bluuebunny/crossref_metadata_2025 huggingface dataset:
S238 – Clip‐fixation or Crimping? Results of 4 Stapes Prostheses
Authors: A'Wengen Daniel F
Published: August 2008

Objectives

Learn about possible differences of results by 4 different stapes prostheses.

Methods

In this retrospective study, all 126 contiguous patients undergoing stapes surgery for otosclerosis are included. All surgeries were performed by 2 surgeons. 4 different types of stapes prostheses were used in separate time intervals. Starting with teflon‐platinum wire prosthesis, to gold piston, to titanium piston, to the self‐retaining titanium Clip‐piston.

Results

Pre‐ and postoperative pure tone and speech audiograms are compared. The best results were achieved by the Clip‐Piston. Improvement in PTA over other pistons was 4 dB with p= 0,027 (Mann‐Whitney). Bone conduction levels were better by 2 dB. In speech audiometry intellegibility was better by 3 dB with p=0,024 (Mann‐Whitney).

Conclusions

The tight self‐fixation of the Clip‐Piston to the long process of the incus achieved the best results in pure tone and even more so in speech audiometry. The reason might be due to reduced slippage of the stapes prosthesis at the attachment to the incus. As other studies have shown, tight fixation of a stapes prosthesis provides the best results. The Clip‐Piston achieves this by its spring action and without the danger of heat and strangulation as by other stapes pistons.
S241 – Acoustic Neuroma Surgery: Hydroxyapatite Cement Cranioplasty
Authors: Kruger Emma A. , Arriaga Moises A , Chen Douglas , Hillman Todd
Published: August 2008

Objectives

To review the outcome of hydroxyapatite cement cranioplasy in acoustic neuroma surgery using trans‐labyrinthine and retrosigmoid approaches.

Methods

Retrospective chart review of the cases of acoustic neuroma resection performed in our institution from January 1, 2007, until November 1, 2007, using 2 separate types of hydroxyapatite cranioplasty in wound closure. Abdominal fat graft in case of translabyrinthine approach and either abdominal fat graft or duragen were covered using Hydrset (Stryker) or Bonesouce (Stryker) hydroxyapatitie cement bone substitute. Translabyrinthine and Retrosigmoid resections were included in the review. The rate of postoperative cerebrospinal fluid leak, lumbar drain use, and early wound complications were recorded.

Results

There were 33 cases of acoustic neuroma resection over a period of 10 months using hydroxyapatite cranioplasty. Hydroset bone substitue was used in 16 cases and no CSF leak was observed. Bonesource bone substitute was used in 17 cases and 1 case of CSF leak was observed. The leak was managed with lumbar drain placement and resolved without any additional interventions. In the Hydroset group no drains were used, and in the Bonsource group drains were placed at the completeion of a procedure and removed 12 hours postoperatively. There were no wound complications seen at the completeion of the review. No other adverse outcomes were noted.

Conclusions

Both forms of hydroxyapatite cranioplasty are reliable methods to avoid CSF leak in acoustic neuroma surgery. The handling characteristics and no need for drain with Hydroset may make it preferable as a bone reconstruction technique in acoustic neuroma surgery.
S242 – Comparing the VEMP and ENG Tests in Vestibular Diagnosis
Authors: Bhansali Sanjay
Published: August 2008

Objectives

1) Compare the VEMP to the ENG test in the diagnosis of vestibular disease. 2) Learn clinical usefulness of the VEMP test.

Methods

We prospectively evaluated 166 patients complaining of dizziness with a complete neurotologic examination. VEMP and ENG testing were done on 160 patients. Brain scans were done when indicated. We compared the clinical diagnosis to the VEMP and ENG test results separately for 4 commonly seen vestibular conditions.

Results

44 patients had no VEMP response and were excluded. Of the 116 patients there were 32 cases of Vestibular Neuronitis, 17 of Meniere's disease, 15 of BPPV, 12 of central vestibular dysfunction, 13 other vestibular diagnoses, and 27 with no vestibular diagnosis. Using a 2×2 contingency table and Fisher Exact Probability Test, there was a statistical difference between the VEMP and ENG tests only in diagnosis of Vestibular Neuronitis (p<0.001) when analyzed individually, and because this difference was so strong, there was a statistical difference with the diagnoses taken all together (p<0.001).

Conclusions

The ENG test remains the gold standard for diagnosis of vestibular disease. The VEMP test is useful in diagnosis of several vestibular disorders, including the 4 considered in this study. There is a strong bias toward the ENG test mainly because the diagnosis of vestibular neuronitis relies heavily on an abnormal caloric response. The VEMP test is administered in a much shorter time than the ENG test and provides valuable information regarding the inferior vestibular nerve and it has a lower false positive rate than the ENG test.
S246 – Chronic Sinusitis in Children: Which Sinuses Are Involved
Authors: Ramadan Hassan H , Douglas Justin
Published: August 2008

Objectives

1) Learn which paranasal sinuses are involved in chronic rhinosinusitis in children. 2) Be able to customize surgical treatment based on those findings.

