bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local and Systemic Administration of Corticosteroids in the Treatment of Olfactory Loss
Authors: Heilmann Stefan , Huettenbrink Karl-Bernd , Hummel Thomas 
Published: August 2018

Background The aim of this study was to evaluate the benefit of patients with olfactory dysfunction from local (group A) or systemic (group B) administration of corticosteroids. Methods This unblinded study was conducted at a smell and taste outpatient clinic of an institutional referral center. Patients with olfactory loss after infections of the upper respiratory tract, patients with apparent sinonasal disease, and patients suffering from “idiopathic” smell loss were included. Effects of mometasone nasal spray, administered for 1–3 months, were studied in 37 patients. In addition, effects of oral prednisolone were analyzed in 55 patients who received decreasing doses over 21 days, starting with a dose of 40 mg. Olfactory function before and after treatment was measured. Results Although odor identification scores tended to increase (p = 0.05), mometasone nasal spray did not significantly improve olfactory function, when looking at the entire group of patients or when analyzing the three diagnostic categories separately. In contrast, after systemic administration of corticosteroids, improvement of olfactory function was seen over all diagnostic categories (p < 0.001). Interestingly, olfactory function also improved in patients diagnosed with olfactory loss after upper respiratory tract infection (p = 0.05) and in patients initially diagnosed with “idiopathic” olfactory dysfunction (p = 0.008). Conclusion In many patients, local application of corticosteroids appears to have little or no positive effect on olfactory dysfunction, especially when considering long-term changes. Duration of disease, the patient's age/sex, or the presence of parosmia does not appear to predict the response to therapy with corticosteroids.
The Low Skull Base: An Invitation to Disaster
Authors: Stankiewicz James A. , Chow James M. 
Published: August 2018

Background Knowledge of anatomy including variations observed with endoscopy or computerized tomography scan is vital to the performance of safe endoscopic sinus surgery. The lower-than-normal skull base/cribriform plate is an anatomic variation, which if not noted preoperatively, can lead to entrance into the brain causing major injury. Methods Four case studies of chronic rhinosinusitis are reviewed in which either the whole anterior skull base or the cribriform plate is lower than usual and major complications occurred. Results All four cases had unilateral or bilateral entrance into the skull base/cribriform plate of the brain in the biopsy specimen, postoperative cerebrospinal fluid leak, and/or brain hemorrhage. One patient died from the injury, three patients had marked neurological sequelae. The low skull base and its meaning for the surgeon is discussed at length. Conclusion The preoperative anatomy as determined by endoscopy and computerized tomography scanning has to be identified. Variations or abnormalities should be noted and taken into consideration for preoperative and operative planning. Failure to note skull base or cribriform anatomy variations may lead to brain entrance, injury, and death.
Nasal Dyspnea: The Place of Rhinomanometry in its Objective Assessment
Authors: Schumacher Michael J. 
Published: August 2018

Background “Nasal dyspnea” describes the common symptom of nasal airway obstruction, which usually is assessed subjectively. Objective, quantitative methods are needed to assess the nasal airway adequately. Methods Rhinomanometry, in use for >30 years, was reviewed. Results No other symptom of rhinitis can be measured as objectively and accurately as that of nasal obstruction. Determinations by rhinomanometry are precise, usually better than 5%. Most rhinomanometers meet the published requirements of standardization by the International Rhinologic Society. An improved system for scoring symptoms of nasal dyspnea is suggested. Rhinomanometry, potentially a gold standard for the objective measurement of obstructed nasal airflow, has a proven place in the selection of patients for septal and nasal valve reconstruction. Conclusion Recommendations are given for extension of the standards to account for the near universal computerization of equipment. Miniaturization of equipment will increase its application to trials of drugs for rhinitis.
Nasal Pyriform Aperture Stenosis in Adults
Authors: Erdem Tamer , Ozturan Orhan , Erdem Gulnur , Akarcay Mustafa , Miman Murat Cem 
Published: August 2018

