bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity and Responsiveness of VELO: A VPI QoL Instrument
Authors: Skirko Jonathan R. , Weaver Edward M. , Perkins Jonathan A. , Kinter Sara , Eblen Linda E. , Sie Kathleen C.
Published: February 2015

Objective

In a study of patients with velopharyngeal insufficiency (VPI) diagnosed by pediatric speech pathologists, test the VPI Effects on Life Outcomes (VELO) instrument for criterion validity, construct validity, reliability, and responsiveness (ability to detect change in quality of life).

Method

VPI subjects/parents completed the VELO at baseline, 2 weeks later, and 3 months posttreatment. Criterion‐validity tested correlation between VELO score and VPI severity; construct‐validity tested correlation with speech intelligibility. Test‐retest reliability tested intraclass‐correlation between baseline VELO score and 2‐week score. Responsiveness tested mean baseline and posttreatment scores with the paired t test.

Results

Parental responses are reported (n = 83); youth responses (obtained in 8+ year‐olds only; n = 24) showed similar results. VPI severity (minimal n = 11, mild n = 31, moderate n = 27, severe n = 14) and speech intelligibility were rated by pediatric speech pathologists. The VELO instrument did not meet criterion validity (Spearman r = −0.21, P =. 07) but did meet construct validity (Spearman r = −0.36, P =. 001). VELO scores demonstrated excellent test‐retest reliability (r = 0.85, P <. 001, n = 40). Treatments included Furlow palatoplasty (n = 20), sphincter pharyngoplasty (n = 14), or an obturator (n = 2) with n = 28 (78%) completing the VELO posttreatment. The VELO showed responsiveness to treatment improving from baseline 54 ± 15 to posttreatment 70 ± 18 (P <. 001).

Conclusion

VELO provides a VPI specific quality of life instrument that demonstrates construct validity, test‐retest reliability, and responsiveness to change in quality of life with treatment.
Weight Gain Post‐tonsillectomy More Common in Young Children
Authors: Vikani Ami , Ishman Stacey L. , Smith David F. , Boss Emily F. , Benke James R.
Published: February 2015

Objective

Adenotonsillectomy (TA), performed for either obstructive sleep apnea (OSA) or recurrent tonsillitis (RT), has been associated with significant weight gain after surgery. The objective of this study was to look at a large population of children undergoing TA and the demographic factors which may contribute to weight gain.

Method

Retrospective chart review of children undergoing TA at an urban tertiary‐academic center between 2008 and 2011. Demographic data (including age, gender, and race), OSA disease severity, pre‐ and 6‐month postoperative normalized body mass index (z scores), and changes in were compared.

Results

One hundred fifteen children had complete data after TA; 85 of whom underwent surgery for OSA. There were no significant differences between OSA and RT patients in mean age (7.2 ± 4.3 vs 7.3 ± 4.4 years, P =. 955) or gender (38% female vs 50%; P =. 323). However, the OSA patients were more likely to be black (60% vs 33%) than RT patients (P =. 026). Overall, the preoperative BMI z scores increased from 0.98 ± 1.50 to 1.21 ± 1.25 (P =. 0009) with no significant difference by surgical indication (P =. 58). Multiple linear regression analysis found that only age was significantly, and negatively, associated with changes in BMI z scores (P =. 015).

Conclusion

Similar to previous studies, children had significant weight gain after TA. This analysis suggests that younger age is a significant predictor of weight gain after surgery. Further investigation of the relationship between weight gain and demographic factors would benefit from prospective evaluation with special attention to the relationship with age.
Can CT Scans Predict Need for Septoplasty in Sinus Surgery?
Authors: Walden Ashley , Choudhury Natasha , Parvizi Nassim , Marais Joe
Published: February 2015

Objective

1) Ascertain whether CT findings correlate with surgical need for access septoplasty during endoscopic sinus surgery. Evaluated due to risk of litigation from patients not consented for septoplasty who require it, despite having a “straight septum” on CT. 2) Establish whether site of septal deviation affects the requirement for septoplasty.

Method

We retrospectively studied 129 endoscopic sinus surgery procedures. The preoperative CT report was recorded. Blinded to the report, 2 independent observers commented on evidence and site of septal deviation and predicted the need for access septoplasty. The operative notes were used to record the surgical outcome.

Results

Septal deviation was reported by radiologists in 57 of the 129 patients (44%). Both observers agreed on septal deviation being present in 85 patients (66%). Thirteen of 87 patients who were predicted not to need access septoplasty underwent the procedure (15%). A confidence interval (CI) of 95% gives a range of 9%‐24% for patients undergoing access septoplasty who were predicted not to. Eight of 72 patients who had no septal deviation reported on CT underwent access septoplasty (11%). A CI of 95% gives a range of 5%‐21%. The most common site of septal deviation requiring septoplasty was antero‐medial (33%).

Conclusion

CT scans cannot always be used to reliably predict the need for access septoplasty. Preoperative clinical examination is the gold standard for assessment. Therefore, patient consent should include that for septoplasty to decrease the chance of litigation should complications of septoplasty occur.
Clinical Relevance of IL‐17 during SLIT on AR to HDM
Authors: An Soo‐Youn , Wee Jee Hye , Kim Dong Kyu , Han Doo Hee , Lee Chul Hee , Min Yang‐Gi , Rhee Chae‐Seo
Published: February 2015

Objective

To investigate the clinical relevance of serum IL‐17 levels in AR patients treated with sublingual immunotherapy (SLIT) to identify the function of TH17 cells and IL‐17 in AR.

