bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome-Oriented Managed Care Comparing Efficacies of Cefaclor and Amoxicillin in Acute and Recurrent Acute Otitis Media
Authors: Perry Brian P. , Zieno Salvatore A. , Yonkers Anthony J. , Moore Gary F. 
Published: May 2019

A study utilizing outcome-oriented care is employed to show the effectiveness of a given medical treatment. A specific patient population is studied in order to determine the most effective treatment for a common clinical disorder. A total of 201 children were retrospectively studied to evaluate the efficacy and side effects of amoxicillin and cefaclor in the treatment of acute otitis media and recurrent acute otitis media. There were 456 episodes of acute otitis media; 245 episodes were treated with amoxicillin with an efficacy of 91%, while 211 episodes were treated with cefaclor with an efficacy of 97%. The dosage of 40mg/kg/day, divided in three equal doses, was employed for both antibiotics in the treatment of acute otitis media, while half of this amount was given once daily for the chemoprophylaxis of recurrent acute otitis media. In the 87 courses of chemoprophylaxis with cefaclor for recurrent otitis media, the efficacy was found to be 53%; while amoxicillin was found to be effective in 30% of the 33 patients studied. There were fewer side effects noted in the cefaclor group than in the amoxicillin group (4% vs. 12%). Both drugs caused diarrhea, while cefaclor also caused a mild maculopapular rash in two patients (1.67%). While amoxicillin remains the drug of choice for acute otitis media (AOM), this study suggests that cefaclor may be a better selection in the chemoprophylaxis of recurrent acute otitis media.
Asthma: An Important Disease to Otolaryngologists — Part I: Suspecting and Diagnosing Asthma
Authors: Gordon Bruce R. 
Published: May 2019

Asthma is a chronic inflammatory disease of the lower respiratory tract which is triggered by exposure to allergens or other airway irritants. This inflammation results in airway hyperresponsiveness, bronchial muscle spasm, mucous gland hypersecretion and mucosal edema, which combine to create symptoms such as cough, wheezing and respiratory distress. Because the inflammatory process is highly variable, asthma is a disorder with many possible presentations. It may therefore proceed for years without clinical recognition, and may challenge the most astute diagnostician. It is important for otolaryngologists to be able to suspect, diagnose and treat asthma. This is so because asthma is a common disease in the otolaryngologic patient population, both as one of the options in the differential diagnosis of respiratory complaints, and as a comorbid condition which may complicate the treatment of other medical or surgical problems. Furthermore, both the understanding of asthma's pathophysiology, and its optimum treatment methods have undergone radical changes during the past decade. This three-part discussion reviews our modern understanding of asthma, and proposes diagnosis and treatment guidelines which can assist otolaryngologists in effectively managing their asthmatic patients. Part one summarizes current information on the pathophysiology and increasing prevalence of asthma, its clinical variability, the assessment of asthma sensitivity, and methods for diagnosis of asthma. Parts two and three cover the strategy for asthma management, and the use of both adjunctive and anti-inflammatory therapies for asthma control.
Pseudotumor of Infancy — the Role of Ultrasonography
Authors: Maddalozzo John , Goldenberg John D. 
Published: May 2019

Pseudotumor of infancy (POI) occurs within the first month of life as a benign neck mass and affects 0.4% of all newborns. Differentiating these lesions from a malignancy or a congenital anomaly requiring surgical intervention can represent a diagnostic challenge for the clinician. While 80-90% of these masses resolve spontaneously within the first six months of life, there is still considerable time expended and cost incurred in the evaluation of POI. We have established and implemented a protocol for the evaluation of these patients consisting of a complete history and physical exam, ultrasonography and routine follow-up every four to six weeks. Seventeen patients were identified who had been evaluated and followed in the aforementioned manner. Two patients underwent diagnostic imaging studies prior to referral, consisting of magnetic resonance imaging (MRI) and computed tomography (CT). Ultrasonography appeared identical in 80% of the cases of POI with a heterogeneous pattern of internal echogenicity and a hypoechoic surrounding rim. The remaining ultrasound studies differed only subtly with regard to the internal echo pattern. There were no patients with pseudotumor of infancy in whom the ultrasound was normal. We concluded that a work-up including a history and physical exam and ultrasound is an accurate and cost-effective method for evaluating newborns with a neck mass, when suspicious for POI. Ultrasonography has a 100% sensitivity for the diagnosis of POI in this clinical scenario.
Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)
Authors: Silverstein Herbert , Choo Daniel , Rosenberg Seth I. , Kuhn Jeffery , Seidman Michael , Stein Ira 
Published: May 2019

