bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction models for postoperative uncontrolled chronic rhinosinusitis in daily practice
Authors: Tao Xiaoyao , Chen Fenghong , Sun Yueqi , Wu Shulian , Hong Haiyu , Shi Jianbo , Xu Rui 
Published: September 2018

Objectives/HypothesisThe European Position Paper on Rhinosinusitis and Nasal Polyps proposes an assessment of clinical control of chronic rhinosinusitis (CRS). However, there are limited data about the percentage of postoperative control, and no prediction models for uncontrolled CRS have been reported. The aim of the study was to develop prediction models for postoperative uncontrolled CRS.Study DesignRetrospective case series.MethodsPatients (n = 136) who had undergone endoscopic sinus surgery at least 1 year prior to the study were recruited to assess the clinical control. Risk factors were determined by logistic models and presented as odds ratio (OR) with a 95% confidence interval. Receiver operating characteristics curves were constructed to set the cutoff points and create predictive models.ResultsApproximately 47.8% of patients had controlled, 22.1% partially controlled, and 30.1% uncontrolled CRS. Univariate regression models revealed the risk factors for uncontrolled CRS: tissue eosinophilia, blood eosinophilia, high computed tomography (CT) score, bilateral disease, asthma, and allergic rhinitis. Multiple regression models found tissue eosinophil ratio >0.206 (OR: 12.96, P = .001) or blood eosinophil ratio >0.025 (OR: 4.56, P = .003), Lund‐Mackay (LM) score ≥ 15 (OR: 15.50, P < .001) and CT ethmoid (E) score ≥ maxillary (M) score (OR: 3.51, P = .037) were independent risk factors. We generated a pathological model (tissue eosinophil ratio and LM score) and a clinical model (blood eosinophil ratio, LM score and E ≥ M score) to categorize CRS into mild, moderate, and severe.ConclusionsThis research provides simplified and efficient prediction models for uncontrolled CRS. It may help otolaryngologists to predict the prognosis before surgery in daily practice.Level of Evidence2b Laryngoscope, 128:2673–2680, 2018
Perceptions of Electronic Health Records Within Otolaryngology Residents Compared to Practicing Otolaryngologists
Authors: Harrill Peter A. , Melon David E. , Seshul Merritt J. , Zanation Adam 
Published: September 2018

ObjectiveThis study investigated the perceived impact of electronic health records (EHR) on otolaryngology residents with regard to education, patient care, and workflow, and then compared the trends with those of practicing otolaryngologists.MethodsA descriptive, cross‐sectional survey was developed for each core study group: the otolaryngology resident group (ORG) and the practicing otolaryngologist group (POG). In total, 536 surveys were submitted: 33 from the ORG survey and 510 from the POG survey. Response rates were 51.5% and 21.3%, respectively.ResultsWithin the two study groups, ORG reported a predominately neutral response relating to the impact of EHR on experience compared with the POG, which reported far more negative responses. The most negative reported change in the ORG related to feeling more like a passive observer and scribe in terms of how EHR negatively impacted the role of resident. Within the POG group, the majority of negative responses were recorded on the impact of EHR on practice efficiency, practice overhead, and number of employees required to maintain practice function.ConclusionWith otolaryngologists making up 1.1% of the U.S. physician workforce in 2015, it is likely that software programing of EHR underrepresents the workflow needs of otolaryngologists at this time. Future studies investigating the impact of EHR on otolaryngology patient care and resident education are needed in the future.Laryngoscope, 128:2726–2731, 2018
Oropharyngeal Injury From Spontaneous Combustion of a Lithium‐ion Battery: A Case Report
Authors: Morse Justin , Tittman Sarah , Gelbard Alexander 
Published: September 2018