Methods

Retrospective review of children who had sinus surgery over a period of 10 years. 76 children whose age ranged between 3 and 14 years had their CT scans reviewed to determine which sinuses were diseased. All children had a CT scan because of failure of medical management and were considered for surgery. Outcome was to determine which sinuses were developed and of those, which ones were diseased and what was the severity of the disease.

Results

The maxillary sinuses were the most common sinuses involved in children with chronic rhinosinusits (92%). The ostiomeatal complex was next most common area involved in these children (88%).

Conclusions

The maxillary sinuses, followed by the ostiomeatal complex, were the most common areas involved in children with chronic rhinosinusitis. Initial surgical management of these children should then be based on those findings.
S249 – Grisel's Syndrome in Otolaryngology: A Systematic Review
Authors: Sivaji Nagaraj , Karkos Peter , Samuel Leong
Published: August 2008

Objectives

To assess etiology, treatment, and outcome of Grisel's syndrome.

Methods

A Medline search was performed using the terms Grisel's syndrome, spontaneous atlantoaxial subluxation, head, neck, ear, nose and throat. A systematic review of the literature was performed. Case series of both adult and pediatric cases were included. Only papers focusing on true non‐traumatic atlantoaxial subluxation were included.

Results

71 papers have been published from 1950 to 2006. 48 of these fulfilled our inclusion criteria, totaling 103 patients for review. The main causes of Grisel's syndrome were infection (48%) and post‐adenotonsillectomy (31%). Less common causes included other postoperative cases such as pharyngoplasty and ear operations. Neurosurgical consultation was paramount in all cases. In the majority of cases, conservative management in the form of bed rest, antibiotics, muscle relaxants, traction, and collar was effective; in a few cases, only surgery in the form of arthrodesis was deemed necessary. Morbidity was significant in those cases where diagnosis was delayed, with the most devastating consequence a permanent neurological deficit in one case.

Conclusions

Grisel's syndrome is a rare but dangerous complication that can go unnoticed in its early phase and can be a major cause of morbidity and mortality following infection or head and neck procedures/interventions. Early recognition of any cervical complication following routine otolaryngological operations, together with early neurosurgical consultation, is mandatory to prevent devastating consequences.
S253 – Management of Pediatric Skull Base Abscesses
Authors: Kimbrough Tyler G , Meyer Abby C , Finkelstein Marsha , Sidman James D
Published: August 2008

Objectives

To describe the presentation and management of pediatric deep neck space infections located at the skull base.

Methods

Design: Retrospective review. Setting: Tertiary children's hospital. The study population comprised pediatric patients admitted to the hospital for management of deep neck space infections between 2000 and 2007. Main Outcome Measure: Resolution of abscess.

Results

Over the study period, 179 patients were admitted for management of deep neck space infections. Of these, 10 (6%) were localized to the skull base by CT scan. 7 of the 10 met radiographic criteria for an abscess; the remaining 3 were designated edema or phlegmon. Patients ranged in age from 2 to 8 years old. The most common presenting symptoms were sore throat (60%), stiff or sore neck (50%), neck or facial swelling (20%), and drooling (20%). Otitis media and Streptococcal pharyngitis were the most common co‐morbidities found in 40% of patients. Initial treatment consisted of IV antibiotics in all cases. 70% resolved with medical management alone. 3 patients failed to resolve following 48 hrs of IV antibiotics and were taken to the operating room for abscess drainage, which was unsuccessful in all cases. Repeat CT after an additional 48 hours of medical therapy indicated persistent abscess in 2 of the 3 operative cases. Repeat drainage was successful in only 1 of these.

Conclusions

Skull base abscesses in children can be effectively managed in most cases by IV antibiotics alone. Surgical drainage is difficult and often unsuccessful and therefore poses unnecessary risk to the patient.
S256 – Microbiology of Pediatric Head and Neck Abscesses
Authors: Meyer Abby C , Kimbrough Tyler G , Finkelstein Marsha , Sidman James D , Helen Finkelstein
Published: August 2008

Objectives

To report the microbiology of pediatric head and neck abscesses.

Methods

The records of a tertiary pediatric hospital were searched and all children with infections of the head and neck region between 2000 and 2007 were identified. Cases of peritonsillar abscess were excluded. Data regarding presentation, physical exam findings, radiographic findings, and treatment were extracted. All children who were diagnosed with abscesses and treated surgically were further identified, and the results of intraoperative cultures were reviewed.

Results

A total of 179 children with infections of the head and neck were treated between the years of 2000 and 2007 of which 57% (102 children) were diagnosed with abscesses. 71% (72 children) with abscesses were treated surgically. Of 62 children with drainable abscesses, culture data was available for 54 children. A single organism was isolated in 24.1% of cultures, 2 organisms in 18.5% of cultures and 3 organisms in 16.7% of cultures. More than 3 organisms were identified in 38.9% of cultures. The most commonly isolated organisms included alpha‐hemolytic streptococci (57.4%), group A streptococci (37.0%), anaerobes (29.6%), hemophilus (22.2%), neisseria (22.2%), and “respiratory flora” (20.4%). Other streptococcal species (14.8%), candida (14.8%), staphylococci (11.1%), stomatococci (11.1%) and other organisms (7.4%) were also identified. One culture showed no growth. No cases of methicillin‐resistant staphylococcus aureus (MRSA) were encountered.

