bluuebunny/crossref_metadata_2025 huggingface dataset:
Silastic Septal Buttons: A Safe, Effective Method to Close Tracheoesophageal Fistulas
Authors: Nicolli Elizabeth A. , Farquhar Douglas , Thompson Nikki , Mirza Natasha
Published: August 2013

Objectives:

Tracheo‐esophageal fistulas (TEFs) are significant source of morbidity, leaving many patients feeding‐tube dependent. Surgical closure may be unsuccessful, especially if the fistula is large or the patient has been irradiated.

Methods:

The first patient is a 64‐year‐old male with a history of total laryngectomy and postoperative radiation therapy and secondary tracheosophageal puncture. The second patient is a 74‐year‐old male with a history of radiation therapy for non‐Hodgkins lymphoma with subsequent iatrogenic TEF during a dilation procedure.

Results:

Both patients failed multiple attempts to close the fistula. A silastic septal button was placed via endoscopy in the operating room, and both patients were able to resume eating without signs of leakage around the button.

Conclusions:

Silastic septal buttons are a safe, effective way to close tracheoesophageal fistulas in patients who have failed other attempts at closure.
Transoral Robotic Resection of a Massive Laryngeal Lipoma
Authors: Adkins Lacey K. , Kalejaiye Adedoyin , Steehler Matthew K. , Pierce Matthew L. , Chia Stanley H.
Published: August 2013

Objectives:

Describe the clinical and radiographic features of a massive laryngeal lipoma and discuss the management through a transoral robotic approach.

Methods:

Retrospective case report. An otherwise healthy 66 year old male presented with 6 months of progressive dysphagia, dyspnea, and muffled voice. On flexible endoscopy a massive, smooth mass was seen filling the oropharynx and obstructing visualization of the vocal folds and hypopharynx. Computed tomography imaging revealed an 8.5x4.9 cm low‐attenuation mass extending from the right paraglottic space posteriorly into the hypopharynx and oropharynx. On magnetic resonance imaging, the mass was T1 hyperintense with slight rim enhancement and complete suppression on T2 weighted fat saturation. The patient underwent tracheotomy under local anesthesia and excision of the mass through a transoral robotic approach.

Results:

Final pathology was consistent with lipoma. The patient began tolerating oral intake on postoperative day 1 and was decannulated on postoperative day 8. At 2 months follow‐up, he had right vocal cord paresis but had significant improvement in both his vocal quality and dysphagia and no recurrent mass in the oropharynx or hypopharynx.

Conclusions:

Lipomas of the larynx are rare, accounting for 0.6% of benign laryngeal lesions. Despite their benign nature, removal is indicated to manage airway obstruction and dysphagia. To our knowledge, this is the first report of transoral robotic resection of a laryngeal lipoma. We propose the use of transoral robotic surgery for large benign lesions of the larynx in order to avoid the morbidity of an open cervical approach.
Analyzing ECoG Distortions in Cochlear Implant Patients and Gerbils
Authors: Forgues Mathieu , Adunka Oliver F. , Choudhury Baishakhi , Campbell Adam P. , Buchman Craig A. , Fitzpatrick Douglas
Published: August 2013

Objectives:

1) Describe how rectification and saturation in hair cell and neural responses contribute to electrocorticography (ECoG) recordings in an animal model. 2) Analyze distortions in intraoperative recordings of cochlear implant patients.

Methods:

ECoG potentials from the round window (RW) of humans and gerbils were measured to tones of different frequencies and intensities. Human subjects receiving cochlear implants had a variable degree of hearing loss. The gerbils had normal hearing or a pattern of high frequency, noise‐induced hearing loss similar to many cochlear implant recipients. In our animal model, forward masking, simultaneous masking, and application of a neurotoxin to the RW were used to isolate hair cell and neural responses.

Results:

In both humans and gerbils, discrete patterns of distortions in the ECoG waveform were present that had either a hair cell or neural origin. Distortions due to phase locking of nerve fibers (the ANN) were the main cause of distortion at low frequencies and up to moderate intensities, while distortions seen at high intensities across all frequencies suggested saturation of stereociliary movement in the CM.

Conclusions:

Distortions originating from phase locking in nerve fibers can be diminished with forward masking or a neurotoxin, helping to isolate the relative contribution of nerve fibers and hair cells. Distortions in the animal model are also present in ECoG recordings in cochlear implant patients, and can have hair cell or neural origins.
Audio‐Visual Vowel Perception of Cochlear Implant Users
Authors: Ogata Erika , Yamasoba Tatsuya , Akamatsu Yusuke
Published: August 2013

Objectives:

We created a vowel perception test to analyze the contribution of visual and auditory inputs during vowel processing in cochlear implant (CI) users.

Methods:

We enrolled 30 adults and 40 children who received cochlear implants (CI). Ten adults and 11 children with normal hearing (NH) also participated as controls. The auditory stimuli were 5 Japanese vowels and the visual stimuli were apparent motions that were succeeded by pictures of faces. The following three test conditions were used: 1) AV, the matched pairs of visual and auditory stimuli, 2) AV‐mismatch, the inconsistent pairs of stimuli, and 3) A‐only. During the session, the subjects were instructed to judge which vowel was said and to press the correct button. Correct rate and reaction time were measured.