Background Congenital nasal pyriform aperture stenosis (CNPAS) leading to respiratory insufficiency in infants has been well documented. Nevertheless, the nasal pyriform aperture stenosis (NPAS) entity in adulthood has not been discussed at all. The normative data of the width of the pyriform aperture, which has not been revealed before, is necessary for evaluation of the adult subjects with nasal bony inlet stenosis. The aim of this study was to define the normative data about the pyriform aperture width measured in 80 adult subjects with paranasal sinus symptoms without nasal obstruction and, additionally, to report the surgical results of two representative cases with NPAS. Methods The nasal bony inlet width measurements have been achieved in axial computerized tomographic sections to establish normative data. The maximal distance between the nasal processes of the opposite maxillary bones was measured. Two adult males complaining of nasal obstruction with overt pyriform aperture stenosis were treated surgically via a sublabial approach. Results The mean widest dimension of the nasal pyriform aperture was 21.6 6 2.2 mm (range, 17–27 mm) in 80 adult subjects. This width was 21.9 6 2.1 mm (range 18–27 mm) in men and 21 6 2.2 mm (range, 17–26 mm) in women. Stenotic pyriform apertures in two patients were widened surgically by drilling via a sublabial approach from 12 and 10 mm to 24 and 21 mm, respectively. Conclusion NPAS should be included in the list of differential diagnosis for nasal obstruction. Surgical enlargement using a sublabial approach was found an effective and adequate treatment in pyriform aperture stenosis.
Inflammation and the Pathogenesis of Inverted Papilloma
Authors: Roh Hwan-Jung , Procop Gary W. , Batra Pete S. , Citardi Martin J. , Lanza Donald C. 
Published: August 2018

Background Despite existing clinical and histopathological evidence, the role of inflammation in the pathogenesis of inverted papilloma (IP) is not well understood. The goal of this study was to describe the inflammatory cell component present in sinonasal papilloma (SP), with the intention of further defining the existence of inflammation in IP and perhaps gaining insight into IP pathophysiology. Methods Computerized database analysis was performed to identify all patients with SP who underwent surgery at the Cleveland Clinic Foundation between 1995 and 2001. Histopathological features of all SP were reviewed and semiquantitative analysis of the inflammatory cells present was performed. IP was histopathologically graded into four categories by the extent of inflammatory infiltrate and cellular atypia. Statistical analysis of the inflammatory cell component present in the epithelial layer of exophytic papilloma and IP was performed. Results SP was classified into three types: cylindrical papilloma (5% [2/41]), exophytic squamous papilloma (34% [14/41]), and IP (61% [25/41]). Twenty-eight instances of IP in 25 patients were identified. Altogether, 11% were grade I (3/28), 54% were grade II (15/28), 25% were grade III (7/28), and 11% were grade IV (3/28). The inflammatory cell population was significantly greater in IP compared with other SPs and greater in grades I and II IP when compared with grade III and IV IP. Conclusion Inflammatory cells were identified as a significant cell population in IP, whereas it was less commonly encountered in other forms of SP. The proposed IP staging system may serve as the foundation for improved understanding of IP and, ultimately, may help to predict recurrence or apparent malignant transformation.
Management of the Lateral Frontal Sinus Lesion and the Supraorbital Cell Mucocele
Authors: Chiu Alexander G. , Vaughan Winston C. 
Published: August 2018