Conclusions

In our series, streptococci and anaerobic bacteria were the most commonly isolated organisms, and almost 40% of cultures identified greater than 3 different organisms. No cases of MRSA were encountered.
S258 – Rapid Intracranial Spread of ENT Infection in B‐thalassaemia
Authors: Tanwee Faiz
Published: August 2008

Objectives

1) To find out the duration of onset of intracranial complications following middle ear and paranasal sinus infection in B‐thalassaemia. 2) To find out the contributory factors for such complications.

Methods

A retrospective study of thalassaemic children who suffered from intracranial complication following ear and sinus infections between Jan ′02‐ Oct ‘04, was done at a tertiary hospital Male’, Maldives. Follow‐up data were obtained from National Thalassaemia Centre. Patients' demographic pattern, thalassaemic status, Desferroxamine therapy, duration of the ear/nose symptom, the intracranial complications, the treatment and the outcomes were noted. We didn't include 3 patients, for whom full data were not available.

Results

We found the records of a series of 5 consecutive patients out of 94 thalassaemic patients which were referred with different ear and nose infections and were treated for intracranial complications. All patients were in the age group of 10–15 years. All were female. Spread of infection from the ear was more common than the spread from sinuses (3 out of 5 patients). The intracranial complications developed in these patients within few days (<5 days) of presentation in the clinic. All of the patients were on regular blood transfusion with desferroxamine therapy but none had spleenectomy. Most common organism found was klebsiella.

Conclusions

Persistent anaemia, repeated transfusion, iron overload, and hypersplenism are the major contributory factors for frequent infections in thalassaemics. Natural thinning of the bony cortex and remodelling of skull in thalassaemics can be considered as an additional factor for the rapid development of intracranial complications.
S259 – Pediatric Tracheotomy: Changing Trends in Puerto Rico
Authors: Alameda Yadiel A , Gonzalez‐Aquino Carlos , Ortiz Melissa , Gonzalez Javier
Published: August 2008

Objectives

We chose to review the outcomes of tracheotomies performed at San Jorge Children's Hospital, San Juan, Puerto Rico, over the last 15 years. Our objectives were: 1) Understand changing trends in the indications for tracheotomy and a perceived reduction in decanulation rates. 2) Be able to propose recommendations for the coordinated care of children with tracheotomy.

Methods

A retrospective chart review was performed of 189 patients undergoing tracheotomy from January 1991 to December 2006. The data were tabulated for age, diagnosis, complications, and outcome. Patients were divided in groups based on the indication for tracheotomy.

Results

5 groups were identified based on the indication for tracheotomy: 1) True vocal cord paralysis: 11% of the study population with a 25% decanulation rate. 2) Airway obstruction: 21% of the study population with a 90% decanulation rate. 3) Craniofacial malformation: 8% of the study population with a 0% decanulation rate. 4) Neurological impairment: 46% of the study population with a 0% decanulation rate. 5) Prolonged intubation: 14% of the study population with a 25% decanulation rate. We report no intraoperative complications, an 18% overall complication rate, and a 10% mortality.

Conclusions

Over the last decades, the indications for tracheotomy have shifted toward children with underlying neurological impairment and need for prolonged mechanical ventilation. Decanulation rates for these children are significantly lower (approximately 10%) than for children with obstructive airway pathology (90%). Therefore, the care of these children and their tracheotomies will require coordinated multidisciplinary settings. We present several recommendations to achieve this goal.
S262 – Effect of Etiology of Mouth Breathing on Facial Morphology
Authors: Hassanzadeh Nadia , Majidi Mohammadreza , Shakeri Mohammad Taghi
Published: August 2008

Objectives

Nasal septal deviation and hypertrophy of the adenoids and palatine tonsils are 2 common causes of nasopharyngeal obstruction and consequently mouth breathing in children. It is accepted that chronic mouth breathing influences craniofacial growth and development. The aim of this study was to evaluate the differences of craniofacial morphology in children with 2 different etiological factors of mouth breathing.

Methods

Study design:cross sectional. The research was conducted between 2005–2007 on 47 predominantly mouth‐breathing patients aged 6–10 years. After otorhinolaryngologic examination and flexible nasofibroscopy, patients were divided into 2 groups based on the etiology of nasopharyngeal obstruction: group 1, with adenotonsillar hypertrophy, and group 2 with nasal septal deviation. Lateral cephalometric radiographs were obtained to assess craniofacial development. Data gained were statistically evaluated by Mann‐Whitney and T‐student tests.

Results

With respect to the inclination of the mandibular and palatal planes, anteroposterior relationship of maxilla and mandible to the cranial base, and indexes of facial height proportions, no significant differences were observed between two groups of children with mouth breathing. Only the angular ArGo. GoMe measurement was significantly larger in children with adenotonsillar hypertrophy (p<0.05).

