bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated Sphenoid Sinusitis after Transsphenoidal Hypophysectomy
Authors: Batra Pete S. , Citardi Martin J. , Lanza Donald C. 
Published: August 2018

Background Literature addressing the incidence and management of sinusitis after transsphenoidal hypophysectomy is sparse. Methods Retrospective chart analysis was conducted on 200 consecutive patients who had undergone transsphenoidal procedures between January 1998 and December 2001. The postoperative incidence of sinusitis was determined. Clinical characteristics, management strategy, and outcome were reviewed. Results Fifteen of the 200 patients (7.5%) developed rhinosinusitis after transsphenoidal surgery. Seven of the patients were referred to otorhinolaryngology for further management. Three additional patients, who had undergone transsphenoidal hypophysectomy at outside institutions, also were evaluated during this time. Nine of 10 patients (90%) had isolated sphenoid sinusitis by computed tomography and/or endoscopic criteria. The most common symptoms included headaches and nasal discharge present for an average of 2.9 years. Medical management resulted in resolution of symptoms in 5 of 10 cases (50%). The remaining five patients required endoscopic sphenoidotomy for recalcitrant disease. Intraoperatively, fungal balls were identified in three cases. Mucocele formation was encountered in one case, and an infected fat graft was evident in one case. Sphenoid sinusitis was resolved successfully in all 10 cases. Conclusion A high index of suspicion must be maintained to avoid an inordinate delay in diagnosis of isolated sphenoid sinusitis in this setting, in light of the nonspecific presentation of this clinical entity. Aggressive medical and/or surgical treatment is required for resolution of refractory symptoms in this patient population.
Surgical Decisions in the Management of Frontal Sinus Osteomas
Authors: Chiu Alexander G. , Schipor Ioana , Cohen Noam A. , Kennedy David W. , Palmer James N. 
Published: August 2018

Background The development of chronic rhinosinusitis, a mucocele, or persistent headaches is a common indication for the removal of a frontal sinus osteoma. The best surgical approach to ensure complete and safe removal of the lesion is less clearcut. The advent of specialized frontal sinus instruments, angled endoscopes, and surgical navigational systems has made removal of frontal sinus osteomas possible through an endoscopic approach. The aim of this study is to review our recent experience with the surgical management of frontal sinus osteomas, and the anatomic features that make specific lesions more or less amenable to endoscopic resection. Methods A retrospective review of all frontal sinus osteomas surgically resected from the years 1999 to 2003 was used. This period was selected to reflect the invention and popularization of surgical navigation systems and specialty instruments designed specifically for the frontal sinus. CT scans, operative reports and postoperative course were reviewed. Results Nine patients were identified. A grading system was devised to reflect the three variables involved in the limitations for endoscopic removal. These are the location of the base of attachment, relative size to the frontal recess, and location in relation to a virtual sagittal plane through the lamina papyracea. Three osteomas were removed through an endoscopic approach. Four were removed by a combined osteoplastic flap and endoscopic dissection of the frontal recess. Two were removed through an osteoplastic flap with obliteration of the sinus. Conclusion The ability to remove a frontal sinus osteoma endoscopically can be determined preoperatively, taking into account the location and size of the lesion. There is still a role for external procedures in the surgical management of these lesions, and such procedures may be combined with endoscopic techniques for optimal results.
The Effect of Endoscopic Sinus Surgery on Symptoms of Eustachian Tube Dysfunction
Authors: Stoikes Nathaniel F.N. , Dutton Jay M. 
Published: August 2018

Background The symptom of eustachian tube dysfunction has been categorized as a “minor” symptom in chronic rhinosinusitis. The aim of this pilot study was to determine the frequency of otologic symptoms in patients with confirmed rhinosinusitis and the likelihood of its resolution in those patients undergoing endoscopic sinus surgery (ESS). Methods Questionnaires were obtained from 168 patients who had undergone prior ESS over a 5-year period. Patients were asked to evaluate if they suffered from several different potential symptoms of eustachian tube dysfunction before ESS and whether that symptom changed postoperatively. Results Using the binomial test, 95% confidence intervals were determined for the following otologic symptoms of tubal dysfunction: “ear fullness and congestion,” “ear cracking and popping,” “dizziness,” and “ear pain.” ESS was found to have a significant treatment effect for the indicated otologic symptoms of tubal dysfunction. Conclusion Tubal dysfunction, as manifested by otologic symptoms, is common in patients with chronic rhinosinusitis undergoing ESS. The classification of this as a “minor” symptom of rhinosinusitis needs to be reevaluated. These symptoms improve or resolve in the majority of patients undergoing ESS.
Opening the Nasal Valve with External Dilators Reduces Congestive Symptoms in Normal Subjects
Authors: Latte Jenny , Taverner David 
Published: August 2018

