bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of IL‐5 and IL‐8 in the Pathogenesis of Nasal Polyps
Authors: Rosato Chiara , Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Di Cristofano Claudio , Cerbelli Bruna , Gallo Andrea
Published: September 2014

Objectives:

(1) Evaluate the histopathological and immunohistochemical characteristics of different types of nasal polyps. (2) Quantify the expression of IL‐5 and IL‐8 in 2 different histotypes of nasal polyps in order to evaluate the role of these cytokines in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP).

Methods:

This retrospective study was conducted on 44 specimens collected from nasal cavities of 44 patients with nasal polyposis who underwent functional endoscopic sinus surgery at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome, from January 2009 to January 2011. The specimens were analyzed at the histopathology unit of the university and divided into 2 groups according to their dominant histological features: Group A (polypoid mucosa and eosinophilia, 34 subjects) and Group B (polypoid mucosa associated with glandular hyperplasia, 10 subjects). Expression of IL‐5 and IL‐8 were analyzed on the specimens using immunohistochemical techniques. The same tests were run on nasal mucosa specimens drawn from 10 patients without sinusitis (control group).

Results:

IL‐5 expression was significantly more expressed in Group A than in Group B (P <. 05). Both IL‐5 and IL‐8 expressions were significantly more expressed in Groups A and B compared to the control group (P <. 05). No significant difference was found in the expression of IL‐8 between the 2 groups.

Conclusions:

The outcomes of this preliminary study suggest that IL‐8 may play a role in the pathogenesis of both histological subtypes of nasal polyps, whereas IL‐5 predominates in the eosinophilic subtype.
SNOT‐22 in a Control Population
Authors: Erskine Sally , Philpott Carl M.
Published: September 2014

Objectives:

This analysis uses data from the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim of CRES is to determine factors which influence the onset and severity of chronic rhinosinusitis (CRS). Sino‐Nasal Outcome Test (SNOT‐22) is a widely used score for nasal symptoms in many ENT clinics internationally, although there are few data characterizing SNOT‐22 scores for a normal population. The aim of this analysis is to establish a dataset of normal values for SNOT‐22 in a British population.

Methods:

Study‐specific questionnaires including demographic and socioeconomic factors and past medical history as well as SNOT‐22 and SF‐36 were distributed to patients with CRS attending ENT clinics and to a control population across several centers in the United Kingdom. This analysis considered just the control population. Controls had no self‐reported nasal problems in the past, no chronic conditions undergoing active treatment, and no hospital admissions in the preceding 12 months.

Results:

A total of 1529 participants were recruited; 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Age range was 18 to 98 years. Two hundred thirteen controls included sufficient information to calculate SNOT‐22 score. Score range was 0 to 85; median 9, mean 13.4.

Conclusions:

SNOT‐22 is an important tool for measuring the impact of nasal symptoms and evaluating effectiveness of treatments. Data for a large population without nasal problems will be invaluable in both clinical and academic settings. Further analysis will characterize SNOT scores for different types of CRS and subgroup analysis of different elements of SNOT‐22.
Spontaneous Cerebrospinal Fluid Rhinorrhea: Correlation with Body Weight and Radiological Data
Authors: Karkas Alexandre , Attye Arnaud , Righini Christian A. , Schmerber Sebastien , Quatre Raphaelle
Published: September 2014

Objectives:

Search for correlations between spontaneous cerebrospinal fluid rhinorrhea (SCSFR) and overweight/obesity and imaging data.

Methods:

Retrospective study of patients with SCSFR operated in a tertiary center (1993‐2013). A 2‐sided test was used for statistics.

Results:

There were 17 patients with SCSFR: 9 females/8 males; mean age 45 years (range, 3‐84 years). Abnormalities on computed tomography (CT) were: bone defect (12), sinus opacity (11). Abnormalities on magnetic resonance imaging (MRI): continuity with meninges (7), meningocele (6), empty sella (6), dilation of optic nerve sheath (6), pneumocephalus (1). Patients underwent endoscopic closure of osteo‐meningeal defect with fat. Primary success rate was 13 out of 17 (76.5%). Regarding body mass index (BMI), 12 patients out of 17 (70.6%) were overweight (BMI ≥25) versus 32% in the French general population (P =. 001). Among patients with SCSFR and overweight, 3 out of 12 (25%) were obese (BMI ≥30) versus 15% in overweight individuals (P =. 483). Increased pneumatization of sinuses was observed in 15 out of 17 (88%) versus 35% in the general population (P =. 00009). Empty sella was found in 6 out of 17 (35.3%) versus 5.5% in the general population (P =. 0002). Dilation of optic nerve sheath was observed in 6 out of 17 (35.3%) versus 10% in the general population (P =. 0047).

Conclusions:

We found statistically significant correlations between SCSFR and overweight individuals, increased pneumatization of sinuses, empty sella, and dilation of optic nerve sheath, but not with obesity. This could be due to the small number of patients in this study and a weak statistical power for obesity. The 2‐sided test is ideal for small samples of patients, but a greater number is needed in the future to confirm these preliminary results.
Ablation‐Assisted Uvulapalatopharyngoplasty Technique for OSAS Treatment: A 5‐Year Follow‐up Study
Authors: Xiao Mang
Published: September 2014

Objectives:

Determine the long‐term outcome of patients suffering from obstructive sleep apnea syndrome (OSAS) treated by ablation‐assisted uvulapalatopharyngoplasty.