Conclusions

The present study did not detect significant morphological differences between children with adenotonsillar hypertrophy and those with nasal septal deviation. Mouth breathing seems to have a similar effect on craniofacial morphology irrespective of its etiology. Prospective studies with larger samples including older children are suggested.
S264 – Pediatric Vagal Nerve Stimulator Implantation
Authors: Munson Patrick D , Kress Melissa G
Published: August 2008

Objectives

1) Learn the indications and procedure for vagal nerve stimulator implantation (VNSI) in pediatric patients with refractory seizures. 2) Understand the surgical outcomes and complications for the procedure.

Methods

A retrospective review of prospectively collected data from 2002–2007 was undertaken on VNSI. The cohort consisted of all pediatric patients ages 0–21 at a single institution tertiary children's hospital. All patients were included if they had treatment resistant seizures and had not previously undergone VNSI. The surgical indications, outcomes, complications, and follow‐up were recorded.

Results

Over the 5‐year period, 36 patients underwent VNSI. Age at surgery ranged from 3 to 20 years (mean 10.5 years). The indications for surgery for all patients included seizures refractory to antiepileptic medications (>5 medications). There were no intraoperative complications and all patients had successful electrode placement as measured by intraoperative testing. After an overnight hospital stay, patients were discharged and programmed by the pediatric neurologist at 2 weeks postoperatively. There were 2 postoperative complications (5.5%), scar hypertrophy of a chest incision and left‐sided Horner's syndrome. Both patients have been managed conservatively without sequelae. Follow‐up ranged from 6 to 72 months (mean 42 months). There were no device failures and all patients and families were subjectively satisfied with the postoperative result. Intraoperative and postoperative photos will demonstrate technique and outcomes.

Conclusions

Pediatric VNSI is a reliable procedure for refractory seizures with a low complication rate and can be performed safely by otolaryngologists. This represents the largest cohort of pediatric patients in the otolaryngology literature.
S265 – Tracheostomy in Bronchopulmonary Dysplasia
Authors: Chelius Daniel C. , Kocdor Pelin , Elidemir Okan , Giannoni Carla M
Published: August 2008

Objectives

To characterize pediatric patients undergoing tracheotomy for bronchopulmonary dysplasia (BPD). To examine the effects of tracheomalacia on tracheostomy outcomes in these patients.

Methods

The medical records of 95 patients with BPD who underwent tracheotomy in an academic tertiary care children's hospital over 8 years were evaluated for gestational age, birthweight, ethnicity, gender, co‐morbid conditions, duration of ventilator support, duration of hospitalization, number of failed extubation attempts before tracheotomy, age at tracheotomy, and time to decannulation.

Results

The average gestational age was 28.9 weeks and the average postnatal age at tracheotomy was 27.6 weeks after having failed an average of 1.2 extubation attempts. The patients averaged 268.2 days of hospitalization, with 41.6% still requiring ventilator support and 57.1% still having tracheostomy at the end of the study. Of 27 patients with tracheomalacia, 4 (15%) were eventually decannulated vs. 36 of 68 patients without tracheomalacia (53%). The average time to decannulation among patients with tracheomalacia was 27.4 months and without tracheomalacia was 25.7 months. Decreased gestational age correlated with increased time to decannulation (Cox regression analysis, p=0.035). Of patients with genetic anomalies, 22.7% were eventually decannulated vs. 49.3% of patients without genetic anomalies (p = 0.027).

Conclusions

This study describes the characteristics of patients undergoing tracheotomy for BPD and begins to clarify the relationship between BPD and tracheomalacia. The presence of tracheomalacia in patients with BPD correlates with decreased likelihood of decannulation, but does not significantly affect time to decannulation. As such, tracheomalacia may be an independent risk factor for worse tracheostomy prognosis.
S270 – Maxillaly Sinusitis Caused by Dental Treatments
Authors: Hideaki Aoki , Mohri Daisuke
Published: August 2008

Objectives

Dental implant therapy has been widely performed in clinical setting to improve esthetics and mastication disorders due to tooth loss by embedding such artificial materials as titanium and BioCelum into the jawbone. Recently, orthodontic specialists make the anchor a fixed source that teeth are moved. The presenters therefore clinically investigated implant‐induced maxillary sinusitis because the number of dental treatment is increasing.

Methods

Subjects were 42 patients with 43 cases of maxillary sinusitis caused by a dental implant between 1973 and 2007.

Results

1) Gender and age: The 42 patients comprised 16 men and 26 women. Mean age was 52.6 years. 2) Cause: Dental implant: 42, Anchor treatment by orthodontist: 1. 3) Duration from implant surgery to onset of maxillary sinusitis: Mean duration was 36.3 months (range, 1 month to 12years). 4) Treatment methods: Therapy comprised implant removal, Caldwell‐Luc procedure and fistula closure in 20 cases, implant removal and fistula closure in 10 cases, implant or anchor removal and conservative therapy in 11 cases, and conservative therapy alone in 2 cases.

Conclusions

1) In the treatment of maxillary sinusitis caused by a dental implant, the basic strategy was based on the Caldwell‐Luc procedure. 2) It is thought that the generation of maxillary sinusitis by the anchor treatment increases in the future. 3) For prevention, thorough anatomical and morphological examinations of the maxilla and proper selection of materials and procedures matching each patient are important.
S272 – Diagnostic and Staging Accuracy of MRI vs. CT in CRS
Authors: Lin Harrison W , Bhattacharyya Neil
Published: August 2008

Objectives

Determine the correlation between computed tomography (CT)‐ and magnetic resonance imaging (MRI)‐based staging and classification of chronic rhinosinusitis (CRS).