Method

The patients with AR to HDM starting to receive SLIT in Seoul National University Hospital between June 2008 and August 2010 were enrolled. We detected serum IL‐17 levels via ELISA before and 1 and 2 years after starting SLIT. Symptom diaries, rescue medication use, and other immunological parameters were analyzed.

Results

Longer onset of symptoms and moderate to severe symptoms were significantly related to higher serum IL‐17 levels before starting SLIT. HDM‐specific IgE significantly increased between the baseline and the first year of SLIT, while HDM‐specific IgG4 had no significant change. There was a significant positive correlation between serum ECP and IL‐17 levels during SLIT. The changes of serum IL‐17 and total IgE levels for 1 year had an inverse relationship with the effectiveness of SLIT. Changed serum IL‐17 levels at the first year was the most significant factor in relation to the effectiveness of SLIT by multivariate analysis.

Conclusion

Serum IL‐17 levels in AR correlated with duration from symptom onset, symptom severity, and serum ECP levels. Changes of serum IL‐17 levels during SLIT are expected to be a prognostic factor to predict the effectiveness of SLIT. Thus, IL‐17 and TH17 cells might have an important role in AR pathogenesis.
Cost Analysis of Approaches to the Anterior Skull Base
Authors: Kroeker Andrew , Raza Syed N. , Kahn Adam , Marentette Lawrence J. , McKean Erin M.
Published: February 2015

Objective

To ascertain 1) the cost‐effectiveness and 2) short‐term outcomes of endoscopic endonasal cribriform resection in comparison to open/subcranial approaches.

Method

Retrospective cohort study reviewing consecutive patients (2008‐2011) undergoing primary surgical treatment for cribriform malignancies via endoscopic or open/subcranial approaches. All patients were reviewed to ensure feasibility of endoscopic approach. Outcomes based on complications and length of stay were reviewed, and cost to society was analyzed using QALYs. Sensitivity analyses were performed.

Results

Eight patients were treated for cribriform malignancies, 4 with an endoscopic endonasal approach, and 4 with an open surgical approach. The mean length of hospitalization following the first surgery did not differ significantly between the 2 groups (5.25 days endoscopic vs 5.5 days open; P =. 92). Differences were seen in blood loss and length of surgery, but neither were statistically significant (blood loss: 275 mL endoscopic vs 1200 mL open; P =. 27; and length of surgery: 314 min endoscopic vs 394.5 min open; P =. 33). Costs of each surgical intervention and associated follow‐up and specialized care appear equivocal.

Conclusion

Economic evaluations are the mainstay for determining cost effectiveness of an intervention, and this is the first such evaluation for endoscopic skull base surgery for anterior cribriform tumors. Though differences between the 2 approaches seem equivocal, this is likely due to the few patients who have received this intervention.
DuraSeal™ in Endoscopic Repair of Cerebrospinal Fluid Leak
Authors: Yelverton Joshua C. , Vyas Priyam K. , DiNardo Laurence J.
Published: February 2015

Objective

1) Review use of DuraSeal (Confluent Surgical, Waltham, MA) as sealant in the primary repair of spontaneous cerebrospinal fluid (CSF) leaks and in secondary repair following transspehnoidal pituitary surgery for persistent leak. 2) Compare success and postoperative course of DuraSeal to fibrin glues in our patients and in the literature.

Method

A database of endoscopic cerebrospinal fluid leak repairs was created by retrospective review of the operative log from 1999 to 2012 at a tertiary care hospital. Operative reports and postoperative hospital records were collected and analyzed for type of repair and CSF leak recurrence.

Results

Nine cases were identified in which DuraSeal was used as a dural sealant during endoscopic CSF leak repair for spontaneous leak or in secondary repair of CSF leaks following previous transsphenoidal pituitary surgery. There was no recurrence of CSF leak in any patients in which DuraSeal was used in the repair. The average follow‐up was 21 months (range 1 to 53 months). There were no complications from the use of DuraSeal. A similar group of 7 patients in whom fibrin glue was used noted 1 repair failure (14.3%) with a 32‐month average follow‐up.

Conclusion

The use of DuraSeal to strengthen CSF leak repair and form a watertight seal was successful in 100% of reported cases and had no adverse events related to its use. This report of 9 patients would be the largest to date where DuraSeal was used in this manner.
Effects of Sinus Surgery on Sinusitis Evaluated by SNOT20
Authors: Tan Guolin , Ma Yanhong
Published: February 2015

Objective

To explore the therapeutic effects of endoscopic sinus surgery on symptoms and quality of life of patients with chronic rhinosinusitis and nasal polyps (CRSP).

Method

A survey of symptoms and quality of life was conducted using Sino‐Nasal Outcome Test‐20 (SNOT‐20) questionnaire in 76 patients before and after endoscopic sinus surgery. The overall effect of endoscopic sinus surgery on CRSP was subjectively self‐evaluated by patients.

Results

After 6 months follow‐up, the total SNOT‐20 score of patients was significantly decreased from the baseline (P <. 001). The most important 5 items were found to be “thick nasal discharge,” “need to blow nose,” “dizziness,” “frontal pain,” and “lack of a good sleep.” The other items, related to sleep and emotion, were also significantly improved. By patients’ self‐evaluation, the ration of “much improved,” “improved,” and “not‐improved” were, respectively, 56.3%, 33.3%, and 10.4%.