Results:

Correct rate in AV‐mismatch and A‐only condition was significantly higher in NH compared to CI. Correct rate of AV‐mismatch condition was significantly lower than that of AV and A‐only conditions in CI. Moreover, CI took longer reaction time in AV‐mismatch condition compared to other conditions. We found that the degree of visual dependence of adult CI users was correlated with speech discrimination score, but not age, duration of deafness, or duration of CI use. Among pediatric CI users, mode of communication during preschool period affected the results.

Conclusions:

The aural group showed results similar to those of adult CI users, which imply that their processing of visual and auditory inputs is close to those who learned speech and language through the auditory modality.
Balance Rehabilitation with Virtual Games in Elderly with Vestibular Disorders
Authors: Dorigueto Ricardo S. , Silva Rodrigo M. , Doná Flavia , Biabock Arlete , Krauser Solange P. , Kasse Cristiane A.
Published: August 2013

Objectives:

Evaluate the effectiveness of balance rehabilitation protocol with virtual games in elderly with vestibular disorders.

Method:

Pilot prospective clinical trial at a university center for balance disorders. Nine older patients of both genders diagnosed with vestibular disorder were elected. Their symptoms, static posturography parameters (functional reserve and velocity of oscillation (VOS) in ten visual‐vestibular interaction and somatosensory conflicts) and the Dynamic Gait Index were evaluated before and after vestibular rehabilitation. The virtual games rehabilitation program used the Wii Balance Board. Patients were put in situations causing dizziness and postural instability, such as walking with eyes open and closed on a stable and unstable surface, beyond optokinetic stimuli, saccadic, and pursuit eye visuovestibular interaction. Sessions lasted 60 minutes, two times per week for eight weeks.

Results:

After treatment, there was significant reduction of the following symptoms: dizziness (P < 0.01), motion sickness (P < 0.05), postural instability (P < 0.01), and fear of falling (P < 0.05). The Dynamic Gait Index increased in all subjects and was above the cutoff score for high risk of falling. Mean values of functional reserve and VOS improved in all conditions after vestibular rehabilitation (P < 0.05), exception in conditions 2,4,9, and 10 of VOS.

Conclusions:

Preliminary results suggest that balance rehabilitation program using virtual games is effective in improving symptoms and clinical parameters related to static and dynamic balance in older patients with balance disorders.
Benign Paroxysmal Positional Vertigo Is More Commonly Associated with Orthostatic Dizziness than Orthostatic Hypotension
Authors: Jeon Eun‐Ju , Park Yong‐Soo , Chang Ki‐Hong
Published: August 2013

Objectives:

Orthostatic dizziness (OD) and positional dizziness (PD) are very common conditions in dizziness clinics, but those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI).

Methods:

Patients presenting with OD (n = 102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI.

Results:

The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for all patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). A total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n = 10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n = 2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P = 0.039).

Conclusions:

It is suggested that orthostatic testing such as OVSM or HUTT should be performed as an initial work‐up for patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.
Er:YAG Laser Ablation of Bone versus Conventional Burrs in Otologic Surgery
Authors: Dalchow Carsten V. , Reimer Rudolph , Böttcher Arne , Kucher Stan , Jowett Nathan
Published: August 2013

Objectives:

The Er:YAG laser (EYL) provides an efficient means of precise and predictable bone ablation, without intense thermal injury associated with CO2 laser use. Use of the EYL in otology is possible, but must be undertaken with caution as ablation is associated with brief intense acoustic transients up to 120 dB. This study details the use of the EYL in otologic and neuro‐otologic surgery and compares ablation using a commercially available EYL with customizable glass fiber tips versus diamond and cutting burrs by means of infrared thermal imaging (IRT) and environmental scanning electron microscopy (ESEM).

Methods:

Five 0.6 mm diameter cylindrical cuts to a depth of 0.6 mm were made in formalin fixed human squamous temporal bone using a 300 µs EYL with pulse energies of 250 and 400 mJ (corresponding fluence levels of 175 and 280 mJ/cm2) and 0.6 mm diameter cutting and diamond burrs. Copious irrigation was used for all cuts. IRT was used to determine temperature rise. Ablation regions were inspected with ESEM.

Results:

Peak temperature rises were similar for all methods of ablation, none exceeding the 12 °C threshold required for irreversible bone injury. ESEM revealed rough margins for cuts made using the cutting burr and smooth edges with no sign of microfracture for those made with EYL and diamond burr.

Conclusions:

EYL ablates bone efficiently and predictably with smooth margins without microfractures or clinically significant temperature rise. When used appropriately, EYL may be a valuable tool for the otologic surgeon.
Gait Speed Seems to Predict Body Balance in Elderly Women
Authors: Dorigueto Ricardo S. , Kasse Cristiane A. , Raso Vagner
Published: August 2013

Objectives:

Determine the influence of body fat distribution, functional capacity, gait speed, and peak oxygen uptake on body balance of elderly women.