Methods

Paired CT and MRI scans of 89 adult patients who were imaged by both modalities within a 3‐month time period for evaluation of pituitary disease were scored for sinus disease using the Lund‐Mackay system in a randomized and blinded fashion. The Lund scores were compared for similarity, correlation, and diagnostic classification between modalities.

Results

The mean Lund scores were 2.3 ± 0.6 (95% CI) for CT‐based staging and 2.1 ± 0.5 for MRI‐based staging with a median time interval between scans of 3 days. The difference in means was not statistically significant (p=0.444, paired t‐test). Correlation analysis revealed a significant association between CT‐ and MRI‐based scores (Pearson's r=0.837, p<0.001). Disease classification agreement analysis using published Lund score cutoffs (3 versus 4) for the likelihood of true sinus disease revealed that CT‐ and MRI‐based scoring agreed on 76 cases (85.4%). Disagreement in disease classification occurred in 13 cases (7 MRI positive but CT negative and 6 CT positive but MRI negative) for a kappa value of 0.557 (p<0.001).

Conclusions

Lund‐Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly over‐stage or over‐classify patients with sinus disease.
S277 – The Role of Helicobacter Pylori in Nasal Poliposis
Authors: Çekin Engin , Erkul Bulent Evren , Cincik Hakan , Dogru Salim , Gungor Atila , Poyrazoglu I. Ethem
Published: August 2008

Objectives

1) To investigate the role of Helicobacter pylori in etiopathogenesis of nasal polyposis. 2) To compare the severity of nasal polyposis disease with presence of Helicobacter pylori.

Methods

This study was performed on 35 patients (29 male, 6 female; aged between 17 and 77) who applied to GATA Haydarpasa Training Hospital Otolaryngology Clinic in 2006 and 2007. They all complained of nasal obstruction and were diagnosed as nasal polyposis after examination. Samples taken from all patients during endoscopic sinus surgery were subjected to cetyl metil amonium bromur (STAB) method to purify DNA of Helicobacter pylori(H. pylori). All patients were evaluated for reflux disease. Severity of nasal polyposis disease was compared with presence of H. pylori by performing endoscopic nasal examination and computerized tomography.

Results

H. Pylori was found negative for 24 patients (%68,6) and positive for 11 patients (%31,4). There was no statistically significant difference between presence of H. pylori and that of reflux disease in nasal polyposis (p>0.05). Difference between presence of H. pylori and results of endoscopic nasal examination and computerized tomography was not statistically significant (p>0.05).

Conclusions

We found that presence of H. pylori and reflux disease are not associated with etiopathogenesis of nasal polyposis.
S278 – Management Strategies for Sinonasal Inverted Papilloma
Authors: Hoa Michael , Bianca Gruber , Krouse John H
Published: August 2008

Objectives

1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy.

Methods

Retrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications.

Results

CT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow‐up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively.

Conclusions

Inverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.
S280 – Current Management of Juvenile Nasopharyngeal Angiofibroma
Authors: Bleier Benjamin Saul , Bloom Jason D. , Chiu Alexander G , Palmer James N , Kennedy David W , Bert O'Malley
Published: August 2008

Objectives

To report on the management of a large series of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) in an effort to further define the optimal treatment algorithm in this patient population.

Methods

Retrospective, IRB approved, review of 18 patients presenting to a tertiary care institution with histologically confirmed juvenile nasopharyngeal angiofibroma between 1999 and 2007, with a mean follow‐up of 732 days. Patients were catagorized by Andrews stage and data was collected on presentation, operative technique, and postoperative course.

Results

All patients underwent preoperative embolization. Stage 1, 2, and one 3a lesions were approached endoscopically, while the remainder underwent open resection. There were no significant differences in mean operative time between the endoscopic and open groups (312 vs. 365 minutes). In the endoscopic group, the intraoperative blood loss was almost half that of the open group (506 vs. 934cc) and the average length of hospital stay was 1 day less (3 vs. 4 days). There were 4 recurrences, all of which occurred in the open treatment group.

Conclusions

Endoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection and suggests that this approach leads to an improved postoperative course.
S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas
Authors: Alameda Yadiel A , Busquets Jose , Portela Juan C.
Published: August 2008

Objectives

1) Describe the presenting symptoms, etiology, treatment, and long‐term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications.

Methods

A retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test.

Results

Endoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow‐up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow‐up, none of the patients reported episodes of meningitis postoperatively.

Conclusions

Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.
S283 – Invasive Fugal Sinusitis: Pathognomic Presentation in MRI
Authors: Min Jinyoung , Chung Seung‐Kyu , Dhong Hun‐Jong , Kim Hyo‐Yeol , Jung Yonggi , Kim Hyung‐Jin
Published: August 2008

Objectives

The aim of this study was to evaluate the pathognomic findings of magnetic resonance image(MRI) and determine the benefit of MRI in early diagnosis of invasive fungal sinusitis(IFS).