Methods:

Seventy‐five subjects were included between 2005 and 2007. All patients suffered from moderate or severe OSAS. They were treated by radiofrequency volumetric tissue reduction (RFVTR) of the palatopharyngeal abnormal tissues (including tonsillar RFVTR or tonsillectomy), the advance of palatopharyngeal arch after the dissection of palatopharyngeal vault, and the inferior one‐third of the palatine velum interspace. Polysomno‐graphy (PSG), snoring (assessed on a 10cm visual analog scale [VAS]), marital status, and presence of cardiovascular risk factors or pathologies were evaluated by postal questionnaire.

Results:

Mean follow‐up time was 5.3 ± 1.3 years. Mean snoring intensity decreased significantly in the immediate postoperative period (8.1 ± 2.9 to 3.5 ± 2.2 cm on VAS). Over the longer term, however, we observed a slight increase in snoring intensity (3.7 ± 2.9 cm) (P >. 05). PSG monitoring, RDN (344 ± 38), apnea‐hypopnea index (AHI; 59 ± 10), obstructive sleep apnea time (OSAT) (35 ± 13)s, longest obstructive apnea time (LOSAT) (87 ± 26)s, and the mean arterial pressure (145 ± 14) mm Hg in OSAS decreased significantly in the immediate postoperative period (P <. 01). Over the longer term, however, we observed a slight increase in PSG monitoring result (P >. 05) but still better than before surgery (P <. 01). Hypertension and diabetes were diagnosed during follow‐up in 12.1% and 6.6% of the subjects, respectively. A minority of patients failed to undergo repeat polysomnography.

Conclusions:

Ablation‐assisted uvulapalatopharyngoplasty is highly effective in the treatment of OSAS. Expected scar formation, enlarged nasopharyngeal and oropharyngeal cavity, reduction of the uvula and lateral pharyngeal bands may contribute to these good success rates.
Drug‐Induced Sleep Endoscopy Informs Management of Obstructive Sleep Apnea after Incomplete Mandibular Advancement Device Response
Authors: Kent David T. , Soose Ryan J.
Published: September 2014

Objectives:

(1) Understand that half of obstructive sleep apnea (OSA) patients failing positive airway pressure (PAP) attempt mandibular advancement device (MAD) therapy but still suffer from residual disease. (2) Describe how drug‐induced sleep endoscopy (DISE) evaluates anatomical patterns of obstruction under conditions that mimic sleep and aids management in patients with incomplete response to MAD.

Methods:

A review of 35 consecutive adult OSA patients, with continuous positive airway pressure intolerance and incomplete response to MAD therapy (apnea‐hypopnea index [AHI] >15 or AHI >5 with persistent subjective symptoms), who underwent DISE with and without the MAD between 12/2010 and 8/2013. Data collected included demographics, body mass index (BMI), Epworth Sleepiness Score (ESS), polysomnography data, and management decisions after DISE. Each DISE video was retrospectively scored using the VOTE classification system by the same blinded reviewer (R.J.S.).

Results:

All patients had multilevel airway obstruction during baseline DISE. 32 (91.4%) obstructed in the velopharynx despite MAD use. 26 (74.3%) patients were recommended to undergo targeted surgery based on DISE findings with 21 (60%) completing it. Nineteen (54.3%) underwent additional medical therapy such as MAD or PAP adjustment. Twelve (34.3%) were treated with surgical and medical therapy. Subjective and objective outcomes were significantly improved in 15 patients with outcome data currently available (mean AHI 39.3 to 10.7, P <. 01; ESS 11.2 to 6.25, P <. 01).

Conclusions:

In patients with incomplete response to MAD therapy, DISE with and without the MAD provides informs management decisions regarding additional medical or surgical options to augment the effectiveness of the MAD.
The Effect of Sleep Disruption on Postoperative Pain
Authors: Miller Anya J. , Roth Thomas , Roehrs Timothy , Yaremchuk Kathleen L.
Published: September 2014

Objectives:

(1) Identify the amount of sleep disruption that occurs in the postoperative inpatient hospital setting. (2) Determine the relationship between sleep disruption and the use of postoperative narcotic for pain. (3) Determine if the postoperative hospital course is impacted by sleep disruption. Sleep disturbance is a common complaint among hospitalized patients. Decreased sleep and poor sleep quality have been found to be correlated with poor hospital outcomes and decreased wound healing.

Methods:

Prospective cohort study. Fifty patients undergoing total hip or knee arthroplasty at Henry Ford Hospital in Detroit, Michigan, between January 2013 and November 2013 were asked to wear an actigraph during their postoperative hospital stay. Total sleep time, sleep efficiency, awake index, narcotic use, visual analog pain scores, and postoperative complications were analyzed.

Results:

A significant correlation was found between lower self‐reported pain scores and total sleep time (P =.03). Spearman correlations between the number of minutes of sleep, sleep efficiency, and awake index were made with the narcotic use on postoperative days (PODs) 0 and 1. None of the results were statistically significant. Narcotic use on POD 0 and sleep on POD 1was marginally significant (P =. 09). Longer hospital stay was associated with decreased sleep efficiency (P =. 01). Complication rates were not statistically different when compared to other sleep parameters.

Conclusions:

Better control of a patient's pain improves sleep efficiency and total sleep time. Attention to decreased sleep disruption for hospitalized patients has the potential to improve patient satisfaction with hospital care and decrease length of stay.
Predicting Success of Transoral Robotic Surgery for OSA Using Preoperative Sleep Endoscopy and MRI Analysis
Authors: Chiffer Rebecca C. , Borek Ryan C. , Schwab Richard , Thaler Erica R.
Published: September 2014

Objectives:

Determine the relationship between surgical success and both preoperative drug‐induced sleep endoscopy (DISE) airway caliber changes and volumetric magnetic resonance imaging (MRI) in patients with obstructive sleep apnea (OSA) undergoing transoral robotic assisted posterior glossectomy and uvulopalatopharyngoplasty (OSA‐TORS).