Methods:

Prospective clinical trial: at a university medical center. The sample consisted of 41 healthy elderly women aged from 61 to 77 years‐old (68.1 ± 0.7 years). Body fat distribution was assessed by subcutaneous central body adiposity and waist girth. Functional capacity was determined by time taken to move from seated to standing position (TSSP) and time to tie sneakers. Gait speed was assessed by the time to walk 3.33 m. Peak oxygen uptake (VO2peak) was measured during cardiopulmonary exercise testing. Body balance was assessed by the time to maintain an unipodal position during 30 seconds.

Results:

There were no significant prediction power for subcutaneous central body adiposity (adjusted R2=.01; P =.471), waist girth (adjusted R2=.01; P =.355), TSSP (adjusted R2=.04; P=.107), time to tie sneakers (adjusted R2 =.01; P =. 413) or VO2peak (adjusted R2=.03; P =. 747) with body balance. Nevertheless, it was observed that the time to walk 3.33 m significantly predicted the body balance (adjusted R2 =.08; P =. 047).

Conclusions:

Our results suggest that gait speed seems to be an important variable to predict body balance in elderly women. The prediction power of this association was very low, but appears to be a biological phenomenon because their impact was significant even in this small sample size.
Malignant Otitis Externa: An Evolving Disease
Authors: Hobson Candace E. , Moy Jennifer , Byers Karin , Raz Yael , Hirsch Barry E. , McCall Andrew A.
Published: August 2013

Objectives:

1) Compare the clinical presentations and outcomes of patients with MOE caused by Pseudomonas aeruginosa and methicillin‐resistant Staphylococcus aureus (MRSA). 2) Recognize the evolving trend of atypical and drug‐resistant organisms causing malignant otitis externa (MOE).

Methods:

A retrospective review of disease course and outcome was performed of patients diagnosed with MOE at a tertiary referral center between 1995 and 2012.

Results:

Forty‐four patients with a diagnosis of MOE were identified. Eighteen patients were excluded due to insufficient or inconsistent clinical data, leaving 26 patients for analysis. Forty‐six percent of patient cultures grew Pseudomonas and 12% grew MRSA. All patients infected with Pseudomonas had diabetes mellitus, compared to 33% of MRSA‐infected patients (P < 0.05). Twenty‐five percent of Pseudomonas‐infected patients presented with at least one cranial nerve palsy, as compared to none of the MRSA‐infected patients (ns). Duration of therapy for Pseudomonas‐infected patients lasted an average of 7.2 weeks, while MRSA‐infected patients lasted 10 weeks (ns). Excluding failed initial treatment courses, the average treatment durations were 5.0 and 7.7 weeks for Pseudomonas and MRSA infections, respectively. Other atypical pathogenic organisms isolated in culture include Candida, Aspergillus, and Enterococcus species.

Conclusions:

Increasingly, MOE is being caused by organisms other than Pseudomonas, including MRSA. Empiric treatment, without culture, can lead to delays in definitive therapy. A high index of suspicion for atypical or drug resistant organisms should be maintained in MOE patients who are not diabetic. Culture directed therapy for treatment of MOE is paramount.
A Novel Interactive 3‐Dimensional Model for Teaching and Learning the Anatomy of the Epitympanum
Authors: Ng Chew Lip , Liu Xuandao
Published: August 2013

Objectives:

The epitympanum is a challenging area for teachers and learners of its anatomy. Its complex 3‐dimensional relations are difficult to appreciate using texts or 2‐dimensional diagrams. We developed an interactive 3‐dimensional computer‐based model of the epitympanum that can be viewed from all angles for teaching and learning.

Methods:

The model was evaluated by 21 fourth‐year medical students in 2013. Students were given textbooks, journal articles, and 2‐dimensional diagrams of the epitympanum to study, followed by a demonstration of spatial relations using the model in one session. A questionnaire was used to assess the usefulness of the model.

Results:

81% of students found the epitympanic anatomy difficult to understand. 14.3% found the texts easy to understand. 33.3% found the texts easy to understand with 2‐dimensional diagrams. More males (50.0%; 6/12) than females (11.1%; 1/9) found it easy with 2‐dimensional diagrams (P = 0.07). 100% agreed that the model helps in understanding and remembering the anatomy (38.1% strongly agreed). 100% agreed that the model made understanding spatial relations easier than 2‐dimensional diagrams (33.3% strongly agreed). 90.5% agreed that the model helps in understanding the texts (28.6% strongly agreed). 100% agreed that the model is useful to residents/students (38.1% strongly agreed). One hundred percent agreed the model will be useful to teachers and would want this resource available if they were ear, nose, and throat (ENT) residents, with 47.6% and 38.1% strongly agreeing, respectively.

Conclusions:

Our model can be a useful tool in demonstrating epitympanic anatomy. It complements textbooks and 2‐dimensional diagrams to facilitate understanding.
Steroid‐Antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell's Palsy
Authors: Kim Tae‐Hyun , Lee Ho‐Yun , Kang Ho‐Min , Byun Jae‐Yong , Park Moon‐Suh , Yeo Seung‐Geun
Published: August 2013

Objectives:

The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell's palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell's palsy.

Methods:

This randomized, prospective study was performed in patients with severe to complete Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors.

Results:

The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P > 0.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P = 0.010). The S+A group showed a 2.6‐times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2‐times higher possibility of complete recovery.