Conclusion

Endoscopic sinus surgery demonstrated positive effects on symptoms and quality of life of CRSP.
Endoscopic Management of Frontal Sinus Fractures
Authors: Chaaban Mohamad R. , Conger Bryant T. , Woodworth Bradford A.
Published: February 2015

Objective

Conventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches.

Method

Retrospective evaluation of patients with posterior table fractures was performed at the University of Alabama at Birmingham from January 2008 through December 2011. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow up

Results

Eleven patients (age 39 ± 5 years) with posterior table fractures were treated using endoscopic techniques from 2008‐2011. Mean follow‐up time was 44 ± 15 weeks (range 2‐164). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13.5 3.6 mm and the average length involving the posterior table was 9.6 mm (1‐30 mm). Skull base defects were covered with a septal flap and/or Surgisus tissue grafts. One patient referred after failed cranialization was endoscopically obliterated. Although 1 individual required a revision frontal sinusotomy, all sinuses remain patent on last follow‐up.

Conclusion

Management of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Posterior table fractures of up to 30 mm in length were adequately managed in this series and indicate this approach should become an active part of the treatment algorithm.
Endoscopic Removal of Fungus Balls in Maxillary Sinuses
Authors: Lo Wu Chia , Liao Li‐Jen , Cheng Po‐Wen
Published: February 2015

Objective

We aimed to compare between a newly developed instrument, powered saline irrigation system, and the traditional technique in the complete removal of fungus balls in maxillary sinuses during functional endoscopic sinus surgery.

Method

Between July 2009 and July 2011, unilateral maxillary sinus fungus balls were removed with the traditional method in 17 patients and with the assistance of powered saline irrigation in 12 patients. The duration, complication and recurrence by these 2 procedures were compared.

Results

The fungus balls could be efficiently cleared in all (100%) maxillary sinuses. However, the mean duration for the traditional method group was 397 ± 42 seconds, significantly longer than 155 ± 29 seconds for the powered saline irrigation group (P <. 001). In the traditional method group, 4 patients (24%) developed focal maxillary mucosal detachment during the procedure and 1 patient (6%) developed chronic bacterial maxillary sinusitis later, requiring a secondary endoscopic sinus surgery. Neither operative complication nor disease recurrence occurred during the follow‐up period in the powered saline group.

Conclusion

Our series confirms the efficacy of functional endoscopic sinus surgery in the treatment of maxillary fungus balls. The assistance of powered saline irrigation provides more timesaving procedures and less postoperative complications.
Endoscopic Treatment of Olfactory Neuroblastomas
Authors: Hermann Diego R. , Balsalobre Leonardo , Abreu Cassiana B. , Balieiro Fernando O. , Stamm Aldo E. C.
Published: February 2015

Objective

To illustrate an transnasal approach (endoscopic assisted transnasal‐craniectomy) used for olfactory neuroblatoma treatment and to advocate this method of management followed by radiation therapy for selected cases, based on the Stamm‐Kennedy (SK) stage system.

Method

A retrospective chart review was performed with 16 patients harboring olfactory neuroblastomas. Patients were categorized secondary to SK staging system. Twelve patients underwent the endoscopic assisted transnasal craniectomy (EATNC) approach, and 4 were submitted to hybrid approach (cranio‐endoscopic) between 2000 and 2011 at a tertiary referral center.

Results

Seven SK‐IVa, 5 SK‐II, 2 SK‐IVb, 1 SK‐I, and 1 SK‐V patients, aged 10 to 67 years (9 females and 7 males), were identified. In 10 cases the tumor was bilateral, and in six cases the tumor was unilateral. Twelve patients were submitted to EATNC, 4 patients were submitted to hybrid approach (cranio‐endoscopic), and 1 was submitted to endonasal approach without craniectomy. Gross total resection was achieved in 12, and near total was achieved in 4 patients. Twelve patients were submitted to radiotherapy (75%). Four cases needed posterior surgery. Fourteen patients were disease free 5 to 72 months postresection, and 2 patients were lost during follow‐up. Only 4 patients preserved olfactory function (unilateral cases treated without radiotherapy).

Conclusion

The EATNC is a promising approach for olfactory neuroblastoma treatment, even for those tumors with intradural extension. Most patients require radiation therapy, and in these cases there is no olfaction preservation.
FESS Malpractice Risk Factors Identified Using Case‐Controls
Authors: Sewell Ryan K. , Roberson David W. , Zappia John J. , Troxel David , Shah Rahul K.
Published: February 2015

Objective

Complications related to functional endoscopic sinus surgery are well documented. These complications will, in some instances, lead to claims of medical malpractice. This study seeks to preoperatively identify both patient and procedural characteristics which are more likely to result in adverse events. This may then allow them to develop risk management strategies as they pertain to functional endoscopic sinus surgery.

Method

Case control study of The Doctors Company closed claims involving functional endoscopic sinus surgery between 2005‐2009. These were then compared with a control group of 196 survey responses sent by The Doctors Company in 2011 to insured otolaryngologists.

Results

A total of 17 claims were closed from 2005‐2009. There was no significant age difference in the claims group and controls. Age greater than 60 inferred a 2.8‐fold increase in risk of a closed claim (P =. 09). The lack of polyps was associated with an increased risk of a claim (P =. 04). All claims involved surgery that included at least an ethmoidectomy. The use of powered instrumentation was not statistically significant. Revision surgery was associated with a 13‐fold increase in risk of a claim (P =. 05).