Methods:

From 2009 to present, as part of a nonrandomized prospective trial, patients with OSA undergoing OSA‐TORS had preoperative DISE and pre‐ and postoperative volumetric MRI of the upper airway. Quantitative analysis of the endoscopy and MRI were compared with surgical success based upon pre‐ and postoperative polysomnogram, with success defined as postoperative apnea‐hypopnea index (AHI) <20 and AHI decrease ≥50%. Preoperative MRI volumes were also compared against DISE changes.

Results:

Thirty‐five apneics undergoing OSA‐TORS underwent DISE, 21 received MRIs. DISE data showed that patients with surgical success had a smaller percentage decrease in overall airway collapse in the retroepiglottic (P =. 045) and retroglottic regions (P =. 08) compared with nonsuccesses. Larger preoperative MRI retroglottic airway volumes correlated with increased retroglottic (P =. 05) and retroepiglottic (P =. 03) lateral airway collapse on DISE, however, differences in pre‐ and postoperative MRI airway volumes did not correlate with surgical success.

Conclusions:

Larger retroglottic airway volume on MRI correlated with greater lateral airway collapse during DISE, but not with surgical success. Successes after OSA‐TORS had significantly smaller airway collapse in the retroepiglottic regions than nonsuccesses during DISE, possibly due to better baseline muscle tone, allowing for better ability to benefit from the relatively small change in airway volume that OSA‐TORS provides. Preoperative quantitative DISE could be used to identify patients more likely to succeed after OSA‐TORS.
Severity of Childhood Obstructive Sleep Apnea and Hypertension Improved after Adenotonsillectomy
Authors: Lee Li‐Ang , Li Hsueh‐Yu , Fang Tuan‐Jen , Lin Yu‐Sheng , Huang Yu‐Shu , Hsu Jen‐Fu
Published: September 2014

Objectives:

Report improvements of childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.

Methods:

Case series with planned data collection of 50 consecutive OSA patients (36 boys and 14 girls; mean age, 7.6 ± 2.8 years) who underwent plasma knife total tonsillectomy and adenoidectomy between January 2010 and March 2013. Body mass index (BMI), apnea‐hypopnea index (AHI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed at baseline and at ≥6 months postoperatively. Changes of these parameters were statistically analyzed.

Results:

The mean values of BMI z‐score, AHI, SBP, and DBP were 1.91 ± 0.27, 15.9 ± 17.2, 102.8 ± 16.8 (mm Hg), and 67.4 m ± 12.6 (mm Hg), respectively. The median follow‐up period was 12 months. Eighteen patients (36%) were cured after adenotonsillectomy. Postoperatively, adenotonsillectomy reduced AHI (Δ = −13.3 ± 17.7, P <. 001) significantly but not BMI z‐score, SBP, and DBP (all P >. 05). Although the proportion of obesity remained similar (32% vs 30%, P =. 56) after operation, the proportion of hypertension significantly reduced from 34% to 14% (P =. 004). At baseline, obesity, severe OSA, and hypertension were significantly associated with postoperative hypertension. In multiple logistic regression analysis, severe OSA and hypertension were independent predictors of postoperative hypertension.

Conclusions:

Hypertension is not uncommon in children with OSA. Decreasing hypertension rate indicates that reduction of AHI is not all that matters after adenotonsillectomy in childhood OSA. However, pediatric patients with severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.
Targeted Multilevel Surgical Management of Obstructive Sleep Apnea: A Case Series of 44 Patients
Authors: Davis‐Malesevich Melinda , Naseri Iman , Salem Whitney B. , Vega Luis , Kraemer Dale
Published: September 2014

Objectives:

(1) Assess the effectiveness of multilevel surgery in the treatment of obstructive sleep apnea (OSA). (2) Analyze outcomes based on reduction of apnea hypopnea index (AHI) and positive airway treatment pressures.

Methods:

Case‐series review in a tertiary referral center. A total of 44 patients underwent multilevel OSA surgery between November 2009 and September 2013. Depending on the preoperative examination and OSA severity based on sleep study, patients underwent multilevel surgery including nasal, oropharyngeal, transoral robotic, tongue base, hyoid, and/or orthognathic surgery. Follow‐up sleep studies at 4 months were obtained and compared with preoperative data.

Results:

Overall AHI was significantly reduced from a mean of 44.5 to 19.9 (P =. 0008), 78.9 to 35.8 (P =. 0001) in the severe OSA group, 21.4 to 7.0 (P =. 0001) in the moderate group, and 8.7 to 4.5 (P =. 0004) in the mild group. AHI reduced from mean of 98.1 to 31.7 (P =. 0013) in those who underwent orthognathic surgery and 36.1 to 18.1 (P =. 011) in those who had soft tissue procedures without orthognathic surgery. Overall continuous positive airway pressure (CPAP) improved from mean of 10.9 to 4.7 cmH20 (P =. 0001). Body mass index was significantly higher in the severe OSA group than the mild and moderate groups. No significant difference was noted in neck circumference between the 3 groups.