Conclusions:

Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone.
Transcanal Endoscopic Tympanoplasty with Tragal Perichondrium Graft by the under‐over Technique
Authors: Valdivia Victor , Venegas Monica M. H. , Morante Juan C. C.
Published: August 2013

Objectives:

Evaluate the anatomical and audiological results of the endoscopic tympanoplasty with tragal perichondrium graft.

Methods:

A case series in patients with chronic otitis media, treated with transcanal endoscopic tympanoplasty by the under‐over technique. Patients were followed six months post treatment with clinical and audiometric evaluations in the Department of Otolaryngology, National Hospital Arzobispo Loayza, Lima ‐ Peru between 2007 and 2011.

Results:

Of a total of 64 patients, 31 met the inclusion criteria. 20 were males (64.5%) and the mean age was 27.5 years. The left ear was the most affected with 61.3%. Only 12.9% had retraction pocket. Perichondrium graft was used in 87.1%, and tragal cartilage with perichondrium with the others. There was complete closure of the perforation in 93.5% and only 2 complications, infection and perforation. The difference of the mean of the audiometries by air previous (39.1 ± 5.8) and posterior (30.2 ± 7.2) of surgery was significant (P = 0.0001). The difference of the air‐bone gap previous (13.1 ± 4.9) and posterior (4.3 ± 2.3) of the surgery was significant (P = 0.0001).

Conclusions:

The endoscopic tympanoplasty improves the audiometric levels and the gap in post‐surgery patients, and allows the complete closure of the perforations with less complications, in the present series.
Kawasaki Disease Resembling a Retropharyngeal Abscess: Clinical Analyses in 9 Cases
Authors: Yagi Masao , Yun Yasutaka , Osumi Yasunori , Tomoda Koichi
Published: August 2013

Objectives:

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology mostly affected children younger than 5 years of age. Although KD is characterized by prolonged fever (more than 5 days duration) plus 4 of the following 5 signs: conjunctivitis, skin rash, changes in the mouth and extremities, and cervical lymphadenopathy; cervical lymphadenopathy is the least common. Some of the unusual neck presentations reported in KD included deep neck infection like peritonsillar abscess and retropharyngeal abscess. Although it is important for patients with KD to receive early diagnosis and intravenous immunoglobulin (IVIG), unusual presentation of KD presents a dilemma for clinicians.

Methods:

We retrospectively analyzed clinical data from nine cases that were unresponsive to antibiotic therapy as retropharyngeal abscess/cellulitis later found to be the symptoms of KD from 2007 April to 2013 Feb. There were 5 boys and 4 girls, aged from 8 months to 9 years.

Results:

The mean white blood cell count in one study was 16000, with a range of 11200‐21300. The mean C‐reactive protein level was 11.1 (6.43 to 21.7). All patients had marked cervical lymphadenopathy with head rotation failure because of severe neck pain. Neck computed tomographic scan demonstrated widening of the retropharyngeal space with a central hypodense region in all cases. Dramatic clinical improvement was seen after a 2‐day course of IVIG treatment in all cases.

Conclusions:

These cases emphasize that KD should be considered in children with suspected cervical lymphadenitis or retropharyngeal abscess with a poor response to empiric antibiotic therapy.
Severity of CMV Hearing Loss due to the Innate Immune Response in Mice
Authors: Park Albert H. , Duval Melanie , Wang Yong , Firpo Matthew A.
Published: August 2013

Objectives:

Demonstrate the role of the innate immune response in a mouse model for Cytomegalovirus (CMV) induced sensorineural hearing loss (SNHL).

Methods:

Forty C57BL/6 and BALB/c mice underwent intracranial injection at postnatal day 3 with 200 pfu of green fluorescent protein (GFP) expressing murine (m) CMV; 10 controls received either saline or no injection. Hearing thresholds were assessed using distortion product otoacoustic emission (DPOAE) and auditory brain stem response testing (ABR). Temporal bones were harvested and sectioned for histologic analysis. A subset of BALB/c and C57B/6 temporal bones were harvested for histologic analysis 3 and 7 days after inoculation.

Results:

Fifty‐five percent of the BALB/c mice had profound hearing loss (≥80 dB) at 4 weeks of age, while 45% initially showed moderate hearing loss that progressed to profound hearing loss by 6 weeks. The green fluorescent protein (GFP)‐labeled virus was abundant in the spiral ganglion and adjacent to the scala tympani at 7 days post‐injection and absent by 4 weeks. In contrast to what was seen in BALB/c mice, the C57/B6 mice showed mild hearing loss. Moreover, temporal bone histology also showed no evidence of mCMV infiltration of the cochlea 3 and 7 days post‐inoculation when peak mCMV infection was expected.

Conclusions:

Since C57BL/6 mice have been shown to possess a Ly‐49H receptor that triggers natural killer cell activation which is not present in BALB/c mice, these results suggest that CMV mediated hearing loss severity may be influenced by the innate immune response.
Stability Measurements of the Baha System in Children
Authors: Felton Mark , Feltham Penny , Andrew Rachel , Bruce Iain
Published: August 2013

Objectives:

Bone conduction implant (eg, Baha®) stability can objectively be measured over time using radio‐frequency analysis (RFA). Adult studies suggest that the Cochlear Baha BI300 Implant® may be loaded as soon as the soft tissue wound is healed. We aim to discuss implant stability in children using RFA measurements.

