bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary Arterial Pressure in Children with Allergic Rhinitis
Authors: Reisli Ismail , Oran Bulent , Baspınar Osman , Baysal Tamer , Karaaslan Sevim 
Published: August 2018

Background Chronic upper airway obstruction may lead to increased pulmonary arterial pressure in childhood. Allergic rhinitis is one of the frequent causes of upper airway obstruction by nasal blockage. The aims of the study were to evaluate the pulmonary arterial pressures in children with allergic rhinitis and the effect of topical corticosteroid therapy. Methods Forty-nine children composed of 27 subjects with seasonal and 22 subjects with perennial allergic rhinitis were enrolled in this study. The pulmonary arterial pressures were measured by using Doppler echocardiography. Results The pretreatment pulmonary arterial systolic, mean, and diastolic pressures of study group were significantly higher than in healthy controls (p < 0.05). The pulmonary arterial systolic and mean pressures of the patient group significantly decreased at the end of study (p < 0.05), whereas the decrease of the diastolic pressure was not statistically significant (p > 0.05) after the treatment of a topical corticosteroid, mometasone furoate (100 μg per day), for 8 weeks. Conclusion Our results showed that children with allergic rhinitis have higher pulmonary arterial pressure levels compared with healthy controls and that increased pulmonary arterial pressure levels due to allergic rhinitis are reversible by using nasal topical corticosteroids. Further studies are needed to determine the clinical aspect of increased pulmonary arterial pressure.
Endoscopic Sinus Surgery in Patients with Chronic Hepatic Failure Awaiting Liver Transplant
Authors: Delgaudio John M. , Martinez Enrique J. 
Published: August 2018

Background Because of the need for posttransplant immunosuppression, patients with chronic liver failure requiring transplantation must be free of infection to maintain an active status on the transplant list. These patients present significant surgical risks due to coagulopathy. Here, we present our experience with endoscopic sinus surgery for medically refractory sinusitis in this patient population. Methods We created a prospective case series of seven patients undergoing 10 surgeries. Results All patients were given preoperative blood product infusions. Operative blood loss ranged from 150 to 1500 cc with an average of 495 cc. Two cases had to be stopped before completion because of bleeding obscuring visualization. The two cases with the greatest blood loss were in patients with the most severe liver disease (highest mathematical model for end-stage liver disease scores), lowest albumin, and most extensive sinus disease. All patients were returned to active status on the liver transplant list and four patients have undergone liver transplantation. Conclusion Patients with chronic hepatic disease awaiting liver transplant can be treated successfully with endoscopic sinus surgery, but significant perioperative bleeding may not be avoidable. Preoperative use of fresh frozen plasma, platelets, and sometimes albumin are necessary, and postoperative blood products may be required with more significant sinus and liver disease. NovoSeven (recombinant factor VIIa) was used on two occasions in one patient, with maximal correction of the patient's coagulopathy. Patients should be counseled on the possible need for additional procedures to adequately clear disease.
The Learning Curve in Minimally Invasive Pituitary Surgery
Authors: Sonnenburg Robert E. , White David , Ewend Matthew G. , Senior Brent 
Published: August 2018

Background Minimally invasive pituitary surgery (MIPS) is performed via an endoscopic transnasal transsphenoidal approach. This provides excellent illumination, visualization, and magnification of the operative field, in addition to avoiding complications associated with other approaches. In this study we examined the first 45 cases of MIPS to determine if a learning curve exists for this technique. Methods A retrospective chart review was performed of the first 45 cases of MIPS at a major academic medical center. Cases were divided into three groups of 15 patients each. Group characteristics including age, sex, and revision surgery were compared. Complication rates investigated included death, intracerebral hemorrhage, intraoperative cerebrospinal fluid leak, postoperative cerebrospinal fluid leak, use of lumbar drain, meningitis, postoperative epistaxis, ophthalmoplegia, visual impairment, and diabetes insipidus. Other factors examined included intraoperative blood loss, length of stay, and tumor histology. One way analysis of variance statistical analysis was used to determine the significance of differences between groups. Results Groups were comparable in respect to characteristics studied. Statistically significant (p < 0.05) differences in complication rates and other factors between groups were not shown. Complication rates are low. Conclusion This study does not establish a learning curve for our first 45 cases of MIPS. This finding supports the concept that an otolaryngology/neurosurgery team skilled in endoscopic techniques and pituitary surgery can safely transition from open approaches to an endoscopic approach in pituitary surgery.
Chronic Sinusitis with Nasal Polyps: Staphylococcal Exotoxin Immunoglobulin E and Cellular Inflammation
Authors: Conley David B. , Tripathi Anju , Ditto Anne M. , Reid Kathryn , Grammer Leslie C. , Kern Robert C. 
Published: August 2018