Background Masses that radiographically appear in the lateral aspect of the frontal sinus can be difficult to access and often are approached through external approaches. Supraorbital ethmoid cells pneumatize the orbital plate of the ethmoid bone to lie posterior and lateral to the frontal sinus. Opacification of a supraorbital cell may radiographically give the appearance of a laterally based frontal sinus lesion. Often, these represent mucoceles, in which their drainage can be achieved through endoscopic techniques and without the need for an external approach. Methods Retrospective review of patients treated for lateral frontal sinus lesions at a tertiary sinus center was performed. Radiology, endoscopic findings, operative reports, and patient symptoms were reviewed. Results Ten patients were identified with lateral frontal sinus lesions based on radiography of the paranasal sinuses and nasal endoscopy. All patients were determined to be supraorbital mucoceles. These patients underwent surgical drainage using computer-aided endoscopic techniques. Initially, endoscopic drainage of the mucocele was successful in all patients. One patient was lost to follow-up after 3 months and one patient underwent a revision endoscopic surgery with trephination 5 months after the initial drainage. The remaining eight patients remain free of disease by nasal endoscopy and postoperative computed tomography scans (median follow-up of 25 months; range, 8–38 months). Conclusion Knowledge of the anatomy of the ethmoid complex and presence of various cells within the frontal recess such as supraorbital cells are important in the management of the laterally based frontal sinus lesion. Often, these lesions may represent supraorbital cell mucoceles amenable to endoscopic drainage. Given the nature of mucoceles, long-term follow-up is needed before endoscopic drainage of these lesions can be validated. However, preliminary data suggest that an endoscopic approach provides for adequate drainage and helps avoid external approaches.
Learning Curves, Acquisition, and Retention of Skills Trained with the Endoscopic Sinus Surgery Simulator
Authors: Uribe S. Jose I. , Ralph Walter M. , Glaser Aylon Y. , Fried Marvin P. 
Published: August 2018

Background As an initial step in evaluating the effectiveness of training otolaryngology residents on an endoscopic sinus surgery simulator (ES3), we have assessed the ability of the ES3 to train persons inexperienced in sinus surgery (medical students) to perform certain simulated procedural tasks needed in endoscopic sinus surgery (ESS). Methods A total of 26 medical students were enrolled and trained on the ES3 following a preset protocol in the three levels of difficulty and complexity (novice, intermediate, and advanced modes). Results In the novice mode (three-dimensional abstract images are used to teach the use of endoscopic surgical equipment), medical students displayed a steep learning curve within three to five trials on the simulator and after an additional four to five trials, they reached a plateau in their learning curves to within 90% of that of experienced sinus surgeons. In the intermediate mode (ESS is performed on a simulated patient with teaching aids), medical students were able to reach a plateau in their learning curves to within 80% of that of experienced surgeons. This performance was sustained in the advanced mode (simulated sinus surgery without teaching aids). We observed that medical students, who had novice or intermediate mode training interrupted with an interval of 11–60 days, were able to resume their training without deviation from their prior learning curves. Conclusion Intensive, proctored training on the ES3 can train inexperienced persons to perform simulated ESS within a reasonable approximation of the performance of experienced sinus surgeons on the ES3 and the training that an inexperienced person receives on the simulator is not short term but is retained over a period of at least 2 months.
An Endoscopic Study of the Greater Palatine Nerve
Authors: Mellema Jonathan W. , Tami Thomas A. 
Published: August 2018

Background Using an endoscopic approach, lateral sphenoid air cells and terminal branches of the internal maxillary artery often can be accessed through the pterygomaxillary fossa; however, injury to the greater palatine nerve (GPN) can occur if the anatomy of this region is not understood clearly. This study was undertaken to define the pathway of the GPN and to identify landmarks useful in preventing its injury. Methods Six cadaveric heads were used to endoscopically dissect and examine 11 pterygomaxillary fossae. An additional latex-injected cadaveric head was sectioned coronally and dissected bilaterally. The relationships between the vascular, neurological and bony structures and foramena were noted and described. Results All specimens studied maintained consistent relationships. The sphenopalatine and posterior nasal arteries cross nearly perpendicular and just superficial to the GPN. The GPN traveled anteriorly and inferiorly to reach the greater palatine foramen. The lateral wall of the canal ranged from a thin bony covering to complete dehiscence and was thinnest as it crossed the inferior turbinate and approached the foramen. The foramen rotundum was located lateral and superior to the sphenopalatine foramen near the roof of the maxillary sinus. Conclusion When surgically approaching the pterygomaxillary fossa, injury to the GPN is avoidable by thorough knowledge of anatomy and awareness of the described landmarks.
A Preliminary Report on the Effects of Paclitaxel-Impregnated Stents on Sheep Nasal Mucosa
Authors: Herrmann Brian W. , Citardi Martin J. , Vogler George , Gardner Laura , Smith Greg , Javer Amin R. , Burt Helen M. , Jackson John , Kuhn Frederick A. 
Published: August 2018

