bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Oxymetazoline on the Ventilation of Paranasal Sinuses in Healthy Subjects
Authors: Paulsson Bo , Lindberg Sven , Ohlin Per 
Published: August 2018

Background Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as α2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of α2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date. Methods In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects. Results No significant effect of oxymetazoline on sinus ventilation was seen in either group. Conclusions The results indicate that α2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.
Cystic Fibrosis in Rhinologic Practice
Authors: Krzeski Antoni , Kapiszewska-Dzedzej Dorota , Górski Norbert P. , Jakubczyk Iwona 
Published: August 2018

Background Cystic fibrosis (CF) is the most common genetic lethal disorder that affects white populations. Chronic rhinosinusitis (CRS) with extensive nasal polyposis is one of the manifestations of CF. Methods The aim of this study was to determine the prevalence and extent of CRS in CF patients. Results The study indicated that the signs and symptoms of CRS were present in all patients with CF and they were more advanced than in the control group. The most severe inflammatory changes in the paranasal sinuses were detected in patients with the dF508 gene mutation type who suffered from CRS for >3 years. Conclusions Massive nasal polyposis, dilated base of the nose, mucociliary clearance impairment, and significant radiological changes (frontal and maxillary sinus hypoplasia, bony destruction, and medial bulging of the lateral nasal wall) were identified to be the characteristic signs of the CRS in CF patients.
Skull Base Erosion by Sphenoid Fungus Balls: Diagnosis and Endoscopic Treatment
Authors: Schlosser Rodney J. , Gross Charles W. , Kountakis Stilianos 
Published: August 2018

Background Fungus balls typically are innocuous lesions found in immunocompetent hosts. They are located most commonly in the maxillary sinus but may be life-threatening when found in the sphenoid sinus. Methods We review our series of four sphenoid fungus balls with skull base erosion. Results Our average patient age was 68.7 years old (56–86 years) with three women and one man. One patient was insulin-dependent diabetic, the other three patients were otherwise healthy. The most common presenting symptoms were headache and dizziness with relatively few sinus-specific complaints. Endoscopy revealed polyps in two of the four patients. Computerized tomography scans revealed thickened osteitic bone in three cases and two of the four computed tomography scans showed microcalcification. All patients had bony erosion over the internal carotid arteries. Additionally, one patient internal carotid artery thrombosis, one patient had erosion of the planum sphenoidale, and a third patient had erosion to the brainstem inferior to the sella turcica. Three patients had magnetic resonance imaging that revealed heterogeneous lesions. Two magnetic resonance images showed hypointense T1 and T2 imaging. The third was isointense on T1 and hypointense on T2. All patients were treated with endoscopic marsupialization and removal of all gross fungal debris without complications. All pathological specimens were diagnostic for fungus balls. One of four cultures was positive for fungus. All patients are asymptomatic at time of last follow-up. Conclusions Sphenoid fungus balls present with vague, non-rhinological symptoms, but may have significant local expansion and destruction. These potentially lethal lesions usually can be suspected on preoperative imaging and are best treated with endoscopic removal.
Primary Paranasal Aspergillus Granuloma: Case Report and Review of the Literature
Authors: Currens John , Hutcheson Patricia S. , Slavin Raymond G. , Citardi Martin J. 
Published: August 2018

Background Primary paranasal aspergillus granuloma (PPAG) is a slowly progressive chronic infection of the sinus extending beyond the confines of the sinus. It has been reported only in patients from the Sudan and India. Microscopically, it differs from chronic invasive fungal sinusitis in that there are pseudotubercles containing giant cells, histiocytes, lymphocytes, plasma cells, newly formed capillaries, eosinophils, and Aspergillus fungal elements. Conclusion We describe the first case of PPAG in the United States in an immunocompetent nonatopic woman who had never left Missouri.
The Comparative Risks of Bacterial Contamination between a Venturi Atomizer and a Positive Displacement Atomizer
Authors: Wolfe Timothy R. , Hillman Todd A. , Bossart Philip J. , Kennedy David W. 
Published: August 2018