Lithium‐ion batteries have been used for more than 20 years, most recently to power handheld devices including cellphones and electronic nicotine‐delivery systems. They have garnered significant media attention due to thermal‐related injuries occurring after spontaneous combustion. Spontaneous combustion of a lithium‐ion battery occurs due to a process that is referred to as the thermal runaway effect. Here, we review the case of a 25‐year‐old female with severe oropharyngeal and upper aerodigestive thermal injuries after spontaneous combustion of a lithium‐ion battery in a flashlight. We discuss the associated management and provide a review of the literature detailing similar injuries.Laryngoscope, 129:45–48, 2019
Wound healing after transoral angiolytic laser surgery for early glottic carcinoma
Authors: Tracy Lauren F. , Hron Tiffiny A. , Van Stan Jarrad H. , Burns James A. 
Published: September 2018

Objectives/HypothesisWound healing after transoral angiolytic laser surgery for early glottic carcinoma was analyzed to identify factors influencing healing and clinical significance of persistent granulation tissue.Study DesignRetrospective review.MethodsA retrospective review of 100 consecutive patients undergoing endoscopic angiolytic laser surgery for T1 and T2 glottic carcinoma was performed. Patients with prior radiation or incomplete data were excluded. Postoperative endoscopic images were analyzed for time to healing, size and location of wound, and presence of granulation tissue. Three blinded, independent raters graded wound appearance and presence of granulation tissue.ResultsSeventy‐nine patients healed without need for intervention at a median of 3.5 months. Two patients had office‐based ablation of granulation without biopsy and healed. The remaining 19 patients had biopsy for granulation tissue. Wounds that underwent biopsy at >3 months were more likely to contain carcinoma (5/6 patients, 83%) than wounds that were biopsied <3 months (2/13 patients, 15%) (P = .004). Presence of granulation significantly correlated with resection involving anterior commissure (P = .01), > 75%vocal fold length (P = .006), and depth into muscle (P = .001). Delayed healing (>3 months) correlated with T2b tumors (P = .02), depth into ligament (P = .002) and anterior commissure involvement (P = .04). T1a carcinomas more commonly healed in <3 months (P = .005).ConclusionsMany vocal fold wounds heal completely within 3.5 months after angiolytic laser surgery for early glottic carcinoma. Larger and deeper wounds are more likely to heal with granulation tissue. Granulation can resolve without surgical intervention; however, granulation present > 3 months warrants biopsy due to increased risk of malignancy.Level of Evidence4 Laryngoscope, 129:435–440, 2019
The Effect of Sedating Agents on Drug‐Induced Sleep Endoscopy Findings
Authors: Viana Alonço , Zhao Chen , Rosa Talita , Couto Arnaldo , Neves Denise Duprat , Araújo‐Melo Maria Helena , Capasso Robson 
Published: September 2018

ObjectiveDrug‐induced sleep endoscopy (DISE) has gained interest for upper airway evaluation in patients with snoring and obstructive sleep apnea (OSA), and different drugs have been used to induce sedation. Nevertheless, all drugs have presented specific advantages and disadvantages with differential effects on respiratory physiology. This study evaluated and compared the effects of midazolam, propofol and dexmedetomidine on DISE findings, O2 nadir, and bispectral index (BIS) in the same sample of patients.Study DesignCase series prospective study.MethodsConsecutive patients who elected to undergo surgery for OSA treatment and were intolerant to conservative therapies underwent DISE with propofol, dexmedetomidine, and midazolam between July 2015 and July 2016.ResultsFifty‐two patients were analyzed, and 43 (82.7%) were men. Agreement among drugs for both degree and patterns of obstruction was excellent at all sites (velum, oropharynx, and epiglottis) except for the tongue base. Dexmedetomidine had the least complete collapse sites and highest O2 nadir and was the only drug for which apnea severity and obstruction levels (upper, lower, or combined) were correlated. The variability among drug treatments for the BIS index was considerable, and propofol had the lowest variability and average value.ConclusionDrug selection had a relevant influence in DISE findings. Compared with dexmedetomidine, midazolam and propofol presented higher incidence of tongue base collapse, lower O2 levels, and lower BIS index values. Propofol resulted in an O2 nadir that most resembled that observed during polysomnography. The BIS index variability differed among drugs, and its use was considered relevant for sedation orientation.Level of Evidence4 Laryngoscope, 129:506–513, 2019
Clinical and Economic Impact of Time From Admission for CSF Rhinorrhea to Surgical Repair
Authors: Villwock Jennifer A. , Villwock Mark R. , Deshaies Eric M. , Goyal Parul 
Published: September 2018

