bluuebunny/crossref_metadata_2025 huggingface dataset:
Extramedullary Hematopoiesis of the Maxilla in Beta‐Thalassemia
Authors: Dorton Leighanne Hoskins , Mims James W.
Published: September 2011

Objective

1) Present a rare case of diffuse craniofacial compensatory marrow expansion in a patient with β‐thalassemia resulting in near‐complete obliteration of bilateral maxillary sinuses and partial nasal obstruction. 2) Learn about compensatory extramedullary hematopoeisis in patients with beta‐thalassemia and its effects on the maxillae and paranasal sinuses.

Method

A 41‐year‐old female with β‐thalassemia presented to the otolaryngology clinic for recurrent epistaxis. The patient was interviewed and examined, and the medical record and radiographic images were reviewed. The patient was observed for 6 months. Literature review of similar cases was performed.

Results

Nasal endoscopy revealed an apparent mass within the right nasal cavity. CT of the sinuses showed diffuse marrow expansion resulting in complete obliteration of the right maxillary sinus, a small residual left maxillary sinus, partial nasal obstruction, and septal deviation. The radiologist described the appearance as consistent with extramedullary hematopoeisis. Despite the extensive bone remodeling, the patient’s remaining sinuses appeared clear, and she was minimally symptomatic. The appearance was stable as compared to imaging obtained 5 years earlier during an unrelated diagnostic workup. We elected to conservatively manage her epistaxis and follow her for worsening symptoms or clinical exam findings.

Conclusion

β‐thalassemia causes characteristic changes of the maxilla that should be recognized on CT. The expansion of hematopoietic tissue may contribute to nasal or sinus symptoms. If asymptomatic, these abnormalities can safely be observed. The cornerstone of treatment for β‐thalassemia patients is frequent blood transfusions to suppress additional hematopoiesis.
Ideal Duration of Nasal Packing after Septoplasty
Authors: Cekin Engin Ibrahim , Pinar Dogan P. , Gungor Atila , Erkul Evern , Cincik Hakan
Published: September 2011

Objective

Septoplasty is a corrective surgical procedure for nasal septal deviation, and nasal packing is usually applied after septoplasty to avoid some complications. The objective of this study was to evaluate the complications and subjective discomfort of 24‐hour nasal packing compared to that of 48‐hour nasal packing in patients undergoing septoplasty.

Method

A total of 149 patients were divided into two groups according to time of nasal packing removal. Nasal packings were removed 24 (group 1) and 48 (group 2) hours after septoplasty. Patients with complications were recorded, and verbal analog pain scores (VAS) of all patients were calculated after surgical procedure.

Results

Postoperative hemorrhage rates were 17.5% in the first group and 6.6% in the second group. Hemorrhages in the first group were mostly reactionary, and only two of them required repacking. None of the patients in the second group required repacking. There was no statistically significant difference between the two groups depending on hemorrhage. First day mean VAS scores were similar in both groups. Second day mean VAS score of the second group was higher compared to first day VAS scores of both groups.

Conclusion

According to our study, routine use of 48‐hour nasal packing after septoplasty is not necessary. We observed that prolonged nasal packing increases the postoperative pain significantly and has no significant beneficial effect on postoperative complications except in patients with hypertension.
Immune Dysfunction in Chronic Rhinosinusitis
Authors: Chang C. W. David , Goodwin Jason C. W.
Published: September 2011

Objective

1) Determine the prevalence of immunoglobulin abnormalities in patients with chronic rhinosinusitis. 2) Compare our results with similar studies for validity. 3) Draw conclusions on when to order these specific tests. 4) Alert providers on the prevalence and workup of immune deficiencies.

Method

Retrospective study of all patients with CRS of a single provider, from 2008 to 2010, with attention given to those with refractory CRS on whom immunoglobulin laboratories were ordered. Measured variables were total patients, number of immune laboratories ordered, and results of those tests.

Results

At our institution, 334 patients were seen by a single provider with the diagnosis of CRS. Of these patients, immunoglobulin levels (IgG, IgG subclasses, IgM, IgA, and/or IgE) were ordered on 37 patients. Deficiencies of at least one immunoglobulin class were found on 20 patients (54 percent of patients tested). This demonstrates a 5.9% prevalence of immunoglobulin deficiency in our chronic sinusitis patient population. The most common deficiency noted on this study was an IgG subclass deficiency. Two patients demonstrated common variable immunoglobulinemia.

Conclusion

Despite aggressive medical and surgical therapy, CRS can be a persistent disease. Immunoglobulin deficiency is common in this subset of refractory patients. The clinician should be aware of this likelihood and order appropriate studies. Proper recognition can allow the clinician to tailor their management of these patients.
Life Threatening Epistaxis in Hereditary Hemorrhagic Telangiectasia: Surgical and Medical Management
Authors: Fatakia Adil A. , Kahn Marc J. , Fazekas‐May Mary A. , Friedlander Paul L.
Published: September 2011

Objective

Provide a comprehensive review of the pathophysiology, clinical presentation, surgical treatment, and advanced medical treatment of hereditary hemorrhagic telangiectasia.

Method

Case study of a patient with hereditary hemorrhagic telangiectasia detailing the clinical presentation and treatment algorithm of the disease. Comprehensive literature review detailing the pathophysiology and clinical presentation, with special attention to the surgical and advanced medical management of the disease.

Results

A comprehensive review of hereditary hemorrhagic telangiectasia with special attention to the most up to date surgical and medical treatment regimens and algorithms.

