bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Pre‐ and Postoperative Sleep in Pediatric Obstructive Sleep Apnea
Authors: Nishimura Yoichi , Ahmed Wael A.
Published: September 2011

Objective

Adenotonsillectomy is a common procedure for treating pediatric obstructive sleep apnea (OSA). It improves child growth as well as his psychological status. The objectives of this study are to compare the results of pre and postoperative polysomnographic data in terms of sleep structure and to identify the difference of each sleep stage.

Method

This is a prospective study of sleep structures of pediatric OSA patients, done on 26 children with OSA. Mean age was 4.5 years. It was done in a tertiary university hospital. All children had adenotonsillectomy. Standard over‐night polysomnography was performed pre‐operatively and one to three months postoperatively.

Results

We identified significant improvements of mean apnea hypopnea index (AHI) after the adeno‐tonsillectomy from 17.1 to 3.53 (P <. 001). Rapid eye movement (REM) sleep did not change significantly. Both Stage 2 and slow wave stage did not change significantly. We also identified significant improvement in the arousal index from 23 to 11 (P <. 001).

Conclusion

We compared pre and post operative sleep structures in OSA children after adenotonsillectomy. We identified significant polysomnographic changes in the sleep structures in form of reduction of sleep stage 1 and arousal index. These polysomnographic parameters may lead to improvement of their physical and psychological conditions after the operation.
Does Tension Matter? A Comparison of Genioglossus Advancement Using Tensiometry to Predict Successful Outcomes
Authors: Andrews Jamie , Barrera Jose
Published: September 2011

Objective

Evaluate the role of tension on the genioglossus muscle in patients undergoing genioglossus advancement for obstructive sleep apnea. We hypothesize that decreased tension and increased bicortical mandibular width will result in successful postoperative outcomes.

Method

Eleven patients underwent preoperative and postoperative polysomnography, nasal endoscopy, and subjective questionnaires. Intraoperatively, the bicortical width of the mandible and the force required to pull the window osteotomy forward was measured with a tensiometer. The preoperative and postoperative data collected was then compared against the intraoperative measurements.

Results

All patients completed pre‐ and postoperative evaluation. 82% (9/11) of patients were responders, defined as a greater than 50% reduction in AHI to an absolute level less than 15 events/h with no oxygen desaturations on postoperative polysomnography below 85%. A total of 18% (2/11) were nonresponders. All patients who were responders demonstrated a relative decreased tension (grams) and increased mandibular width (millimeters) with a tension to width ratio of less than sixty. All non‐responders had a tension to width ratio of greater than sixty. Further, patients with the lowest ratio demonstrated the greatest subjective and objective improvement based on sleep questionnaires and polysomnography.

Conclusion

We conclude that decreased tension and increased mandibular width are positive predictive factors for postoperative success, and increased tension and narrow mandibular width are negative predictive factors for postoperative success. Thus, the tension to bicortical width ratio may be an independent predictor of postoperative success following genioglossus advancement.
Effect of Uvulopalatopharyngoplasty on Retropalatal Region
Authors: Tanyeri Hasan , Serin Gediz M. , Polat Senol
Published: September 2011

Objective

Retropalatal region is a part of upper airway contributing to obstructive sleep apnea (OSA). We aimed to demonstrate the changes in the retropalatal surface area (RPSA) after uvulopalatopharyngoplasty (UPPP) in an attempt to exhibit enlargement as a predictor of surgical treatment.

Method

Twenty patients with OSA who underwent UPPP were retrospectively evaluated. Pre and postoperative respiratory disturbance index (RDI), RPSA measurements were studied. Retropalatal region photos were captured at the base of uvula during fiber optic nasopharyngolaryngoscopy to measure RPSAs using AutoCad2004. RDI levels, RPSA measurements were compared using paired t test.

Results

The RPSA measurements in the preoperative subjects were between 20 and 72 (mean 44.18). The RPSA measurements in the postoperative patients were between 37 and 107 (mean 72.82). The RPSA significantly increased in postoperative patients (P =. 001). The mean RDI decreased from 27.5 ± 22.2 to 14.6 ± 12.4 (P >. 05).

Conclusion

RPSA increases in UPPP patients postoperatively with evidence of an enlarged retropalatal region. Decreased RDI levels indicate amelioration in OSA. RPSA measurements can be used to predict UPPP surgical treatment success.
Effects of Minimally Invasive OSA Surgery on Middle Ear
Authors: Lin Hsin‐Ching , Friedman Michael
Published: September 2011

Objective

Study the impact of Pillar implantation plus radiofrequency tongue base reduction (RFBOT) for the treatment of obstructive sleep apnea (OSA) syndrome on middle ear function.

Method

The patients who underwent a Pillar implantation combined with RFBOT for OSA were enrolled. All subjects had normal eardrums. Pure‐tone audiometry and tympanometry were performed preoperatively, and at 1 day, 7 days, 1 month, and 3 months postoperatively. Baseline and postoperative middle ear pressures (MEPs) in decipascals were compared.

Results

Twenty patients (17 men, 3 women; mean age 45.7 years) were reviewed. Six patients (6/20, 30.0%) reported otologic complaints such as ear pressure and/or otalgia within one week postoperatively. No permanent otologic discomfort occurred. A trend toward reduced MEP was noted in this study. The decrease in MEP became apparent on day 1 and 7. However, mean pressure changes were no longer significantly different from preoperative values by one week after surgery.

