bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Arista Powder in 514 Nasal Septal and Sinus Surgery Patients
Authors: Phillips P. Perry 
Published: August 2013

Objectives:Determine the safety and efficacy of Arista powder in preventing postoperative bleeding during nasal septal and sinus surgery at a community hospital and surgery center.Methods:514 consecutive patients undergoing nasal septal and or sinus surgery from March 4, 2008 until December 11, 2012 were treated with Arista powder to control hemostasis without intranasal packing material. These patients were prospectively accrued.Results:One of 514 patients experienced bleeding requiring packing of the nose postoperatively, and no patients encountered any drug reactions or complications. No patients required blood transfusion. No patients developed scarring requiring a second surgical intervention.Conclusions:The results demonstrate a highly effective and safe role for Arista powder in controlling bleeding postoperatively in a large population of nasal septal and sinus surgery patients.
Surgical and Anatomic Considerations in Endoscopic Revision of Failed External Dacryocystorhinostomy
Authors: Liang Jonathan , Hur Kevin , Merbs Shannath L. , Lane Andrew P. 
Published: August 2013

Objectives:Identify key clinical and anatomic considerations in endoscopic revision DCR (r‐EnDCR) following failed external dacryocystorhinostomy (ExDCR). Study Design: Case series.Methods:A retrospective review was performed of patients undergoing r‐EnDCR after failed ExDCR over the past 6 years. Those with primary or previous EnDCR, proximal nasolacrimal procedures, and nasolacrimal lesions were excluded. All patients had pre‐operative maxillofacial computed tomography (CT). Data were collected on patient demographics, clinical characteristics, and radiographic findings. We developed a classification system for the anterior ethmoid‐lacrimal fossa complex.Results:Twenty‐five r‐EnDCRs were performed on 22 patients (18 female, 4 male; average age 50.0 yrs) after failed ExDCR. Concurrent sinusitis and previous maxillofacial trauma was seen in 8% (2/25) and 12% (3/25), respectively. CT analysis demonstrated agger nasi pneumatization in 88% (22/25), of which 77% (17/22) partially overlapped the medial aspect of the lacrimal fossa, resulting in a DCR ostium located within the middle meatus. The presence of ipsilateral septal deviation, concha bullosa, and middle turbinate lateralization or scarring to the lateral nasal wall was seen in 24% (6/25).Conclusions:ExDCR is a highly successful operation for nasolacrimal duct obstruction. When failures do occur, variability of the anterior ethmoid anatomy often plays an important role. CT imaging and endoscopy, which are not routinely performed prior to ExDCR, can help define the pattern of agger nasi pneumatization as it relates to the failed surgical DCR ostium. An understanding of the relationship between the agger nasi cells and the lacrimal fossa is essential for successful r‐EnDCR.
Surgical Relationship of the Nasolacrimal System to the Anterior Maxillary Line: Performing Safe Mega‐antrostomy
Authors: Sarber Kathleen M. , Weitzel Erik K. , O'Connor Peter 
Published: August 2013

Objectives:In patients with chronically diseased maxillary sinuses, poor mucociliary clearance may result from long‐standing inflammation or scarring from previous surgery. Endoscopic extended maxillary mega‐antrostomy is a recently described technique that facilitates mucus clearance and sinus irrigation in terminally dysfunctional maxillary sinuses by allowing the sinus to drain by gravity alone. As the procedure is a modification of the medial maxillectomy and it is standard to perform dacryocystorhinostomy (DCR) at the end of a medial maxillectomy procedure, it was our intent to determine if a DCR is likewise indicated after mega‐antrostomy. As a first step towards this answer, we aimed to study the relationship of the lacrimal system to the mega‐antrostomy procedure using cadaveric dissection.Methods:In 12 operated sides, the nasolacrimal duct was violated 42% of the time during anterior dissection. The average anterior‐posterior distance was 29.8mm. Lacrimal system violation occurred at an average of 3.7mm posterior to the anterior maxillary line. Unpaired Student t‐test was performed to determine if the limit of anterior dissection was associated with lacrimal system penetration.Results:More anterior dissection was significantly associated with lacrimal system penetration (6.1mm negative penetration to 4.6mm positive penetration p=0.038) however the overall AP diameter was not significantly related to penetration (p=0.511).Conclusions:Our results indicate that lacrimal system injury is highly likely to occur during mega‐antrostomy. To this end, DCR is indicated after mega‐antrostomy. However, using the maxillary line as a surgical landmark, damage may be avoided by maintaining a distance of >7mm from the anterior most aspect of the dissection.
Validation of EPOS 2012 Disease Control Assessment in Chronic Rhinosinusitis
Authors: Snidvongs Kornkiat , Sacks Raymond , Harvey Richard J. 
Published: August 2013