Conclusion

Hereditary hemorrhagic telangiectasia creates a backdrop for life threatening epistaxis. While surgery remains the mainstay of treatment for refractory epistaxis in the setting of HHT, medical management plays a vital role in the prevention and treatment of this disease entity.
Management for Nonmalignant Primary Tumors of the Nasal Cavity
Authors: Hashimoto Shigehisa , Takahashi Sugata T.
Published: September 2011

Objective

Assess the treatment strategy for nonmalignant primary tumors of the nasal cavity.

Method

The subjects were 41 patients who underwent surgery for nonmalignant tumors of the nasal cavity during the 3 years. An endoscopic examination, contrast‐enhanced computed tomography (CT), and magnetic resonance imaging (MRI) were performed preoperatively, and all of the patients were treated surgically.

Results

The diagnosis was papilloma in 21 cases, hemangioma in 15 cases, juvenile angiofibroma in 3 cases, and leiomyoma in 2 cases. For patients diagnosed with papilloma by endoscopy and CT, additional MRI was performed to identify the tumor base. Computer‐aided surgery was used, and the tumor was endoscopically resected. Because blood flow was sufficient in cases of hemangiomas or angiofibromas, preoperative embolization was performed in 2 cases. Although external incision was anticipated in some cases, endoscopic resection of tumors was possible in all cases, and none of the patients required transfusions.

Conclusion

It was possible to make the differential diagnosis between papilloma and hemangioma/angiofibroma on the basis of the preoperative endoscopic and CT findings. Safe and reliable resection was possible by combined use of MRI and computer‐aided surgery for the papillomas, and use of embolization for the hemangiomas and angiofibromas.
Meta‐analysis of Endoscopic vs Sublabial Pituitary Surgery
Authors: DeKlotz Timothy , Aulisi Edward , Makambi Kepher , Lu Wenxin , Chia Stanley , Deeb Ziad
Published: September 2011

Objective

Determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.

Method

A Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta‐analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.

Results

A total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P <. 0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P <. 01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P <. 0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay (P =. 01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery.

Conclusion

The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta‐analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.
MRSA Central Skull Base Osteomyelitis and Occipital Condylar CSF Leak
Authors: Friedel Mark Erik , Liu James K. , Eloy Jean , Tomovic Senja
Published: September 2011

Objective

Community acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) is emerging as an important pathogen in paranasal sinus disease. However, CA‐MRSA has been a rarely reported source of central skull base osteomyelitis or a subsequent occipital condylar cerebrospinal fluid leak in an otherwise immunocompetent patient.

Method

Case report and current literature review.

Results

We report on an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA‐MRSA sphenoid sinusitis requiring endoscopic surgical repair.

Conclusion

The increasing prevalence of CA‐MRSA, in conjunction with its potential for intracranial complications, challenges the otolaryngologist to remain vigilant about detecting its possible manifestations. This case clearly demonstrates the expanding spectrum of severe infections caused by CA‐MRSA, which requires prompt diagnosis and appropriate medical and/or surgical management.
Nasal and Exhaled Nitric Oxide in Chronic Sinusitis with Polyp
Authors: Jeong Jin Hyeok , Park Chul‐won , Lee Seung‐Hwan
Published: September 2011

Objective

Nitric oxide (NO) is known to be an important mediator and inflammatory marker of airway. The purpose of this study is to analyze the distribution of nasal NO (nNO) and exhaled NO (eNO) in chronic sinusitis (CRS) with polyp and to predict clinical features of CRS with polyp by NO, which is easy to measure.

Method

We used chemiluminescent analyzer to measure nNO and eNO between healthy individuals (32) and CRS with polyp patients (30), CRS with polyp and allergic rhinitis and compared it with a variety of clinical features of chronic sinusitis like sinus CT and symptoms.

Results

The nNO were significantly lower in CRS with polyp (88.5 ± 54.7 ppb) compared with controls (241.0 ± 89.5 ppb), CRS with polyp and allergic rhinitis (167.0 ± 47.6 ppb) (pp < 0.009) with a positive relationship with the extent of sinus disease, and it was different from nNO.

Conclusion

The nasal NO could be used to predict CRS with polyp, which eventually has to be treated with surgery. The upper airway disease could affect the lower airway inflammation, and it reflects, “One airway, one disease.”
Nasal Mucosal Histologic Changes after Polypectomy
Authors: Majidi Mohammadreza , Nurizadeh Navid
Published: September 2011

Objective

Evaluate the effects of polypectomy on nasal mucosa in patients with allergic rhinosinusitis.

Method

This clinical trial was done in patients with chronic rhinosinusitis with polyposis. Tissue samples taken from inferior turbinate before and one month after surgery were evaluated for histological study.

Results

The percentage of goblet cells in inferior turbinaire epithelium were significantly (P =. 03) reduced after polypectomy (from 39.86% to 13.3%).

Conclusion

This study shows that relieving nasal obstruction after polypectomy may have an additional effect on goblet cell concentration in nasal mucosa and, therefore, on postoperative rhinorrhea.
Nasal Symptoms and Sleep Problems in Chronic Rhinosinusitis
Authors: Okushi Tetsushi , Asaka Daiya , Moriyama Hiroshi , Otori Nobuyoshi , Chiba Shintaro , Nakayama Tsuguhisa
Published: September 2011

Objective

In recent years various studies have been conducted regarding the effects of CRS on the patient’s quality of life (QOL). There have, however, been few reports of its effects on the quality of sleep. Accordingly, we examined which factors are involved in sleep problems associated with CRS.