Background The etiology of chronic sinusitis with nasal polyposis (CS/NP) remains enigmatic. Frequently, Staphylococcus aureus is present in the nose of CS/NP patients, although the significance is unclear. Recent reports have suggested the hypothesis that these bacteria may secrete exotoxins triggering the inflammatory mucosal changes seen in CS/NP. This mechanism of immunopathology has been established in other diseases associated with Staphylococcus colonization and exotoxin secretion such as atopic dermatitis. In atopic dermatitis, the exotoxins incite a local superantigen response in which clonal T-cell activation and massive cytokine release occur in the affected skin. Second, these exotoxins can act as traditional allergens, stimulating a typical immunoglobulin E (IgE) response in the serum, which has been correlated with disease severity. This study is designed to begin the assessment of the hypothesis that a similar mechanism takes place in CS/NP. Methods Serum was drawn from patients with CS/NP undergoing endoscopic sinus surgery as well as 13 atopic and nonatopic control subjects without sinusitis. IgE levels to S. aureus exotoxins A (SEA), SE exotoxins B (SEB), and toxic shock syndrome toxin 1 were measured using enzyme-linked immunosorbent assay. Tissue eosinophilia and the presence of lymphocytes on hemotoxylin and eosin-stained sections of polyps were scored by a blinded pathologist and correlated to presence of toxin IgE in the serum. Results Staphylococcal exotoxin (SE)-specific IgE was found in the serum of 5/10 (50%) of the patients with CS/NP. In contrast, 0/13 control patients had IgE to the exotoxins (p = 0.031). Polyp eosinophil, lymphocyte, and mononuclear cell counts were compared in IgE exotoxin-positive and -negative subjects. A trend toward increased eosinophil counts in patients with SE IgE (SE IgE+) was present, but not statistically significant. Conclusion These results indicate that a high percentage of CS/NP patients show a systemic IgE response to S. aureus exotoxins in comparison with controls without CS/NP. Although these results are consistent with the actions of Staphylococcus toxins in other diseases, additional work is necessary to establish a local superantigen response in the nasal mucosa of CS/NP patients. (American Journal of Rhinology 18, 273–278, 2004)
How Subjective is Nasal Endoscopy? A Study of Interrater Agreement using the Lund and Mackay Scoring System
Authors: Annamalai Sivakumar , Davis Jeremy , Kubba Haytham 
Published: August 2018

Background Scoring systems exist to standardize the recording of nasal endoscopy findings. The extent to which two surgeons will agree on the findings of nasal endoscopy in adults currently is unknown, although a study in children showed high rates of agreement between two observers. We studied the interobserver agreement of adult nasal endoscopy scored with the system proposed by Lund and Mackay. Method: A consecutive series of otolaryngology patients attending with a variety of nasal complaints were recruited. All were examined with a 0o 4-mm endoscope by two surgeons on the same clinic visit. Each independently recorded their findings using the Lund and Mackay scoring system. Neither surgeon was aware of the other's findings. Results Thirty patients were studied (16 women and 14 men). Because the endoscopic findings were recorded separately for each side of the nose, each surgeon made 60 observations. Interrater agreement was calculated as Cohen's κ, and suggested moderate agreement for edema (κ = 0.45), good agreement for crusting (κ = 0.62), and very good agreement for polyp (κ = 0.93) and discharge (κ = 0.84). Conclusions Two independent observers agree on the findings of nasal endoscopy in a high proportion of cases. Nasal endoscopy is a reliable tool, especially when a scoring system such as that of Lund and Mackay is used. (American Journal of Rhinology 18, 301–303, 2004)
Magnetic Resonance Imaging Findings of Inverted Papilloma: Differential Diagnosis with Malignant Sinonasal Tumors
Authors: Maroldi Roberto , Farina Davide , Palvarini Laura , Lombardi Davide , Tomenzoli Davide , Nicolai Piero 
Published: August 2018