Conclusion

The present article illustrates the utility of a case control method to identify scenarios that are more likely to result in malpractice claims. Identification of risk factors preoperatively has the potential to help avoid complications and, thus, lawsuits. This methodology may be useful when examining other surgical procedures as well.
Flexural Modulus in Tissue‐Engineered Human Septal Cartilage
Authors: Kushnaryov Anton , Wong Van , Reuther Marsha S. , Briggs Kris , Sah Robert L. , Masuda Koichi , Watson Deborah
Published: February 2015

Objective

1) Determine the flexural modulus (intrinsic flexibility) of tissue‐engineered human septal neocartilage constructs using 3 point bending mechanical testing. 2) Compare the flexibility of native human septal cartilage to human tissue‐engineered septal cartilage constructs using 3‐point bending mechanical testing.

Method

Strips of tissue‐engineered human septal neocartilage and native septal cartilage were subjected to 3‐point bending using a testing apparatus with axial load cell and actuator. Uniform stress was applied while displacement and strain were recorded. The flexural rigidity or bending modulus was calculated for each sample.

Results

After 10 weeks in culture, the flexural modulus of tissue‐engineered human septal neocartilage constructs was 0.462 N/mm2 versus 3.28 N/mm2 for native tissue (P =. 002). No samples fractured or demonstrated plastic deformation.

Conclusion

Tissue‐engineered septal neocartilage was 7.1‐fold more flexible than native septal cartilage. This study demonstrates that flexural moduli of tissue engineered septal cartilage can be determined after 10 weeks in culture, providing a useful measure of construct properties relative to native tissue.
Improving the Detection of Fungi in CRS Histopathology
Authors: Guo Canting , Ghadersohi Saied , Kephart Gail , Sherris David A. , Kita Hirohito , Laine Roger , Ponikau Jens U.
Published: February 2015

Objective

To investigate the improvement in histologic detection of fungi with Gomori methenamine silver (GMS) stain by trypsin predigestion in the mucus of chronic rhinosinusitis patients (CRS).

Method

Prospective, single group, descriptive analysis conducted in multiple institutions. Thirty‐four sinus specimens from 12 CRS surgical patients were stained with hematoxylin and eosin, GMS stain, GMS stain with trypsin digestion, and immunofluorescence for chitinase and anti‐Alternaria. Patients received skin testing, IgE serology, and radioallergosorbent tests for 23 fungal IgE antibodies.

Results

The conventional GMS stain detected fungi only in 9/34 (27%) of the specimens. Predigesting the specimen with trypsin dramatically improved the visualization of fungi; 31 out of 34 specimens (91%) stained positive for fungi. The Chitinase immunofluorescence visualized fungi in 32/34 (94%), and anti‐Alternaria was visualized in 33/34 specimens (97%). Only 8/12 (75%) patients had detectable allergies.

Conclusion

This report describes a modification of the conventional GMS stain that significantly improves the visualization of fungi on histology and explains the lack of detection in previous studies. These novel, more sensitive histologic methods reveal fungi within mucin in allergic and also non‐allergic CRS patients.
Macrophage Quantification in Chronic Rhinosinusitis
Authors: Banks Caroline A. , Mulligan Jennifer K. , Wang Eric W. , Casey Sarah E. , Mulligan Ryan M. , Schlosser Rodney J.
Published: February 2015

Objective

Macrophages are major producers of inflammatory cytokines; however, their role in chronic rhinosinusitis (CRS) has not been clearly defined. The aim of this study was to quantify monocytes and macrophages in sinonasal tissue of patients with various subtypes of CRS.

Method

Human sinonasal tissue was taken from patients with CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP), and allergic fungal rhinosinusitis (AFRS). Control tissue was taken from patients without evidence of inflammatory sinus disease. Samples were immunhisotychemically stained for macrophage/monocyte markers Mac387, CD68, and PM‐2K.

Results

AFRS patients had approximately 4 times as many Mac387 and CD68 staining cells as CRSsNP and control patients (P <. 05). CRSwNP patients had approximately 2.5 times as many Mac387 cells and 3 times as many CD68 cells as CRSsNP and control patients (P <. 05). There were trends toward increased numbers of cells staining positively for PM‐2K in tissue samples of AFRS and CRSwNP, and increased staining of CD68 and PM‐2K in atopic CRWwNP patients; however, this did not reach statistical significance.

Conclusion

Macrophages are increased in CSRwNP and AFRS patients and may contribute to the immunopathology of CRS.
Microdebrider versus Conventional Partial Turbinectomy
Authors: Damaty Ahmed Hesham El , Badran Hatem
Published: February 2015

Objective

Compare the microdebrider assisted partial inferior turbinectomy with the conventional turbinectomy in patients with inferior turbinate hypertrophy.

Method

Sixty patients with nasal obstruction and bilateral hypertrophied inferior turbinates were included.The patients were randomly assigned to receive microdebrider partial turbinectomy (n = 30) or conventional surgical turbinectomy (n = 30). Main outcome measures: operative time, blood loss, subjective improvement of the patients symptoms, and postoperative complications.

Results

The 2 groups were comparable in age and sex. The operative time and operative blood loss were less in the microdebrider group (P <. 001). Follow‐up visit after 3 months revealed improvement in 93.3% of the patients in the microdebrider group vs 96.7% in the surgical group (P >. 05). There was no difference in the incidence of postoperative complications between the 2 groups.