Objectives:1) Validate a clinical staging system on disease “control” in chronic rhinosinusitis (CRS) proposed by the European Position Paper on Rhinosinusitis (EPOS) 2) Propose a new, data driven staging system.Methods:Prospective study over a 12‐month period of CRS patients who underwent endoscopic sinus surgery in tertiary care. The Sinonasal Outcome Test‐22 and endoscopy score along with patient's and physician's report on clinical progress were recorded at 6 and 12 months. Ordinal regression was used for modeling symptoms and endoscopic findings to build up “disease control” criteria. Patients were defined as either “controlled,” “partly controlled,” or “uncontrolled” according to both EPOS and proposed criteria. The agreements with physician's and patient's report were analyzed.Results:106 patients were assessed (49.1% female, age 49.0±13.9yrs). Nasal obstruction was the only symptom which predicted patient's report (maximum likelihood (ML) ‐3.6, P = 0.02). Mucosal inflammation (ML ‐2.4, P < 0.001) and thick and/or purulent discharge (ML‐2.5, P = 0.01) predicted physician's report. A new “NOSE” staging system of nasal obstruction, systemic medication used, and endoscopic inflammation was proposed. EPOS system had fair agreement (k 0.29, P < 0.001) with physician's and slight agreement (k 0.18, P = 0.01) with patient's report, while the NOSE system had better agreement with both physician's (k 0.40, P < 0.01) and patient's report (k 0.32, P < 0.01). Both systems predicted treatment outcome at 12 months (both, P < 0.05).Conclusions:The disease control assessment by EPOS staging system has slight agreement with patients and physicians. A new system using nasal obstruction, diseased mucosa, and discharge is proposed.
Viral Disruption of Olfactory Progenitors Is Exacerbated in Allergic Mice
Authors: Ueha Rumi , Kondo Kenji , Ueha Satoshi , Yamasoba Tatsuya , Sumanta Mukherjee , Lukacs Nicholas W. , Kunkel Steven L. 
Published: August 2013

Objectives:Viral infection in the upper respiratory tract (URT) is a major cause of olfactory impairment. Allergic inflammation such as asthma or rhinosinusitis often exacerbates smell problems in patients with viral infections by a mechanism that remains unclear. Here, we examined the effects of allergic airway inflammation on the progression of virus infection and on olfactory lineage cell populations in a mouse model of respiratory syncytial virus (RSV) infection.Methods:Balb/c mice were immunized subcutaneously and intraperitoneally with cockroach antigen (CR) on day −22, then administrated intranasally with CR every 4 days from day −8 to day 0 to induce asthma and allergic inflammation (allergic mice). Allergic and control mice were infected intranasally with RSV line 19 on day 0. RSV‐RNA in the nasal mucosa and olfactory bulb were quantified by reverse transcription polymerase chain reaction (RT‐PCR). The numbers of OMP+ mature olfactory neurons (ORNs), Sox2+ olfactory progenitor cells (OPs), and CK5+ basal cells (BCs) were determined by immunohistochemical staining.Results:RSV‐RNA rapidly decreased and became undetectable on day 14 in control mice, whereas RSV‐RNA persisted over 14 days in allergic mice. There were no changes in OMP+ORN or CK5+BC numbers following RSV infection. In control mice, Sox2+OP numbers were significantly reduced on day 2 but recovered thereafter. In allergic mice, this decrease was more severe and prolonged.Conclusions:Allergic background impedes RSV clearance in the URT and exacerbates viral disruption of Sox2+OPs. These results provide novel insight into the mechanism underlying the exacerbation of virus‐induced olfactory impairment in allergic airway inflammation.
Hyoid Advancement in Females with OSA: Comparison of Two Techniques
Authors: Mickelson Samuel A. , Capp Casey 
Published: August 2013