Method

Multicenter prospective study. We analyzed 685 consecutive CRS patients between April 2007 and March 2008. All patients completed a QOL questionnaire and background parameters. The patients who had sleep problems (SP group) were compared with other patients in regard to nasal symptoms and background parameters.

Results

A total of 148 patients (21.6%) had sleep problems. The scores for each of the nasal symptoms were significantly higher in the SP group. In addition, the sleep score was significantly higher in the patients with a complication of allergic rhinitis and the patients with high peripheral and tissue eosinophil counts. Logistic regression analysis found that nasal congestion, cough, and ear fullness were nasal symptoms that contributed to the SP group.

Conclusion

This study indicated that, in addition to nasal symptoms, inflammatory conditions such as allergic rhinitis and eosinophilic inflammation have the potential to directly affect sleep problems. Logistic regression analysis revealed that subjective symptoms, such as nasal congestion, cough, etc, are closely related to sleep problems.
Conduction Velocity of Swallowing Pressures in the Pharynx
Authors: Hara Minoru , Takahashi Haruo , Takasaki Kenji
Published: September 2011

Objective

During normal swallowing, longitudinal conduction of pharyngeal pressure occurs from the velopharynx to the esophagus for the transportation of a food bolus. In this study, we analyzed the conduction velocity (CV) of swallowing pressures in the pharynx using a novel high‐resolution manometry (HRM) system.

Method

Pharyngeal pressure topographies (PPTs) were obtained from 95 asymptomatic subjects. PPT is a derivative of HRM data that dynamically displays intrapharyngeal swallowing pressure. We measured CV at the velopharynx (V1), meso‐hypopharynx (V2), upper esophageal sphincter (UES, V3), and cervical esophagus (V4). We also measured their swallowing pressure durations by analyzing PPT.

Results

V1 to V4 were 24.7, 14.5, 15.0, and 4.7 cm/sec, respectively. The differences between V1 versus V2 and V3 versus V4 were statistically significant. Swallowing pressure durations at the same regions were 0.57, 0.23, 1.94, and 1.27 seconds, respectively.

Conclusion

These findings indicate the conduction pattern of pressures. The CV from the mesopharynx to the UES is almost constant because of the anatomical similarity of middle and inferior pharyngeal constrictors. The duration at the UES is longer than the others; this accounts for the prevention of backflow from the esophagus.
Nebulized Medical Therapy for Chronic Sinusitis
Authors: Lanza John T. , Hilton Aaron
Published: September 2011

Objective

Nebulized intranasal medical therapy (NIMT) is a novel treatment for chronic rhinosinusitis (CR). To determine the role of NIMT in CR, we compared 50 patients treated with NIMT and oral therapy. We present our findings of pre‐ and posttreatment modified SNOT 20 scores and sinus cultures.

Method

Pretreatment nasal endoscopy with culture was obtained, and a modified SNOT 20 questionnaire was completed. Patients were treated with either NIMT or oral antibiotic therapy twice daily for 21 days. Patients were re‐evaluated 2 weeks post‐completion of treatment with repeat SNOT 20 questionnaire and endoscopic culture.

Results

Pre‐ and posttreatment sinus cultures were assessed. Bacteriology cultures and sensitivities demonstrated a wide range of organisms, including Staph aureus, H influenzae, Pseudomonas aeruginosa, Pseudomonas fluorescens, Moraxella catarrhalis, Stenotrophomonas maltophilia, Serratia marcescens, Morganella morganii, and Cornybacterium. Both solitary and mixed infections with various degrees of antibiotic resistance were encountered. Early results indicate a change in bacteriology as a result of treatment. Additionally a preliminary review of outcomes demonstrates a reduction in the pre‐ and posttreatment modified SNOT 20 scores in both groups. Final comparison of the 2 study groups and statistical analysis is pending.

Conclusion

The use of NIMT in the treatment of CR is an effective alternative. It is particularly valuable in those patients who cannot tolerate traditional oral therapy and/or whose cultures identify an organism for which an oral antibiotic is not available. Patient compliance and treatment morbidity is favorable.
Obesity and Allergic Rhinitis: Any Relationship?
Authors: Cervoni Edoardo
Published: September 2011

Objective

Allergic rhinitis is a very common comorbidity in asthma, both in children and in adults, but its relationship with obesity, often associated with asthma, has not been established. The aim of this paper is to ascertain if there is a statistically significant relationship between allergic rhinitis and obesity.

Method

A population search using Primary Care software EMIS on a cluster of 5499 subjects was undertaken to identify prevalence of allergic rhinitis among obese patients.

Results

There was a statistically significant relationship between allergic rhinitis and obesity only in the group aged 5 to 16 years (P =. 0003).

Conclusion

Perhaps surprisingly, the relationship between allergic rhinitis could be present, but only in the younger population, while there is a consistent relationship between asthma and obesity.
Outcome of FESS in Symptomatic CRS Patients with Minimal Change CT
Authors: Chakravarti Arunabha , Naglot Shakuntala
Published: September 2011

Objective

1) Assess the efficacy of functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis (CRS) patients with minimal radiological findings on CT scan. 2) Correlate between the preoperative symptoms and CT score.