Introduction This laboratory study determined the incidence of internal contamination of Venturi principle atomizers and positive displacement atomizers exposed to high external concentrations of Staphylococcal aureus (Staph). Methods Atomizer device nozzle tips were immersed into a Staph solution and 1 ml of spray was atomized via compressed wall air (Venturi) or hydraulic pump (positive displacement). The Venturi nozzle was then wiped with 70% isopropyl alcohol while the disposable positive displacement nozzle was replaced. After 30 minutes, 1 ml of atomized fluid was collected and cultured and the process was repeated. After sixteen uses the fluid remaining in the bottles was cultured. The Venturi atomizer also was subjected to a single use trial to determine the location of device contamination. Results Venturi atomizers sprays grew Staph in every case (144/144), while positive displacement atomizer sprays never grew contaminants (0/144; p < 0.0001). At the end of 16 uses, 7/9 of Venturi atomizers had Staph within their medication reservoirs while none (0/9; p = 0.002) existed in the positive displacement atomizers. After a single use of the Venturi atomizer, the medication reservoir, the air lumen and the medication lumen of the nozzle were all contaminated with Staph. Conclusions External bacterial contamination of the atomizer nozzle tip results in internal bacterial contamination of Venturi devices in as little as one use but not of positive displacement devices. These results warrant further investigation to determine whether a risk of cross-contamination exists in a clinical setting.
Comparison of Endoscopic Sinus Surgery with and without Image Guidance
Authors: Fried Marvin P. , Moharir Vik M. , Shin Jennifer , Taylor-Becker Marta , Morrison Paul , Kennedy David W. 
Published: August 2018

Background Image guidance based on preacquired computed tomography scans of the patient is a technique used to assist the physician during endoscopic sinus surgery (ESS). This study seeks to compare ESS with and without image guidance, analyzing a number of parameters that can impact on efficacy. Methods Retrospective chart review took place at a tertiary care referral center. The study group consisted of 97 consecutive patients confirmed to have undergone ESS using an electromagnetic intraoperative image guidance system (IGS). The control group consisted of 61 consecutive patients who underwent ESS, before the IGS was available at the study hospital. The main outcomes measured were analysis of patient profile, including coexisting conditions such as asthma and polyposis, assessment of which specific sinuses underwent surgical treatment; major and minor complications; estimated blood loss (EBL); operative time; and the need for repeat surgery. Results The IGS group had 74% of patients with polyposis; more sinuses, on average, which underwent surgical revision; one major and three minor complications; an average EBL of 134 cc, an average procedure time of 154 minutes; and one patient who needed repeat surgery in a 3-month follow-up period. The non-IGS group had 40% of patients with polyposis; seven major complications and one minor complication; an average EBL of 94 cc; and three patients who needed repeat surgery within 3 months. Conclusions The use of an IGS for endoscopic sinus surgery may reduce the complications associated with the procedure and allow for a more thorough operation. However, operative time and EBL may be increased.
A Diagnostic Dilemma for Chronic Rhinosinusitis: Definition Accuracy and Validity
Authors: Stankiewicz James A. , Chow James M. 
Published: August 2018

Background The current definition of chronic rhinosinusitis is a symptom-based definition with minimal reliance on objective information. Based on this definition, patients are diagnosed and treated with medical therapy. A computed tomography (CT) scan is obtained only if the patient is not improved after medical therapy. No study is available evaluating in an evidence-based manner the accuracy of the current definition and its impact on diagnosis and treatment. Methods This study represents 78 patients evaluated in a prospective fashion who met the subjective criteria for the definition of chronic rhinosinusitis. All patients underwent a complete history with a questionnaire evaluating symptom severity, a physical exam including anterior rhinoscopy and endoscopy, and a CT scan obtained on the day of their initial visit. Objective CT scan findings were compared with the subjective findings and related to the ultimate diagnosis of chronic sinusitis. Results Only 37/78 (47%) had a positive (1) CT scan, indicating demonstrable sinusitis. There also was no real difference in symptom severity between patients with positive (1) and negative (2) CT scanning. Conclusion The current symptom-based definition of chronic sinusitis poorly predicts whether a patient truly has chronic sinusitis and needs reevaluation.
Endoscopic Management of Benign Sinonasal Tumors: A Decade of Experience
Authors: London Scott D. , Schlosser Rodney J. , Gross Charles W. 
Published: August 2018