Background We examined whether the use of two different external nasal dilator devices influenced the size of the nasal valve area and symptoms of nasal congestion. Methods This was a randomized blind-allocation, open three-way crossover study of Breathe Right, Side Strip Nasal Dilators, and placebo. We studied 12 healthy subjects (10 female, 2 male; age range 26–56 years). Measures of total volume and total minimum cross-sectional area were collected. Subjective symptoms were collected using a visual analog scale and an ordinal scale. Results With both products, there was significant increase in the size of the minimum cross-sectional area compared to placebo, p = 0.004. This is supported by the decrease in the subjective reports of congestion; on the visual analog scale, compared to placebo p = 0.012 and the ordinal scale, compared to placebo, p = 0.004. Conclusion Both devices significantly increase the size of the nasal valve area and reduce congestion in normal subjects.
The Effects of an External Nasal Dilator on Labor
Authors: Sadan Oscar , Shushan Sagit , Eldar Ido , Evron Shmuel , Lurie Samuel , Boaz Mona , Glazerman Marek , Roth Yehudah 
Published: August 2018

Background The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus. Methods One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed. Results No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001). Conclusion Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.
Long-Term Effects of FloSeal™ Packing After Endoscopic Sinus Surgery
Authors: Chandra Rakesh K. , Conley David B. , Haines G. Kenneth , Kern Robert C. 
Published: August 2018

Background A previous study by our group showed increased adhesions and granulation tissue in ethmoid cavities packed with FloSeal (FS) compared with those packed with thrombin-soaked gelatin foam after endoscopic sinus surgery (ESS). That study included 20 patients whose cavities were graded 6–8 weeks postoperatively. The goal of this study was to report long-term follow-up on this cohort. Methods At least 1 year follow-up was available in 18/20 patients. The number of office procedures required to lyse adhesions during the follow-up period was tabulated also. Pathology was available from one patient who underwent lysis of adhesions on an FS side. The histopathological findings are presented. Results The mean follow-up period was 21.4 (±2.3) months, and none of the 18 patients required revision ESS during this interval. The overall incidence of adhesions (p = 0.013) and the number requiring lysis of adhesions (p = 0.046) were both greater in the FS group. During the interval between previous study evaluation (6–8 weeks postop) and last follow-up, five FS sides required a total of seven procedures to lyse adhesions. Silent adhesions were observed in an additional five FS sides. Although asymptomatic adhesions were observed in two thrombin-soaked gelatin sides at last examination, none underwent lysis. Biopsy of an adhesion from a patient packed with FS 25 months earlier revealed incorporated foreign material. Conclusion FS appears to be associated with scar tissue formation and may be incorporated into recovering mucosa. Use of FS may increase the degree of postoperative care required after ESS.
The Effect of Topical Corticosteroid on Basic Fibroblast Growth Factor in Nasal Polyp Tissue
Authors: Yariktas Murat , Doner Fehmi , Sutcu Recep , Demirci Mustafa , Dogru Harun , Yasan Hasan 
Published: August 2018

Background The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. Methods Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 μg/day. The bFGF levels were measured by competitive enzyme immunoassay method. Results The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 ± 826 ng/mg protein (range, 416–3434 ng/mg) and 1340 ± 749 ng/mg protein (range, 330–3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). Conclusion Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.
The Effect of Insulin-Like Growth Factor 1 Incorporated into a Hyaluronic Acid-Based Nasal Pack on Nasal Mucosal Healing in a Healthy Sheep Model and a Sheep Model of Chronic Sinusitis
Authors: Rajapaksa Suresh , McIntosh David , Cowin Allison , Adams Damian , Wormald Peter-John 
Published: August 2018