Method

CRS patients >18 years refractory to 3 weeks medical therapy were evaluated with CT PNS. Patients were grouped based on the Lund‐Mackay Staging system: A (0‐6 score), B (7‐24 score). All patients were subjected to FESS. Symptom scoring was done by visual analog scale and SNOT 20.

Results

Seventy patients (35 in each group) were evaluated. CRS with minimal disease on CT showed significant statistical improvement in symptom score after FESS. There was no correlation between preoperative symptoms and CT score.

Conclusion

A good subjective outcome in terms of symptom improvement can be obtained with FESS in patients with CRS with minimal disease on CT scan.
Perioperative Prophylactic Antibiotics in Endoscopic Sinus Surgery
Authors: Saleh Amy , Torres Katherine , Driscoll Colin
Published: September 2011

Objective

Determine if the routine use of prolonged systemic perioperative antibiotics decreases the rate of infection and improves outcomes in patients undergoing endoscopic sinus surgery by performing a systematic review of the available literature.

Method

Cochrane (2nd Quarter 2010), Ovid MEDLINE (1950‐2010), EMBASE (1988‐2010), and Scopus databases were searched. Two authors independently reviewed studies for inclusion and extracted data. All clinical trials examining the impact of perioperative administration of systemic antibiotics on outcomes of endoscopic sinus surgery were included. Qualitative analysis was undertaken.

Results

Of 482 articles reviewed, 3 trials met eligibility criteria. These were prospective randomized control trials comparing either no or single dose antibiotics to a prolonged systemic course. The largest study enrolled 202 patients, was double‐blinded, and was placebo controlled with good allocation concealment and without loss to follow up. The others were of varying quality (smaller numbers; variable blinding, allocation concealment, and follow‐up). None of the trials found a significant difference in prevention of infection. They also failed to show improvement in subjective, endoscopic, or CT evaluation with the use of prolonged antibiotic therapy.

Conclusion

The present review suggests that the routine use of systemic perioperative prophylactic antibiotics does not reduce the rate of infections or improve the outcomes of endoscopic sinus surgery and, therefore, should not be automatically prescribed.
Predictive Factors of Depression on Outcomes in Chronic Rhinosinusitis after Endoscopic Sinus Surgery
Authors: Pernas Francisco G. , Hughes Sharon , Coughlin Andrew M. , Maeso Patricia
Published: September 2011

Objective

The improvement in quality of life after endoscopic sinus surgery (ESS) has been well documented. However, oftentimes patients’ mental health is not assessed, ignored, or attributed to other causes. There is a lack of evidence that chronic rhinosinusitis can cause mental anguish and depression, which affects outcomes after FESS.

Method

Patients were selected from a busy rhinology tertiary care center. Prior to ESS, participants were given a depression scale and a SNOT‐20 sinonasal symptomatology questionnaire, and endoscopic scores were noted. Participants repeated questionnaires at 6 weeks and 3 months after ESS. Endoscopic scores were noted at all three visits.

Results

The most useful instrument to predict outcomes was the SNOT‐20 scale. The SNOT‐20 scale was highly correlated with the HDS. ESS did not result in any significant changes in a patient’s score on HDS, but it did improve SNOT‐20 scales. Patients with lower preoperative values on HDS had significantly better surgical outcomes as defined by Lund‐Kennedy and SNOT‐20. Higher preoperative values on HDS had significantly less improvement on Lund‐Kennedy and SNOT‐20.

Conclusion

The data presented here confirm a high incidence in depressive‐like symptoms in patients who have CRS. We have demonstrated that patients with moderate and severe depression on HDS have worse outcomes after ESS independent of their preoperative scores. We also demonstrated SNOT‐20 to be highly correlated to HDS.
Prevalence and Risk Factors of Chronic Rhinosinusitis in Korea
Authors: Kim Kyung‐Su
Published: September 2011

Objective

Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases with multiple etiologies. Despite its high prevalence, risk factors influencing its prevalence have not been thoroughly revealed. Therefore, we investigated the prevalence and risk factors of CRS in Korea.

Method

The 4,098 subjects that participated in the Korea National Health & Nutrition Examination Survey were included in the study. Risk factors were categorized into socio‐demographic and personal medical factors. Univariate and multivariate analysis were performed to identify significant risk factors of CRS.

Results

The prevalence of CRS in Korea was 6.95%. Among socio‐demographic factors, male sex, old age, and heavy stress were significantly related with CRS. Influenza vaccination, septal deviation, and persistent allergic rhinitis were significant personal medical risk factors of CRS. Among these risk factors, persistent/moderate to severe allergic rhinitis was proven to be the most significant risk factor for CRS at the population level.

Conclusion

Even though the prevalence and risk factors vary according to time, place, and diagnostic criteria, periodic epidemiologic study on CRS is necessary to reduce socioeconomic expenditure and establish an improved national health care policy.
Progressive Vision Loss of a Deployed Soldier with Paranasal Sinus Mass
Authors: Rohrer Joseph M. , Thomas Roy F.
Published: September 2011

Objective

Understand the causes of progressive vision loss of a deployed soldier with paranasal sinus mass. Evaluate effectiveness of a multidisciplinary treatment team on the patient’s disease morbidity.

Method

Case report of a soldier deployed to Iraq who developed allergic fungal sinusitis and presented with compressive optic neuritis. He was treated with high dose steroids and functional endoscopic sinus surgery with recurrent bilateral optic neuritis two weeks after surgery.