Conclusion

The minimally invasive surgery with Pillar implantation plus RFBOT for OSA induces changes in middle ear function. However, the changes were temporary and not significant after 3 months follow‐up.
Culturomic Analysis of Trends in Otolaryngology
Authors: Tward Aaron , Lee Daniel J.
Published: September 2011

Objective

1) Quantitatively describe historical trends in diagnoses and treatments in otolaryngology as measured by frequency of word use. 2) Quantitatively describe historical trends in terminology used in otolaryngology.

Method

A variety of search terms of n‐grams (words or short phrases) specific to the practice of otolaryngology was used to search the English Language Corpus of Google Books. Trends in n‐gram frequency across years were correlated to known historical milestones in otolaryngology.

Results

A variety of search terms was used, the results of which quantitatively document historical trends in otolaryngology. For example the frequency of “stapes” in the corpus increased sharply around 1957, correlated with increases in the frequency of the terms “otosclerosis” and “stapedectomy,” whereas “incus” showed no similar increase in frequency. These frequencies correlate well with the popularization of stapedectomy for otosclerosis. Many additional analyses are presented with similarly strong correlations. In addition, trends of word use in otolaryngology were quantified by the same technique.

Conclusion

Culturomic searches accurately demonstrate historical trends in otolaryngology, permitting both quantitative analysis of known trends and revelation of previously unknown trends in diagnosis, treatment, and terminology use in otolaryngology.
Effects of Minimally Invasive Surgery for OSA on Quality of Life
Authors: Lin Hsin‐Ching , Friedman Michael , Wang Pa‐Chun
Published: September 2011

Objective

Study the impact of Pillar implantation plus radiofrequency tongue base reduction (RFBOT) for the treatment of obstructive sleep apnea (OSA) syndrome on quality of life (QOL).

Method

All OSA patients with multilevel obstruction who failed or refused the CPAP treatment and then underwent single‐staged multilevel minimally invasive surgery (Pillar implantation and RFBOT) were enrolled. The subjective symptoms and QOL (SF‐36 Taiwan Standard Version 1.0) parameters were collected pre‐ and postoperatively. Postoperative morbidity was recorded.

Results

Twenty patients (3 women, 17 men) were reviewed. The mean visual analog scale (0‐10) score of postoperative pain was 1.9. One pillar dislocated after implantation. One patient had tongue abscess after RF tongue base surgery. The mean ESS (Epworth Sleepiness Scale) changed from 11.9 ± 5.1 to 10.4 ± 5.0 (P =. 049, Wilcoxon signed rank test). The mean snoring VAS reduced from 9.8 ± 0.6 to 4.9 ± 2.0 (P =. 000). The mean score of SF‐36 increased from 65.5 ± 19.6 to 75.2 ± 16.7 (P =. 000). The SF‐36 sub‐scales in bodily pain, general health, vitality, social functioning and role‐emotional showed statistically significant changes.

Conclusion

This study has demonstrated that the single‐staged multilevel minimally invasive surgery (Pillar implantation and temperature‐controlled radiofrequency of the base of tongue) appears to be an effective and safe tool for treating OSA patients who may be unresponsive to conservative therapy.
Evaluation of Palatal and Tongue Base Hyperaemia and Its Relationship to Snoring and Obstructive Sleep Apnea Using Narrow‐Band Imaging
Authors: Prasad Vyas , Kotecha Bhikhlal , Stimpson Paul , Heywood Rebecca , Chisholm Edward J.
Published: September 2011

Objective

Evaluate digital still images and video recordings utilising narrow‐band imaging (NBI) in order to assess whether this modality of fiberoptic investigation can be used to predict a relationship between increased superficial vasculature of the upper airway in patients with snoring and obstructive sleep apnea.

Method

Prospective study with patients allocated in to 3 groups. Twenty‐five subjects (30‐77 years) had still photographs taken in normal and narrow‐band light settings of their oropharynx‐palatal and tongue base views. All images were compared to normal controls.

Results

Distinct patterns of hyperemia were seen in the regions of posterior pharyngeal wall, tongue base and epiglottis in some patients. It was also noted that the oral surface of the soft palate and tonsillar region vascular pattern was different in the three groups.

Conclusion

NBI has recently been used to diagnose neoplasia in‐vivo in the upper aerodigestive tract, colon, esophagus and lung. Our study explored an additional role to see if NBI with magnifying endoscopy (NBI‐ME) could also help predict likelihood of snoring and severity of OSA as well as response to treatment.
Hypoglossal Nerve Stimulator
Authors: Woodson B. Tucker , Netzer Aviram , Lin Hosheng , Maurer Joachim T , Hohenhorst Winfried , Van de Heyning Paul
Published: September 2011

Objective

OSA is a common cause of sleep morbidity. A novel treatment for obstruction at the level of the tongue is a unilateral hypoglossal nerve implant system (Inspire, Inspire Medical, Minneapolis, Minnesota). Study objectives were to assess sleep outcomes in a multicenter academic setting feasibility trial.

Method

Nerve stimulation effect on AHI and self reported sleep outcomes were assessed at two and six months (Epworth Sleepiness Score (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ).

Results

Thirty‐one subjects underwent placement of a unilateral hypoglossal nerve implant (two explanted). Fifty‐five percent of subjects at 6 months were AHI responders (AHI < 20/hr. and 50% reduction). In the entire group, ESS improved (baseline=10.7(4.9) 2 months= 8.2(4.0), 6 months= 7.7(4.2), P <. 005). At baseline, 2 months and 6 months: ESS improved in both responders (10.4 to 8.0 to 6.6) and non‐responders (11.8 to 9.4 to 8.9), and FOSQ improved and normalized in responders (15.6 to 17.1 to 18.0, P <. 05) but not non‐responders (13.6 to 14.2 to 15.2, P = NS).

