 66 had allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument, and 66 were age‐ and sex‐matched controls. (χ2 = 0, df = 1, P = 1 and χ2 2 = 1.24, df =2, P =. 54, respectively). Information on HRQoL was obtained using the 14‐parameter mini Rhinoconjuctivitis Quality of Life questionnaire (mRQOL). Socio‐demographic variables possibly contributory to patient's well‐being were obtained. Analysis of variance and T test were used to compare means.

Results:

The overall Total Symptom Score (TSS) was 3.37 ± 0.9, while male and female allergic patients and control TSS were 3.61 ± 1.0; 3.16 ± 0.8, and 0.98 ± 0.2; 0.95 ± 0.2, respectively. Effects of sex, marital status, senatorial districts, residential area, and duration of symptoms had significant impact on quality of life. The highest correlation between the components of the mRQOL questionnaire existed between eye problems and other symptoms (P =. 703).

Conclusions:

AR had appreciable impact on HRQoL of the participants. Sex, marital status, senatorial districts, residential area, and duration of symptoms were major identifiable contributory factors to patient well‐being. We recommend prompt diagnosis and management as appropriate.
Hypoxia Increases Epithelial Permeability in Human Nasal Epithelia
Authors: Chung Hyo Jin , Min Hyun Jin , Kim Da Hee , Kim Chang‐Hoon
Published: September 2014

Objectives:

The nasal mucosa is the first site that encounters pathogens and forms continuous barriers to various stimuli. Here, we studied the effect of hypoxia on barrier function in normal human nasal epithelial (NHNE) cells. The expression levels of various junction complex proteins were assessed in hypoxia‐stimulated NHNE cells and human nasal mucosal tissues.

Methods:

We performed real‐time polymerase chain reaction analysis, western blotting, and immunofluorescence assays to examine differences in the mRNA and protein expression of ZO‐1 and E‐cadherin in NHNE cells. Moreover, we evaluated the transepithelial resistance (TER) of NHNE cells after hypoxic stimuli to check for changes in permeability. The expression of ZO‐1 and E‐cadherin was measured in human nasal mucosa samples by western blotting.

Results:

Hypoxia time‐dependently decreased the expression of ZO‐1 and E‐cadherin at the gene and protein levels. We also found that hypoxia decreased the TER of NHNE cells, which indicated increased permeability. Human nasal mucosa samples, which are supposed to be hypoxic, showed significantly decreased levels of ZO‐1 and E‐cadherin expression compared to control.

Conclusions:

Our results demonstrate that hypoxic condition in the nasal cavity, which can occur because of natural ostium obstruction, alters the expression of junction complex molecules and increases epithelial permeability in human nasal epithelia. This suggests that hypoxia is a major pathogenic mechanism of rhinosinusitis through its effect of deteriorating barrier function.
Increased Intracranial Pressure in Spontaneous CSF Leak Patients Is Not Associated with Papilledema
Authors: Aaron Geoffrey , Vaphiades Michael , Riley Kristen , Doyle Jennifer , Woodworth Bradford A.
Published: September 2014

Objectives:

Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks.

Methods:

Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1‐year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure was measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema.

Results:

Sixteen patients (avg. age 52 years) were evaluated. Obesity was present in 94% of individuals (avg. BMI 43.5; range, 27‐65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.7 cmH20 (P <. 001). IIH controls (avg. age 33 years, avg. BMI 36.7, 22‐52) exhibited average ICP (36 ± 10.5) identical to post‐clamp measurements in the spontaneous CSF leak cohort.

Conclusions:

Subjects with spontaneous CSF leaks had post‐clamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.
Long‐term Low‐Dose Doxycycline for Difficult‐to‐Treat Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago , Soter Ana C. , Pezato Rogerio , Pinna Fabio , Bachert Claus , Van Zele Thibaut , Voegels Richard L.
Published: September 2014

Objectives:

Assess the clinical outcome of long‐term low‐dose oral doxycycline in difficult‐to‐treat chronic rhinosinusitis with polyps.