Results

The patient was found to have allergic fungal sinusitis of a pneumatized clivus with a dehiscent optic nerve. He originally had excellent recovery of his vision after FESS. While recovering at home he had a subsequent relapse in both eyes 2 weeks later. Repeat imaging and exam in the operating room did not show a recurrence of the fungal debris. A multidisciplinary team involving ophthalmology, neurosurgery, and infectious disease subsequently found false positive Lyme titers with positive serology for syphilis in conjunction with his infectious optic neuritis.

Conclusion

Vision loss from optic neuritis can be caused by sinusitis of the sphenoid such as with allergic fungal sinusitis, but other diagnoses and a multidisciplinary team must be pursued if initial treatment does not result in sustained or expected improvement.
Quality of Life in Allergic Rhinitis in Mexico
Authors: Hernandez Maria I. M. , Ojeda Alejandro G. , Cruz Rodriguez Amelia M. , Reyes Claudia M. , Plascencia Miguel R. O. , Marcias‐Reyes Hector , Orozco Clotilde F.
Published: September 2011

Objective

Evaluate quality of life in untreated Mexican patients with allergic rhinitis, using the Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire (RQLQ).

Method

Cross‐sectional survey study. Fifty‐six patients with diagnosis of persistent, moderate or severe untreated allergic rhinitis from January to December 2007 were included. The RQLQ was applied to each patient. This work was done at Hospital Fray Civil Fray Antonio Alcalde, in the Otolaryngology Department (Guadalajara, Jalisco, México).

Results

Fifty‐six patients were included, 35 women and 21 men. The mean age was 28 years (range, 12‐65 years). All of them were diagnosed with persistent allergic rhinitis: 36 moderate cases and 20 severe cases. The most common symptoms were: rhinorrhea, congestion or nasal obstruction, sneezing, fatigue, itching, and headache. All the areas had a moderate impact (2.26 to 3.75). The most affected areas were the nasal symptoms and practical problems (3.75 and 3.73). The lowest scores were observed in sleep disturbance and ocular symptoms (2.26 and 2.46).

Conclusion

The quality of life of patients depends on the severity and frequency of the symptoms in its daily activities. It is a cheap instrument, easily obtained and well accepted by the patient. The Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire should be applied in the patients.
Septal Flap for Reconstruction of the Skull Base Defect
Authors: Won Tae Bin , Lee Chul Hee , Han Doo‐Hee , Rhee Chae‐Seo , Lee Ji Eun , Kim Dong‐Young
Published: September 2011

Objective

The pedicled septal flap (SF) is one of the most valuable methods to reconstruct the surgical defect after endoscopic skull base surgery. We aimed to assess the feasibility of the SF for reconstruction of the entire anterior SBD in Koreans and attempted to provide tips for improving its design.

Method

CT scans of 2 patients with olfactory neuroblastoma awaiting endoscopic CFR were analyzed. Specific skull base landmarks were measured to estimate the potential anterior SBD. The length and width of the potential SF dimension was also measured. Actual intraoperative defect size and reconstruction method were also compared.

Results

The maximal width and length of the potential anterior SBD was 17.62 to 24.63 mm, and 33.49 to 33.61 mm, respectively. The potential width and length of the sepal flap was 40.14 to 45.21 mm, and 55.43 to 60.87 mm, respectively. According to the radioanatomic studies, the calculated lengths of SF were sufficient to cover the anticipated anterior SBDs in all subjects. All subjects were underwent endoscopic craniofacial resection for anterior skull base lesion, and reconstructed with SF. Actual size of the defect was 20.06 x 13.71 mm and 26.80 x 33.44 mm, respectively.

Conclusion

Preoperative radioanatomic analysis is helpful in anticipating SBD and subsequent planning of the SF design. Increasing flap length by extending the anterior incision to the caudal septum and increasing flap width by incorporating the mucoperiosteum of the nasal floor can compensate for the relatively small septum in Asians.
Staphylococcus Aureus Enterotoxins in Chronic Rhinosinusitis
Authors: Cheng Lei , Zhu Luping
Published: September 2011

Objective

Analyze the role of Staphylococcus aureus enterotoxins (SEs) in the pathogenesis of chronic rhinosinusitis (CRS) with and without nasal polyps (CRSwNP and CRSsNP).

Method

Forty patients with CRSwNP, 30 patients with CRSsNP, and 30 healthy controls were enrolled in the study. Serum specific IgE against SEA, SEB, and SEC was measured using ImmunoCAP 100E system, and statistical analysis was performed by SPSS 13.0 software.

Results

The serum level of specific IgE to SEB in patients with CRSwNP or CRSsNP was significantly higher than that in controls, respectively (P =. 05).

Conclusion

Staphylococcal superantigen SEB may play a role in the development of CRS with or without nasal polyps.
Correlating Participation in Team Sports and Resident Success
Authors: Immerman Sara , Shaikh Jamil , Lebowitz Richard , Roehm Pamela C.
Published: September 2011

Objective

We hypothesize that participation in “team sports” as an undergraduate or in high school fosters development of a skill set improving interactions between the resident and other members of the healthcare team. The objective is to determine the utility of team sports participation as a criterion in resident selection.

Method

Retrospective review of applications to an otolaryngology residency program and scores on evaluations of otolaryngology residents.

Results

Residents who participated in organized team sports tended to have higher overall rankings on their evaluations as compared with co‐residents without such past involvement. No correlation was seen with objective measures such as performance on in‐service or Board certification examinations.