Conclusions:

Targeted multilevel OSA surgery in this cohort was successful in an overall reduction of AHI and CPAP pressures. The maximum improvement in AHI was seen in patients with moderate OSA and in those who had an orthognathic procedure.
Targeted Stimulation of the Hypoglossal Nerve for Treatment of Obstructive Sleep Apnea
Authors: Friedman Michael , Yalamanchali Sreeya , Jacobowitz Ofer , Campana John P. , Rombaux Philippe , Bergler Wolfgang , Maurer Joachim T.
Published: September 2014

Objectives:

Determine safety and effectiveness of targeted hypoglossal neurostimulation sleep therapy system for obstructive sleep apnea (OSA). Titration with multi‐contact electrode and multi‐channel pulse generator (IPG) allows stimulation of multiple areas of the proximal hypoglossal nerve permitting identification of optimal tongue position in each patient.

Methods:

A total of 105 adults were screened in this prospective, multicenter, single‐arm study. Inclusion criteria were continuous positive airway pressure (CPAP) failure/intolerance, apnea hypopnea index (AHI) > 20, and body mass index (BMI) > 37. 56 patients meeting inclusion/exclusion criteria were surgically implanted with the unilateral hypoglossal nerve stimulator electrode and IPG (aura6000TM System, Imthera Medical, San Diego). Patients were evaluated at 1, 3, 6, and 12 months. Outcomes included AHI, oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS), Sleep Apnea Quality of Life Index, and EQ‐5D quality of life questionnaire.

Results:

Postsurgical transient tongue paresis was observed in 5 out of 56 patients (8.9%); all resolved spontaneously. Four patients withdrew, leaving 52 subjects to complete the study by September 2014. All were male, with mean age of 54.8 ± 10.6 years, and mean BMI of 30.4 ± 3.6. Preliminary data at month 3 showed significant decrease in AHI by 43.7% from 50.5 ± 18.4 to 26.7 ± 19.8 (P <. 001) and significant improvement in ESS from 12.4 ± 4.0 to 9.1 ± 4.5 (P <. 001).

Conclusions:

Surgical implantation of targeted hypoglossal neurostimulation sleep therapy system appears to be a safe and practical treatment option for OSA. Preliminary data shows significant improvement in objective and subjective outcomes. Final safety and effectiveness will be determined.
Taste Disturbance following Coblator Open Tongue Base Resection for OSA
Authors: Lin Hsin‐Ching , Friedman Michael
Published: September 2014

Objectives:

Retrospectively investigate the taste disturbance (TD) following endoscopic Coblator open tongue base resection (Eco‐TBR) for the treatment of obstructive sleep apnea syndrome (OSA).

Methods:

Eighty patients with OSA who failed CPAP therapy and then underwent modified UPPP combined with Eco‐TBR were enrolled in this study. TD in the postoperative questionnaire was examined. The 3‐drop‐method gustatory function test was used to study the taste status preoperatively and at 7 days, 1 month, and 3 months postoperatively.

Results:

Six female and 74 male patients with OSA (mean age, 42.6 years; mean apnea‐hypopnea index, 48.5/h) had a minimum follow‐up of 3 months and complete data available for analysis. One patient had postoperative oral bleeding. No long‐term obvious dysphagia was encountered. Twelve patients had obvious TD in 4 basic tastes (sweet, sour, salty, and bitter). Eight patients still had the change of taste sensation up to postoperative 3 months; however, the TD severity decreased and did not impact the patient's regular social life.

Conclusions:

This study shows coblator open tongue base resection may increase the likelihood of taste disturbance postoperatively. Patients with taste disturbance after Eco‐TBR may gradually recover their taste function over time.
Upper Airway Collapsibility and OSA: A Novel Method in Detecting Pharyngeal Wall Floppiness
Authors: Qian Wei , Jiang Guo‐Chang , Tang Jun‐Xiang , Zhao Lin
Published: September 2014

Objectives:

Upper airway collapse is the major reason of obstructive sleep apnea (OSA). However, the site and mechanism of the obstruction remains unclear. To measure the pharyngeal wall floppiness under different pressures, a novel method and technique is introduced in the present study.

Methods:

Forty‐seven normal subjects (male: 32; mean age, 37.9 years) and 49 OSA patients (male: 6; mean age, 41.45 years) were recruited in this prospective clinical study. The pharyngeal cavity volumes were measured by means of acoustic reflection under positive (10 cmH2O) and negative (–10 cmH2O) pressures. The pharyngeal wall floppiness was calculated from the difference of pharyngeal cavity volumes under positive and negative pressures divided by the sum of the volumes under different pressures.

Results:

The pharyngeal wall floppiness was 0.19 ± 0.11 in normal subjects and 0.24 ± 0.07 in OSA group with a significant difference (P <. 01). There was moderate positive correlation between pharyngeal wall floppiness and age or body mass index (BMI) in normal subjects. In OSA patients, the pharyngeal wall floppiness had a weak negative correlation to age, whereas it had moderate positive correlation to sleep apnea severity (apnea‐hypopnea index), BMI or neck circumference, respectively.

Conclusions:

The OSA population had greater pharyngeal wall floppiness. The age dependent of pharyngeal wall floppiness in normal subjects implied that aging might play important roles in the development of OSA. The measurement of pharyngeal wall floppiness could be a useful and valuable parameter in diagnosis of OSA and predicting the adherence in continuous positive airway pressure (CPAP) treatment.
Factors Associated with Hypertrophy of the Lingual Tonsils
Authors: Yalamanchali Sreeya , Salapatas Anna M. , Friedman Michael , Joseph Ninos J.
Published: September 2014

Objectives:

Identify factors that may be associated with lingual tonsil hypertrophy (LTH).