Background Endoscopic sinus surgery (ESS) is the accepted surgical treatment for chronic refractory rhinosinusitis. Prolonged healing and adhesion formation remain common problems. This study investigates the use of a hyaluronic acid-based pack impregnated with insulin-like growth factor (IGF) 1 to facilitate more rapid and effective healing after ESS in a healthy sheep model and a sheep model of chronic sinusitis. Methods This study used 12 healthy sheep and 9 sheep with chronic sinusitis. In each sheep one side (computer randomized) was used as a control. Under endoscopic guidance, mucosal injuries and adhesions were created on both sides and were either packed with a hyaluronic acid pack impregnated with IGF-1 or left unpacked as a control. Serial biopsies were performed for 4 months. Results In the healthy sheep there was a statistically significant (p < 0.05) improvement in reepithelialization in IGF-1 packed wounds at day 28 (89% for IGF-1 versus 44% for controls). In both healthy sheep and sheep with sinusitis there was no significant difference in mucosal reepithelialization at any of the other measured time points. In the sinusitis group, there was a significant decrease in ciliary regeneration at day 56 in the Merogel/IGF-1 group compared with the control group: 59.20% versus 77.68% (p < 0.01) and at day 112, 69.70% versus 87.26% (p < 0.01). Conclusion Hyaluronic acid impregnated with IGF-1 improved reepithelialization in the healthy sheep but not in the sheep with chronic rhinosinusitis. These packs had a detrimental effect on mucosal ciliary regeneration in the sheep with chronic rhinosinusitis.
Effects of Anatomical Variations of the Nasal Cavity on Acoustic Rhinometry Measurements: A Model Study
Authors: Cakmak Ozcan , Çelik Huseyin , Cankurtaran Mehmet , Ozluoglu Levent Naci 
Published: August 2018

Background The goal of this study was to assess how anatomic variations of the nasal cavity affect the accuracy of acoustic rhinometry (AR) measurements. Methods A cast model of a human nasal cavity was used to investigate the effects of the nasal valve and paranasal sinuses on AR measurements. A luminal impression of a cadaver nasal cavity was made, and a cast model was created from this impression. To simulate the nasal valve, inserts of varying inner diameter were placed in the model nasal passage. To simulate the paranasal sinuses, side branches with varying neck diameters and cavity volumes were attached to the model. Results The AR measurements of the anterior nasal passage were reasonably precise when the passage area of the insert was within the normal range. When the passage area of the insert was reduced, AR measurements significantly underestimated the cross-sectional areas beyond the insert. The volume of the paranasal sinus had limited effect on AR measurements when the sinus ostium was small. However, when the ostium size was large, increasing the volume of the sinus led to significant overestimation of AR-derived areas beyond the ostium. Conclusion The pathologies that narrow the anterior nasal passage result in the most significant AR error by causing area underestimation beyond the constriction. It also appears that increased paranasal sinus volume causes overestimation of areas posterior to the sinus ostium when the ostium size is large. If these physical effects are not considered, the results obtained during clinical examination with AR may be misinterpreted.
Impact of Gender on General Health-Related Quality of Life in Patients with Chronic Sinusitis
Authors: Baumann Ingo , Blumenstock Gunnar 
Published: August 2018

Background The aim of this study was to evaluate the impact of gender on health-related quality of life (HRQOL) in patients with chronic sinusitis Methods A prospectively administered survey was performed. For measuring HRQOL, we used the German versions of the Short Form 36 (SF-36; eight subscales) and the European Quality of Life—5 Dimensions (EQ-5D) (two subscales). For all SF-36 subscales we used norm-based scoring of the general German population. Results One hundred twenty-three patients (45 women and 78 men) underwent HRQOL evaluation at baseline (preoperatively) and 3 months after endonasal sinus surgery. Compared with male patients, female patients scored a significantly worse baseline in all SF-36 and one EQ-5D subscales and 3 months later in only one SF-36 subscale. Compared with the norm-based scores, both women's and men's SF-36 scores reached normal levels in seven subscales after 3 months. Conclusion Compared with men, women assessed preoperative HRQOL as being worse. Most women's and men's SF-36 subscales reached normal levels at the 3-month follow-up.
An Evaluation of Effect of Pterygopalatine Fossa Injection with Local Anesthetic and Adrenalin in the Control of Nasal Bleeding during Endoscopic Sinus Surgery
Authors: Wormald Peter-John , Athanasiadis Theodore , Rees Guy , Robinson Simon 
Published: August 2018

Background The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery. Methods A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation. Results At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade. Conclusion Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.
Anatomic Measurements for the Endoscopic Modified Lothrop Procedure
Authors: Farhat Firas T. , Figueroa Ramon E. , Kountakis Stilianos E. 
Published: August 2018