Conclusion

Sleep outcomes improved using a hypoglossal nerve implant. Consistent with other interventions, ESS improvements were unrelated to change in AHI. FOSQ improvements were observed in responders but not non‐responders. Data support a clinical device effect but highlight the need for controlled studies to evaluate sleep outcomes in surgical trials.
Impact of Obstructive Sleep Apnea Syndrome in P300 Latency
Authors: De Oliveira Barros Thiago , Mendez Raquel , Caiaffa Rosana , Tomita Shiro , Melo Tavares Lima Marco Antonio
Published: September 2011

Objective

Evaluate the impact and linear correlation between Obstructive Sleep Apnea Syndrome (OSAS) and P300 latency. It also aimed to identify which variables of polysomnography and scales of excessive daytime sleepiness best correlate with the increase in P300 latency.

Method

This is a survey study, conducted between March 2010 and January 2011, in which polysomnography, scales of sleepiness and P300 latency from 54 patients were analyzed. These results were evaluated in patients with different stages of OSAS, using as independent variables: sleep stages, arousals, apnea/hyponea index(AHI), oxyhemoglobin desaturation and limb movements (PLM).

Results

All patients were male, mean age 41.3 ± 2.1 years, body mass index of 29.3 ± 1.2 kg/m2 and hearing threshold in17.1 ± 1.3 dB. According to the AHI, the patients were divided into normal (n = 15), mild (n = 14), moderate (n = 9), and severely increased (n = 16). It was found the following correlations with P300 latency: Epworth scale (r = 0.33; P =. 2), Karolinska scale (r=‐0.14; P =. 55), Stanford scale (r=0.01; P =. 29), sleep efficiency (r = 0.11; P =. 83), percentage of N3(r = ‐0.48; P =. 24) and REM (r = ‐0.18; P =. 13), arousals index (r=0.74; P <. 05), AHI (r = 0.99; P <. 01), oxyhemoglobin desaturation index (r = 0.99; P <. 01), PLM (r=0.44; P <. 01), mean oxyhemoglobin saturation (r = ‐0.84; P <. 01) and minimum oxyhemoglobin desaturation (r = ‐0.85; P <. 01).

Conclusion

The apnea/hypopnea index, arousals, oxyhemoglobin desaturation index and periodic limb movements were positively correlated with P300 latency (P <. 05). The average and minimum oxyhemoglobin saturation exhibited negative correlation with P300 latency (P <. 01). No statistically significant correlation was seen between P300 latency and sleepiness scales, as well as REM and N3 sleep stage percentage.
Multilevel Coblation Therapy of OSA in Long Face Syndrome
Authors: Merugumala Srinivasa
Published: September 2011

Objective

Evaluate the efficacy and safety of multilevel coblation surgery in patients with sleep‐disordered breathing (S‐D B/OSA) and in Long Face Syndrome and to understand these rare presentations for effective management.

Method

Evaluate 5 Long Face Syndrome and 182 consecutive S‐BD patients, who had 423 coblation surgical procedures from October 2006 to September 2010. Multilevel S‐BD surgery was performed at nasal level (turbinate reduction, functional endoscopic sinus surgery, septorhinoplasty), palate level (somnoplasty, pharyngoplasty, coblation UPPP), and tongue base reduction.

Results

A total of 187 patients had adequate follow‐up, A total of 124 men and 63 women, with mean age of 47 years and mean BMI 30.2. ESS Score has improved from 16 ± 2 to 4 ± 2. The AHI improved in the patient with Long Face Syndrome from 69.3 to 11.8 and the patient is nondependent on CPAP. The overall complication rate 3.64%, none of the patients had any airway compromise requiring ICU care. The major complications include (a) two patients had palatal ulceration, (b) one negative pressure pulmonary edema (c) one patient had secondary hemorrhage (aspirin). Patients that had tongue procedure required overnight stay.

Conclusion

This study illustrates that multilevel coblation surgery provides a minimally invasive technique with less morbidity and has good outcome for moderate to severe OSA. Long Face Syndrome is very rare in which primary surgery may be considered.
Objective vs Subjective Measurements of Palatine Tonsil Size in Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael , Wang Pa‐Chun
Published: September 2011

Objective

Study the difference between subjective and objective palatine tonsil size measurements in patients with obstructive sleep apnea (OSA) syndrome.

Method

Bilateral tonsillectomy was enrolled as a part of the OSA surgery. Subjective tonsil size was valuated using the 0‐4 scale. Tonsil size was also objectively measured. The relationship of the subjective and objective tonsil measurements and polysomnography (PSG) was assessed.

Results

Fifty‐one OSA patients (46 men, 5 women; mean age 42.1 years; mean apnea/hypopnea index, AHI 47.5/h; mean BMI 26.9) were reviewed. Objective tonsil height, width, thickness, weight and volume were strongly correlated with subjective tonsil size by Spearman correlation. Evaluation of possible outliers with Pearson correlation indicated objective tonsil measurements were the better predictor of preoperative AHI and snoring index than subjective tonsil size.

Conclusion

Both objective and subjective tonsil measurements were not correlated with age, BMI, or other anatomic parameters of the upper airway. Subjective tonsil size measurements correlate with objective tonsil measurements; however, only objective tonsil measurements may help the prediction of objective PSG‐measured OSA severity.
Orexin Genes Polymorphisms and Obstructive Sleep Apnea Syndrome
Authors: Ahmed Wael A. , Fujisawa Toshiyuki , Nishimura Yoichi
Published: September 2011

Objective

1) Study the association between orexin and orexin receptor genes mutations and obstructive sleep apnea syndrome. 2) Examine the effects of the identified significant mutations on the gene transcription.