Methods:

Retrospective chart review identified 380 patients from August 2013 to January 2014 with graded lingual tonsils, documented during routine flexible laryngoscopy. Lingual tonsils were graded using a 0 to 4 scale: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covers entirety of tongue base with limited thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (above tip of epiglottis). Reflux symptom index (Reflux Symptom Index (RSI)–collected during patient intake), presence of obstructive sleep apnea (OSA; confirmed by polysomnogram), smoking habits, and basic demographics were gathered. Ï•2 and linear multi‐variate regression analyses were used to identify significant correlating demographics with LTH.

Results:

Overall, 59.5% were male with a mean age of 50.2 ± 16.5 years and body mass index (BMI) of 30.1 ± 18.0. Ï•2 analysis revealed no significant relationship between OSA and LTH (P =. 059). When RSI was stratified to ≥10 or <10, a Cochran‐Armitage test supported the trend hypothesis that as RSI increases lingual tonsil grading increases. Significant univariate correlates included age (r = –0.307, P <. 001) and smoking (r = 0.186, P =. 002). Multivariate regression revealed the combination of age and smoking (r = –0.297, P <. 001) to be a significant correlate.

Conclusions:

LTH does not seem to be associated with OSA in this group of patients. Abnormal RSI may be a factor associated with increased lingual tonsil thickness. Younger patients who smoke are more likely to have LTH.
Gland‐Preserving Transfacial Removal of Parotid Stones
Authors: Carroll William W. , Gillespie M. Boyd , Walvekar Rohan R.
Published: September 2014

Objectives:

(1) Analyze the evolving technique for gland‐preserving transfacial removal of parotid stones including ultrasound, needle localization, and the combination of endoscopy with transfacial removal. (2) Review the success rate for patients treated with gland‐preserving transfacial removal of parotid stones in an updated cohort.

Methods:

Case series with chart review at a tertiary care university hospital from 2010 to 2014. Disease: Parotid sialolithiasis. Subjects: Patients with parotid sialolithiasis unmanageable with endoscopy alone. Intervention: Transfacial removal. Outcome measurements: Symptom relief, gland preservation, use of ultrasound, use of needle localization, stone size, stone location, facial nerve visualization, complications, and endoscopic confirmation of stone location prior to stone removal.

Results:

A total of 25 patients underwent transfacial operation for symptomatic parotid sialolithiasis. Ultrasound was used in 88% of cases and needle localization was used in 64% of cases. Sixteen out of 25 patients (64%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Ten of the remaining eleven patients without complete symptom resolution did endorse significant symptom improvement, while the final patient eventually underwent parotidectomy. Fifteen out of 25 patients (60%) had a stone that was localized with the endoscope prior to transfacial resection.

Conclusions:

Transfacial removal of certain parotid stones is a functional alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Ultrasound and needle localization are useful adjuncts in stone retrieval.
NSAIDs and Tonsillectomy: A Systematic Review and Meta‐analysis of the Literature Addressing Pain
Authors: Cohen Natasha , Sommer Doron D. , MacLean Jonathan
Published: September 2014

Objectives:

The use of nonsteroidal anti‐inflammatory drugs (NSAIDs) post‐tonsillectomy is controversial, but recent severe complications associated with codeine and a resulting black box warning from the Food and Drug Administration have caused us to reassess their use. The aim of the study was to determine the efficacy of NSAIDs compared with other analgesics post‐tonsillectomy.

Methods:

We systematically searched Medline, EMBASE, the Cochrane trial registry, and Web of Science. Only randomized controlled trials (RCTs) that compared an NSAID with either placebo or non‐NSAID active comparators were included. Studies had to measure a pain‐related outcome (eg, total morphine used, pain scores). Secondary outcomes included differences in vomiting, bleeding, admission to the hospital, and return to emergency department. We did not discriminate for age of patients. RevMan 5.0 was used to synthesize and analyze the data extracted from studies reviewed.

Results:

Based on the meta‐analysis of the data retrieved from 60 articles, NSAIDs were found to be equivalent to other active comparators in the early postoperative period. There was also significantly less vomiting in the NSAID group. Small sample sizes of studies and heterogeneity of methods for reporting pain restricted the sample size for comparison of outcomes.

Conclusions:

NSAIDs are as effective as active comparators for pain relief. We recommend a large RCT to confirm these findings.
Signs and Symptoms Predictive of Airway Involvement in Angioedema
Authors: Du Eugenie , Helman Samuel N. , Loftus Patricia A. , Patel Gunj , Ow Thomas J. , Tan Melin
Published: September 2014

Objectives:

Patients with angioedema present to the emergency department (ED) with myriad signs and symptoms with a wide range of severity, from mild discomfort to severe airway compromise. Initial estimation of angioedema course and patient airway safety can be challenging. Base of tongue (BOT) and laryngeal involvement are recognized to correlate with need for intubation; however, there are few clear indicators of potential future airway compromise. We evaluated the relationship between presenting signs and symptoms with fiberoptic laryngoscopic findings to help in the immediate stratification of angioedema patients.

Methods:

Retrospective chart review of patients presenting with angioedema to the ED of a tertiary care center from January 2005 to July 2013.

Results:

Of 1987 patients treated by the ED for angioedema, 401 generated an otolaryngology consult; of these, 79 (19.7%) and 128 (31.9%) had base of tongue (BOT) and laryngeal involvement, respectively. Dysphagia and voice change correlated with both BOT and laryngeal edema (P <. 01). Sensation of throat closure correlated with laryngeal edema alone (P <. 01). Tongue, floor of mouth (FOM), and neck swelling correlated with BOT edema while FOM, uvular, and neck swelling were correlated with laryngeal edema (P <. 01). Lip edema had strong negative correlations to both BOT and laryngeal edema (P <. 0001).