Background A variety of benign tumors present in the nasal and paranasal sinuses. Methods We review our experience over the last 10 years with endoscopic management of these tumors and discuss presentation, diagnostic considerations, and therapeutic options. Results Eighteen patients with benign sinonasal tumors were managed with endoscopic techniques. Representative cases are presented, including pleomorphic adenoma, ameloblastoma, meningioma, cholersterol granuloma, ossifying fibroma, fibrous dysplasia, and osteomas. Three patients (16.7%) required one revision endoscopic sinus procedure. Average follow-up was 4 years. Conclusions With the treatment of more complex cases being undertaken endoscopically, the need for individual therapeutic consideration and close follow-up is stressed. The combination of removal of benign tumors endoscopically and endoscopic surveillance in the outpatient setting has allowed a less radical surgical approach while resulting in decreased morbidity and better tumor control.
Bacteriology of Chronic Maxillary Sinusitis in Relation to Sinoscopic Appearance
Authors: Jiang Rong-San , Lin Jen-Fu , Hsu Chen-Yi 
Published: August 2018

Background The bacteriology of chronic maxillary sinusitis in relation to different sinoscopic appearances is reported in this study. Methods When transantral sinoscopy via an anterior wall puncture was used to examine the maxillary antra in patients with chronic maxillary sinusitis, the sinoscopic appearances were divided into five types. Maxillary antra in which ostia were recognized under the endoscope and no secretion existed were classified as type 1. Maxillary antra in which ostia were not recognized and no secretion existed belonged to type 2. Maxillary antra in which seromucoid secretion existed belonged to type 3. Maxillary antra in which mucopurulent discharge existed belonged to type 4. Maxillary antra in which fungal balls existed belonged to type 5. Swab specimens of these antra were sent for aerobic and anaerobic cultures. Results Between 1988 and 1998, 493 sinoscopic appearances of maxillary antra were classified. Among them, 72 were classified as type 1, 59 were type 2, 75 as type3, 227 were type 4, and 60 were type 5. The culture rate of swab specimens from those antra with type 1 sinoscopic appearance was 56.9%. The culture rates were 59.3% for type 2, 48% for type 3, 64.8% for type 4, and 88.3% for type 5. Common cultured bacteria were similar among antra with different types of sinoscopic appearances, except type 5 antra, but less gram-negative aerobes grew from type 1 antra. Conclusions This study shows that the bacteriology of noninvasive fungal sinusitis was different from that of ordinary chronic maxillary sinusitis. However, among ordinary chronic maxillary sinusitis, the bacteriology was similar between maxillary antra with different sinoscopic appearances except with mild disease.
Epstein-Barr Virus—Mild Acquired Immune Deficiency Syndrome (EBV—MAIDS) in Postsurgical Sinusitis
Authors: Toffel Paul H. , Christensen Joshua 
Published: August 2018