Objectives:1) Describe the effectiveness of hyomandibular advancement performed alone versus hyomandibular advancement along with other pharyngeal procedures versus hyoid advancement to the thyroid cartilage (hyo‐thyroid advancement) along with other pharyngeal procedures, in adult females with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:Retrospective case series, 2001‐2011. Setting: Private practice. Subjects: 48 females with OSAHS: Hyomandibular advancement performed alone (N=12, age 51.8+7.2, body mass index [BMI] 27.8 kg/m2), Hyo‐mandibular advancement along with ancillary procedures (N=23, age 50.8+11.3, BMI 32.9 kg/m2), and hyothyroid advancement along with ancillary procedures (N=13, mean age 49.7+12.4, BMI 29.4 kg/m2.Results:Polysomnography: Respiratory disturbance index (RDI), Apnea hypopnea index (AHI), Lowest oxygen saturation (LSAT), Epworth Sleepiness Score (ESS). Hyo‐mandibular advancement alone had the lowest success rate [RDI fell: 32.5/hr to 28.0/hr (14.2% reduction), AHI fell: 30.8/hr to 23.4/hr (24.0% reduction), LSAT improved: 84.2% to 83.5%, overall success rate 36.4%]. Hyo‐thyroid advancement along with ancillary procedures had an intermediate success rate [RDI fell: 27.6/hr to 21.8/hr (21.0% reduction), AHI fell: 26.3/hr to 21.6/hr (18.3% reduction), LSAT improved: 85.8% to 87.3%, overall success rate 58.3%]. Hyo‐mandibular advancement along with ancillary procedures had the highest success rate [RDI fell: 26.5/hr to 13.7/hr (48.3% reduction), AHI fell: 25.5/hr to 12.6/hr (50.6% reduction), LSAT improved: 81.8% to 87.8%, overall success rate 61.1%]. BMI was unchanged. ESS scores improved in all groups.Conclusions:Hyomandibular advancement, coupled with other pharyngeal procedures, is more effective than hyothyroid advancement coupled with other pharyngeal procedures and more effective than hyomandibular advancment performed alone.
Nasal Anatomy Abnormalities and Objective Sleep‐Disordered Breathing Severity
Authors: Leitzen Keith , Lindsay Robin W. , Brietzke Scott E. 
Published: August 2013