Conclusions:

Patient report of dysphagia, voice change, sensation of throat closure along with tongue, floor of mouth, uvular, or neck swelling on initial presentation should raise suspicion of compromising BOT or laryngeal involvement. This cohort of patients requires a higher index of suspicion for potential airway intervention.
Systematic Review of HPV‐Related Head and Neck Cancers in Latin American Countries
Authors: Chu Amy W. , Varier Indu V. , Patsias Alexis , Sikora Andrew G.
Published: September 2014

Objectives:

Human papillomavirus (HPV)–related head and neck squamous cell carcinoma (HNSCC) is extensively studied in the developed world but relatively less studied in developing countries. The goal of this review is to determine the state of knowledge of HPV‐related HNSCC in Latin American countries (LACs) and to highlight areas that would benefit from additional research.

Methods:

Databases searched included PubMed and Virtual health library (LILAC). All Latin American studies addressing HPV‐related HNSCC of oral cavity, oropharynx, and larynx were selected. We did not restrict studies by type of study, sample size, or method of HPV detection; however, case reports were excluded. Each article was reviewed for incidence/prevalence of HPV‐positive HNSCC, demographics, social history, and clinical outcomes.

Results:

Thirty‐eight full‐text articles were reviewed that identified HPV‐positivity in 33%, HPV 16 being most prevalent. Twenty‐three of 38 (60%) had a sample size <50, and a HPV‐negative control group was described in only 8 out of 38 (21%) articles. Oral cavity rather than oropharynx was mostly studied, with “tongue” the most commonly involved site, raising concerns for misclassification of site between oral cavity and oropharynx. Sexual history, the most significant risk factor for HPV, was addressed in only 2 out of 38 articles. Prognosis/survival was addressed in 8 out of 38 articles, and only 2 articles described better survival outcomes in HPV‐positive cases.

Conclusions:

Future research on HPV in LACs should emphasize consistent classification of tumor topography, larger sample sizes, and comparison with HPV‐negative control groups. The role of sexual history/behavior and better prognosis of HPV‐positive tumors are critical observations in the developing world that require further investigation in LACs.
Vestibulo‐ocular Reflex (VOR) Impact on USAF Undergraduate Pilot Training Proficiency
Authors: Johnson Paul C. , Schall David G. , Sorensen Jeffrey A. , Stephens Kenneth W.
Published: September 2014

Objectives:

The US Air Force (USAF) enrolls 1400 Specialized Undergraduate Pilot Trainees (SUPT) at 3 locations within the United States each year. SUPT training has an estimated accumulated cost of $1M to $1.5M per trainee. Attrition rates from training have ranged from 7.8% to 36.9%. The cost associated with trainee disqualification is estimated at $1M per percentage point of annual attrition. One percent of UPT disqualifications are due to medical factors and another 1.5% are due to failure to adapt to flying.

Methods:

In 1994 the USAF conducted rotary chair vestibulo‐ocular (VOR) test on 150 SUPT candidates at the USAF Research Laboratory, Brooks Air Force Base as part of the second phase of the Enhanced Flight Screening‐ Medical Study (EFS‐M). Retrospective review of SUPT scores was correlated with pre‐training VOR test results of the original 150 pilots who participated in the EFS‐M VOR data collection. Twenty‐year prospective survey data collected from EFS‐M study pilots was correlated to initial EFS‐M VOR test results to identify trends in their subsequent pilot career progression and incidence of in‐flight physiologic events deemed linked to vestibular illusions.

Results:

VOR performance trends exist between USAF pilot trainee cohorts. VOR performance can predict initial flight training proficiency in SUPT candidates. Long term follow‐up survey responses indicate that VOR performance can predict flight career proficiency in SUPT training candidates.

Conclusions:

A validated correlation between VOR results and flight performance can help establish VOR test parameters associated with successful flight training ability.
Who Is Performing Tracheotomies: A 10‐Year Review
Authors: Patel Hetal H. , Siltumens Aldis P. , Bess Leah , Camacho Fabian , Goldenberg David
Published: September 2014

Objectives:

(1) Determine the trend of the number of tracheotomies performed by otolaryngologists. (2) Determine the changes in surgical technique over time.

Methods:

A retrospective chart review of all patients undergoing tracheotomy between 1999 and 2013 was performed at a large tertiary care hospital. Data were gathered from billing and operative reports to determine the specialty service performing the tracheotomy. Additionally, the surgical technique and indication for surgery were recorded. Negative binomial regressions (extension of Poisson regression to account for over dispersion) were conducted to examine number of tracheotomies for each specialty as function of year.

Results:

In 1999, 46.55% of tracheotomies were being performed by the otolaryngology service, compared with only 28% in 2013. This is a decline of 21.55% over time. Since 1999, general surgery has a steady increase in number of tracheotomies performed in comparison to the steady decrease performed by otolaryngology. Since 2008 general surgeons have significantly increased the number of percutaneous tracheotomies they perform (76%/year). Over the same period, the number of tracheostomies performed by the cardiothoracic (CT) surgery service has steadily increased by 26% per year. Most of the tracheotomies performed by CT surgery are percutaneous tracheotomies.