Conclusion

Partial turbinectomy with the microdebrider is as effective and safe as the conventional surgical turbinectomy with shorter operative time and minimal blood loss.
Non‐invasive Correction of Nasal Septum Deformities
Authors: Helidonis Emmanuel S. , Sobol Emil N. , Svistushkin Valery , Ovchinnikov Yuri , Shekhter Anatoly , Velegrakis George A. , Sviridov Alexander
Published: February 2015

Objective

1) To study laser septochondrocorrection (LSC) technology. 2) To characterize the medical equipment. 3) To present clinical data. The LSC uses the thermo‐mechanical effect of non‐destructive laser radiation for a bloodless and painless correction of septonasal deformities.

Methods

The equipment for non‐invasive reshaping of cartilage includes a fiber 1.56‐micrometer laser, special instrument and feedback control system. The LSC was performed on 1000 patients whose ages ranged between 12 and 68 years of age, including 934 patients in Russia and 64 patients in Greece.

Results

The straightening of nasal septum and the improvement of breathing were obtained immediately after laser procedure in all patients. No age limitations, no complications, and no negative secondary effects were observed. Partial return to initial position of the nasal septum was observed in 20% of the patients 2 or 3 weeks after LSC. A 2‐year follow‐up did not show any posterior alterations in the position of the nasal septum. Only 5% of the patients who underwent LSC showed no improvement of nasal breathing. The positive results were obtained in 95% of the treated patients.

Conclusion

LSC is a new non‐invasive procedure with many advantages over the traditional traumatic surgical techniques applied to correct septonasal deformities. The high effectiveness and the safety of laser procedure are ensured by strictly meeting the appropriate correction conditions and by using a feedback control system.
Olfactory Bulb Volume for Prognosis in Olfactory Loss
Authors: Rombaux Philippe , Huart Caroline , Deggouj Naïma , Duprez Thierry
Published: February 2015

Objective

The olfactory bulb (OB) is essential for olfactory perception, and its volume is correlated to the olfactory function in normal and pathologic cases. We hypothesized that olfactory bulb volume could also be used as a new predictor of olfactory recovery.

Method

A cohort of 60 patients suffering from PI (n = 28) and PT olfactory loss (n = 32) was studied. Assessment of olfactory function was performed using orthonasal and retronasal tests, at the time of the diagnosis and 15 months later. All patients were examined on a 3T‐MRI. The olfactory bulb volume was calculated.

Results

Recovery rate was 25% in patients with PT olfactory loss and 35.7% in patients with PI olfactory loss. There was a correlation between both the orthonasal and the retronasal score, and between olfactory testing and the total olfactory bulb volume, both at T1 and at T2. In addition, we observed a significant correlation between changes in olfactory functions and initial measures of the total OB volume, with larger volumes relating to higher improvement on olfactory. Finally, we found that none of the patients with a total OB volume of 40 mm or less exhibited recovery of olfactory function.

Conclusion

Olfactory bulb volume is a predictor of olfactory recovery in patients suffering from PI and PT olfactory loss.
Predictors of Performance in Endoscopic Rhinology Procedures
Authors: Awad Zaid , Touska Philip , Arora Asit , Tolley Neil S. , Darzi Ara
Published: February 2015

Objective

Investigate the best predictor of performance of otolaryngology trainees in a rhinology skills lab.

Method

Cross‐sectional study carried out in February 2012 where 15 trainees from the London otolaryngology training program (year 3‐5) were asked to complete 9 operative tasks on a sheep head model and were assessed by 5 experts on task‐specific and global performance using a previously validated tool. We tested 7 factors as predictors of performance including time (months) in surgical training, time in otolaryngology training and time in rhinology sub‐speciality training, practical rhinology courses attended, total rhinology procedures, procedures as main operating surgeon, and precourse operative global scores from video recordings.

Results

The task‐specific and global scores correlated well (Pearson 0.66). Six out of the 7 factors did not show correlation with performance at the skills lab (time in surgery, time in otolaryngology, time in rhinology, number of courses, total procedures, and procedures performed, Pearson: 0.19, 0.12, 0.3, 0.11, 0.28, and 0.13, respectively). The only measure that correlated well is precourse performance scored blindly and independently using the same tool based on video recordings of trainees operative procedures (Pearson: 0.62)

Conclusion

Predicting surgical performance is a multi‐factorial complex process. The assessment process including the tool and assessors have been validated further by showing consistency in scoring the same trainee twice, before and during the course as well as good correlation between task‐specific and global assessment. Previously acquired skills have the highest predictive value.
Regional Patterns of Nasal Decongestion
Authors: Cetto Raul , Rennie Catherine E. , Bates Alister J. , Schroter Robert C. , Doorly Denis J. , Tolley Neil S.
Published: February 2015

Objective

We present a study investigating the effect of a decongestant on the nasal mucosa, showing results in terms of the change in erectile tissue volume (ETV) in normal subjects using high resolution 3T‐MRI scanning.

Method

Seven volunteers with no nasal complaints (SNOT‐22) or obvious rhinoscopic abnormalities were studied. Each subject underwent 2 MRI scans producing a series of 120 contiguous 1.2 mm sections pre‐ and postdecongestion. Patients were decongested with xylometazoline‐HCL, remaining immobilized following the first scan. The scans were segmented using ITK‐Snap and analyzed using MATLAB.

Results

Subject age ranged from 21‐38 years (mean = 28). The SNOT‐22 scores ranged from 1‐10 (mean = 4.8). Decongestion had the greatest effect in 3 sites: the inferior turbinates, middle turbinates, and septum. The greatest change in ETV was observed in the inferior turbinates (P <.005), reducing by up to 1/3 at the posterior aspect of the inferior turbinate following decongestion. Changes were also seen in ETV of the middle turbinate and septal mucosa to a lesser extent.