Introduction Traditional frontal sinus stents serve only as mechanical devices. It has been proposed that stents also may serve as drug-delivery systems for the topical application of drugs that minimize postoperative scarring. Paclitaxel (Taxol), which has recognized antiscarring effects, may be incorporated via a polymeric formulation into standard rubber stents. The impact of topically applied paclitaxel on the morphology of the nasal mucosa is unknown. Methods An adult sheep model was used for this study. A modified rubber T-tube stent (incorporating paclitaxel at varying dosages) was secured to each side of the septum in four animals (eight sides). An unmodified T-tube was placed on each side of one animal, a T-tube with the drug carrier (but no paclitaxel) was placed on each side of the second animal, and T-tubes with varying paclitaxel were placed on each side of the final two animals. After 4 weeks, animals were killed and the nasal mucosa was harvested. The nasal mucosa was sectioned and stained with hematoxylin and eosin. A pathologist then assessed the nasal mucosa for vascular congestion, glandular atrophy, chronic inflammation, mucosal metaplasia, and mucosal ulceration. Results No consistent histopathological differences were noted in the specimens. All specimens showed varying degrees of vascular congestion, glandular atrophy, chronic inflammation, and mucosal metaplasia; the paclitaxel-impregnated stents were not consistently associated with more severe mucosal injury. Finally, mucosal ulceration was noted to be very rare in all specimens. Conclusion This preliminary report describes the impact of paclitaxel-impregnated stents on sheep nasal mucosa, which tolerated these stents very well. Because paclitaxel minimizes scarring reactions at very low concentrations, paclitaxel-impregnated stents may prove useful in clinical situations in which frontal sinus stenting is deemed necessary. Additional investigations with animal models, as well as clinical trials, may be warranted.
Long-Term Quality of Life Measures after Functional Endoscopic Sinus Surgery
Authors: Khalid Ayesha N. , Quraishi Sadeq A. , Kennedy David W. 
Published: August 2018

Background Chronic rhinosinusitis (CRS) is a common disease that has a significant impact on quality of life (QOL). The aim of this study was to evaluate the longer-term effects of combined medical and surgical therapy for CRS on overall health status and QOL. Methods We used a prospective study that utilized the Short-Form 36 Survey at baseline presentation and at a mean time of 3 years post-functional endoscopic sinus surgery to assess the general health status of patients who presented for their initial visit from 1996 to 1998. Of the 200 randomly selected patients, 150 respondents completed follow-up surveys (a 75% response rate). Results Eighty-nine (59.3%) women and 61 (40.7%) men were included in the study. Baseline QOL scores indicated significant differences between patients with CRS and published norms in 6/8 subscale parameters (role physical, bodily pain, general health, social function, vitality, and mental health). Significant improvement in all six categories was maintained at the end of the study period (p < 0.05) with QOL scores within limits of published norms for the general population. Conclusion Our data indicate that functional endoscopic sinus surgery, combined with appropriate postoperative care, is effective at maintaining a significant improvement in the overall general health status of patients for at least 3 years after surgical intervention and that the overall scores return to a range of normative values for the general population.
Anosmia after Intranasal Zinc Gluconate Use
Authors: Jafek Bruce W. , Linschoten Miriam R. , Murrow Bruce W. 
Published: August 2018

Background Zinc is an essential mineral. Beneficial zinc absorption takes place via enteral, parenteral, or cutaneous routes. However, direct application to the olfactory epithelium has been reported to cause loss of smell. Recently, intranasal zinc gluconate has been recommended as a treatment for the common cold. Severe posttreatment hyposmia and anosmia have been observed. Methods The case report of a typical patient is presented and analyzed in detail, followed by a series of patients with severe hyposmia or anosmia after the use of intranasal zinc gluconate. Results Although interindividual variation in drug response and drug effect is apparent, the severe hyposmia or anosmia appears to be long lasting or permanent in some cases. The mechanism of olfactory loss is thought to be the direct action of the divalent zinc ion on the olfactory receptor cell. Conclusions Zinc ions are toxic to olfactory epithelium. Reports of severe hyposmia with parosmia or anosmia have occurred after intranasal use of zinc gluconate.
Quantitative Computer-Aided Computed Tomography Analysis of Sphenoid Sinus Anatomical Relationships
Authors: Citardi Martin J. , Gallivan Ryan P. , Batra Pete S. , Maurer Calvin R. , Rohlfing Torsten , Roh Hwan-Jung , Lanza Donald C. 
Published: August 2018