Methods:

We conducted an open label prospective study in a university‐based tertiary care center from 2013 to 2014 with 60 patients with difficult‐to‐treat chronic rhinosinusitis with nasal polyps uncontrolled after 6 or more months of endoscopic sinus surgery. They were divided into 2 groups: 28 patients received nasal steroids plus doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks while 32 patients received only nasal steroids. The main outcome measure was a meaningful improvement in SNOT‐20 (>0.80). Other outcome measures were the SNOT‐20, NOSE, and Lund‐Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, DREA and blood testing before treatment for IgG, IgA, IgE, IgM, antineutrophil cytoplasmic antibodies, and blood eosinophil count.

Results:

There was a statistically significant association among meaningful improvement in SNOT‐20 and doxycycline treatment [50.0% (14/28) vs 9.4% (3/32), P =. 01]. The patients who received doxycycline also showed a statistically significant outcome in SNOT‐20 (P =. 002), NOSE (P =. 046), and Lund‐Kennedy (P =. 004). The group who presented a clinically significant improvement of SNOT‐20 also presented better outcomes on SNOT‐20 and NOSE scores (P =. 001),and almost statistically significant on Lund‐Kennedy (P =. 07). The presence of asthma (P =. 006), aspirin‐exacerbated respiratory disease (AERD; P =. 018), and raised serum IgE (P <. 035) were associated with a worse prognosis after treatment.

Conclusions:

These findings suggest that doxycycline may have a beneficial role in chronic rhinosinusits with polyps, particularly in patients without high levels of IgE, asthma, and AERD.
Medical Treatment of Traumatic Anosmia
Authors: Jiang Rong‐San
Published: September 2014

Objectives:

Study the effects of zinc and steroid in the treatment of traumatic anosmia.

Methods:

Patients with a clear history of complete loss of smell after head injury were collected from January 2010 to May 2013. All patients received phenyl ethyl alcohol threshold test, and those whose thresholds were –1 were included in this study. They were randomly divided into 4 groups. Patients in group 1 were treated with zinc sulfate (15mg tid) for a month and high dose prednisolone (1 mg/kg per day) with tapering for 2 weeks. Those in group 2 only took zinc, and those in group 3 only took prednisolone. Patients in group 4 did not take any medicine. All patients were followed up by phenyl ethyl alcohol threshold test to find whether their olfactory function improved and had magnetic resonance imaging to measure the volume of olfactory bulbs.

Results:

There were 145 patients completing the study. Thirty‐nine belonged to group 1, 34 to group 2, 35 to group 3, and 37 to group 4. Olfactory function improved in 11 patients (28.2%) who took prednisolone and zinc, in 9 (25.7%) who took zinc, in 4 (11.8%) who took prednisolone, and in 1 (2.7%) who did not take any medicine. The olfactory improvement rates of groups 1 and 2 are significantly higher than that of group 4. The volume of olfactory bulbs is not significantly different between those with and without improved olfactory function.

Conclusions:

Our results show that zinc has good effect in treating traumatic anosmia.
Olfactory Improvement and Decline in Patients with Posttraumatic Olfactory Dysfunction
Authors: Kuo Chin‐Lung , Fan La‐Yuan , Shiao An‐Suey , Shu Chih‐Hung
Published: September 2014

Objectives:

Identify the prognosis for patients with post‐traumatic olfactory dysfunction.

Methods:

From 2007 to 2013, patients with posttraumatic olfactory dysfunction were enrolled. The threshold, discrimination, and identification (TDI) score of Sniffin’ Sticks test was ≤15 for anosmia, ≥30 for normosmia, and between these values for hyposmia. Olfactory improvement/decline was defined as an increase/decrease in TDI score ≥ 6 points. The cumulative incidence rates of olfactory improvement and decline were calculated using the Kaplan‐Meier method. Variables with a potential impact on olfactory changes were entered into Cox regression analysis. The correlation between the TDI scores of the first and last visit was evaluated.

Results:

We included 80 patients with an average 9.4‐month follow‐up period (range, 1‐52 months). The 12‐month cumulative rates of olfactory improvement and decline were 8.4% and 11.8%, respectively. Anosmia, hyposmia, and normosmia were noted in 71.2%, 27.5%, and 1.2% of the patients at the first visit and 72.5%, 23.8%, and 3.8% at the last visit (Fisher's exact, P =. 583). Multivariate analysis revealed no associations between clinical predictors and olfactory changes (all P >. 05). A positive correlation between the TDI scores of first and last visit (Spearman test, Rho = 0.532, P <. 001) confirmed the absence of significant changes in olfaction.