Conclusion

The effect of decongestion on ETV has been investigated here in far greater detail than previously studied, and at higher spatial resolution. 3T‐MRI was found to be an excellent modality for mapping changes in nasal mucosa. Our results demonstrate the significant effect of decongestion on ETV of the inferior turbinates.
Submucosal Resection of the Middle Turbinate
Authors: French Christopher , Goyal Parul
Published: February 2015

Objective

1) Describe a new technique to improve access to the middle meatus in select endoscopic sinus surgery (ESS) cases. 2) Describe the indications and outcomes of this technique. 3) Compare outcomes of this technique to those of conventional middle turbinate resection.

Method

Retrospective chart review, January 2007 to January 2012. Eleven subjects underwent submucosal resection of the middle turbinate during routine ESS. The indication was middle turbinate bony hypertrophy that prevented adequate middle meatal access. The technique involves elevating submucosal flaps along medial and lateral aspects of the middle turbinate. The prominent bone is then resected.

Results

Submucosal resection of the middle turbinate improved surgical access in all cases (11 patients, 13 turbinates). Follow‐up duration ranged from 1‐41 months (mean 10.4 months). Adequate middle meatal access was obtained intraoperatively in all cases. Postoperatively, the middle meatus remained patent in all patients. None of the patients experienced any complications.

Conclusion

This study describes a safe and effective technique for improving middle meatal access in ESS. Complications of conventional middle turbinate resection were not seen in our study. This technique allows for preservation of the majority of middle turbinate structure and function, avoiding risks associated with total or partial full‐thickness resection.
The Practicioner’s View: Sinus Surgery with Image Guidance
Authors: Breinlich Thomas W.
Published: February 2015

Objective

1) Learn about the cost (time necessary to get an image guidance system ready to use), and 2) understand the benefits of using image guidance for routine cases of microscopic‐endoscopic sinus surgery as an attending physician.

Method

A prospective case series of 24 consecutive patients undergoing FESS with image guidance from April to December 2011 was conducted. The technical and patient related setup time was measured, and minor and major complications were recorded. The benefit of a safer or more complete surgery was estimated by the surgeon.

Results

Among the 24 patients were 3 tumor cases (12.5%) and 21 cases of chronic sinusitis (87.5%). Six patients were revision cases (25%). The technical setup time shows a mean value of 245 seconds (minimum 170, maximum 330 seconds). The patient related setup time shows a mean of 192 seconds (minimum 25, maximum 595 seconds). The total mean value of the time necessary is 437 seconds. There were no minor or major complications. The advantages as estimated by the surgeon are a more complete or safer surgery (16.6%) and the educational value for the surgeon and staff.

Conclusion

In this study the cost of time (mean value 7 minutes and 17 seconds) in 24 consecutive routine cases of FESS is highlighted against the benefits of a more complete or safer surgery and the educational value for the surgeon and staff.
Video‐Assisted ALT Harvesting, Technique Validation, and Results
Authors: Moreno Mauricio A. , Suen James Y.
Published: February 2015

Objective

We have previously described a novel video‐assisted technique (VAT) for the identification of cutaneous perforators of the anterolateral thigh (ALT) free flap. We sought to validate the technique by comparing its findings with standard open thigh exploration in a series of consecutive patients.

Method

Retrospective review of a prospectively collected database; 23 consecutive cases operated at a tertiary academic institution between September 2010 and October 2011. In all these cases a standard open exploration of the thigh—considered the gold standard—was performed immediately after the endoscopic exploration. Data retrieved included surgical findings, demographics, and outcomes.

Results

There were 16 males and 7 females with a mean age of 55 (23‐83). The most common defect location was cutaneous n = 7 (30.4%) and oral cavity in n = 6 (26.1%). Average operative time for VAT was 25.4 minutes (9‐47). On standard exploration there were 53 total perforators identified; 49 of these were successfully identified endoscopically. Findings were discordant in 4 cases (17.4%), with the endoscopic technique missing 1 perforator in all of 4 of them. The sensitivity of VAT was 92.4% (CI, 80.9‐97.5) with a correlation coefficient of 0.91 with open exploration. All flaps survived, and there were no complications associated with the technique.

Conclusion

Video‐assisted exploration has a high sensitivity for identification of cutaneous perforators of the thigh. There is a high correlation between findings with this technique and a standard open approach. This minimally invasive technique could help minimize donor site morbidity in patients undergoing reconstruction with an ALT free flap.
Transnasal Endoscopic Approach to Sino‐orbital Lesions
Authors: Damaty Ahmed Hesham El , Badran Hatem
Published: February 2015

Objective

To present Cairo University experience in approaching sino‐orbital lesions endoscopically.

Method

Fifty‐one patients with sino‐orbital and medially placed orbital lesions admitted and operated endoscopically by a combined ENT and ophthalmology team were included in this study. Their preoperative and postoperative signs, symptoms, outcomes, and radiologic data as well as their operative details were collected and analyzed.

Results

Among those 51 patients the majority of cases were inflammatory (26 patients) followed by neoplasms (16 patients) mainly of sinuses extending to the orbit followed by thyroid orbitopathy (7 patients) and finally 2 traumatic cases. The final outcome was favorable as a whole, zero mortality, 1 unilateral loss of vision, and good control of pathology with only 11.8% recurrence rate (6 patients); 4 of them required reintervention. The mean follow‐up period was 12 months.