Background This study describes a novel computer-generated anatomic symmetry plane as a framework for the quantitative description of sphenoid sinus anatomy. The aim of this study was to (1) determine relationships and distances between a midline sphenoid reference point (called the central sphenoid point [CSP]) and lateral sphenoid wall structures and (2) assess the incidence of anterior clinoid process (ACP) pneumatization and pterygoid recess (PR) pneumatization. Methods Axial computed tomography (CT) scans (1-mm slice thickness) were obtained on a VolumeZoom CT scanner (Siemens Medical, Erlangen, Germany). Mathematically derived anatomic symmetry planes were created using custom postprocessing software. A standardized review of each CT scan using surgical planning software (CBYON Suite version 2.6; CBYON, Mountain View, CA) was performed. The CSP was defined as a reference point in the midline sagittal plane at the intersection of the vertical sellar face and the horizontal sellar floor. Results A total of 128 sides in 64 cadaveric specimens were available for review. The incidences of ACP pneumatization and PR pneumatization were 23.4 and 37.5%. The mean distances from the CSP to the left optic canal midpoint, the left ACP entrance point, and the left PR lateral wall were 17.2, 15.6, and 27.6 mm, respectively. The corresponding distances from the CSP on the right side were 17.3, 15.8, and 28.0 mm, respectively. Measurements from the maxillary spine to the optic canal midpoint, ACP entrance point, and PR lateral wall on each side were performed also. Conclusion This approach provides both quantitative and qualitative understanding of sphenoid osteology and may be coupled with intraoperative surgical navigation to reduce the risks of sphenoid surgery. Both PR and ACP pneumatization are surprisingly common. Because the CSP-derived relationships may be referenced during endoscopic surgical navigation, they may provide greater clinical utility than traditional alternatives. This paradigm may facilitate a greater understanding of sphenoid anatomy and enhance surgical safety and precision.
Congenital Nasal Piriform Aperture Stenosis or Bony Inlet Stenosis: A Report of Three Cases
Authors: De Mot Peter , Hermans Robert , Jorissen Mark , Poorten Vander Vincent 
Published: August 2018

Background Congenital nasal piriform aperture stenosis is an uncommon disorder causing nasal obstruction in neonates. Findings on computed tomography (CT) greatly facilitate the diagnosis. Methods Three cases of congenital nasal piriform aperture stenosis are reported, with an emphasis on CT findings. Conclusions At birth, a diameter of the piriform aperture at the level of the inferior nasal meatus of ≥5 mm on CT may indicate a good chance of success using conservative treatment.
Possible Involvement of Nitric Oxide and Peroxynitrite in Nasal Polyposis
Authors: Kang Bor-Hwang , Huang Nan-Chieh , Wang Hsing-Won 
Published: August 2018

Background Nitric oxide (NO) is implicated in inflammation. Its role in the pathogenesis of nasal polyposis is not clear. Methods The expression of inducible NO synthase (iNOS), and the production of peroxynitrite represented by the formation of 3-nitrotyrosine (3-NT) were examined by immunohisto-chemistry in nasal polyps. The contents of superoxide dismutases (SODs) in nasal polyps and nasal mucosa were assessed by Western blot analyses. Results iNOS expression and 3-NT accumulation were noted in mucosal epithelium, vascular endothelium, and interstitial cells of nasal polyps. In comparison with our previous study on the nasal mucosa from patients with rhinitis, the stromal cells of the nasal polyp had higher labeling intensity for both iNOS and 3-NT. The polyp showed similar levels of CuZnSOD and MnSOD as those of nasal mucosa. Conclusions The iNOS/NO system may be important in the pathophysiology of nasal polyposis. The increased peroxynitrite may result from increased iNOS expression but is not related to decreased SODs.