Methods

We retrospectively reviewed 15 cases of biopsy‐proven IFS. The preoperative MRI was reviewed to identify the pathognomic findings and correlation between radio‐graphic and surgical findings were investigated.

Results

The MRI findings included decreased signal intensity on T1‐weighted images with no enhancement on contrast‐enhanced images and markedly decreased signal intensity on T2‐weighted images in all cases. In our series, the interval between the onset of symptom and timing of MRI was from 48 hours to 2 weeks. Radiographic findings were correlated with histopathologic findings in 13 of 15 patients.

Conclusions

We could find typical MRI findings in IFS. MRI should be considered early in patients at high risk for IFS.
S285 – Long‐Term Efficacy of RF Turbinoplasty for Allergic Rhinitis
Authors: Lin Hsin‐Ching , Friedman Michael
Published: August 2008

Objectives

To study the long‐term outcomes of radiofrequency turbinoplasty for the treatment of allergic rhinitis.

Methods

146 consecutive patients who underwent radio‐frequency turbinoplasty due to allergic rhinitis refractory to medical therapy were enrolled in this study. A 0–10 visual analog scale (VAS) was used to assess the allergic symptoms including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes preoperatively and 5 years postoperatively. The long‐term clinical benefits and complications were reviewed. Statistical analysis was determined by paired t‐test.

Results

None of the patients had obvious discomfort except mild numbness over the teeth (27/146, 18.5%) during operation. No long‐term adverse reactions, including bleeding, infection, adhesion, or olfactory change were encountered. 119 patients had a minimum follow‐up of 5 years and complete data available for analysis. The response rate was 60.5% (72/119). 18 patients received additional nasal surgery due to no obvious response to the surgery. These patients were excluded from the final analysis. 5 years after the treatment, the other 101 patients obtained improvement of nasal obstruction, with the VAS degree changing from 6.65 ± 1.92 to 4.45 ± 2.54 (p<0.0001). The VASs of rhinorrhea, sneezing, itchy nose, and itching eyes changed from 5.90 ± 2.79 to 3.79 ± 2.97, 5.15 ± 2.77 to 3.50 ± 2.77, 3.67 ± 3.03 to 2.41 ± 2.30 and 2.94 ± 3.02 to 2.02 ± 2.42, respectively (all p<0.0001).

Conclusions

The long‐term study demonstrated that radiofrequency turbinoplasty appears to still be effective and safe for treating allergic rhinitis refractory to medical therapy.
S286 – UV Phototherapy of Nasal Polyps: Results of a Pilot Study
Authors: Bella Zsolt , Kadocsa Edit , Koreck Andrea , Kemeny Lajos
Published: August 2008

Objectives

Nasal polyps (NPs) are characterized by high recurrence rates despite medical and\or surgical treatment. Recently, it has been shown that exposure of NPs to ultraviolet light (UV) results in induction of apoptosis of inflammatory cells. Therefore phototherapy may represent a new therapeutic approach in NPs. A pilot feasibility study was performed to assess the clinical efficacy and tolerability of phototherapy and to identify the clinical effective UV dose range in NPs.

Methods

A dose‐titration study was conducted in 13 subjects with bilateral grade 1–3 NPs. Patients were exposed to gradually increasing doses of UV light over a 12‐week period (3 exposures/week). Subjects rated their nasal obstruction symptom scores weekly on a visual analogue scale from 0 to 6. The NOSE quality of life questionnaire was used at baseline and end of treatment period. Adverse events were monitored by endoscopy.

Results

10 subjects completed the study. Nasal obstruction symptom scores improved at end of treatment compared to baseline. Improvement of quality of life (NOSE) at end of treatment compared to baseline was also noted. Treatments were well tolerated and no device‐related adverse events were reported. In most subjects, symptom improvement was observed after a certain threshold UV dose was reached. Therefore, the study was also informative about the clinically effective doses which will be tested in future studies of much shorter duration.

Conclusions

The results suggest that phototherapy may represent a potential new treatment option in NPs.
S287 – Microbiological Study of Nosocomial Sinusitis in ICU
Authors: Filho Leonardo Lopes Balsalobre , Cavalcante Ricardo , Stefanini Renato , Vieira Fernando , Santos Rodrigo de Paula , Gregorio Luis‐Carlos , Stamm Aldo Eden Cassol
Published: August 2008

Objectives

1) Identifying the bacteria causing sinusitis in an intensive care unit (ICU) through the nasal swab and puncture of maxillary sinus. 2) Comparing their results with the cultures and antibiograma.

Methods

22 patients in the ICU with uni‐ or bilateral maxillary sinusitis diagnosed by computed tomography were submitted to nasal swab and puncture of the maxillay sinus. The materials were sent to culture and antibiograma and their results were compared.

Results

The present study evaluated 22 patients. There was exact correlation among the isolated microbial agent in the swab and in the puncture in 14 of the 22 cases (63%). The prevalence of the aerobic gram negative was: Pseudomonas aeruginosa (29%), Proteus mirabillis (26%) and Acinetobacter baumanni (14%). The antibiograma presented a high index of resistance to the antibiotics used in daily practice.