BackgroundIf conservative management of CSF leak is unsuccessful, surgical repair is indicated for the prevention of severe complications such as meningitis. This study investigated the influence of surgical timing on clinical and economic outcomes.MethodsRetrospective review of the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2002–2011) for nonelective admissions with a principal diagnosis of CSF rhinorrhea treated with surgical repair of the meninges. Demographics and outcomes of patients undergoing meningeal repair for CSF rhinorrhea were analyzed. Cases were classified into four groups based on timing of surgical intervention: 1) performed on the day of admission (day 0), 2) performed between days 1 and 3, 3) performed between days 4 and 7, and 4) performed between days 8 and 14.ResultsA total of 1,088 emergent admissions were analyzed. On average, patients underwent surgical repair between the second and fourth day of admission. Lowest rates of meningitis were in patients treated on the day of admission (6.1%); those treated at 2 weeks had a 34.7% incidence. Multivariate analysis controlling for comorbidity burden, gender, and surgical timing found the highest odds of meningitis in patients treated with surgical repair during the second week of admission compared to repair on the day of admission (OR 8.2, P < .001). Length of stay (LOS) and hospital costs increased as time to repair increased.ConclusionMultiple factors influence outcomes in patients with CSF rhinorrhea. Early surgical repair was significantly associated with decreased rates of meningitis, LOS, and hospital costs. Expedient treatment of patients admitted for CSF rhinorrhea may prove to be both a cost‐ and morbidity‐saving measure.Level of Evidence2C Laryngoscope, 129:539–543, 2019
A Population‐Based Analysis of Nodal Metastases in Esthesioneuroblastomas of the Sinonasal Tract
Authors: Kuan Edward C. , Nasser Hassan B. , Carey Ryan M. , Workman Alan D. , Alonso Jose E. , Wang Marilene B. , John Maie A. St. , Palmer James N. , Adappa Nithin D. , Tajudeen Bobby A. 
Published: September 2018

ObjectiveEsthesioneuroblastoma is an uncommon malignancy of the sinonasal tract arising from the olfactory epithelium. Surgical management of the primary site, often via an endoscopic approach, with or without adjuvant radiation, is often curative. There is growing but ultimately limited data regarding management of the neck and the risk of nodal metastases. In this study, we examine the incidence and patterns of esthesioneuroblastoma‐related cervical nodal metastases using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThe SEER registry was queried for all patients with esthesioneuroblastomas diagnosed between 1973 and 2012. Patient data was then analyzed with respect to age, sex, race, modified Kadish stage, grade, survival functions, and nodal disease including specific nodal basins.ResultsThree hundred and eighty‐one cases of esthesioneuroblastoma with information on nodal metastases were identified. The overall cervical nodal metastasis rate was 8.7%. Level II metastases were most common (6.6%). A total of 4.5% of cases presented with multiple positive nodal basins. Male sex (P = 0.009) and higher tumor grade (P = 0.009) correlated with the presence of level II metastases. There was no association of primary tumor site to the presence of nodal metastases (P > 0.05). The presence of nodal disease significantly predicted poorer overall (P = 0.001) and disease‐specific survival (P = 0.017).ConclusionThe incidence of nodal metastases in esthesioneuroblastoma at diagnosis is rare, and elective management of the neck remains controversial. Primary tumor site does not appear to predict metastases at specific nodal basins. Higher tumor grade may be a harbinger of eventual nodal metastases.Level of EvidenceNA Laryngoscope, 129:1025–1029, 2019
Disparities in Postoperative Therapy for Salivary Gland Adenoid Cystic Carcinomas
Authors: Cassidy Richard J. , Switchenko Jeffrey M. , El‐Deiry Mark W. , Belcher Ryan H. , Zhong Jim , Steuer Conor E. , Saba Nabil F. , McDonald Mark W. , Yu David S. , Gillespie Theresa W. , Beitler Jonathan J. 
Published: September 2018