Method

Prospective genetic association study. It was conducted between April 2008 and March 2010. Seventy obstructive sleep apnea patients and seventy control subjects were enrolled. Tertiary university hospital. PCR amplification followed by sequencing for Orexin Gene and TaqMan SNP Genotyping Assay for Orexin Receptor Genes was done for all participants.

Results

A novel single nucleotide deletion (IVS1+188delG) was found in one patient. An intronic mutation (rs9902709) was identified in the Orexin gene with significant difference between patients and controls when using dominant model (P =. 04). A new mutation in the intron of Orexin gene was identified with significant difference between patients and controls as regards (P =. 02). By examining Splicing Site Programs, this mutation showed change of the splice donor site in some of them or change of the score in others. No significant changes between patients and controls as regard Orexin receptor genes abnormalities were detected.

Conclusion

The plasma levels of Orexins have been previously evaluated in obstructive sleep apnea patients with contrary findings. This study identified two intronic mutations in the orexin gene with significant difference between patients and controls. These results suggest that orexin gene mutations may be involved in pathogenesis of obstructive sleep apnea.
Outcomes of Combined Pharyngoplasty and Midline Glossectomy
Authors: Vivero Richard J. , Ruiz Jose W. , Cofnas Paul
Published: September 2011

Objective

1) Discuss the theory of multilevel sleep surgery for obstructive sleep apnea (OSA) management. 2) Evaluate the outcomes of lateral pharyngoplasty and midline glossectomy.

Method

Retrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care center with multilevel surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included change in preoperative and postoperative AHI, RDI, and oxygen nadir. Statistical analysis performed using Wilcoxon rank test.

Results

Thirty‐three patients were identified that met inclusion criteria. The mean preoperative BMI was 30.4, and postoperative BMI was 29.1 (P =. 04). The mean decrease in AHI was 12.5 from 32.7 to 20.2 (P =. 027). The mean decrease in RDI was 16.4 from 37.2 to 20.7 (P =. 17). The mean improvement in oxygen nadir was 13% from 63.5 to 76.8 (P =. 09).

Conclusion

Multilevel sleep surgery results in a statistically significant improvement in polysomnographic metrics, such as AHI and RDI, for obstructive sleep apnea.
Pulling on Hyoid Reduces Airway Collapse in Human Cadavers
Authors: Rosenbluth Kathryn H. , Kwait Dillon , Harrison Michael , Kezirian Eric J.
Published: September 2011

Objective

This study examined the changes in upper airway dimensions and collapsibility associated with force applied to the hyoid bone using a suture and a novel magnetic system (internal magnet secured to the hyoid and external magnet) in un‐fixed human cadavers.

Method

Eight cadavers were tested with traction on the hyoid using 1) suture around the hyoid to apply 0.5‐5 Newtons of force and 2) a novel magnetic system. Changes in airway dimensions were measured with fluoroscopy and 3‐dimensional computed tomography reconstructions. Airway collapsibility was measured using a previously‐described flow‐based model.

Results

A 2N (0.5 lb) force applied to the hyoid bone increased airway dimensions, with greatest effect in the retrolingual region. The anterior direction of traction was more effective than inferior or superior. There was a linear association between the magnitude of force and critical airflow, at 1.5L/min/N (R2 = 0.75). All magnitudes of pull increased the critical airflow (P <. 001). At 2N, the hyoid was advanced 1cm, and the critical airflow was increased 3‐fold (3.0 ± 1.71L/min). The magnet system showed similar airway effects to the direct 2N applied force. An increase in upper airway dimensions occurred with inter‐magnet distances of 2cm.

Conclusion

Forces applied to the hyoid improve upper airway dimensions and collapsibility in the human un‐fixed cadaver model. A novel magnet system may represent a promising therapy for treatment of upper airway obstruction in disorders such as obstructive sleep apnea.
Sleep Medicine Clinical and Surgical Training during Otolaryngology Residency: A National Survey of Otolaryngology Residency Programs
Authors: Shen Tianjie , Shimahara Erika , Capasso Robson
Published: September 2011

Objective

The vast majority of otolaryngologists are involved in the medical and surgical care of patients with obstructive sleep apnea. ABOTO residency curriculum has quite extensive sleep medicine requirements. We sought to assess resident training experiences in adult sleep medicine and sleep surgery during their residency in the United States.

Method

This Internet survey study was emailed to the program directors from 103 US Accreditation Council for Graduate Medical Education (ACGME)‐approved otolaryngology residency programs in 2010.

Results

A total of 47 (46%) program directors responded. Only 24% of programs had faculty members who spent more than 50% of their clinical time on adult sleep medicine/surgery. The majority of programs (65%) had total training time less than 0.6 month during the residency training. While most residents were well prepared in commonly performed procedures for OSA, the training on hypopharyngeal surgeries such as hyoid suspension (51%), tongue suspension (40%), and geniotubercle advancement (26%) were less adequate. Only 29% of programs taught their residents both the interpretation of the study report and the original sleep study data.

Conclusion

This survey suggests that current residency training in adult sleep medicine and sleep surgery is suboptimal to keep residents up to date with the evolution in this field in the majority of otolaryngology programs. The teaching on the evaluation and various therapeutic approaches should be improved during residency training.
The Effect of CPAP on Middle Ear Pressure
Authors: Lin Fred Y. , Popelka Gerald , Gurgel Richard , Capasso Robson
Published: September 2011

Objective

While continuous positive airway pressure (CPAP) is commonly used for obstructive sleep apnea treatment, its effect on middle ear pressure is unknown. The purpose of this study is to measure the effect of CPAP on middle ear pressure and describe the correlation between CPAP levels and middle ear pressures.