Conclusions

The nasal swab was of little value to the diagnosis, while the direct puncture of the maxillary sinus could assess the specific bacterial agents, allowing a right‐to‐the‐point therapeutic. The early and specific treatment decreases the morbi‐mortality in these patients.
S288 – Balloon Dilation for Treatment of Recurrent Choanal Atresia
Authors: Silver Natalie Lea , Tassler Andrew B , Malekzadeh Sonya , Harley Earl
Published: August 2008

Objectives

1) To investigate alternative methods of maintaining choanal patency in patients with choanal atresia. 2) To assess the feasibility and efficacy of balloon dilation in maintaining patency of repaired choanal atresia.

Methods

Choanal atresia is the developmental failure of the nasal cavity to communicate with the nasopharynx. Several approaches have been described for primary repair of choanal atresia. A transnasal endoscopic approach has been fully developed and is now the preferred method of primary repair. Restenosis is known to occur after surgical correction and primary patency rates after all surgical procedures have been reported to be 55% to 75%. We reviewed the charts of 3 patients at a single institution with a diagnosis of choanal atresia (2 bilateral, 1 unilateral). All were primarily repaired with traditional methods but subsequently developed restenosis; 1 patient developed complete restenosis of her choanae. All 3 underwent serial endoscopic dilation with sinuplasty balloons.

Results

After endoscopic serial dilation with the use of sinuplasty balloons, all 3 patients have maintained patent choanae on follow‐up examination up to 1 year postoperatively.

Conclusions

Dilation of a restenosed choanal atresia with sinuplasty balloons may be an effective new application of this technology. The procedure is simple to perform and can be easily repeated to increase long‐term patency for these patients.
S290 – Sinonasal Pathology and Severity of Bronchiectasis
Authors: Guilemany Jose Maria , Alobid Isam , Silvia Centellas , Bernal‐Sprekelsen Manuel S , Miret Joaquim Mullol I
Published: August 2008

Objectives

1) To investigate the prevalence of nasal symptoms, nasal polyposis, and sinusal opacification in patients with bronchiectasis. 2) To investigate the association between the degree of sinusal opacification and the bronchiectasis extension.

Methods

88 consecutive patients with stable non‐cystic bronchiectasis were prospectively evaluated for nasal symptoms (RASP, 0–3), polyp size (nasal endoscopy, 0–3), sinusal occupation (CT, 0–24), and chest HRCT (0–18).

Results

Following EP3OS criteria, 77% of patients presented had chronic rhinosinusitis (CRS). Nasal congestion (incidence: 90%; score: 1.6±0.1) Anterior (99%; 1.9±0.1) and posterior (91%; 1.8±0.1) rhinorrhea, were reported by patients as the major complaints. Nasal polyps (NP) of a mild‐moderate size (1.6±0.3) were found in 25% of patients. Sinonasal CT was abnormal in patients with CRS, with a CT score of 8.4±0.4, with predominance in maxillary sinus (2.1±0.1), anterior ethmoid sinus (1.9±0.1), and ostiomeatal complex (2.2±0.2). Patients with CRS had significantly worse scores on chest HRCT (CRS: 3.7±0.7; no CRS: 7.2±0.5).

Conclusions

More than 75% of patients affected with BQs fulfil EP3OS criteria of CRS and 25% of patients presented NP. Patients with CRS presented more affectation on chest HRCT scan. We conclude that patients with bronchiectasis should be evaluated to assess the presence of chronic rhinosinusitis and nasal polyposis.
S291 – A Public Health Survey of Epistaxis Management
Authors: Hissett Graham , Watson Joanna , Kanegaonkar Rahul , Stevenson Justina
Published: August 2008

Objectives

To assess the level of knowledge held by the general public regarding the treatment of epistaxis.

Methods

We have conducted a survey of patients and relatives attending the ENT outpatient department at Medway Maritime Hospital, Kent, England, during November and December 2007. The survey entailed 5 multiple choice questions regarding the immediate management of epistaxis and the risk factors predisposing to episodes of epistaxis.

Results

Of the 500 questionnaires distributed, 477 were completed legibly. Only 15.2% of respondents knew that to control epistaxis they should compress the lower part of the nose. 7.6% of patients knew the optimum period of compression to be greater than 10 minutes. 47.0% of patients knew to adopt a sitting position with the head held forward during compression. 52.7% knew the correction positioning of an ice‐pack would be over the bridge of the nose, and 10.2% of respondents recognised that both aspirin and Warfarin led to an increased occurrence of epistaxis.

Conclusions

The results of the survey reveal the need for greater public awareness of the initial management of this common ENT emergency. We have designed posters and leaflets to distribute to the outpatient departments and the surgeries of general practitioners.
S292 – Health Outcomes for Endonasal DCR Measured by GBI
Authors: Hathorn Iain , Spielmann Patrick , Ahsan Farhan , Cain Angus , White Paul
Published: August 2008

Objectives

To measure the effect of Endonasal Dacrocystorhinostomy (DCR) on the health status of patients, using a validated outcomes measure, the Glasgow Benefit Inventory.