ObjectivesThe patterns of care for salivary gland adenoid cystic carcinomas (ACC) are unknown. We sought to assess predictors of receiving postoperative radiation and/or chemotherapy for patients with nonmetastatic, definitively resected ACC, as well as report unexpected nodal disease.MethodsThe National Cancer Data Base was queried for definitively resected nonmetastatic ACC from 2004 to 2014. Logistic regression, Kaplan‐Meier, and Cox proportional‐hazard models were utilized. Propensity‐score matched analysis was employed to reduce confounding variables.ResultsA total of 3,136 patients met entry criteria: 2,252 (71.8%) received postoperative radiation, with 223 (7.4%) also receiving concurrent chemotherapy. Median follow‐up was 4.87 years. In clinically lymph node negative (cN0) patients, 7.4% had pathologically positive lymph nodes (pN) + after elective neck dissection. Patients who lived closer to their treatment facility and had positive margins were more likely to receive postoperative radiation. Black patients and uninsured patients were less likely to receive radiation. Older age, male sex, advancing stage, and positive surgical margins were associated with worse overall survival (OS). With limited follow‐up, receipt of radiation or chemotherapy was not associated with OS.ConclusionPostoperative radiation was frequently given for resected ACC, with a minority receiving chemotherapy. Black patients and uninsured patients were less likely to receive radiation. Postoperative radiation and/or chemotherapy had no association with OS but were given in greater frequency in more advanced disease, and our series is limited by short follow‐up. The disparity findings for this rare disease need to be addressed in future studies.Level of Evidence2c Laryngoscope, 129:377–386, 2019
Snoring and carotid artery disease: A new risk factor emerges
Authors: Deeb Robert , Smeds Matthew R. , Bath Jonathan , Peterson Edward , Roberts Matthew , Beckman Nanette , Lin Judith C. , Yaremchuk Kathleen 
Published: September 2018

Objectives/HypothesisPrevious studies have identified a relationship between snoring, carotid intima media thickening, and the presence of atherosclerosis. This study examines the correlation between snoring and carotid artery disease through use of duplex ultrasound identifying greater than 50% internal carotid artery stenosis.Study DesignProspective cohort study.MethodsPatients presenting to three academic vascular laboratories for carotid duplex examination completed the following surveys: demographic information, assessment of risk factors for carotid stenosis, assessment of history of obstructive sleep apnea, or continuous positive airway pressure use and Snoring Outcomes Survey. Patients were categorized into 2 groups based on the presence or absence of carotid disease. Data were analyzed by univariate contingency tables and logistic regression analysis.ResultsFive hundred one patients completed the survey, of whom 243/501 (49%) had evidence of carotid occlusive disease. On univariate analysis, smoking, hypertension, heart disease, hypercholesterolemia, diabetes, and stroke all correlated with greater than 50% carotid stenosis. Multivariate analysis indicated that snorers were significantly more likely to have carotid disease. Three hundred twenty‐seven participants were thought to have primary snoring. On univariate analysis, snorers were found to be significantly more likely to have carotid disease. After adjustment for covariates, snoring was not significant for carotid disease. However, multivariate analysis showed snorers to be significantly more likely to have bilateral carotid disease.ConclusionsThis study shows a potential relationship between snoring and bilateral carotid artery stenosis greater than 50%; snorers have risk of carotid stenosis twice that of nonsnorers. Further investigation is warranted to better elucidate this relationship.Level of Evidence2b Laryngoscope, 129:265–268, 2019
Social isolation alters ultrasonic vocalizations but not thyroarytenoid neuromuscular junctions in old rats
Authors: Johnson Aaron M. 
Published: September 2018