Methods:

Consecutive children having a Cochlear Baha BI300 Implant had RFA measurements taken peri‐operatively, 1 week post‐surgery, within 3 months of surgery, and then subsequently at least 3 monthly. RFA measurements were measured at loading of the hearing processor and at 1 week post‐loading. Standard practice has been to load the implant at 3‐6 months postoperatively.

Results:

Nine children had 10 Cochlear Baha BI300 implants® (8 unilateral and 1 bilateral) with a mean age of 9 years 4 months (4 years 9 months to 13 years 5 months). The mean time to loading of the hearing processor was 3.3 months (3 to 5 months, n = 9). Mean follow‐up was 9 months (6 weeks to 23 months). Peri‐ and postoperative RFA measurements will be discussed with 6 children having RFAs sufficiently high for hearing processor loading much earlier post‐implantation. Implant stability was maintained after loading with the hearing processor.

Conclusions:

This study indicates that a larger study is warranted to evaluate both the role of sequential RFA measurements in the timings of Baha hearing processor loading and the possibility of loading at 4‐6 weeks in selected children. Subsequently RFA measurements may also be used to decide between single‐ and two‐stage surgery.
Systematic Review of Endoscopic Balloon Dilation of Pediatric Subglottic Stenosis
Authors: Lang Michael , Brietzke Scott E.
Published: August 2013

Objectives:

1) Critically assess the literature reporting on the outcomes of endoscopic balloon dilation (EBD) of pediatric subglottic stenosis.

Methods:

Adhering to PRISMA principles, a systematic review of pediatric EBD was performed using the PUBMED (MESH) and EMBASE databases. Inclusion criteria consisted of sample size of five or greater pediatric patients, and primarily EBD without adjuvant procedures such as laser ablation or prolonged stenting. Meta‐analysis was performed with random effects modeling and meta‐regression.

Results:

Eleven studies were identified on the initial search. Cross‐checking references led to identification of 2 additional studies. After detailed review and application of the inclusion/exclusion criteria, 6 studies were included in the final dataset with 145 total subjects. All studies were case series (level 4 evidence). The average sample size was 16 (range = 8‐37). Grand mean age was 29.3 months (range = 4.8‐60 months). EBD treatment success was defined as avoidance of more definitive procedures (airway reconstruction, tracheostomy). The random effects model estimate of the overall treatment success was 64.8% (95% CI = 56.5‐73.1%, P < 0.001, Q test for heterogeneity = 31.0, P < 0.001, I squared = 74.2%). Follow‐up was inconsistently reported but averaged 5.0 months (range =. 25‐12.5 months) in studies that did report it. Only one study reported significant complications (one death, two tracheal lacerations). Meta‐regression results did not indicate that age, Cotton‐Myer stage (1, 2, or 3) or primary versus secondary treatment significantly affected the odds of EBD treatment success.

Conclusions:

EBD is successful in the majority of patients over short‐term follow‐up, and reported complication rates are low. Factors predictive of treatment success have not been conclusively determined.
A Case of Recurrent Postoperative Aseptic Meningitis after Craniopharyngioma Resection
Authors: Lam Allen C. , Mamanov Marlen , Curry William T. , Holbrook Eric H.
Published: August 2013

Objectives:

1) Describe a case of aseptic meningitis following craniopharyngioma resection. 2) Review of literature and pathophysiology surrounding aseptic meningitis secondary to cranipharyngioma resection. 3) Recognize diagnostic and management difficulties regarding this phenomenon.

Methods:

This is a case report of a 65‐year‐old female with a compressive craniopharyngioma who underwent endoscopic trans‐sphenoidale resection followed by aseptic meningitis, regrowth, open re‐resection, and recurrence of meningitis.

Results:

The patient was found to have a cranoiopharyngioma on magnetic resonance imaging after presentation with 2‐months of diplopia. She underwent trans‐sphenoidale resection with improved vision post‐operatively. However, she presented to the emergency department (ED) with fatigue and fever concerning for meningitis. Cerebrospinal fluid (CSF) analysis demonstrated elevated leukocytes and total protein, and normal glucose levels consistent with meningitis. Cultures returned sterile. She was discharged on long‐term antibiotics. Unfortunately, her craniopharyngioma regrew requiring open craniotomy re‐resection. She did well post‐operatively but presented to the ED with altered mental status, emesis, and fever. Again, CSF analysis was sterile with elevated leukocytes and total protein. She was treated with another course of long‐term antibiotics. After radiation therapy, repeat MRIs found no regrowth of her craniopharyngioma.

Conclusions:

Aseptic meningitis after craniopharyngioma resection is a rare phenomenon but can introduce a diagnostic and management conundrum. This case highlights the importance of awareness for chemical‐induced meningitis following craniopharyngioma resection. While symptomatic relief is important, the course of antibiotic coverage is controversial. Coordinated multi‐team efforts are necessary to provide optimal care for these patients.
The Effect of PM10 on the Symptoms of Allergic Rhinitis during Spring
Authors: Baek MinKwan , Jung JuHyun , Jang Taeyoung , Kim Suntae , Ko Kwangpil , Kim YoungHyo
Published: August 2013

Objectives:

Clarify the effect of PM10 (particulate matter less than 10 Î¼m), which is the major component of air pollution, on the symptoms of allergic rhinitis patients during spring.