Conclusions:

Posttraumatic olfactory dysfunction was associated with a lower risk of decline in olfaction and a lower likelihood of improvement. Although most patients maintained a stable disease status, anosmia in the majority of patients may reflect a poor prognosis in olfactory recovery for patients with head trauma.
Characterization of Contemporary Otolaryngology‐Specific Emergency Room Care at the Massachusetts Eye and Ear Infirmary
Authors: Sethi Rosh K. V. , Kozin Elliot D. , Remenschneider Aaron K. , Lee Daniel J. , Gray Stacey T. , Shrime Mark G. , Gliklich Richard E.
Published: September 2014

Objectives:

(1) Characterize contemporary utilization patterns of a stand‐alone otolaryngology emergency room (ER). (2) Assess the range of otolaryngologic complaints. (3) Determine characteristics of patients that require inpatient admission. (4) Provide a practical discussion about the utility of a specialized ER in otolaryngologic care.

Methods:

Retrospective review of demographic and diagnostic data for all patients with an otolaryngologic complaint evaluated at our institutions ER from January 2011 through September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Multivariable regression modeling was used to identify predictors of inpatient admission. Geocoding analysis was performed to characterize the ER catchment area.

Results:

A total of 12,234 patient visits were evaluated. Mean patient age was 44.7 years with equal sex distribution. The majority of visits occurred during daytime hours (75%) with peak volume occurring mid‐day. Auditory and vestibular problems constituted the most frequent presenting complaints (50.0%). The majority of patients were discharged home (92.3%). Significant predictors of inpatient admission were pediatric designation (odds ratio [OR] 1.9, P <. 0001), male sex (OR 1.3, P <. 0001), arrival overnight (OR 3.3, P <. 0001), postoperative complaint (OR 7.3, P <. 0001), and laryngeal complaint (OR 2.4, P <. 0001). Median distance traveled was 9.6 miles. Patients traveled farther for evaluation of hearing loss (11 miles) and less far for common diagnoses including impacted cerumen (7.1 miles; P <. 0001).

Conclusions:

This study provides a contemporary analysis of patterns of specialized otolaryngology ER care in the United States. This study has broad implications for otolaryngology care and resource utilization in the emergency care setting.
Prosthetics for Nasoseptal Perforation Repair: A Systematic Review
Authors: Taylor Robert J. , Kern Eugene B. , Sherris David A.
Published: September 2014

Objectives:

Prosthetics—including buttons and other obturators serve as an option for nasoseptal perforation repair in patients who have active systemic disease, are poor surgical candidates, or wish to avoid surgery. By systematically reviewing the literature on prosthetics for nasoseptal perforation repair, the objective of the present study is to critically appraise previous studies, provide evidence‐based guidelines for nasoseptal prosthetic use, and identify areas for further investigation.

Methods:

The Cochrane Controlled Trials Register, EMBASE, PubMed, and Web of Science were queried for relevant articles published from 1965 to 2013. Articles were selected for inclusion if they presented primary data for human nasoseptal perforation treatment utilizing prosthetic materials. The reference lists of included articles were searched for additional studies. Each included article's level of evidence was identified and grades of recommendation were assigned.

Results:

The search yielded 4756 abstracts for review, with 23 case series and 5 case reports meeting inclusion criteria. A total of 706 cases of prosthetic nasoseptal perforation repair were identified, with a case series median n = 20. All articles provided level 4 evidence, with an overall conclusion grade of C for improvement in nasoseptal perforation symptoms, prosthetic in situ rate, and complication rate.

Conclusions:

The literature provides considerable level 4 evidence for the efficacy and safety of prosthetics for nasoseptal perforation repair with success rates of 33% to 100% and minimal complications: only 1 fungal infection and 9 unspecified infections in 706 cases. The disease‐ and prosthetic‐specific factors influencing symptom improvement and prosthetic tolerance require additional study for further elucidation.