Objectives:1) Explore the association between nasal anatomy and sleep disordered breathing (SDB) severity as measured by polysomnogram (PSG). 2) Explore the association between nasal anatomy and validated subjective measures of snoring, nasal obstruction, and daytime somnolence.Methods:A detailed nasal anatomy assessment on 100 subjects (80% male) including the nasal septum, internal/external nasal valves, and turbinates was performed. Subjects additionally completed the Snore Outcomes Survey (SOS), Nasal Obstruction and Symptom Evaluation (NOSE) instrument, and Epworth Sleepiness survey (ESS) which are all validated, disease‐specific surveys. Nasal anatomy assessments were then compared to PSG, SOS, NOSE, and ESS results.Results:The mean age was 42 (range=22‐72) and mean BMI was 28.9 (range=20.8‐39.8). Sixty‐nine patients (69%) were found to have OSA (mean AHI=13.1, range=0‐64). OSA severity was associated with age (spearmans rho=0.386, p=0.0001), male sex (0.229, p=0.022), BMI (0.279, p=0.005), and neck circumference (0.356, p=0.0003). No nasal anatomy measurement was found to correlate to ESS results or objective SDB severity measured by PSG. The sample size should have provided over 90% power to detect a significant association if one existed. The SOS score was correlated to an observed change in inferior turbinate size with oxymetazalone (‐0.252, p=0.116). The NOSE score was correlated to turbinate hypertrophy (0.299, p=0.0025), internal nasal valve collapse (0.258, p=0.0101), and septal deviation (0.204, p=0.418). Subjective snoring was correlated to PSG measured SDB severity (0.273, p=0.0065).Conclusions:Abnormal nasal anatomy was not correlated to PSG‐measured SDB severity. Specific measurements of abnormal nasal anatomy were correlated to subjective measures of snoring and nasal obstruction.
Prospective Outcomes Study of the Impact of Nasal Surgery on Sleep Quality
Authors: Stapleton Amanda L. , Gillman Grant 
Published: August 2013

Objectives:Evaluate the impact of functional nasal airway surgery on the quality of sleep in patients using validated outcomes measurements. Study Design: Prospective, single center, outcome study of sleep quality before and after functional nasal surgery in patients with nasal airway obstruction treated from August 1, 2011, to August 1, 2013. Patients >18 years old with symptomatic structural nasal airway obstruction treated surgically at an academic otolaryngology practice. Intervention: Primary septoplasty, revision septoplasty, functional septorhinoplasty.Methods:Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale (0‐100 scale), Epworth Sleepiness Scale (ESS) (0‐21 scale), the Pittsburgh Sleep Quality index (PSQI) (0‐21 scale), and Likert scales pre‐operatively and at 3 months post‐operatively. The impact of nasal surgery outcome on sleep quality was analyzed. Linear regression analyses were carried out to identify independent variables affecting sleep outcomes in nasal surgery patients.Results:48 patients enrolled, and 7 were lost to follow‐up. 41 patients for preliminary analysis: 19 septoplasty, 4 revision, and 18 functional septorhinoplasty. Mean NOSE scores decreased from 67 pre‐op to 17 at 3 month follow‐up. ESS scores decreased from 7.8 to 5.8. PSQI decreased from 7.9 pre‐op to 5.0 post‐op. Additional analyses are ongoing.Conclusions:Nasal airway surgery does have an effect on sleep quality when evaluated using validated outcomes measurements. The NOSE score showed the most significant improvement in symptomatology. The ESS and PSQI also showed improved sleep quality after nasal surgery.
Provent Therapy for Obstructive Sleep Apnea: Impact of Nasal Obstruction
Authors: Friedman Michael , Pott Thomas R. , Lundgren Mary E. , Farajian Viken , Joseph Ninos J. 
Published: August 2013