Intratympanic instillation of Depo-Medrol® (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser-assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.
Errors in Otology
Authors: Kartush Jack M. 
Published: May 2019

Practicing medicine successfully requires that errors in diagnosis and treatment be minimized. Malpractice laws encourage litigators to ascribe all medical errors to incompetence and negligence. There are, however, many other causes of unintended outcomes. This article describes common causes of errors and suggests ways to minimize mistakes in otologic practice. Widespread dissemination of knowledge about common errors and their precursors can reduce the incidence of their occurrence. Consequently, laws should be passed to allow for a system of non-punitive, confidential reporting of errors and “near misses “ that can be shared by physicians nationwide.
Persistent Trigeminal Artery as a Cause of Dizziness
Authors: Battista Robert A. , Kwartler Jed A. , Martinez Daniel M. 
Published: May 2019

Complaints of vertigo and dizziness are common problems referred to otolaryngologists for evaluation. Awareness of uncommon causes of dizziness increases the physician's ability to diagnose and treat these patients. We present the case of a middle-aged woman who presented with episodes of vertigo and symptoms suggestive of vertebrobasilar insufficiency. These symptoms were the result of a persistent trigeminal artery (PTA) and occlusive carotid artery disease. A PTA is a carotid-basilar anastomosis that has been reported to be demonstrated on 0.1% to 0.6% of all cerebral angiograms. Persistence of this vessel usually leads to hypoplasia or agenesis of the ipsilateral posterior communicating artery, and leaves the internal carotid artery as the main source of blood supply to the region of the upper brainstem. The appearance and clinical significance of this unusual condition will be discussed.
A Bone-Anchored Percutaneous Connector System for Neural Prosthetic Applications
Authors: Downing M. , Johansson U. , Carlsson L. , Walliker J. R. , Spraggs P. D. R. , Dodson H. , Hochmair-Desoyer I. J. , Albrektsson T. 
Published: May 2019

A percutaneous connector system has been developed for use in neural prosthetic applications. It is based on a skin-penetrating, bone-anchored titanium pedestal, housing an 11-channel electrode array. Initial applications for the system are in audiology and, as such, the proposed fixture site is in the temporal bone. The titanium pedestal is based on existing design features of the EPI Bioglass® implant, developed by University College London (UCL), and the Brånemark System®, employed by Nobel Biocare AB. The electrode array, consisting of platinum wires in a silicone carrier, can be custom designed to suit the application. The design features of the connector system are reviewed. Animal studies have been used to assess soft tissue reactions and the osseointegration of the pedestal. The histological data are presented. The pedestal, electrode array and the mating external connector are currently undergoing mechanical and electrical testing. The percutaneous connector system will undergo clinical trials, initially in the study of tinnitus (employing stimulation via an extracochlear electrode), and as part of a cochlear implant system (using a multichannel intracochlear electrode array and digital signal processing techniques).
Pre- and Postoperative Mucociliary Clearance in Functional Endoscopic Sinus Surgery
Authors: Kaluskar Shashikant K. 
Published: May 2019

The advent of functional endoscopic sinus surgery (FESS) has revolutionized the treatment of chronic sinusitis over the last decade. Although it has been well-established that FESS is more efficacious than conventional surgery, the lack of a quantifiable means of assessing results remains one of the major shortcomings of the technique, and hence a source of criticism. Since the pathophysiology of chronic sinusitis is intimately related to the mucociliary mechanism of the nose and sinuses, it seems logical to use this parameter as a yardstick of success. We undertook a prospective, controlled study of 40 patients and measured their “saccharin times” before and after surgery. The results show a marked reduction in clearance times postoperatively, corresponding well with improvement in symptom profile. We therefore propose this technique as a simple, safe and reliable method of assessing the results of surgery. Furthermore, the method could act as a preoperative indicator of ciliary motility disorders, as the prognosis in these patients is distinctly poor.
Sarcoidosis with Nasal Obstruction and Septal Perforation
Authors: Baum Eric D. , Boudousquie Alan C. , Li Shiyong , Mirza Natasha 
Published: May 2019