Background Functional endoscopic sinus surgery has remarkably improved the treatment of chronic rhinosinusitis patients. Computed tomography, endoscopic optical instrumentation, powered microdebriders, and computer-assisted surgery have surmounted the technical problems of obstructive sinusitis care. Most experienced practitioners achieve reported success rates of 85–95% among their surgical patients. However, the 5–15% refractory patients reported by all rhinologic surgeons leave an exasperating and perplexing group who, despite appropriate mechanical corrections, continue to experience debilitating rhinosinusitis episodes requiring repeated oral, nebulized, or intravenous antibiotics, and in some cases, antifungal therapy. Methods Recent studies have indicated that host immune response mechanisms may be altered in the paranasal sinus tissues of sinusitis patients. After years of observation, it was felt that these difficult patients may suffer from a common thread of significant partial immunocompromise. Drawing on military experience of treating immunoimmature populations prone to Epstein-Barr virus (EBV) infectious mononucleosis and the consequent postmononucleosis syndrome, it was sought to screen disabled refractory postsurgical sinusitis patients for this factor and treat them with long-standing military protocols for the immunoimmature populations dispatched to third-world combat conditions. Results Treatment of Epstein-Barr Virus-Mild Acquired Immune Deficiency Syndrome consisted of periodic intramuscular serum immune globulin injections (immunomodulator therapy), after obtaining their thorough written informed consent, which produced substantial and sustainable improvement in patient's quality of life. Conclusion Detection of mild-to-moderate acquired immune deficiency among postsurgical rhinosinusitis patients can lead to successful treatment and an improved quality of life.
A Retrospective Analysis of Treatment Outcomes and Time to Relapse after Intensive Medical Treatment for Chronic Sinusitis
Authors: Subramanian Hamsa N. , Schechtman Kenneth B. , Hamilos Daniel L. 
Published: August 2018

Background Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment. We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy. Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse. Methods Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids). After intensive medical therapy, adjunctive medical therapy was continued. A sinus computed tomography was performed at baseline and 6–8 weeks later and scored for extent of disease. Pre- and posttreatment symptom scores also were assessed. Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids. Results Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen. Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment. A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores. Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively). In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse. Conclusion Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks. A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms. In contrast, the presence of atopy, a history of asthma, or persistent OMU obstruction was not associated with earlier relapse. Although long-term benefits have not been established, a prospective study of treatment outcomes from intensive medical treatment appears to be warranted.
Complications of Hydroxyapatite Use for Transnasal Closure of Cerebrospinal Fluid Leaks
Authors: Stankiewicz James A. , Vaidya Abhay M. , Chow James M. , Petruzzelli Guy 
Published: August 2018

Background Hydroxyapatite cement (HAC) was first introduced in the 1980s as a new method for bone replacement. However, it has not been recommended for use in areas exposed to air. Despite this, surgeries have been performed using HAC to close nasal/sinus cerebrospinal fluid (CSF) leaks or in the treatment of encephaloceles. Methods This study retrospectively documented four patients in whom HAC was used for closure of ethmoid and sphenoid sinus CSF leaks. Results This study showed that exposed hydroxyapatite could be extremely problematic resulting in scarring, chronic granulation, infection, and prolonged healing. Oftentimes, revision surgery was necessary to help control the reaction to hydroxyapatite. Conclusion Because of the frequent complications occurring with use of hydroxyapatite in the paranasal sinuses, its use should be limited to selected individuals in whom difficulty in achieving closure of the CFS leak could be anticipated and in whom adequate tissue coverage could be provided.
The Human Vomeronasal Organ: Part IV. Incidence, Topography, Endoscopy, and Ultrastructure of the Nasopalatine Recess, Nasopalatine Fossa, and Vomeronasal Organ
Authors: Bhatnagar Kunwar P. , Smith Timothy D. , Winstead Welby 
Published: August 2018

Background Previous reports on the human vomeronasal organ (VNO) have been inconsistent. Observations of fossae on the nasal septum have been reported as the VNO. Methods Adult human subjects (210) and cadavers (31) were examined using rigid nasal endoscopy, serial histology, and biopsy ultrastructure (5). Results The nasopalatine fossa (NPF) and the nasopalatine recess (NPR) are discrete, but variable, structures located adjacent to the VNO region. The NPF is not a vomeronasal pit. A septal mucosal pit could hide the vomeronasal duct opening. The VNO is a submucosal structure located 2–8 mm superior to the NPR and cannot be positively identified either macroscopically or endoscopically. Conclusion The VNO has long been mistaken for the NPF and septal mucosal pits. We show that serial histology is the correct method for identifying the VNO.
Microbiology of Middle Meatus in Chronic Rhinosinusitis
Authors: Araujo Elisabeth , Palombini Bruno C. , Cantarelli Vladimir , Pereira Alexandre , Mariante Afonso 
Published: August 2018