Objectives:Prospective, two‐arm, clinical pilot study.Methods:Fifty obstructive sleep apnea patients who failed continuous positive airway pressure (CPAP) therapy enrolled in a 30 night Provent trial. Polysomnography was performed prior to trial (baseline) and day 10 of the study using Provent. Epworth sleepiness scale (ESS), quality of life index, and snoring intensity were assessed day 0 and 30. Nasal obstruction was determined prior to trial by endoscopy. Subjects were divided based on nasal patency (control: obstruction 80% were excluded).Results:Forty‐four patients completed the trial averaging 7.01± 0.66 hours/night of sleep and tolerating Provent 6.04± 1.3 hours/night (mean±SD). Control cohort (n = 24) showed statistically significant improvement in apnea‐hypopnea index (AHI), oxygen saturation and snoring. Control cohort had greater mean reduction in AHI (11.7±3.2 P = 0.005), ESS (0.63±1.1 P = 0.59), snoring (2.6±1.1 P = 0.04), mean increase in oxygen saturation (0.08±0.03, P = 0.04), and quality of life outcomes (0.72±0.31 P = 0.60) when compared with the obstruction cohort, n = 20, (AHI 4.7±5.8 P = 0.44; ESS 2.5±0.96 P = 0.08; snoring 1.3±0.52 P = 0.90; oxygen saturation 0.04±0.02, P = 0.03; quality of life outcomes 0.63±0.24, P = 0.80) (mean difference ± standard error of difference). Acceptance as a long‐term solution was equivalent between both groups (56%).Conclusions:Provent therapy was effective in reducing AHI in all patients. Patients without nasal obstruction had greater success in reducing AHI and snoring while improving quality of life and minimum oxygen saturation. Correction of nasal obstruction may be a valuable prerequisite for Provent therapy.
Safety and Effectiveness of Upper Airway Stimulation via the Hypoglossal Nerve for Obstructive Sleep Apnea
Authors: Steward David L. , de Vries Nico , Froymovich Oleg , Soose Ryan J. , Gillespie Marion B. , Maurer Joachim T. , Woodson B. Tucker 
Published: August 2013

Objectives:Determine safety and effectiveness of upper airway stimulation for treatment of obstructive sleep apnea (OSA) in a prospective, multi‐center trial; with subsequent randomized, controlled therapy withdrawal evaluation.Methods:This study enrolled and screened 900 adult subjects. Inclusion criteria were moderate‐to‐severe OSA (apnea‐hypopnea index [AHI] 20‐50), prior continuous positive airway pressure (CPAP) failure or intolerance, and body mass index (BMI) < 32. All qualified subjects underwent further screening with drug‐induced sleep endoscopy (DISE) to exclude those with concentric palatal collapse. 126 subjects meeting all inclusion/exclusion criteria then underwent surgical implantation of a right sided unilateral hypoglossal nerve stimulation electrode, with pulse generator and respiration sensor (Upper Airway Stimulation System, Inspire Medical Systems, Minnesota). Patients were evaluated at 2, 6, and 12 months. Primary outcome measures included AHI, oxygen desaturation index, Epworth Sleepiness Scale, and Functional Outcomes of Sleep Questionnaire at 12 months. Therapy withdrawal effect was evaluated by randomizing a subset of consecutive responders to one week of on or off therapy for controlled comparison.Results:All 126 subjects were successfully implanted. In general, subjects were middle aged (mean 54.5 ± 10.2 yrs), male (83%), with severe OSA (mean baseline AHI 32.0 ± 11.8). Transient dysarthria and dysphagia were noted in a minority of patients. Over 70% of subjects have completed the study, with the remaining scheduled to complete 12 month evaluation by April, 2013. Final safety and effectiveness outcomes will be presented.Conclusions:Implantation of an upper airway stimulation system involving unilateral hypoglossal nerve electrode placement appears safe and feasible, with transient dysarthria occurring infrequently. Effectiveness will be addressed after completion of 12 month follow‐up for all subjects.
Short‐term Outcomes of Obstructive Sleep Apnea Surgery: Revisiting the Complication and Mortality Rates following Uvulopalatopharyngoplasty
Authors: Zapanta Philip E. , Khoury Tawfiq 
Published: August 2013