Although sarcoidosis is predominantly a pulmonary disorder, it often produces disease in the head and neck. For this reason, otolaryngologists should be comfortable in evaluating and treating the disease. The diagnosis of sarcoidosis often can be made with a biopsy of conjunctival or oral mucosa, even when disease manifestations are not apparent in those parts of the body. In a case of sarcoidosis involving the nose, a 54-year-old black man had a pro life ration of small lumps on the tip of his nose. For many years, he had had daily epistaxis, anosmia and severe difficulty breathing through his nose. The bridge of his nose was deformed, and he had a large anterior septal perforation. Physical examination revealed palpable bilateral cervical lymphadenopathy. Laboratory test results were, for the most part, normal; however, fine-needle aspiration of one of the cervical lymph nodes showed multiple epithelioid granulomas with interspersed lymphocyte, and an incisional biopsy of the nasal tissue was highly suggestive of sarcoidosis. Unenhanced computed tomography also revealed widespread nasal inflammation and an abnormal soft tissue mass anterior to the maxilla consistent with chronic osteomyelitis. The patient's condition dramatically improved following treatment with oral prednisone; however, he considered undergoing reconstructive surgery for the noticeable nasal septal deformity.
Oral Candida albicans in Patients with Sjögren's Syndrome
Authors: Rhodus Nelson L. , Bloomquist Cynthia , Liljemark William , Bereuter Janna 
Published: May 2019

Candida species are common inhabitants of the oral cavity of patients with salivary gland dysfunction. The purpose of this study was to determine the prevalence and density of oral Candida albicans in patients with Sjögren's syndrome, to assess the infectious agent's oral manifestations and to compare the number of colony-forming units (CFU) of C. albicans in patients with primary (n=9) and secondary Sjögren's (n=18) with the whole unstimulated salivary flow rate in each group. An age- and sex-matched group of control subjects (n=14) was selected for comparison. An oropharyngeal collection of samples was taken from each subject and cultured. Quantitative cultures specific for C. albicans were obtained. The frequency distribution showed that more than 80% of all research subjects had positive results for C. albicans whereas the control subjects had no positive results. The most common lesion was erythematous candidiasis, followed by angular cheilitis. The Sjögren's subjects also demonstrated significantly higher numbers of C. albicans CFU than controls. Findings from this study demonstrate that patients with primary or secondary Sjögren's syndrome had significantly greater C. albicans colonization compared with the control population. C. albicans colonization was greater in primary Sjögren's patients than in secondary Sjögren's patients; however, the quantity of C. albicans found in each population was not universally relative to salivary flow.
Central Electrical Stimulation of the Auditory Pathway in Neurofibromatosis Type 2
Authors: Laszig Roland , Marangos Nicolas , Sollmann Wolf-Peter , Ramsden Richard T. 
Published: May 2019

The auditory brainstem implant (ABI) is a viable treatment option for patients with neurofibromatosis type 2 (NF2) whom either vestibular schwannomas or the surgery used to remove them has rendered totally deaf. This device stimulates the central auditory pathways in a manner similar to the cochlear implant in individuals with a total hearing loss. A multichannel model with transcutaneous signal transmission is in use experimentally in both the United States and Europe. Of 14 patients implanted with the ABI in a European pilot study, 13 received auditory sensations at initial tuning. Surgical implantation of the ABI is generally, but not always, performed at the same time as tumor removal, with the preferred route being the transmastoid-translabyrinthine approach. After insertion, monitoring of the device is required to optimize the location of its electrode on the cochlear nucleus complex.
Neurotologic Evaluation of Facial Nerve Paralysis Caused by Gunshot Wounds
Authors: Qiu William W. , Yin Shengguang S. , Pate William E. , Hardjasudarma M. , Stucker Fred J. 
Published: May 2019

Facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis—including direct injury, compression, fracture, and concussion of the temporal bone—were demonstrated by audiologic, radiologic, and surgical findings. Hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.
Initial Report of Primary Sinusitis caused by an Atypical Pathogen (Mycobacterium Chelonae) in an Immunocompetent Adult
Authors: Spring Paul M. , Miller Robert H. 
Published: May 2019