Method

This is a prospective cohort study conducted in January, 2011. 10 volunteers with no known history of Eustachian tube dysfunction or obstructive sleep apnea had standard tympanometry measurements while wearing a CPAP device. Measurements were taken at baseline and with CPAP air pressures of 5, 10, and 15 cm H20.

Results

Prior to a swallowing maneuver to open the Eustachian tube, average middle ear pressures were 21.67 daPA, 22.63 daPA, 20.42, daPA, and 21.58 daPA with CPAP pressures of 0, 5, 10, and 15cm of H20, respectively. After swallowing, average middle ear air pressures were 18.83 daPa, 46.75 daPa, 82.17 daPa, and 129.17 daPa with CPAP pressures of 0, 5, 10, and 15cm of H20, respectively. The post‐swallow Pearson Correlation Coefficient correlating CPAP and middle ear pressures was 0.783 (P <. 001).

Conclusion

Middle ear air pressure is directly proportional to CPAP air pressure in subjects with normal Eustachian tube function. While further investigation is necessary, there may be otologic implications for patients who are chronically CPAP dependant. These findings may also influence the perioperative practice of otologic and skull base surgeons.
Detection of Helicobacter Pylori in Oropharyngeal Diseases
Authors: Lukes Petr , Potuznikova Bela , Pavlik Emil , Nartova Eva , Astl Jaromir , Plzak Jan , Betka Jan
Published: September 2011

Objective

Helicobacter pylori (HP) is a well‐known gastric pathogen. Recently it was also found in the oropharyngeal tissue. The direct impact of HP on oropharyngeal pathogenesis was not satisfactorily proven. HP strains differ according to the virulence factor genes carried. The presented study focused on detection and genotyping of oropharyngeal HP.

Method

A total of 104 patients were enrolled. The blood and tissue specimens from patients with tonsillar cancer (n = 41), chronic tonsillitis (n = 38), and obstructive sleep apnea syndrome (OSAS) (n = 25) were collected. Anti‐HP antibody levels were detected. Detection of HP strains and genotyping for establishment of cagA and vacA genes status was performed by real‐time PCR.

Results

Serum antibodies were positive in 32 (78.05%) cancer patients, 13 (34.21%) chronic tonsillitis patients, and 18 (72%) OSAS patients. Statistically significant differences were found between tumor and tonsillitis groups and between OSAS and tonsillitis groups (Chi‐square, P =. 0001, P =. 0049). 56 specimens (23 carcinoma, 20 chronic tonsillitis, and 13 OSAS) were investigated using real‐time PCR. Tissue specimens were positive in 17 (73.91%) tumors, 14 (70.0%) tonsillitis, and 9 (69.23%) OSAS. No statistically significant differences were found among all groups. PCR genotyping of oropharyngeal HP strains showed the majority of s1b (56.7%) and m2 (59.5%) alleles of vacA and low presence of cagA gene (13.5%).

Conclusion

Oropharyngeal HP was found in a high number of cases. Its distribution among different pathologies does not support the hypothesis of its direct carcinogenic potential. Presence of less virulent strains confirms this finding. The possibility of influencing local immune response leading to chronic inflammation or idiopathic hypertrophy of tonsillar tissue was not excluded.
Effect of Chin Position on Swallowing Assessed by Manometry
Authors: Hara Minoru , Takahashi Haruo , Takasaki Kenji
Published: September 2011

Objective

Evaluate the effects of chin position during swallowing in the neutral, chin‐up, and chin‐tucked positions using a novel high‐resolution manometry (HRM) system.

Method

Twenty asymptomatic volunteers were studied by HRM. We measured the maximum swallowing pressures at the velopharynx, mesohypopharynx, and upper esophageal sphincter (UES), the mean values of resting UES pressure, its length, the minimum swallowing pressure at UES, and the relaxation interval (RI) of UES, in each position.

Results

In the chin‐up position, in comparison with the neutral position, the maximum UES pressure (311.1 mmHg vs 214.7 mmHg; P <. 01), the mean value of the resting UES pressure (67.0 mmHg vs 29.5 mmHg; P <. 01), the length of the UES (44.2 cm vs 32.7 cm; P <. 01), and the minimum UES pressure during the RI (−0.5 mmHg vs −6.9 mmHg; P <. 01) increased and the RI (0.29 sec vs 0.63 sec; P <. 01) decreased significantly. In the chin‐tucked position, significant change was seen only in the minimum UES pressure during the RI (−4.5 mmHg vs −6.9 mmHg; P <. 05).

Conclusion

The chin‐tucked position showed no change except for the increase in UES pressure during RI, and seemed to have no appreciable benefit in the facilitation of swallowing. In contrast, the chin‐up position brought a marked disadvantageous effect against smooth swallowing by increasing the pressure in the region of the UES.
Analysis and Optimization of the Rhombic Flap Wound Closure
Authors: Topp Shelby Gates , Gaball Curtis , Lovald Scott , Khraishi Tariq
Published: September 2011

Objective

1) Develop a hyperelastic computational model of skin viscoelastic properties for analysis of wound closures, and 2) Apply the model to variations of the rhombic skin flap to quantify closure force vectors and optimize wound closure tension.

Method

A computational model employing the finite element method was created to simulate skin defect closure employing rhombic transposition flaps. Variables of transposition angle, flap width, and tissue undermining were analyzed. Outcome measures of tissue stress, strain, and wound distortion were evaluated and optimized for a standard defect.