Conclusions:

This study illustrates that otolaryngologists in our institution are performing fewer tracheotomies over time. If this trend continues, the experience of our trainees may become diluted through reduction in surgical volume. While multi‐institutional studies are warranted, this review provides a summary of the trend at a tertiary care institution which may well reflect national trends.
3D Endoscopic Endonasal Approach in Skull Base Surgery: Experience on 87 Consecutive Patients
Authors: Pecorari Giancarlo , Zenga Francesco , Raimondo Luca , Pacca Paolo , Ducati Alessandro , Garzaro Massimiliano
Published: September 2014

Objectives:

Assess advantages and disadvantages of 3‐dimensional endoscopy in the transnasal approach to sellar region, posterior skull base, and cervical junction.

Methods:

Between January 2012 and December 2013, 87 patients were consecutively treated at the Neurosurgery Division of the University of Turin for sellar, skull base, and cervical junction pathologies. All procedures were performed by the same team (2 ENT surgeons and 2 neurosurgeons) using a 3‐dimensional (3D) stereoendoscope (VSII system, Visionsense Ltd, Petach Tikva, Israel). After each procedure each surgeon was asked to fill out a questionnaire (based on visual analogue scales) designed to assess comfort and learning curve.

Results:

Seventy patients were treated for pituitary macroadenomas, 10 for chordomas, 6 for a malformation of the cervical junction, and 1 for a chondrosarcoma of the odontoid process of C2. A cerebrospinal fluid (CSF) leak was observed in 6 out of 70 patients, 1 out of 10 patients, and 0 out of 7 patients, respectively; 5 out of 7 CSF leaks were intraoperatively solved and 2 out of 7 required revision surgery. No vascular complications were recorded. Median global comfort score (sensation of strain + dizziness + system ergonomics scores), recorded at the end of the first and second procedure, was 9.1 and 9.6, respectively; after the third procedure it reached 10. The learning curve score reached the maximum level of 9.5 after the eighth procedure.

Conclusions:

3D stereoscopic vision system is comfortable for the surgeons allowing them to have a better visualization of anatomic structures and landmarks; it is easy to use and after only a few procedures surgeon skills reach high levels.
Analysis of Clinical Negligence Claims Arising from Thyroidectomy in the UK from 1995 to 2013
Authors: Mathew Rajeev , Tornari Chrysostomos , Hay Ashley , Odutoye Babtunde
Published: September 2014

Objectives:

Determine the outcome and cause of negligence claims relating to thyroid surgery in the National Health Service (NHS).

Methods:

A request was submitted to the NHS Litigation Authority for claims relating to thyroid surgery between 1995 and 2013 by searching for the key words: “thyroid,” “endocrine,” or “neck.” Claims were analyzed for cause of injury, type of injury, outcome of claim, and costs.

Results:

Of 132 cases, 90% were closed with 55% of closed claims leading to payment of damages and 72% of closed claims leading to payment of any sort (including settlement out of court). Fifty‐two percent of claims were related to complications of surgery with the rest being related to errors in diagnosis and treatment. Lack of informed consent was claimed in 11 cases. The most common injuries claimed were vocal cord dysfunction (n = 28) followed by endocrine disturbance such as hypocalcemia or hypothyroidism (n = 20). Eight fatalities occurred, of which 7 were due to hematoma and one was due to hypocalcemia. The highest payment was £945,700 ($1,585,000) for bilateral vocal cord paresis requiring a permanent tracheostomy. The median payment per claim was £21,390 ($35,850).

Conclusions:

Thyroidectomy‐related claims in the National Health Service are rare but have a high success rate. Negligence from operator error correlates well with known complications of thyroid surgery. However, a significant proportion of claims are not related to surgery and represent areas where good care should be addressed by a multidisciplinary approach to the management of thyroid pathology.
Antibiotic Choice in Laryngectomy Affects Outcomes and Costs: An Analysis of University HealthSystem Consortium Data
Authors: Langerman Alexander , Pisano Jennifer , Ham Sandra
Published: September 2014

Objectives:

(1) Identify antibiotic practice patterns for laryngectomy. (2) Determine the clinical and cost outcomes associated with antibiotic management strategies.

Methods:

University HealthSystem Consortium inpatient billing data on patients undergoing laryngectomy in 2008 to 2011 for 95 academic and affiliated medical centers were analyzed for antibiotic use, outcomes, and cost.

Results:

Data from 1912 patients (18.1% women) were included in the study. Antibiotic management over the first 72 hours revealed 458 unique management strategies. Antibiotic choice had a significant association with rate of surgical site infection (SSI), with standard regimens of ampicillin/sulbactam (1.4%) or cefazolin+metronidazole (4.3%) having lower rates compared to clindamycin (11.8%; P <. 0001). Non–penicillin‐allergic patients treated with nonstandard regimens had a higher likelihood of wound dehiscence (odds ratio = 2.8 [1.7‐4.5]). Flap procedures on the day of surgery did not have an association with SSI or wound dehiscence in adjusted models. The total cost of hospital admission for patients who were managed with either ampicillin/sulbactam or cefazolin+metronizadole was substantially less than for patients managed with clindamycin ($30,120 [$28,807‐$31,432] versus $37,164 [$33319‐$41009]; P =. 0007).

Conclusions:

There is substantial variability in perioperative antibiotic strategies for laryngectomy. Clindamycin had a much higher rate of SSI compared with other common regimens and was associated with a higher total hospital cost. Based on this data, standardization of antibiotic practices should be considered and clinical trials should be planned to firmly establish the most cost‐effective antibiotic management for laryngectomy and determine potential alternatives to clindamycin for penicillin‐allergic patients.
Assessing Impact of Sociodemographic, Clinical, and Facility Characteristics on Survival after T1 Laryngeal Cancer Treatment
Authors: Misono Stephanie , Marmor Schelomo , Yueh Bevan , Virnig Beth A.
Published: September 2014

Objectives:

Prior work identified differences in survival by treatment type for localized laryngeal squamous cell carcinoma (LSCC) in the Surveillance Epidemiology and End Results (SEER) registries. We sought to determine whether these differences were attributable to sociodemographic, clinical, and treatment facility characteristics in the elderly.