Methods:

We investigated changes in allergic symptoms (rhinorrhea, sneezing, nasal obstruction and sleep disturbance) and nasal obstruction level as measured using a portable peak nasal inspiratory flowmeter (PNIF) in 108 allergic patients. Forty‐seven control subjects were also included. Spring pollen counts and PM10 concentrations in Incheon city were also evaluated. We conducted long‐term observation of the effect of PM10 on allergic symptoms for 120 days from February to May and compared the changes in symptom scores before and after the 2 days when PM10 concentration was 100Î¼g/m3 (short term).

Results:

The highest concentration of PM10 during the study period was <150 mg/m3. No significant correlations between PM10 and nasal obstruction (P = 0.0670), rhinorrhea (P = 0.1485), sneezing (P = 0.3991), itching (P = 0.2044), sleep disturbance (P = 0.4413) and the sum of all symptoms (P = 0.0816) were identified. However, the variation in nasal obstruction, as assessed by PNIF, was significantly correlated with the PM10 level (P = 0.0410). There was also a significant correlation between outdoor activity duration and the sum of clinical symptoms (P < 0.001). Neither frequency of drug use nor PNIF values were affected by the short‐term changes in PM10 levels.

Conclusions:

Our data suggest that PM10 concentration during spring influences nasal obstruction as determined by PNIF; this nasal obstruction was also influenced by the duration of outdoor activity.
Endoscopic Anatomy Variation of the Medial Pterygopalatine Fossa Structures and Its Surgical Applications
Authors: Polev Georgy
Published: August 2013

Objectives:

Describe the endoscopic anatomy variability of the medial Pterygopalatine Fossa (PPF) structures during cadaveric dissection, and analyze the relationship of the neurovascular structures in this region.

Methods:

20 non‐injected fresh cadaveric specimens were dissected bilaterally via the endonasal endoscopic approach.40 medial PPF regions are described. The distances between the vidian canal (VC) and palatovaginal canal (PVC) orifices are measured and the mean length of the PVC is estimated. Also we measured the distances between VC orifice and foramen rotundum (FR) to estimate the risk of maxillary nerve lesion during the transnasal vidian neurectomy. The 3‐D relationship between the greater palatine neurovascular bundle (GPB) and the aforesaid structures has been analyzed.

Results:

The mean distance between PVC and VC orifices equaled 2.6 mm and the mean length of the PVC was 6.4 mm. The mean length of the palatine bone sphenoid process is 7.2 mm, which is always approximately equal to the distance between the GPB and the PVC cranial orifice. The mean distance between the VC orifice and FR is 4.6 mm.

Conclusions:

Based upon this study, modified “retrograde” approach to the VC orifice from the choanal arch behind the middle turbinate tail via the palatine bone sphenoid process along the PVC is proposed. The peculiarity of this approach is the preservation of the PPF contents and sphenopalatine neurovascular bundle, which are moved aside laterally during the dissection. Further investigation is needed to establish the feasibility of this approach in vivo.
Ethmoid Adenocarcinoma: Systematic Associated Skull Base Resection Improves Disease‐Free Survival
Authors: Durand Nicolas , Espitalier Florent , Ferron Christophe , Cassagnau Elisabeth , Bord Eric , Langlois Emanuelle M. , Malard Olivier
Published: August 2013

Objectives:

Ethmoid adenocarcinoma is an occupational tumor affecting woodworkers with prognosis correlated to the local control of the disease. Since 1998, we have developed a technique of skull base resection with reconstruction by exclusive transfacial approach. This method allows a resection of the cribriform plate and dura mater associated with the removal of the tumor with simplified postoperative features compared with mixed approach.

Methods:

We performed a retrospective analysis of 89 patients presenting with ethmoid adenocarcinoma from 1998 to 2010 (144 months). All patients treated with surgical removal and postoperative adjuvant radiotherapy were included. Postoperative features and oncologic outcomes were analyzed.

Results:

89 patients were treated by surgical removal of the ethmoid tumor associated or not with skull base resection by a transfacial approach. The median age was 67.6 years, and 91% were occupational woodworkers. Among these 89 patients, 71 benefited from skull base resection by transfacial approach. Disease free survival was significantly better in the skull base removal group (P = 0.009) and decreased for T4 stages (P = 0.008). Overall survival was not influenced by the surgical technique. This method provided less morbidity than mixed approach and good results of 5‐years specific survival (85 %).

Conclusions:

Prognosis of ethmoid adenocarcinomas is related to local control. In our experience the transfacial approach for systematic skull base resection associated with tumor removal and reconstruction is safe, efficient, and improves local control with a low morbidity, allowing a curative treatment for a larger number of patients.
Improvement in Eustachian Tube Function after Endoscopic Sinus Surgery for Polypoid Chronic Rhinosinusitis
Authors: Yu Vivian M. , Yu Jeffrey W.
Published: August 2013

Objectives:

1) Discuss the evidence for polypoid chronic rhinosinusitis causing Eustachian tube dysfunction and the role of endoscopic sinus surgery. 2) Demonstrate a case report of a patient with otologic complaints of Eustachian tube dysfunction showing that Functional Endoscopic Sinus Surgery (FESS) results in both symptomatic and objective improvement on tympanogram with Toynbee maneuver.