Primary sinonasal infections caused by atypical mycobacteria are rare. In fact, only four examples of a primary nontuberculous mycobacterial etiology of paranasal sinusitis have been cited in the literature. The patients in all these cases were infected with the human immunodeficiency virus and, by definition, they all had acquired immunodeficiency syndrome. We present a report of an immunocompetent adult with a history of chronic sinusitis who consistently and repeatedly manifested a fast-growing, nonpigmented, atypical mycobacterium of the Runyon group IV category: Mycobacterium chelonae. The patient was successfully treated over a 3-year period with a combination of antimicrobial agents, multiple limited endoscopic sinus surgeries, and eventually a total globe-sparing maxillectomy. At this time, the patient is disease-free and has received no further treatment. This case represents the first report of an immunocompetent adult host with a primary atypical mycobacterial infection of the paranasal sinuses. It also demonstrates the multimodal nature of the treatment of atypical mycobacterial infections. We also discuss the Byzantine classification scheme relative to atypical mycobacteria, the disease process in the immunocompromised host, and the various treatment options.
The Impact of Comorbidity and Age on Survival with Laryngeal Cancer
Authors: Sabin Steven L. , Rosenfeld Richard M. , Sundaram Krishnamurthi , Har-El Gady , Lucente Frank E. 
Published: May 2019

Previous studies have evaluated the effects of comorbidity on survival in patients with cancer. We applied the Charlson comorbidity index (CCI) to a cohort of patients with laryngeal cancer to validate its use and to assess the prognostic impact of age. Our study population consisted of 152 patients with laryngeal cancer who were seen over a 10-year period. Patients were assigned CCI scores and were categorized into low- and high-grade comorbidity groups for comparison. Age adjustments were performed by adding 1 point to the Charlson score for each decade over the median age. Low- vs. high-grade comorbidity was a valid predictor of survival independent of TNM (tumor, nodes, and metastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. High-grade comorbidity was present in 26 patients; their median survival was 8 months (p = 0.0002). The addition of the age factor to the CCI did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups. We conclude that the CCI is a strong predictor of survival inpatients with laryngeal cancer. The confounding effects of comorbidity should be considered in the TNM staging of laryngeal cancer to improve our prognostic ability. Further investigations are necessary to assess the validity of this index inpatients with other head and neck cancers.
The Use of ENT-Prescribed Home Sleep Studies for Patients with Suspected Obstructive Sleep Apnea
Authors: Davidson Terence M. , Do Katherine L. , Justus Susan 
Published: May 2019

Sleep disordered breathing, including obstructive sleep apnea, is a common and morbid health problem. Traditionally, sleep disordered breathing is diagnosed by complex sleep studies. However, newer, easy-to-use, highly sensitive, and highly specific home sleep study equipment is now available. The present study was undertaken to determine whether an otolaryngologist could easily and effectively dispense home sleep equipment from the office. We used a portable AutoSet home sleep machine. Our experience with the first 100 consecutively presenting patients was recorded and analyzed under institutional review board approval. Ninety-nine of the 100 tests were completed successfully on the first attempt; the one failure was successful on the second attempt. Our results were consistent with those reported from in-house polysomnogram sleep studies; 71 % of our patients had an apnea-hypopnea index (AH1) of 15 or higher, and 93% had an AHI of at least 5. We conclude that an otolaryngologist, using state-of-the-art home sleep testing equipment, can accurately and cost-effectively prescribe home sleep studies.
Safety of Endoscopic Sinus Surgery in a Residency Training Program
Authors: Nguyen Quoc A. , Cua David J. , Ng Matthew , Rice Dale H. 
Published: May 2019

Over the past decade, endoscopic sinus surgery has become one of the most frequently performed operations in otolaryngology. Nevertheless, concerns have been raised about the safety of this procedure in a residency training program. To address this issue, we carried out a retrospective review to assess the complications of endoscopic sinus surgery performed by otolaryngology residents under close supervision. We reviewed the medical records of 597 patients who had undergone 719 operations performed by residents in the Department of Otolaryngology–Head and Neck Surgery at the University of Southern California–Los Angeles County Medical Center and at the University Hospital between June 1988 and December 1995. Most of these procedures were performed by junior residents under the supervision of either a senior resident or faculty member. We found that the incidence of minor and major complications was 12.2 and 0.4%, respectively. The most common minor complications were vascular. The only major complication was excessive bleeding that required transfusion. There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. We conclude that endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.