Background Computed tomography and magnetic resonance imaging (MRI) are the techniques of choice for pretreatment staging in neoplasms of the sinonasal tract. In inverted papilloma (IP), the information provided by computed tomography regarding characterization of the lesion is rather nonspecific. The present retrospective study was performed in the attempt to identify distinguishing features of IP on MRI. Methods MRI examinations of 23 patients affected by IP (16 primary and 7 recurrent) and 23 patients affected by malignant tumors (MT; 12 adenocarcinomas, 9 squamous cell carcinomas, and 2 neuroendocrine carcinomas) of the sinonasal tract were evaluated. IP arose from the lateral nasal wall in 17 cases, the maxillary sinus in 5 cases, and the nasal septum in 1 case. The signal intensity of IP and MT was compared with muscles on spin-echo (SE) T2 and SE T1 images; contrast enhancement was compared with nasal septum mucosa. Possible specific MRI patterns in the two groups of patients were investigated. Bone involvement was graduated as remodeling or erosion (focal, ≤15 mm; intermediate, >15 mm and ≤30 mm; extended, >30 mm). The size of the lesions was assessed by measuring the greatest diameter on MRI. Parametric statistics in the form of Student's t-test or chi-squared test was used for data comparison. Results IP showed a columnar pattern in all 23 cases by enhanced SE T1 images and in 16 of 23 lesions (>20 mm in diameter) by SE T2. This pattern was observed in only 1 of the 23 MTs; pathological examination of that specimen showed multiple foci of IP associated with squamous cell carcinoma. Bone remodeling was observed in 19 of 23 IPs, which in four patients was associated with focal (two cases) or intermediate (two cases) erosion. In MT, remodeling was present, which was always combined with focal (2 cases) or extended (21 cases) erosion. A strong correlation was found between the pattern of bone changes and histology (p = 0.00001). Bone alterations did not correlate with the size of the IP. The mean size of the IPs was significantly less than that of MT (33.9 ± 15.7 mm versus 59 ± 16 mm; p = 0.0003). Conclusion A columnar pattern is a reliable MRI indicator of IP and reflects its histological architecture (positive predictive value of 95.8%). The combination of this finding with the absence of extended bone erosion allows for the confident discrimination of IPs from MTs. (American Journal of Rhinology 18, 305–310, 2004)
Evaluation of Protective and Therapeutic Effects of Dexpanthenol on Nasal Decongestants and Preservatives: Results of Cytotoxic Studies in Vitro
Authors: KlOucker Norbert , Rudolph Peter , Verse Thomas 
Published: August 2018

Background More than 600 million units of nasal decongestants are sold worldwide annually. The cytotoxic and ciliary toxic potential of decongestants, as well as the preservatives of these products, in particular benzalkonium chloride (BKC), is well established. Recently, a beneficial effect of dexpanthenol on the tolerability of the ά-sympathomimetic xylometazoline and BKC has been described; however, it was unclear if this effect, resulting in significantly higher cell counts in a cytotoxicity study and an increase in ciliary beat frequency in a ciliary toxicity study was of protective or therapeutic nature. The objective of this study was (a) to evaluate whether dexpanthenol would be a useful additive to nasal decongestants to counter the cytotoxic and ciliary toxic effects of the active ingredient and the preservative and (b) to find out whether this beneficial effect is of protective or therapeutic nature. Methods Systematic cytotoxic in vitro tests were performed. After exposure to xylometazoline (0.1%), the effect of dexpanthenol (5%) and BKC (0.01%) was determined by placebo-controlled assessment of cell growth in a human amniotic cell line. Results Dexpanthenol significantly reduces the toxic effects of xylometazoline regarding cell growth (p < 0.001) when applied in advance. When BKC is eliminated from the nasal sprays, a further significant increase of cell growth was found (p < 0.001). When dexpanthenol is therapeutically applied after xylometazoline, effects on cell growth are only one-half of those of the protective approach. Conclusion The additive application of dexpanthenol (5%) given before nasal decongestants or preserved nasal sprays is able to improve the tolerability of these substances and to counteract the toxic effects. (American Journal of Rhinology 18, 315–320, 2004)
Pediatric Medial Subperiosteal Orbital Abscess: Medical Management Where Possible
Authors: Brown Christopher L. , Graham Scott M. , Griffin Mark C. , Smith Richard J. H. , Carter Keith D. , Nerad Jeffrey A. , Bauman Nancy M. 
Published: August 2018