Methods:

A patient with polypoid chronic rhinosinusitis was assessed with two runs of tympanometry: a run before and after a Toynbee maneuver. The same test was repeated at 12 and 22 weeks after surgery.

Results:

Preoperatively, there was no shift in the tympanogram in either ear after the Toynbee maneuver. At the first post‐operative visit, our patient demonstrated a shift in the tympanogram curve after a Toynbee maneuver in the left ear. At the second visit the patient demonstrated a shift in both ears. The patient also described subjective improvement in symptoms of Eustachian tube dysfunction.

Conclusions:

This case study demonstrates that endoscopic sinus surgery in patients with chronic rhinosinsitis can improve symptoms of Eustachian tube dysfunction. Improvement in Eustachian tube function can be demonstrated by vigorous testing by shifts in the tympanogram curve after pressurization using the Toynbee maneuver. This suggests that a large prospective study should be performed using subjective and objective measures of Eustachian tube function in patients with otologic complaints and chronic rhinosinusitis. We feel that this unique test is clinically relevant and uses equipment readily available in a standard office rather than more extensive that are restricted to research laboratories.
The Influence of Body Mass Index and Other Patient Factors on Parotidectomy Complications
Authors: Thorpe Eric , Teng Stephanie , Greenbaum Evan , Borrowdale Richard W. , Marzo Sam J. , Leonetti John P.
Published: August 2013

Objectives:

1) Determine if body mass index (BMI) influences the outcome of patients undergoing a parotidectomy. 2) Identify other factors that influence patients undergoing a parotidectomy. Study Design: Chart review. Setting: Tertiary care academic hospital. Subjects: Three hundred and sixty‐five surgical cases were reviewed from 2005‐2011. A total of two hundred and fifty‐five met inclusion criteria. Cases were excluded if other procedures were completed at the same time as the parotidectomy.

Methods:

BMI categories were separated. Outcomes reviewed included nerve weakness, hematoma/seroma formation, infection, and other noted complications. Complications were broken down into early (less than 30 days) and late (more than 30 days). Other variables assessed include age, gender, diabetes, surgeon, and superficial vs. total parotidectomy.

Results:

Fisher's exact test was used to identify variables associated with post‐operative complications. BMI was shown to not have a statistically significant effect on complications. Patients undergoing a total parotidectomy had significantly more early complications and nerve weakness early and late (P = 0.0293). Diabetic patients had significantly more nerve weakness early and late (P = 0.0148).

Conclusions:

BMI does not influence post‐operative complications in patients undergoing parotidectomies and should not prevent elective parotidectomies in patients. Patients with diabetes and those undergoing total parotidectomies have significantly more complications.
Is There a Relationship between Epistaxis and Staphylococcus aureus Colonization in the Nasal Vestibule?
Authors: Ulusoy Seçkin , Babaoğlu Gülçin , Cingi Cemal
Published: August 2013

Objectives:

Although epistaxis is still very common in children and adults, its cause in most non‐traumatic cases remains unknown. We aimed to find out if nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and new vessel formation and ends with epistaxis in association. We also wanted to investigate the relationship between positive cultures and seasons.

Methods:

One hundred twenty‐nine patients were recruited for the study group (86 had crusting in the nasal vestibule while 43 did not) and compared with 40 healthy control subjects. A microbial swab was taken from the anterior nasal cavity of each subject. The same procedure was repeated at each season.

Results:

S aureus was found to be more common in the epistaxis group when compared with the control group, with a percentage of 37% and 19% respectively. There was no difference in the prevalence of S aureus between crust and noncrust groups. When positive cultures were grouped and compared according to season, we observed that the positive culture with epistaxis was much higher (44.82 %) in autumn.

Conclusions:

A positive correlation between nasal colonization with S aureus with epistaxis highlights the importance of healthcare and preventive care. Further studies should be performed to decrease epistaxis by diminishing the colonization of S aureus. Special attention should be given in autumn.
Surgical Treatment for Paranasal Mucoceles: Usefulness of Preoperative MRI and Computer‐Aided Surgery
Authors: Hashimoto Shigehisa , Takahashi Sugata
Published: August 2013

Objectives:

Surgical procedures for paranasal mucoceles are associated with different levels of difficulty depending on the sites and the number of mucoceles, because the walls of mucoceles are excised and opened into the nasal cavity. We examined the usefulness of magnetic resonance imaging (MRI) in addition to computed tomography (CT) and also that of computer‐aided surgery.

Methods:

The study involved 70 patients undergoing surgical treatment for paranasal mucoceles. Preoperative CT and MRI were carried out, and mucoceles were opened into the nasal cavity by endoscopic sinus surgery (ESS) using computer‐aided surgery. Mucosal flaps were created within the nasal cavity and inserted into the mucoceles by sliding them down.