Results

A second order Yeoh hyperelastic model was fit to previously published experimental skin data with good approximation of observed properties. In the analysis of transposition flap closures of the 60 to 120 degree rhomboid defect, the model suggests that a biomechanically ideal flap design is constructed with distal flap angle of 30 degrees, as is employed in the Webster flap, with the donor site near margin oriented parallel to the short axis of the defect, as in the traditional Limberg flap. This configuration minimizes tissue stress and strain and most evenly distributes wound tension across the closure line.

Conclusion

The model quantitatively demonstrates several recognized principles of the rhombic flap. Square defects, as compared with rhomboid defects, close with lower tissue strain, but form a larger standing cutaneous deformity. The Webster flap best distributes wound tension across the incision line, and the Dufourmental modification alters the closure force vector.
Does the Duration of Ofloxacin Otic Drops Matter in Immediate Post‐tube Otorrhea?
Authors: Asnaashari Amir M. H. , Darban Atefeh Amiri , Babaeian Mahasti , Taiarani Mohammad , Rezaei Saman , Fatemi Seideh Sedigheh , Shakeri Mohammad Taghi
Published: September 2011

Objective

The effect of upper respiratory tract diseases on phonation has been reviewed, but the effect of lower respiratory tract diseases on phonation has been little studied. The influence of asthma as a reversible obstructive small airway disease on phonatory variables is not clear yet.

Method

This cross sectional, case control trial was performed from March to September 2008 to evaluate the quality of phonation in asthma. Eight vocal parameters were evaluated in 34 asthmatic patients and a control group by a voice meter device using Dr Speech statistical software.

Results

Vocal variables such as FO, Jitter, and Shimmer were almost similar in both groups statistically. This fact likely reflects the normal phonatory mechanism at the level of vocal cords in asthmatic patients, but harshness, hoarseness, NNE, S/Z ratio (P <. 01) and breathy voice (P =. 015) were different statistically. This indicates the role of the lower airway in the phonation process.

Conclusion

Small airway diseases such as asthma may have direct effect on phonation, but we suggest further studies with more cases.
Harmonic Scalpel in the Treatment of Snoring
Authors: Guastini Luca , Crippa Barbara , Mora Francesco , Dellepiane Massimo , Mora Renzo , Santomauro Valentina
Published: September 2011

Objective

The Ultracision Harmonic Scalpel (HS) is an ultrasonic cutting and coagulating surgical device. The mechanism of the HS is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency. This work aims to report our 4 years’ experience with HS in the treatment of snoring (uvulopalatopharyngoplasty).

Method

Specific handpieces shaped like hook and blade were preferred. After tonsillectomy, 2 incisions, were made on each side of the lateral margin of the uvula, with upward direction. Thereafter, an excision of the redundant mucosa of each posterior arch and subsequent creation of neouvula by a partial uvulectomy was done.

Results

In all the patients treated, the HS allowed rapid intraoperative management with a precise and safe cut: the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Compared with other techniques (laser, cold knife dissection, etc) HS’s group experienced shorter operation time, lesser blood loss, fewer days of hospitalization, lower postoperative pain, and improvement of voice quality. No complications with regard to hemostasis or other major complication (temporary velopharyngeal insufficiency, bleeding, globus sensation, etc) were noted in the HS group.

Conclusion

Our experience highlights that the use of HS in uvulopalatopharyngoplasty confers some advantages over conventional methods: its use led to diminished bleeding, shorter operation time, lesser pain, better wound healing in the postoperative period, and reduction of snoring and improvement of voice quality.
Hyoid Movement as a Predictor of Aspiration in Patients with Dysphagia
Authors: Yasmeh Siamak , Arjomandi Hamid , Funamura Jamie L. , Sinha Uttam K.
Published: September 2011

Objective

1) Quantify the differences in hyoid movement in elderly patients with and without aspiration. 2) Determine whether reduced hyoid displacement is a significant predictor of aspiration in patients with dysphagia.

Method

Data on hyoid displacement and aspiration was collected from pre‐existing modified barium swallow (MBS) studies at USC University Hospital from the past 5 years. Patient studies were selected on the basis of bolus volume (5 and 10 mL), age (>60 years), and dysphagia symptoms at the time of the study.

Results

Studies were grouped by absence of aspiration on MBS, bolus volume, sex, and complaint of dysphagia as documented in their medical records at the time of the study. Preliminary results show that patients without aspiration or penetration (n = 2) achieved a mean hyoid displacement of 2.05 cm, whereas patients with aspiration or penetration (n = 5) achieved a hyoid displacement of only 1.53 cm.

Conclusion

Based on preliminary results, it appears that hyoid movement may accurately predict patients who are at high risk of aspiration and may serve as a parameter for treatment goals in these patients. However, greater sample size and establishment of controls are needed to further validate these findings.
Immune Reconstitution Causing Regression of Kaposi’s Sarcoma
Authors: Wudel Justin , Wine Todd
Published: September 2011

Objective

Examine whether conservative management of invasive Kaposi’s sarcoma of the maxilla during immune reconstitution can prevent or reduce the need for surgical intervention.

Method

We report an unusual case of a patient who presented to a tertiary care medical center with newly diagnosed acquired immunodeficiency syndrome and an erosive mass of the maxilla as demonstrated by both clinical and radiographic examinations.