Background Controversy exists about the optimal management of subperiosteal orbital abscesses (SPOAs) in pediatric patients. Some otolaryngologists advocate immediate surgical drainage while others recommend medical management initially and reserve surgery for nonresponders. We hypothesized that patients who can be managed without surgery have identifiable features on presentation that may aid in predicting their response to medical therapy. Methods A retrospective chart review was performed on all patients ≤18 years of age who were admitted to the University of Iowa between 1984 and 2001 with findings consistent with an SPOA on computed tomography imaging. Patients were divided into two groups: group I received medical treatment only while group II underwent surgical drainage of the abscess. Presenting features were compared between the two groups. Results Forty-two patients were identified with 17 group I patients and 25 group II patients. All patients had resolution of their SPOA and favorable outcomes. The following variables attained significance: group I patients were younger than group II patients (5.1 years versus 11 years; p < 0.0001), had less restriction of ocular motility (—1.0 versus —2.3), and were hospitalized for fewer days (6.5 days versus 9.6 days; p = 0.011). The following clinical variables did not vary significantly between the groups: gender, side of abscess, temperature, total white blood cell count, neutrophil count, chemosis, visual acuity, and proptosis. Culture results predominantly showed growth of anaerobic organisms (7/23). With increasing age, there was an increase in the number of organisms cultured (p = 0.005). Conclusion A subset of patients with SPOAs can be managed medically. These patients tend to be younger and present with minimal restriction of ocular motility. (American Journal of Rhinology 18, 321–327, 2004)
Clinical Outcomes of Septoplasty and Inferior Turbinate Reduction in the Geriatric Veterans’ Population
Authors: Busaba Nicolas Y. , Hossain Monir 
Published: August 2018

Background Patients older than 65 years constitute an increasingly large percentage of the patient population that presents to an adult otolaryngology practice due to the increase in life expectancy. The objective of this study is to assess the clinical outcomes of septoplasty with or without inferior turbinate reduction in patients who are 65 years or older. Methods This is a prospective nonrandomized longitudinal study of 40 patients aged 65 years or more and who underwent septoplasty with or without inferior turbinate reduction. Patients received Nasal Health Survey (NHS) and General Health Status Short Form (SF-12) questionnaires before and 6 months after surgery. Statistical analysis was performed using the paired t-test. Results The preoperative NHS score was 52.3, while the postoperative score was 76.6 (p < 0.001). The reported benefit reflected improvement in symptoms (p < 0.001) and reduction in medication usage (p < 0.001). In addition, the SF-12 score improved after the surgery but the difference did not reach statistical significance (p = 0.055). Conclusion and Significance Septoplasty and inferior turbinate reduction is beneficial in the veterans’ population for patients 65 years or older who present with nasal obstruction and are noted on physical examination to have septal deviation and inferior turbinate hypertrophy.
Nasal Airflow, Mucociliary Clearance, and Sinus Functioning during Viral Colds: Effects of Allergic Rhinitis and Susceptibility to Recurrent Sinusitis
Authors: Alho Olli-Pekka 
Published: August 2018