Results:

CT confirmed bone defect sites, and tumor differentiation was performed using MRI preoperatively. Multilocular mucoceles could be confirmed intraoperatively in 19 patients and on preoperative MRI in 18 cases (94.7%). Preoperative nasolacrimal ducts and orbital cavities were marked on the monitor by computer‐aided surgery so that they could be avoided while the walls of mucoceles were excised and widely opened into the nasal cavity. There were no postoperative complications or residual mucocele, and only one patient (1.4%) showed re‐closure of the opened site 6 months after the operation.

Conclusions:

Evaluation of the mucoceles by preoperative MRI was useful to accurately grasp the number of mucoceles and their sites. Because concomitant use of computer‐aided surgery allows the mucoceles to be opened as safely and widely, it can be considered to be useful for reducing the rate of postoperative re‐closure.
Transillumination‐Guided Endoscopic Endonasal Dacryocystorhinostomy: Approach to Revision Cases and Challenging Anatomy
Authors: Vazquez Alejandro , Blake Danielle M. , Langer Paul , Eloy Jean A.
Published: August 2013

Objectives:

Dacryocystorhinostomy (DCR) is a surgical procedure whereby a connection is established between the lacrimal sac and the nasal cavity in an effort to bypass an obstruction of the distal lacrimal apparatus. Endoscopic endonasal DCR (EEDCR) is a minimally invasive technique used to achieve this goal. In patients with altered anatomy, EEDCR can be challenging. Here, we describe the use of canalicular transillumination with EEDCR in two complicated cases and discuss the benefits of this technique compared to external DCR and standard EEDCR.

Methods:

Case series.

Results:

A 33‐year‐old woman suffered an iatrogenic skull base injury while undergoing right‐sided EEDCR. An intraoperative rhinologic consultation was requested from our service, and the patient underwent emergent endoscopic repair of a right skull base defect. Grossly abnormal endoscopic and radiographic anatomy was noted, and a diagnosis of ozena was ultimately established. Two years later, the patient underwent successful right‐sided transillumination‐guided EEDCR (TG‐EEDCR). A 71‐year‐old woman who had previously undergone a right‐sided open DCR developed recurrent epiphora. Attempts to recanalize the fistula under endoscopic visualization was challenging due to the abnormal anatomy and excessive scarring. TG‐EEDCR was performed successfully. In both of these described cases, a 20‐gauge vitreoretinal light pipe was used for canalicular transillumination.

Conclusion:

EEDCR with canalicular transillumination represents a feasible alternative approach for cases in which prior surgery, trauma or other sinonasal pathology have significantly altered the native sinonasal/lacrimal anatomy.
Clinical Predictors of Pediatric Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Lin Hsin‐Ching , Friedman Michael
Published: August 2013

Objectives:

Identify standard clinical parameters that may predict the presence and the severity of pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS).

Methods:

Eighty‐eight pediatric patients with habitual snoring who underwent a physical examination and full‐night polysomnography were included in this study. Severity of nasal obstruction (NO) and mouth breathing, modified Mallampati grade (aka updated Friedman's tongue position), tonsil size, and the body mass index (BMI) z‐score in the study population were recorded.

Results:

When physical parameters were correlated singly with the apnea/hypopnea index (AHI), we found that gender, severity of snoring, NO, and mouth breathing status were reliable predictors of pediatric OSAHS. When all important factors were considered in a multiple stepwise regression analysis, a significant correlation with pediatric OSAHS emerged by factoring the snoring VAS, NO, and BMI z‐score (Pediatric AHI = 0.108 + 0.103 Snoring VAS + 0.894 NO + 0.207 BMI z‐score).

Conclusions:

This study has identified those findings that predict OSAHS. There is a positive correlation between snoring VAS, NO, and BMI z‐score with levels of severity of OSAHS. The study can also help identify pediatric patients with habitual snoring who should be further evaluated for the presence of OSAHS.
Do Pharyngeal Surgeries for Treatment of Snoring and Sleep Apnea Have an Impact on Nasalance?
Authors: Karakoc Omer , Akcam Murat T. , Genc Hakan , Birkent Hakan , Binar Murat , Gerek Mustafa
Published: August 2013

Objectives:

Most of the surgeries used in the treatment of snoring and obstructive sleep apnea mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty, lateral pharyngoplasty, and anterior pharyngoplasty on nasalance.

Methods:

Forty‐four consecutive patients with primary snoring or obstructive sleep apnea (OSA) who underwent anterior palatoplasty, lateral pharyngoplasty, and expansion sphincter pharyngoplasty procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed by using Nasometer II instrument (model 6400; Kay Elemetrics) preoperatively and 3 months after surgery.

Results:

The mean preoperative nasalance score for AP, LP, and SP groups were 49.06±10.72, 46.65±8.70, and 48±10.95, respectively. The mean postoperative nasalance score for AP, LP, and SP groups were 48.25±8.78, 46.82±5.2, and 49.36±10.81, respectively. There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all three passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, two patients after AP, and five patients after SP. None of these symptoms showed persistence, and they revealed at approximately 1‐month follow‐up.

Conclusions:

The results of this study showed that these surgical techniques did not lead to an objective velopharyngeal insufficiency, since no significant change in nasalance scores was observed.