Conclusion

Involvement in team sports activities is a marker of skills and social attributes that correlates with improved scores on resident evaluations. Involvement in team sports can potentially be used during the resident selection process to select for similar individuals.
Study of Bone Changes in Human Chronic Sinusitis
Authors: Melgarejo‐Moreno Pablo J. , Darr Elizabeth A. , Hellin‐Meseguer Diego
Published: September 2011

Objective

After sinus surgery, disease sometimes persists despite appropriate medical therapy and postoperative debridement until the underlying bone is removed. The aims of this study were to explore the pathogenic role of bone in chronic sinusitis and to determine whether mucosal disease may be induced by underlying disease within the bone.

Method

Ten patients with chronic sinusitis were studied at the Virgen de la Arrixaca University Hospital (Murcia, Spain). Nasal endoscopy and computed tomography of the paranasal sinuses were performed. Bone and nasal mucosa specimens were collected during endoscopic sinus surgery and were studied with light and electronic microscopy.

Results

In 45.3% of the specimens, the ethmoid cells and maxillary sinus mucosa were normal but the bone displayed inflammatory changes. These changes included alterations in bone architecture with coordinated osteoclasis and appositional bone formation adjacent to the infected sinuses, as well as intramembranous bone remodeling. In addition, fibrosis within the haversian system and increased vascularity were observed. The bony ethmoid septae showed demineralization and irregular bony thickening. The osseous changes in histopathology were significantly increased with higher mucosal grades in nasal endoscopy. The findings in CT scans and histopathology were well correlated with nasal endoscopy.

Conclusion

Bone plays an active role in the process of chronic sinusitis. This may in part explain the recalcitrance of late‐stage disease. If the potential for inflammation to spread through the bone exists, it may well explain some of the clinical findings seen in chronic sinusitis.
The Changes of Clinical Characteristics of Pre‐ and Post immunotherapy in Allergic Rhinitis Patients Sensitized to Dermatophagoides farinae (Df)
Authors: Jung Su Young , Cho Jung Seang
Published: September 2011

Objective

By analyzing the difference of clinical manifestations, such as MAST results, total IgE, and Eosinophil count, before and after IT in AR patients who have been sensitized to the Df allergen, this research tried to find out about the character of the treatment response.

Method

The study included 192 patients, excluding one patient who stopped therapy during the process. After dividing the group by the duration of therapy and the degree of sensitization to the Df, the MAST, total IgE, and eosinophil count of each group were compared before and at least 6 months after therapy.

Results

After dividing the subjects into different groups according to the duration of IT into the 6 to 12‐months group (n = 136) and the more than 12‐months group (n = 56), the latter group showed a significant reduction in the Df specific antibody IgE, Dermatophagoides pteronyssinus (Dp) specific antibody IgE, and eosinophil count.

Conclusion

In conclusion, immunotherapy has greater treatment response in patients with a more severe degree of sensitization to the Df allergen and the duration of treatment for more than 1 year.
The Effect of Slow‐Release bFGF with Gelatin on Anosmia Mice
Authors: Nota Jumpei , Gyo Kiyofumi , Hato Naohito
Published: September 2011

Objective

Basic fibroblast growth factor (bFGF) may regenerate the olfactory system. However, it does not work well because of short acting time. We developed a new drug delivery system by embedding bFGF in a gelatin hydrogel that degrades slowly. This study is designed to identify the effects of bFGF‐hydrogel in anosmia mice.

Method

An anosmia mouse model was induced by i.p. injection of 3‐methylindole. The animals were divided into four groups by the following procedures: group A, no further treatment; B, single intranasal administration of bFGF; C, single intranasal administration of PBS‐hydrogel; D, single intranasal administration of bFGF‐hydrogel. A month later, we evaluated by behavioral observations and histological findings.

Results

The results for groups A, B, and C were similar in all investigations. In contrast, group D revealed better results; behavior observation showed improvement of olfactory loss and, in histological study, the thickness of olfactory epithelium and the number of Olfactory Marker Protein (OMP)‐immunoreactive cells increased after a month. These results indicated the efficacy of single intranasal administration of embedding bFGF in hydrogel for impaired olfactory function.

Conclusion

This preliminary study revealed the efficacy of a bFGF‐impregnated biodegradable hydrogel as a drug‐delivery medium in the olfactory mucosa. Single intranasal administration of embedding bFGF in hydrogel facilitates faster healing from olfactory dysfunction. Further studies are necessary to fully evaluate the usefulness of this procedure.
The Effects of Septoplasty on QTc Dispersion
Authors: Erkul Evren , Isilak Zafer , Gungor Atila , Cekin Engin Ibrahim , Cincik Hakan
Published: September 2011

Objective

Studies have shown that nasopharyngeal airway diseases, such as obstructive sleep apnea, are closely associated with cardiovascular diseases. The purpose of this study was to investigate whether there is any impact of septoplasty operation on QTc dispersion (QTcD) in patients with nasal septum deviation.

Method

This study included 28 young deviated nasal septum patients. All patients underwent septoplasty. The QT interval, the heart rate‐corrected QT, and the QT dispersion were calculated digitally using computerized electrocardiograms (ECG) by Holter ECG. Heart rates, QT intervals, QTc, and QTcD values were compared preoperatively and one‐month postoperatively.