ObjectiveAge‐related muscle atrophy of the laryngeal muscles contributes to presbyphonia. Remodeling of the neuromuscular junction is one aspect underlying age‐related muscle atrophy. Although muscle disuse has been shown to exacerbate age‐related neuromuscular changes in the limb muscles, it is unknown if reduced vocal use has a similar effect in the laryngeal muscles. The objective of this study was to examine the use of social isolation as a novel method to reduce vocal use in old rats—and the impact of that reduced vocal use on ultrasonic vocalization acoustics and neuromuscular junction morphology in the thyroarytenoid muscle.Study DesignAnimal group comparison.MethodsOld F344/BN rats (31 months of age) were socially isolated (n = 8) or communally housed (n = 8) for 8 weeks. Effect of housing condition on ultrasonic vocalization acoustics was assessed by calculating the changes in vocalization fundamental frequency and amplitude from baseline to 8 weeks. Neuromuscular junction morphology was measured in the lateral and medial portions of the thyroarytenoid muscle at the conclusion of the experiment.ResultsVocalization amplitude decreased by a mean of −4.4 dB (standard deviation [SD], 4.49) after social isolation, whereas amplitude increased by a mean of 5.7 dB (SD, 5.07) in the communally housed rats (P = 0.002). There was no significant difference in the change in fundamental frequency between groups. Furthermore, there were no group differences in any measure of neuromuscular junction morphology.ConclusionThese results suggest that neuromuscular junctions in the thyroarytenoid muscle of old rats are unaffected by 8 weeks of social isolation, despite functional changes in vocalizations.Level of EvidenceNA Laryngoscope, 129:E9–E14, 2019
Does Medical Therapy Improve SinoNasal Outcomes Test–22 Domain Scores? An Analysis of Clinically Important Differences
Authors: Chowdhury Naweed I. , Mace Jess C. , Bodner Todd E. , Alt Jeremiah A. , Deconde Adam S. , Levy Joshua M. , Smith Timothy L. 
Published: September 2018

Objectives/HypothesisMinimum clinically important differences (MCIDs) for the 22‐item SinoNasal Outcomes Test (SNOT‐22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS.Study DesignProspective observational cohort study.MethodsOne hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT‐22 survey responses were collected. Four distribution‐based methods for calculating MCIDs (e.g., half‐standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT‐22 total and domain scores.ResultsThe average MCID value for SNOT‐22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT‐22 total scores following CAMT exceeded the MCID, none of the average SNOT‐22 domain score improvements surpassed their respective MCID thresholds.ConclusionsMCID values for SNOT‐22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT‐22 domain scores.Level of Evidence2c Laryngoscope, 129:31–36, 2019
Granulomas of the membranous vocal fold after intubation and other airway instrumentation
Authors: Sadoughi Babak , Rickert Scott M. , Sulica Lucian 
Published: September 2018

Objectives/HypothesisWe describe the clinical features of granulomas of the membranous vocal fold secondary to endotracheal intubation, bronchoscopy or esophagogastroduodenoscopy.Study DesignRetrospective case series.MethodsReview of cases at a single tertiary institution with evaluation of patient demographic characteristics, time to presentation, time to treatment, and clinical outcomes.ResultsThirteen adult patients were identified with postintervention granuloma of the membranous vocal fold. All patients were female, with a mean age of 60 years (range, 28–81 years). None noted hoarseness prior to the intervention, and all noted significant hoarseness postoperatively. Conservative treatment with proton pump inhibitors and vocal rest was initially implemented in all patients. Four cases resolved without further intervention. Nine underwent surgical management because of airway symptoms, failure to improve, or patient request. One patient had injury to the contralateral vocal fold upon intubation. None experienced recurrence. Five had complete recovery of voice postoperatively, four did not.ConclusionIatrogenic granulomas of the membranous vocal fold after intubation or other upper airway instrumentation are rare complications presenting in the early postprocedure period with worsening hoarseness. Initial conservative treatment may be sufficient to yield resolution, and surgical treatment is effective for those failing medical management. Permanent voice damage may result from the original injury.Level of Evidence4 Laryngoscope, 129:441–447, 2019