Conclusion

The transnasal endoscopic surgical technique for orbital and sino‐orbital lesions is a minimally invasive alternative to traditional invasive approaches for selected patients and can achieve favorable outcome with very low morbidity. More practice and time are required to increase our skills and experience to master this approach.
Acoustic Pharyngometry: A Substitute for Drug‐Induced Sleep Endoscopy?
Authors: Friedman Michael , Samuelson Christian G. , Hamilton Craig S.
Published: February 2015

Objective

Upper airway collapse measured using supine acoustic pharyngometry at respiratory residual volume (RV) has previously been correlated with obstructive sleep apnea‐hypopnea syndrome (OSAHS) severity. We aim to assess the agreement between sites of maximal upper airway obstruction measured by supine acoustic pharyngometry and drug‐induced sleep‐endoscopy (DISE) in snoring/OSAHS patients.

Method

In this case series, 50 consecutive patients with known snoring/OSAHS underwent in‐office supine acoustic pharyngometry and DISE. Pharyngometric measurements at respiratory tidal volume were compared against the standard normal curve to establish airway landmarks. Sites of minimal cross‐sectional‐area at respiratory RV were compared with sites of maximal obstruction identified through DISE.

Results

Fifty patients (68% male, 32% female, age 47.3 ± 13.7, mean AHI 37.0 ± 26.8) were evaluated. All endoscopic assessments were performed by a single investigator (M.F.). Regions of maximal upper airway collapse per DISE were classified as retropalatal, mixed retropalatal and retroglossal, retroglossal, mixed retroglossal and retroepiglottic, or retroepiglottic. Graphical and numerical pharyngometric data were assessed by 3 investigators with complete agreement regarding regional collapse. Agreement between sites of maximal upper airway obstruction per DISE and regions of minimal cross‐sectional‐area per supine pharyngometry was 89.2% (95% CI 74.5, 95.9; P <. 001).

Conclusion

Acoustic pharyngometry is a completely non‐invasive mode of assessment through which numerical and graphical data regarding regional upper airway collapse can be rapidly obtained. Findings demonstrate a high level of agreement with those of DISE in the pretreatment/preoperative evaluation of patients with known snoring and/or OSAHS.
Ambulatory Visits and Comorbidity in Obstructive Sleep Apnea
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: February 2015

Objective

1) Understand the epidemiology of obstructive sleep apnea (OSA) ambulatory office visits in the US. 2) Quantify and learn about the prevalence of comorbid illnesses that are likely to occur in the setting of OSA.

Method

From the 2008‐2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, adult cases with a diagnosis of OSA were extracted. The epidemiology of OSA was determined. The prevalence of comorbid priority illnesses (obesity, asthma, cerebrovascular disease, depression, hypertension, and ischemic heart disease) was also determined.

Results

There were an estimated 8.1 ± 2.4 million office visits with a diagnosis of OSA (60 ± 3.2% male; mean age, 56.4 ± 0.9 years). There were 389 ± 49 thousand visits to otolaryngologists for OSA. Comorbid illnesses were: obesity (23.8 ± 5.2%), asthma (14.3 ± 3.0%), cerebrovascular disease (2.5 ± 1.5%), depression (23.2 ± 2.6%), hypertension 53.8 ± 3.9%), and ischemic heart disease (10.3 ± 3.0%). Adjusting for age, sex, ethnicity, obesity and race, statistically significant increased odds for the presence of obesity (3.6, P <. 001), asthma (2.7, P <. 001), depression (2.5, P <. 001), and hypertension (2.0, P <. 001) with obstructive sleep apnea were noted. Increased odds for cerebrovascular disease and ischemic heart disease were not identified (P >. 083).

Conclusion

OSA is a common diagnosis in ambulatory and otolaryngologic care. It is associated with a significantly increased prevalence of several key priority healthcare conditions in the United States. Healthcare providers should be aware of these associations understanding the potentially broad impact of OSA on general health.
Extra‐Esophageal Reflux (EER) and Sleep Disorders
Authors: Laohasiriwong Supawan , Woodson B. Tucker , Johnston Nikki
Published: February 2015

Objective

GERD is associated with sleep disorders, but how other reflux related disorders affect sleep is unknown. This study’s goal is to evaluate the interaction of extra‐esophageal reflux (EER) using subjective and objective (salivary pepsin) measures and sleep disorders including insomnia, hypersomnia, and sleep disordered breathing (SDB).

Method

A prospective cohort of sleep and non‐sleep adult patients were evaluated for insomnia, hypersomnia, SDB, sleep quality of life, nasal symptoms, and EER using validated questionnaires (PSQI, ESS, STOP BANG, FOSQ10 RSI, NOSE). Simultaneous pharyngeal saliva samples obtained in clinic underwent Western blot immunoassay for pepsin.

Results

Prevalence of pepsin (+) and elevated Reflux Symptom Index (RSI) in 70 adult subjects (54 assay complete) was 26% and 46.3%, respectively. Significant heartburn symptoms were reported in 14.8%. Pepsin (+) was not associated with any measure of sleep or non‐sleep outcomes (P >. 05). In contrast, a significant correlation (P <. 001) was observed between RSI and insomnia (r = 0.47), sleep QOL (r = 0.45), and nasal symptoms (0.54) but not SDB (r = 0.03, ns). Nasal symptoms were strongly correlated with sleep disorders (r = 0.54, P <. 001).