Results

The patient underwent an incisional biopsy of the hard palate mass. Immunohistochemical analysis demonstrated the tumor cells to be immunoreactive with CD34 and CD31 and negative for factor VIII, consistent with the diagnosis of Kaposi’s sarcoma. Following biopsy the patient was followed with serial exams while his CD4 count and viral load were monitored throughout the initiation of HAART (highly active antiretroviral therapy). After reconstitution of the immune system and decrease in viral load, the lesion demonstrated significant regression and symptomatic improvement.

Conclusion

Invasive Kaposi’s sarcoma, although rare, can be a locally aggressive and destructive lesion. Treatment of this disease has centered on surgical removal, chemotherapy, and radiation therapy. However, we demonstrate a case report in which observation in the acute setting has led to significant regression of the disease during immune reconstitution.
Infected Branchial Cleft Cyst Presenting as a Recurrent Peritonsillar Abscess
Authors: Athavale Sanjay Manohar , McGuire Peter , Rangarajan Sanjeet , Langerman Alexander , Mannion Kyle
Published: September 2011

Objective

Peritonsillar abscess (PTA) is the most common deep infection of the head and neck in young adults. The incidence of recurrent unilateral PTA is extremely low, and a patient with recurrent unilateral PTA development deserves a more vigorous workup for other pathologic entities, including branchial cleft cysts (BCC).

Method

We describe a unique clinical case illustrating the workup and diagnosis of a patient presenting with “recurrent unilateral PTA” that actually turned out to be a second BCC. We discuss the necessity to keep a broad differential when evaluating patients presenting with “classic” symptomatology.

Results

A 40‐year‐old male presented to the emergency department with a history of 5 previous right‐sided PTAs. The patient was again treated for “recurrent PTA” due to computed tomography (CT) scan and physical examination findings. An outpatient CT scan later showed a residual fluid collection in the peritonsillar and parapharyngeal space. The patient was subsequently taken to the operating room for a definitive exploration where a second BCC was discovered and removed.

Conclusion

BCCs may be asymptomatic but commonly present as recurrent infected neck abscesses. In any patient who presents with recurrent unilateral PTAs, a broader differential diagnosis should be formulated (including BCC), and necessary imaging studies should be ordered to properly classify and treat these individuals.
Isthmusectomy: The Un‐thyroidectomy
Authors: Cannon C. Ron
Published: September 2011

Objective

Learn the indications, surgical technique, and role of isthmusectomy in the overall surgical management of thyroid disease.

Method

Prospective observational case series in which 7 patients with lesions confined to the thyroid isthmus underwent isthmusectomy.

Results

All of the patients successfully underwent isthmusectomy. There were no operative complications, and blood loss was minimal. In 6 patients benign pathology was found. The other patient had a papillary thyroid cancer and was converted to a total thyroidectomy at the same setting. None of the patients with benign disease required thyroid supplementation postoperatively.

Conclusion

For lesions 3 cm and under, isthmusectomy is a safe alternative to lobectomy with isthmusectomy for lesions confined to the thyroid isthmus. The technique is straight forward and can be performed as an outpatient procedure. As the majority of the gland is preserved, postoperative thyroid supplementation is seldom required.
Left‐handed Otolaryngologists: Adaptations and Implications for Resident Training
Authors: Kuhn Maggie , Edelstein David R.
Published: September 2011

Objective

1) Describe ergonomic and procedural modifications for the left‐handed otolaryngologist. 2) Present resident and practicing otolaryngologist perspectives on handedness.

Method

Survey of otolaryngology training programs, electronic questionnaires offered to residents and established otolaryngologists, and review of the literature.

Results

Approximately 11% of the population is left‐handed, with a similar prevalence among surgeons. The otolaryngologist’s reliance on specialized equipment requires adaptations to facilitate use by left‐handed physicians. We propose modifications for the left‐handed otolaryngologist in the outpatient setting and in endoscopic sinus, otologic, head and neck, facial plastic, and upper aerodigestive procedures. Furthermore, survey results regarding handedness are presented. A minority of left‐handed otolaryngologists had specific mentoring or instruction during their training. Most surgeons, regardless of handedness, believe that proficiency with their nondominant hand is crucial and that left‐handedness does not impede successful surgical performance or residency training.

Conclusion

Adaptations made by the left‐handed otolaryngologist who practices in a right‐handed‐dominated field are often intuitive. However many surgeons, particularly trainees, may benefit from recommendations specifically tailored for left‐handed otolaryngologists. We offer suggestions for these individuals and present results of a survey regarding handedness among otolaryngology residents and attendings.
Lipoid Proteinosis: Case Report of Otolaryngological Findings
Authors: Dias Priscila S. , Braga Frederico B. , Sabaneeff Lidia , Milward Marina , Leite Jorge B. , Mosciaro Manuela S. , Melo Maria‐Helena
Published: September 2011

Objective

Lipoid proteinosis, or Urbach‐Wiethe disease, was first described in 1929. It is a rare recessive genetic disorder that causes a buildup of hyaline material in the skin and mucosa. The objective of this paper is to report a case of lipoid proteinosis, or Urbach Wiethe disease, emphasizing its otolaryngological manifestations.

Method

A 38‐year‐old patient presented since young childhood with skin lesions on buttocks, face, arms, and legs and a weak cry. Currently, the patient has hoarseness that keeps her from talking on the telephone, anodontia, pale and stiff oral mucosa (specially frenulum and tongue), and narrowed nasal vestibules.

Results

The clinical investigation included a videolaryngoscopy that showed an infiltration of the arytenoids and epiglottis. The vocal cords had normal mobility and coaptation. In order to confirm the diagnosis, a skin biopsy was performed, and the deposition of hyaline positive PAS material was found in the papillar derme. This rare disease does not have a specific treatment. The patient was treated with topical and systemic corticosteroids and also phonotherapy, obtaining some improvement. She was not interested in any surgical option. She is in clinical follow‐up in Gaffrée Guinle University Hospital.