Background The aim of this study was to introduce preoperative radiographic frontal recess and sinus anatomic measurements to assist in the selection of patients considered for the modified Lothrop procedure. Methods Data were collected from sagittally reconstructed computed tomography (CT) scans of seven cadaver heads. Four anatomic parameters for measurement were defined as follows: (1) thickness of the nasal beak (desirable <10 mm); (2) midsagittal distance from nasal beak to skull base (adding 1 and 2 provides the anterior–posterior (AP) space at the cephalad margin of the frontal recess; desirable, ≥15 mm); (3) accessible dimension (in a parasagittal plane through the frontal ostium; the distance between two lines drawn parallel to the plane of the anterior skull base and perpendicular to the line of the insertion of the nasal endoscope during surgery; the posterior line is drawn at the skull base and the anterior line is drawn at the posterior margin of the nasal beak; the distance between the lines indicates the space available for instrumentation; desirable, >5 mm); (4) AP dimension of each frontal sinus. Results The average and the range of each parameter measured were as follows: (1) nasal beak thickness = 8.0 mm (5.0–10.4 mm); (2) nasal beak–skull base = 7.9 mm (2.5–14.1 mm); (3) accessible dimension, 6.1 mm (0.9–9.6 mm); (4) AP diameter of the frontal sinus, 9.7 mm (5.2–14.1 mm). Four specimens were considered candidates for modified Lothrop and three were not. Conclusion Preoperative radiographic frontal recess and sinus anatomic measurements may assist in the selection of patients considered for the endoscopic modified Lothrop procedure.
Orbital Volumetric Analysis of Allergic Fungal Sinusitis Patients with Proptosis before and after Endoscopic Sinus Surgery
Authors: Stonebraker Angela Chu , Schlosser Rodney J. 
Published: August 2018

Background The aim of this study was to examine the changes of orbital volumes in allergic fungal sinusitis (AFS) patients with proptosis who undergo endoscopic sinus surgery. Methods A retrospective study of operative patients with proptosis due to AFS was performed. Normative data were obtained using patients with chronic sinusitis without orbital involvement. Orbital volume measurements were obtained using digitized images and computer software to calculate volumes (cm3) of outlined regions on 1.3-mm axial computed tomography images. Orbital volumes were measured as total volumes and volumes within the bony orbit. Bony orbits were defined using two techniques: (1) the region posterior to a line from ipsilateral zygoma to contralateral zygoma and (2) the region posterior to a line from zygoma to ipsilateral lacrimal bone. Four affected orbits in three AFS patients with proptosis were evaluated. Twenty-eight unaffected orbits in 14 patients were used as normal comparisons. Results Orbital involvement by AFS resulting in proptosis decreased orbital volumes within the bony orbit to a mean of 70% of normal. After successful endoscopic sinus surgery, bony orbital volumes normalize or approach normal ranges to a mean 90% of normal with resolution of clinically apparent proptosis. Total volumes remained stable before and after surgery. Conclusion Massive AFS may affect the orbit resulting in proptosis. Spontaneous orbital remodeling with clinical resolution of proptosis and normalization of bony orbital volumes can be seen in AFS patients several months after sinus surgery and aggressive medical treatment. Surgical orbital reconstruction typically is not needed once the sinus disease is adequately addressed.
Endoscopic Management of Sinonasal Tumors: A Preliminary Report
Authors: Poetker David M. , Toohill Robert J. , Loehrl Todd A. , Smith Timothy L. 
Published: August 2018

Background The increased experience with the endoscopic approach to sinonasal inflammatory disease has resulted in the increased use of endoscopes to manage many different sinonasal pathologies. Methods A chart review of patients with sinonasal tumors treated with primary endoscopic management, from January, 1993 to November, 2003 was performed. Results Forty patients were identified (26 men and 14 women). The mean age was 53.2 years, and the mean follow-up was 31.1 months. For benign tumors, 24 patients were identified with a mean age of 50.7 years, a mean follow-up of 17.5 months, and a recurrence rate of 4.2%. For malignant tumors, 16 patients were identified, with a mean age of 57.3 years, a mean follow-up of 51.5 months, and a recurrence rate of 31.3%. The overall survival rate was 87.5%. Conclusion Endoscopic surgical excision of selective sinonasal tumors may be an effective therapeutic modality. In some cases, adjuvant external procedures may be required based on tumor location.