Conclusion

Despite a low prevalence of GER in this population, a strong association between measures of EER and multiple measures of sleep quality as well as nasal obstruction was observed. Findings support that patient symptoms related to EER are associated with sleep disorders and sleep quality independent of GER.
Friedman and Mallampati Tongue Positions and Obstructive Sleep Apnea Severity
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G.
Published: February 2015

Objective

1) To assess the association between tongue position, classified by both Mallampati (MP) and Friedman Tongue Position (FTP) scales, and severity of sleep apnea (OSA) as determined by the apnea‐hypopnea index (AHI). 2) To determine which of these assessment methods is most closely correlated with OSA severity.

Method

PubMed, MEDLINE, and Cochrane Trial Registry through December 2011 were searched, combined with review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the association of tongue position and OSA severity were performed. Outcomes are reported as correlations.

Results

Ten studies met inclusion criteria and had data suitable for pooling (2515 patients). Overall, increasing tongue position (categorical variable) was significantly associated with increasing OSA severity (continuous variable of AHI) with a correlation of. 351 (95% CI. 094,. 564; P =. 008). Sensitivity analysis revealed correlations of. 184 (95%CI. 052,. 310; P =. 006) and. 388 (95% CI. 049,. 646; P =. 026) for MP and FTP, respectively. Analysis of publication bias revealed a nonsignificant Egger’s regression intercept; however, 4 imputed values to the right of the mean were found using Duval and Tweedie’s trim and fill method. Adding these values yielded an overall correlation of. 498 (95% CI. 474,. 521).

Conclusion

Both the MP and FTP assessment techniques are significantly correlated with OSA severity. Publication bias does not affect or skew our results. The strength of the correlation between AHI and tongue position is greater for FTP than for MP, though the 95% confidence intervals for their respective correlation coefficients overlap.
Mandibular Advancement for Obstructive Sleep Apnea: Relating Outcomes to Anatomy
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G.
Published: February 2015

Objective

Previous studies assessing the correlation between airway anatomic factors and success with oral appliance (OA) therapy in the treatment of obstructive sleep apnea (OSA) have failed to reach consensus. We aim to assess the role of regional upper airway obstruction measured by acoustic pharyngometry as a determinant of OA success.

Method

In this outpatient case‐series, data from OSA patients (100% CPAP‐failures) fitted with a custom OA between 07/2011‐01/2012 were reviewed. Regional maximal upper airway collapse was determined on acoustic pharyngometry and classified as retropalatal (RP), retroglossal (RG), or retroepiglottic (RE). Apnea‐hypopnea index (AHI) improvement on titration‐polysomnography was assessed against regional collapse.

Results

Seventy‐five patients (74.7% male, age 49.0 ± 13.6, BMI 29.4 ± 5.2, mean AHI 30.6 ± 20.0) were assessed and their data grouped on the basis of region of maximal collapse on pharyngometry at respiratory residual volume (RP = 29, RG = 28, RE = 18). Overall AHI reduction at OA‐titration was –20.2 (95% CI –23.6, –16.8; P <. 001) with no significant difference in AHI reduction between groups. There was no significant difference in the rate of response to treatment when defined as >50% AHI reduction plus AHI <20 (RP = 69%, RG = 75%, RE = 83%; P =. 545), or rate of cure defined as AHI <5 (RP = 52%, RG = 43%, RE = 72%; P =. 146). Correlation of minimum cross‐sectional‐area and response trended toward significance (r =. 202; –.026,. 410; P <. 1).

Conclusion

Success with oral appliance therapy is not predicted by identification of the region of maximal upper airway collapse as measured by acoustic pharyngometry. OA therapy achieves reasonable objective response and cure rates in patients with primary retropalatal, retroglossal, or retroepiglottic obstruction at the time of initial titration‐polysomnography.
OSA Diagnosis by Peripheral Arterial Tonometry
Authors: Friedman Michael , Samuelson Christian G. , Hamilton Craig S.
Published: February 2015

Objective

To assess the correlation between respiratory sleep indices as measured by portable sleep testing using peripheral arterial tonometry (PAT) and respiratory sleep indices as measured by formal polysomnography (PSG). Thereby assess the validity of PAT devices as diagnostic tools for obstructive sleep apnea in the adult population.

Method

PubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. Articles were assessed by 3 reviewers. Systematic review and meta‐analysis of studies assessing correlation of respiratory sleep indices between PAT devices and PSG in adults (>18 years) was conducted. Included studies provided an r value for correlation.

Results

Eleven studies met inclusion criteria and had data suitable for pooling (775 patients). Of these, 10 studies were “blinded” in that PAT and PSG were conducted simultaneously in either the home or laboratory setting. One study contained 2 trial phases for the same patient group (n = 21), 1 laboratory and 1 home‐based, which were analyzed separately. Overall correlation of respiratory sleep indices was high (r =. 867,. 836‐.892, P <. 001). Studies comparing respiratory disturbance index (RDI) had a combined r =. 854 (.823‐.880, P <. 001), and those comparing apnea‐hypopnea index (AHI) had a combined r =. 890 (.833‐.929, P <. 001). Analysis of publication bias revealed a nonsignificant Egger’s regression intercept.

Conclusion

Respiratory indices calculated using PAT‐based portable devices correlate well with those calculated from the scoring of formal PSG. The strength of this correlation is supported by the “blinded” nature of the majority of the included studies. This technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.