Background Nasal endoscopy allows the collection of middle meatus secretion samples and is an alternative method for determining microorganisms in rhinosinusitis. This study assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with ipsilateral maxillary sinus aspirates and microbiological data of healthy individuals. Methods Middle meatus samples were collected from 114 CRS patients for aerobic, anaerobic, and fungal cultures; maxillary sinus secretions were collected from 13 of these patients. Twenty-three healthy volunteers served as controls. Results Aerobes were isolated in 86% of CRS patients, anaerobes were isolated in 8% of CRS patients, and fungi were isolated in 11% of CRS patients; the most frequent microorganisms were Staphylococcus aureus (36%), coagulase-negative Staphylococcus (20%), and Streptococcus pneumoniae (17%). Middle meatus and maxillary sinus cultures presented the same pathogens in 80% of cases. In healthy individuals, coagulase-negative Staphylococcus (56%), S. aureus (39%), and S. pneumoniae (9%) were the most frequent isolates. Conclusion The culture of endoscopically collected middle meatus secretions is effective in identifying microorganisms in CRS patients.
Outcome in Patients with Chronic Sinusitis after the Minimally Invasive Sinus Technique
Authors: Catalano Peter , Roffman Eric 
Published: August 2018

Background Controversy persists regarding the use of minimally invasive sinus techniques (MIST) to treat chronic sinusitis primarily because of an absence of comparative outcome data. Methods In this prospective study of 85 patients with chronic sinusitis treated surgically with MIST, the long-term postoperative outcome was assessed using the duration-based Chronic Sinusitis Survey (CSS) quality of life instrument. Patient age ranged from 4 to 81 years old (mean age, 42 ± 16.7 years). Forty-three subjects were male patients and 42 were female patients. Mean follow-up time was 23.8 ± 2.2 months. Results At follow-up, there was a 124.0% improvement in the mean CSS symptom score (p < 0.00001), a 30.1% improvement in the mean CSS medication score (p < 0.00001), and a 62.0% improvement in the mean CSS total score (p < 0.00001). An overall improvement was found in 78.8% of patients; 12.9% of patients were worse and 8.2% of patients were unchanged. Thirty-four patients (40.0%) had postsurgical CSS total scores within the normative interquartile range obtained in healthy controls. Twenty-six of these patients had postsurgical scores that actually surpassed the mean normative CSS total score. Before follow-up evaluation, 5 of the 85 patients (5.9%) had revision surgery after the initial procedure. All had revision MIST procedures and all were found to have an overall improvement at the time of follow-up. Conclusion We conclude that MIST significantly improves the outcome in patients with chronic sinusitis and should strongly be considered as the initial surgical option for such patients.
Rhinoplasty from the Goldman/ Cottle Schools to the Present: A Survey of 7447 Personal Cases
Authors: Stucker Fred J. 
Published: August 2018

Background To review the personal experience of a single surgeon over a 31 year period. Method A retrospective analysis of 7447 rhinoplasties performed by a single surgeon from 1969 to 2000. Ninety-five surgeries performed at educational courses were excluded from this series. Results During the many years of performing rhinoplasties, cartilage splitting, delivery, and external approach are among the most common techniques. In the first decade, 62% were cartilage splitting, 33% delivery, and 3% external. In the second decade, 13% were cartilage splitting, 58% delivery, and 26% external. In the third decade, 11% were cartilage splitting, 52% delivery, and 36% external. Conclusion Over a three-decade period, the techniques of the author have been influenced by national trends, training, and patient outcomes.