Conclusion

Lipoid proteinosis is a rare disease, with approximately 300 reported cases, that has a chronic and benign course, still without a specific treatment. Because of the variety of symptoms in the oral cavity, larynx, and nose, it is important that the otolaryngologist is familiar with that affection.
Loss of Cervical Lordosis and Foreign Body Ingestion
Authors: Ibrahim Shahrul Izham , Lo Stephen , Tay Sok Yan
Published: September 2011

Objective

In this retrospective study, we look at the sensitivity and specificity of the loss of cervical lordosis as a radiological sign for the presence of a foreign body in the aerodigestive tract.

Method

A total of 39 cases of foreign body ingestion, confirmed with positive surgical removal in the emergency department and operating theatre were reviewed. All 39 had lateral neck x‐rays performed in the Emergency department.

Results

Of the 39 cases, 36 had loss of cervical lordosis on lateral neck x‐ray. All had foreign bodies removed that were between C4 and T level. Therefore, the sensitivity of the loss of cervical lordosis as a sign of the presence of a foreign body in the aerodigestive tract in this study is 92.31%.

Conclusion

We conclude that the loss of cervical lordosis is a good sign for the presence of a foreign body in the aerodigestive tract, and we should have a high index of suspicion in these cases despite negative clinical examination.
Applicability of Questionnaire in Outcome in Rhinoplasty
Authors: Duarte Juliana Antoniolli , Macoto Eduardo , Santiago Jose , Garcia Leonardo B. , Gregorio Luis‐Carlos
Published: September 2011

Objective

Evaluate the satisfaction and the actual benefit if rhinoplastic surgery, using questionnaires that assess since aspects related to appearance and function, even aspects of social order and compare them.

Method

In a cross‐sectional study of 105 patients who underwent rhinoplasty, the patients answered 2 questionnaires, the GBI (Glasgow Benefit Inventory) and the SNOT‐22 (sino‐nasal outcome test‐22). Student t test was used to compare the SNOT‐22 scores before and after surgery and Pearson correlation coefficient between SNOT‐22 and GBI scores.

Results

These 49 patients could be reached by telephone these 21 were men (42.85%), with a mean age of 28.96 years. The SNOT‐22 were on average 17.41 points preoperatively and 13.63 in the postoperative. The results of the GBI in the postoperative period were 31.69 points on average.

Conclusion

There was a high satisfaction rate of patients undergoing rhinoplasty when assessed through questionnaires GBI and SNOT‐22 separately, but a weak correlation between them.
MRSA Bacteremia Associated with Lemierre Syndrome
Authors: Kizhner Victor Zeev , Samara Ghassan J. , Panesar Rahul , Krespi Yosef P.
Published: September 2011

Objective

Community acquired MRSA (CA‐MRSA) is a growing health concern. CA‐MRSA behaves differently between the adult and pediatric population. Lemierre’s syndrome is septic jugular thrombophlebitis affecting mainly young adults. We intend to identify a possible sub group of Lemierre’s syndrome (LS) associated with CA‐MRSA through a case report and literature review.

Method

We review a case report of an 18‐year‐old athlete admitted for increasing fever, tachycardia, tachypnea, and neck pain. MRSA bacteremia was identified, and following ARDS the patient was intubated. Neck CT showed jugular thrombophlebitis at the skull base. The patient was treated with rifampin, vancomycin, ceftriaxone, and clindamycin.

Results

Following intravenous antibiotic treatment the patient improved and was extubated, and subsequent CT and Doppler showed normal jugular flow. Sterilization of blood cultures predicted improvement. A literature review showed a rise in the past 2 years of LS associated with MRSA all with patients less than 18 years old.

Conclusion

CA‐MRSA in the pediatric population is associated with dermatologic infection and trauma. CA‐MRSA bacteremia can lead to pulmonary sequela. CA‐MRSA associated with pharyngitis, nasopharyngitis, and parapharyngeal lymphadenitis may predispose one to LS. LS can be associated with CA‐MRSA. As the CA‐MRSA carrier is predominantly nasal, pharyngitis may not be present.
Nasal Packing of Calcium Alginate after Endoscopic Sinus Surgery
Authors: Omura Kazuhiro , Asaka Daiya , Moriyama Hiroshi , Otori Nobuyoshi , Okushi Tetsushi , Nakayama Tsuguhisa , Matsuwaki Yoshinori
Published: September 2011

Objective

Sorbsan (calcium alginate) is an absorbent packing that shows a potent hemostatic effect and can maintain moist wound surfaces. The aim of this study was to evaluate the early symptoms and QOL with Sorbsan versus Beschitin‐F (chitin‐coated gauze) for middle meatus packing after endoscopic sinus surgery (ESS).

Method

We performed a cohort study of 40 patients who underwent ESS. The patients were randomly allocated into 2 groups who underwent insertion of either Sorbsan or Beschitin‐F into the middle meatus. A daily diary was used to record the symptoms and QOL, measured using visual analogue scales.

Results

The scores for each of the symptoms of nasal pain, headache, nasal bleeding, and postnasal drip were statistically significantly lower in the Sorbsan group. The scores for each of the QOL parameters, including the effect on their stay in the hospital and sleep disturbance, were also significantly lower in the Sorbsan group. There were no findings of postoperative hemorrhage or local infection in either group.

Conclusion

Sorbsan packing did not cause any major complications and has the potential to reduce nasal pain and suffering in post‐ESS patients compared with gauze packing.