Methods:

The SEER‐Medicare linked files (1991‐2009) identified patients (ages 66+ years) with T1 LSCC. Logistic regression models were constructed to identify sociodemographic characteristics associated with treatment type. Kaplan‐Meier methods were used to examine the association of treatment type and survival. Cox proportional hazards modeling was used to assess the impact of potentially important factors such as sociodemographic, clinical, or facility characteristics.

Results:

We identified 1369 patients with T1 LSSC. Radiation alone was the most common treatment. Treatment with local surgery ± radiation was associated with slightly better survival than treatment with radiation alone in our unadjusted Kaplan Meier model. Adjusted for comorbidity, treatment with both local surgery and radiation was associated with greater survival (P =. 002) than treatment with local surgery or radiation alone. No significant association was observed between sociodemographic factors (income and urban/rural location) or facility characteristics (hospital size or volume) and hazard of death.

Conclusions:

Previously observed differences in survival across single modality treatment types for T1 LSSC in the elderly may be partially attributable to medical comorbidity, but treatment with both surgery and radiation was associated with improved survival independent of comorbidity. Other patient and facility characteristics showed no appreciable impact on survival after treatment of T1 LSSC in this population.
Biomarkers pS6 and pERK as Predictors of Skin Cancer Aggressiveness
Authors: Nathan Cherie Ann O.
Published: September 2014

Objectives:

The role of elective parotidectomy and the extent of surgery for occult nodal metastasis in cutaneous squamous cell carcinoma (SCC) is controversial. We wanted to determine if the MEK/ERK pathway and pathologic features in the tumor could predict skin cancer aggressiveness and allow for preemptive treatment of occult metastasis.

Methods:

Retrospective experimental laboratory study and chart review. Specimens from basal cell carcinoma (BCC; n = 13), squamous cell carcinoma (SCC; N = 10), and SCC with parotid metastasis (n = 11) were analyzed by immunohistochemistry (IHC) for pERK (Thr202/Tyr204) and pS6 (Ser235/236) and scored by the study pathologist. Simple logistic regression analysis evaluated all subjects with previous resection of cSCC and parotidectomy (n = 13) for independent risk factors of disease aggressiveness.

Results:

Expression of pS6 increased in cSCC with parotid metastasis (P =. 01) compared with other groups. BCCA and SCCA comparison showed an increase in pS6 expression in SCC (P <. 01). There was no significant difference in pERK expression between groups. Factors associated with cSCC with nodal metastasis were previous skin positive margins (P =. 03) and parotid perineural invasion (P =. 04). Positive margins on primary lesions is an independent risk factor for deep lobe involvement (P =. 03).

Conclusions:

Positive margins on primary skin lesions, perineural involvement of parotid specimens, and Biomarker pS6 appear to be predictors of aggressiveness in cSCC and should prompt increased monitoring or elective treatment. As pERK was not significantly activated, pS6 overexpression could indicate activation of the Akt/mTOR pathway.
Can Preoperative Thyroglobulin Antibody Levels Be Used as a Marker for Well‐Differentiated Thyroid Cancer?
Authors: Hosseini Sarah , Zawawi Faisal , Varshney Rickul , Mlynarek Alex M. , Hier Michael P. , Forest Veronique‐Isabelle , Payne Richard J.
Published: September 2014

Objectives:

Evaluate whether the presence of preoperative thyroglobulin antibody (TgAb) levels can help predict the final pathology of thyroid nodules. Assess whether higher levels of preoperative TgAb increase the likelihood that a thyroid nodule is malignant.

Methods:

A retrospective chart review of patients who underwent thyroidectomy in 3 McGill University‐affiliated hospitals between January 2012 and 2014 was conducted. Demographic data, TgAb levels, and final histopathology were recorded. Patients were divided into 2 groups: TgAb positive (defined as TgAb ≥30 IU/mL) and TgAb low/negative (defined as TgAb <30). Micropapillary thyroid carcinomas were considered to be benign. These data were then statistically analyzed using SPSS.

Results:

Preoperative TgAb levels were available in 412 patients. There were 360 patients in the TgAb low/negative group (malignancy rate: 51.39%) and 52 patients in the TgAb positive group (malignancy rate: 65.38%). The sensitivity, specificity, positive predictive value, and negative predictive value of TgAb ≥30 IU/mL as a diagnostic test for thyroid malignancy were 15.53% (confidence interval [CI] 11.00‐21.01), 90.67% (CI 85.66‐94.38), 65.38% (50.91‐78.03), and 48.61% (CI 43.34‐53.91), respectively. The relative risk was 1.2723 (CI 1.0192‐1.5883) and the odds ratio was 1.7868 (CI 0.9732‐3.2804). Both the Pearson chi‐square test (P =. 024) and Fisher's exact test (P =. 017) yielded statistical significance between the 2 groups.

Conclusions:

Our study demonstrates that patients with preoperative TgAb ≥30 IU/mL had a higher rate of malignancy when compared to patients with TgAb <30 IU/mL. This suggests that an elevated TgAb level may increase the risk that a thyroid nodule is malignant.