Results

QTcD was measured 62.9 ± 7.9 in young patients with nasal septal deviation. While there was no significant change in ECG QT interval periods obtained from the patients taken after the procedure (354.8 ± 25.7 and 360 ± 25.4, P >. 05), there was a significant decrease in QTc values (398 ± 22.9 and 383.7 ± 21.2, P =. 013 [<0.05]), and there was a significant decrease in QTcD values (62.9 ± 7.9 and 45.7 ± 6.7, P =. 000). In addition, heart rates were significantly decreased after surgery (76.5 ± 13.2 and 67.4 ± 10.4, P =. 007).

Conclusion

In our study, QTcD values were increased in young patients with nasal septal deviation. High QTcD value indicates increased heterogeneity of ventricular repolarization. Septoplasty is important for young people with nasal deviations to provide improvement of QTc dispersion. Nasopharyngeal airway diseases have negative effects on myocardial repolarization.
The Efficacy of Endoscopic Sinus Surgery in the Management of Silent Sinus Syndrome
Authors: Javer Amin R. , Akbari Elaheh , Manji Jamil , Rahmanian Ronak , Sunkarneni San
Published: September 2011

Objective

Evaluate the efficacy of endoscopic sinus surgery (ESS) without orbital floor augmentation in restoring maxillary sinus volume and resolving enophthalmos in patients with silent sinus syndrome.

Method

A retrospective chart review was conducted in all patients with silent sinus syndrome managed with endoscopic sinus surgery at St Paul’s Hospital from 2005 to 2010. A comparison of pre‐ and postoperative ophthalmometric and CT scan maxillary sinus volumetric measurements were performed.

Results

In total, there were 25 patients aged 24 to 71 years who were managed with ESS. All patients underwent ESS with maxillary sinus antrostomy. All patients had a significant improvement in postoperative maxillary sinus volumetric measurements, with a mean increase of 22.7%.

Conclusion

ESS without orbital floor augmentation can be used to improve enophthalmos and reverse maxillary sinus atelectasis in most patients with silent sinus syndrome.
The Endoscopic Trephination Approach for Repair of Frontal Sinus CSF Leaks
Authors: Crozier Daniel L. , Goyal Parul
Published: September 2011

Objective

1) Describe a less invasive technique than craniotomy or frontal sinus obliteration for the management of frontal sinus skull base defects. 2) Be able to assess the long term results of using a combined endoscopic and frontal sinus trephination approach for the management of frontal sinus skull base defects.

Method

Review of series of three cases of patients with frontal sinus skull base defects repaired using a combined endoscopic and trephination approach.

Results

The technique was used successfully in 2 patients with traumatic frontal sinus skull base defects and one patient with a spontaneous frontal sinus encephalocele. The cases described demonstrate safe and effective use of endoscopic frontal sinus trephination to repair CSF leaks. In all cases, the surgical approach provided excellent exposure of the skull base defect and allowed for a layered repair. In all cases, long term follow‐up has revealed excellent cosmesis and functional frontal sinuses with patent outflow tracts.

Conclusion

A combined endoscopic and frontal sinus trephination approach is a safe and effective technique in the management of frontal sinus skull base defects. This technique provides excellent exposure of all aspects of the frontal sinus without the need for a craniotomy or frontal sinus obliteration procedure.
The Expression of Histamine Receptor and Chemokines in Epithelial Cells and Fibroblasts of the Upper Respiratory Tract after Respiratory Syncytial Virus (RSV) Infection
Authors: Young Su Jung , Cho Jung Seang
Published: September 2011

Objective

Identify the effect of RSV on upper respiratory tract infections or the symptoms of allergic rhinitis by investigating the changes of the aspect of the expressions of many chemokines or the histamine receptor when the epithelial cells of the nasal mucosa or the fibroblast are infected by RSV.

Method

A mucosa sample of the inferior turbinate is obtained from 12 patients. One half of the sample is used for incubation of epithelial cells, and the other half is used in culturing fibroblasts. After infecting the cultured samples by RSV, we check the expression of Eotaxin, RANTES, IL‐8, GRO‐a, and HRc.

Results

The study suggests that as time passes by after RSV infection, upper respiratory tract epithelial cell samples show an increase of H1RC, H2RC, H4RC, RANTES, and IL‐8, and fibroblast samples show an increase of expression of H1RC, H2RC, H3RC, H4RC, GRO‐a, and IL‐8.

Conclusion

The epithelial cells of the human upper respiratory tract, similar to those of the human lower respiratory tract, cause an influx of variable inflammatory cells and, therefore, induce inflammatory response and hyperreactivity, cause increased expression of histamine receptors, and induce symptoms similar to those of allergic rhinitis, such as rhinorrhea and sneezing.
Transnasal Endoscopic Microdebrider‐Assisted Marsupialization of a Nasolabial Cyst and a Nasopalatine Duct Cyst
Authors: Kim Dong Hyun , Jeon Eun‐Ju , Park Young‐Soo
Published: September 2011

Objective

Investigate the management of the nasolabial cyst and nasopalatine cyst by transnasal endoscopic microdebrider‐assisted marsupialization.

Method

We performed transnasal endoscopic microdebrider‐assisted marsupialization for nasolabial cyst and nasopalatine duct cyst.

Results

Patients experienced decreases in operation time, blood loss, and hospitalized time when treated with transnasal endoscopic microdebrider‐assisted marsupialization.

Conclusion

Transnasal endoscopic microdebrider‐assisted marsupialization is an effective treatment for nasolabial cyst and nasopalatine duct cyst.
CPR Outcomes in Hospitalized Patients with Tracheostomies
Authors: Sultan Omer , Loeslie Vicki , Rabatin Jeff
Published: September 2011

Objective

1) Outcomes of cardiac arrest in hospitalized patients with tracheostomies. 2) Disposition of patients at the time of hospital discharge.