Objectives:1) Determine current complication rates following uvulopalatopharyngoplasty (UPPP) per the American College of Surgeons’ National Surgery Quality Improvement Program 2006‐2010 data (NSQIP). 2) Compare this more diverse sample population to a larger but less diverse VA study (1991‐2001 data).Methods:Using the NSQIP database, we examined a prospective cohort of adults undergoing UPPP for obstructive sleep apnea with or without other simultaneous procedures performed between the years of 2006 and 2010. We determined the serious complication and mortality rates. Serious complications were defined by 17 specific life threatening complications. Patient mortality was recorded up to 30 days post‐operatively.Results:On average, patients (n = 808) were 41 years old, had a body mass index (BMI) of 32.6, were predominantly white (57%), and were predominantly male (74.8%). The serious complication rate was 3.5% (28/808) (95% confidence interval [CI] 2.0% to 4.9%), and the mortality rate was 0.1% (1/808) (95% CI 0.0% to 0.2%). Mallampati, age, BMI, or year of operation did not have a significant effect. For multilevel surgery, the odds ratio for complications was 1.99 (95% CI 0.89 to 4.44).Conclusions:Based on prospectively collected quality improvement data available in NSQIP, the incidence of serious complications and mortality from UPPP surgery in a more diverse patient population is not significantly different from a larger, less diverse 2004 VA study. Post‐operative complications in multilevel surgery for obstructive sleep apnea may be slightly higher than the complication rate in patients who only received single level surgery.
Sleep Surgery and Medical Malpractice
Authors: Tolisano Anthony M. , Bager Jennifer M. 
Published: August 2013

Objectives:Describe and analyze the causes and outcomes of lawsuits pertaining to sleep surgery in order to mitigate future litigation and improve physician education.Methods:The LexisNexis MEGA Jury Verdicts and Settlements database was reviewed for all lawsuits including settlements and trial verdicts related to sleep surgery. Data including type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed.Results:Fifty‐one cases met inclusion criteria. Of these, 30 were decided by a jury, 9 were settled out of court, and 10 were resolved by other means. Overall, 57% of known outcomes favored the defendant. The most common surgery performed was tonsillectomy (57%) followed by uvulopalatopharyngoplasty (45%), adenoidectomy (31%), and septoplasty (31%). No difference was found between outcomes when comparing the most common injuries cited, including wrongful death (p = 0.572), airway compromise (p = 0.376), and drug reaction (p = 0.443). If failure to recognize a complication (p = 0.034) or delay in diagnosis (p = 0.026) was a component of the legal allegations, the outcome significantly favored the plaintiff. The average settlement ($535,000) and plaintiff award ($1.52 million) were not significantly different (p = 0.13).Conclusions:The majority of outcomes favored the defendant with a trend towards higher payouts in cases settled by a jury when compared to a settlement. Type of injury did not predict outcome. Failure to recognize complications and delay in diagnosis strongly predicted a verdict in favor of the plaintiff.
Utility of Post‐reduction Radiographic Analysis of Mandible Fractures
Authors: Guy William M. , Pena Israel , Pattisapu Prasanth , Brissett Anthony E. 
Published: August 2013

Objectives:Recognize that immediate post‐reduction films: 1) Have a significant associated cost; 2) Do not alter management.Methods:A retrospective review of the medical record was performed on patients with mandible fractures operated on by the otolaryngology‐head and neck surgery service between November 1, 2010, and November 30, 2012, at a level 1 county hospital. The post‐operative imaging modalities were determined as well as if any changes in care were initiated by that image. Those patients who did have repeat imaging were evaluated to determine what led to the second image and what action was taken.Results:Fifty‐seven patients met inclusion criteria. Fifty‐five patients (96.5%) had a post‐reduction image with 45 (79.0%) having a computed tomography (CT; $1,965) and 10 (17.5%) having a Panorex ($282). No immediate intervention was performed. Eleven patients (19.3%) had a second post‐operative image with 4 (36.4%) receiving at least 1 panorex and 8 (72.7%) receiving at least one CT. Of these 11 patients, 8 (72.7%) underwent an intervention based on the imaging. Analysis showed imaging significantly affected the management of the second group of 11 but did not affect the first group of 55 (p=0.0000).Conclusions:In this study, 96.5% of patients received postoperative imaging at a cost of $91,245 with no change in management. This supports the conclusion that routine post‐reduction imaging does not alter the immediate clinical course and should be reserved for those patients who have a postoperative clinical finding or complaint.