Background The aim was to compare nasal airflow and mucociliary clearance (MCC) and their association with paranasal sinus functioning during acute natural colds and convalescence in allergic and sinusitis-susceptible patients and healthy controls. Methods Nine allergic subjects, 16 sinusitis-susceptible subjects, and 20 healthy controls were examined during days 2–4 of acute colds and 3 weeks later by taking viral specimens, recording symptoms, performing rhinomanometry and dyed saccharin tests, and evaluating sinus functioning with computed tomography (CT). Results Viral etiology of the cold was identified in 31 (69%) subjects. Nasal airflow was decreased and MCC time prolonged during the cold compared to convalescence. A higher proportion of the allergic subjects, but not of the sinusitis-susceptible subjects, compared to the control subjects tended to have abnormal nasal airflow and MCC values. Abnormal nasal airflow and MCC values associated significantly with higher ipsilateral paranasal sinus CT scores. Conclusion Abnormal nasal airflow and MCC rates seem to be associated with impaired functioning of paranasal sinuses during viral colds and tend to be more common in allergic subjects.
Management of the Lacrimal System during Maxillectomy
Authors: Habib Ramez , Har-El Gady 
Published: August 2018

Background Oncologic resection of the maxilla requires management of the nasolacrimal sac/duct system (NLS). A variety of techniques may be used: simple transection, transection with transcanalicular stenting, drilling of the entire nasolacrimal bony canal to the inferior meatus with mobilization of an intact NLS, marsupialization of the NLS with or without stenting, and simple transection with routine delayed dacryocystorhinostomy (DCR) for symptomatic epiphora. Rates of prolonged epiphora range from 13 to 63%. Objectives We present our approach to NLS management during maxillectomy, and our rates of epiphora. Study Design Review of 212 consecutive patients who underwent transection of the NLS during medial maxillectomy, complete maxillectomy with preservation of orbital contents, suprastructure maxillectomy, or maxillectomy as part of anterior craniofacial resection. Patients with primary NLS tumors were excluded. Prolonged epiphora is defined as persistent if it lasts more than 6 months. Methods After exposure of the anterior maxillary wall and inferior and medial orbital rim, a high-speed drill and Kerrison rongeurs are used to remove the anterior wall of the nasolacrimal canal. The NLS is transected 12–15 mm distal to the periorbita and removed from the canal. Two 4–6-mm opposing incisions are made at the distal duct. Two semicircular flaps are everted, folded, and sutured to the proximal sac or periorbita. A transcanalicular stent is not placed. Results Two-hundred twelve patients underwent the abovementioned procedure. Four patients (1.9%) developed prolonged epiphora, which required delayed DCR. Conclusions Marsupialization of the NLS without stenting provided us with an acceptably low rate of prolonged epiphora.
Thresholds in Nasal Histamine Challenge in Patients with Allergic Rhinitis, Patients with Hyperreflectory Rhinopathy, and Healthy Volunteers
Authors: Wuestenberg Eike G. , Hauswald Bettina , Huettenbrink Karl-Bernd 
Published: August 2018

Background Characteristic symptoms of hyperreflectory rhinopathy include recurrent sneezing, nasal obstruction, and nasal secretion without an allergic background. The diagnosis can only be made if all differential diagnoses have been excluded. So far no clinical test has been established to reliably diagnose hyperreactivity of the nasal mucosa. The present study aimed to investigate whether nasal provocation with histamine allows identification of patients with hyperreflectory rhinopathy. Materials and Methods One-sided nasal challenge with histamine was applied to 13 patients with allergic rhinitis, 13 patients with hyperreflectory rhinitis, and 12 healthy volunteers. Histamine concentrations used were 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, and 16.0 mg/mL. Test results were quantified using a symptom score (positive at values above 3) and active anterior rhinomanometry (positive at a reduction of airflow of 40% or more in comparison to challenge with solvent). Results While there was a significant difference between controls and patients with allergic rhinitis or hyperreflectory rhinopathy, respectively, no significant difference was observed between the two groups of patients. Results indicated that one-sided nasal provocation with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. In terms of the differentiation between subjects with hyperreactivity of the nasal mucosa and healthy controls, the sensitivity of one-sided nasal histamine provocation with 1 mg/mL was found to be 100%; its specificity was 83% if it was evaluated by rhinomanometry and symptom score. Conclusion The present results indicate that one-sided nasal challenge with histamine at a concentration of 1 mg/mL is sufficient to separate healthy subjects from patients with hyperreactivity of the nasal mucosa. However, the test does not differentiate between patients with allergic rhinitis and patients with hyperreflectory rhinitis.