Methods

Postal questionnaire with telephone follow‐up of patients undergoing Endonasal DCR in two otolaryngology (ORL) departments in Scotland between 2005 and 2007. All adult patients who had achieved greater than 12 months follow‐up since surgery were included in this study. The GBI score ranged from −100 to +100 with 0 reflecting no change.

Results

92 of 123 patients (75%) completed the questionnaire; the mean age was 59 years and the sex ratio m:f was 1:1.8. The mean overall GBI for this intervention was +32.7 (95% confidence intervals 27.8‐; 37.6). The ‘general wellbeing’ subset improvement was +44.2 (38.5 − 49.9), physical wellbeing +12.9 (6.9‐18.9) & social wellbeing +14.0 (8.4‐19.5). The patients were grouped according to the indication for intervention: Obstruction of lacrimal system GBI +32.7 (26.3‐37.1), mucocele +40.1 (28.7‐514), dacrocystitis +19.4 (10.0‐28.9) & functional +9.7 (‐31.1‐; 50.56). There were 16 revision cases, the GBI for these patients was +49.5 (35.3‐63.7).

Conclusions

The GBI provides a measure of the effect of an ORL intervention on the health of a patient. Endonasal DCR scores highly when compared with a number of other rhinological procedures including rhinoplasty (GBI +20), endoscopic sinus surgery (GBI +23), and septal surgery (mean ranges from +6 to +24). Endonasal DCR is a successful intervention with demonstrable health benefits to the patient, especially for revision cases.
S294 – Pre‐op Prevalence of MRSA in Intranasal Surgery Patients
Authors: Nicholas Brian , Bhargave Geeta , Heffelfinger Ryan , Rosen Marc R , Pribitkin Edmund A
Published: August 2008

Objectives

1) Understand the extent of methicillin‐resistant Staphylococcus aureus among those undergoing intranasal surgery. 2) Be able to describe potential risk factors for MRSA colonization. The purpose of this study is to outline a prevalance of MRSA colonization among those undergoing inranasal surgery, with an exploration of potential risk factors for colonization.

Methods

Patients undergoing intranasal surgery (endoscopic sinus surgery, rhinoplasty, septoplasty, etc) at a tertiary care medical center had preoperative nasal swab cultures. The primary endpoint was positive culture of methicillin‐resistant Staphylococcus aureus (MRSA). Patient demographic information was also collected to ascertain potential risk factors for colonization of MRSA.

Results

Early results have demonstrated that the prevalence of MRSA in patients is less than the reported prevalence in hospital inpatient populations. Of the initial 25 patients enrolled in this study, none were shown to be colonized with methicillin‐resistant Staphylococcus aureus (0/25), with 1 patient having reported a history of MRSA infection (4%).

Conclusions

Preliminary data suggests that the prevalence of methicillin‐resistant Staphylococcus aureus among patients undergoing intranasal surgery is less than the prevalence of inpatient populations as reported in several previous studies. While preliminary data suggests a potential decreased prevalence of MRSA in this population, a much larger sample of patients is needed to make a more definitive statement. In the coming weeks and months, as more data is gathered and the sample size included in the study grows, it will be interesting to note whether the initial trend, as suggested here, continues.
S299 – Videolaryngoscopy in Patients with Obstructive Sleep Apnea
Authors: Siupsinskiene Nora , Toohill Robert J. , Adamonis Kestutis , Grebliauskaite Milda , Woodson B. Tucker
Published: August 2008

Objectives

To evaluate symptoms and videolaryngoscopic findings common in reflux in patients with obstructive sleep apnea (OSA) and to determine the relationship between laryngeal inflammation and OSA severity.

Methods

Data of 38 adult outpatients with first‐proven OSA verified in overnight polysomnography during 2006–2007 were prospectively analyzed. Symptoms common in laryngopharyngeal reflux were self‐rated using reflux symptoms index (RSI). Videolaryngoscopic laryngeal changes were evaluated with reflux finding score (RFS). Body mass index (BMI) was calculated for all patients.

Results

30 males and 8 females with mean age of 49.5 years were assessed. BMI of patients ranged from 23.1 to 46.6 kg/cm2 showing 86.8% of patients overweight. 52.6% of selected patients had mild OSA, 10.5%‐ moderate, 36.8‐ severe. Mean value of self‐rated RSI was 13.8 points. Abnormal RSI was detected in 52.6% of patients. The most common symptoms indicated medium to severe problem were chronic throat clearing‐; 48.6% of patients, increased amount of mucus coming into the nasopharynx‐; 40.5%, and globus sensation‐; 35.1%. The inflammation of the larynx was diagnosed for 78.9% of patients with mean RFS value of 10.1 points. The pronounced findings were vestibular folds hypertrophy‐; 81.6%, posterior commissure hypertrophy‐ 73.7%, thick endolaryngeal mucus‐; 63.2%, and vocal folds edema‐; 44.7% of patients. Only diffuse laryngeal edema showed significant positive correlation with increasing of AHI.

Conclusions

A high prevalence of laryngeal symptoms and inflammation indicating reflux in OSA patients was identified. Direct significant correlation between laryngeal inflammation and OSA severity was not determined.