Method

A retrospective electronic chart review was performed of 1102 patients who had cardiac arrest (absence of pulse or non‐perfusing rhythm) at a tertiary care academic medical center between Jan 2005‐Dec 2009. Data was abstracted and summarized using descriptive statistics.

Results

Twenty‐six of 1102 (2%) had a tracheostomy at the time of arrest. Median age years = 61 years (range 24‐83 years). A total of 18 out of 26 (69%) were male. A total of 18 out of 26 (69%) had return of spontaneous circulation following resuscitation. Fourteen out of 26 (54%) were on mechanical ventilation (MV) at the time of arrest. Twenty‐two out of 26 (84%) patients had tracheostomy secondary to prolonged MV. Twelve out of 26 (46%) patients were alive at 3 months and 7 out of 26 (26%) patients were alive at 1 year. Of the 11 patients who survived to discharge, disposition included: 6 out of 11 (54%) home; 3 out of 11 (27%) long‐term acute care hospital (LTAC); 2 out of 11 (18%) skilled nursing facility (SNF).

Conclusion

The frequency of cardiac arrest in patients with a tracheostomy was 2.4%. Survival at 1 year was 26%. Of those who survived to discharge, 54% of patients went home and 45% were discharged to a LTAC or SNF.
Turbinate‐Conserving Medial Maxillectomy for Sinonasal Inverted Papilloma
Authors: Asako Mikiya , Tomoda Koichi
Published: September 2011

Objective

Present the authors’ experience and outcomes in the maxillary inverted papilloma using turbinate‐conserving medial maxillectomy, so‐called swinging‐turbinate procedure.

Method

Case series with retrospective investigation.

Results

Endoscopic medial maxillectomy (EMM) is one of the best approaches for the maxillary tumor arising from the lateral and/or frontal wall of the maxillary sinus. However, the function of turbinate mucosal membrane is sacrificed. We present turbinate‐conserving medial maxillectomy, providing wide surgical fields that compare favorably with EMM. The most distinctive feature of the swinging‐turbinate procedure is conserving the inferior turbinate membrane and the nasolacrimal duct. Five of 45 patients who underwent swinging‐turbinate procedure qualified for the analysis. The outcome of the surgery was satisfactory except for 1 case of recurrence.

Conclusion

Most of the T3 cases and some of the T4 cases in Krouse’s classification system can be treated as ESS. Swinging‐turbinate procedure provides good results for IP.
Use of the KTP DermaStat for Recurrent Anterior Epistaxis
Authors: Frampton Steven James , Jain Abhiney , Sachinanda Ravi , Rhys‐Williams Stuart , Jain Parmod K.
Published: September 2011

Objective

Assess the efficacy of the potassium‐titanyl phosphate (KTP) laser DermaStat handpiece in treating prominent anterior septal vessels that cause recurrent epistaxes. The handpiece is reusable, unlike the traditional disposable light fiber, facilitating more cost‐effective use of KTP technology, with potential for more widespread use in the office setting.

Method

A UK‐based, single‐center retrospective and prospective case series. From 2004 onward 37 patients with recurrent epistaxes and prominent anterior septal vessels with/without previous cauterization (age 4‐80 years; M:F 21:16) underwent a single laser treatment. The primary outcome measure was continued cessation of epistaxis after two months.

Results

A total of 89% of patients attended follow‐up at 2 months, and 88% of these had experienced complete cessation of bleeding. The remaining 12% subjectively experienced a reduction in the frequency of epistaxes. No undesirable side‐effects of the treatment were experienced or evident at follow‐up.

Conclusion

The “Jain technique” using the DermaStat handpiece with the KTP laser is an effective method of controlling recurrent anterior epistaxes. The technique is safe, with no observed complications, and the re‐usability of the hand piece facilitates more widespread and cost‐effective use of KTP technology.
Validation of Sniffin’ Sticks Olfactory Test and Olfactory Disorder Questionnaire in a UK Population
Authors: Neumann Codruta , Philpott Carl M. , Clark Allan
Published: September 2011

Objective

Validate the applicability of Sniffin’ Sticks in a UK population. These pen‐like odor dispensing devices are used to assess threshold, discrimination, and identification. Odor identification is strongly dependent on familiarity with the odors and has an important cultural component, which has limited the usefulness of other validated tests.

Method

A prospective study of 63 subjects, 24 healthy volunteers with a reported normal sense of smell, and 39 patients with an impaired sense of smell presenting either at a rhinology or an olfactory disorder clinic. Each subject’s olfactory function was assessed using the Sniffin’ Stick test.

Results

The mean age of the subjects tested was 46.7 years; 40 female and 23 male. In the patient group, 30 were hyposmic and 9 anosmic. In the healthy volunteers group, all subjects were normosmic. The mean TDI score for patients and healthy volunteers was 21.06 (range, 8‐30.5) and 33.73 (range, 29.25‐37.75) respectively. Mean identification score in the 2 groups was 8.84 (range, 1‐15) for patients (range) and 13.69 (range, 11‐16) for healthy volunteers.

Conclusion

In our sample of the UK population the TDI and odor identification scores for healthy volunteers and patients with olfactory disorders are comparable with the normative data published on large samples of European populations. Discussion of commonly mistaken odors in the odor identification test is undertaken.