bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes of Sinogenic Intracranial Suppuration: The Alder Hey Experience
Authors: Leong Samuel Chee , Waugh Lucy-Katherine , Sinha Ajay , De Sujata 
Published: October 2014

Objectives: The aim of this study was to present a series of cases of sinogenic intracranial suppuration in a pediatric tertiary referral center and to review the long-term outcomes of the patients. Methods: We performed a retrospective review of the hospital database and the patient case notes. Results: Over 10 years, 14 patients were identified. The clinical presentations at the time of admission tended to include headache, vomiting, pyrexia, limb weakness, and decreased level of consciousness, in decreasing order of frequency. Sinonasal symptoms such as discharge and obstruction were only present in 36% and 21% of cases, respectively. The most common intracranial complication was subdural empyema in the frontal lobe region. The mortality rate was 21% (3 of 14). The remaining 11 patients remained alive at latest follow-up. The average follow-up period after hospital discharge was 19 months (median, 15 months; range, 6 to 64 months). No significant complications were noted in 4 patients, who had returned to normal daily activities at 6 months of follow-up. A significant proportion of patients who survived have some form of neurologic sequelae, although 64% of cases became asymptomatic in the 12 months following hospital discharge. Conclusions: The significant risk of morbidity and mortality of this disease requires a multidisciplinary approach that is best delivered at a tertiary referral center.
Airway Complications of Pediatric Extracorporeal Membrane Oxygenation
Authors: Agar Nicholas J. M. , Berkowitz Robert G. 
Published: October 2014

Objectives: Prolonged intubation is a risk factor for the development of laryngotracheal stenosis. Children who undergo extracorporeal membrane oxygenation (ECMO) usually remain intubated for an extended period. It is unclear whether the impaired cardiorespiratory status that necessitated ECMO places these children at a higher risk of laryngotracheal stenosis. This study was performed to assess the incidences of laryngotracheal stenosis and tracheostomy in children who undergo ECMO. Methods: We identified all patients under 18 years of age who underwent ECMO over a 10-year period concluding July 1, 2009, by use of the extracorporeal life support database of Royal Children's Hospital, Melbourne. All children in this database who underwent either a diagnostic or a therapeutic surgical procedure on the airway were identified. Results: The 218 patients included in the study had an overall survival rate of 51.4%. A total of 14 patients (6.4%) required a surgical procedure on the airway, and 11 of these (5.0%) needed tracheostomy. Ten of these 14 patients (71.4%) survived; of these, 2 presented with congenital laryngotracheal stenosis, 3 developed clinically significant laryngotracheal stenosis as a likely consequence of ECMO, and 5 required tracheostomy alone for long-term ventilation. The rate of airway stenosis was 2.7% in survivors. Conclusions: The rate of laryngotracheal stenosis in children who require ECMO is acceptably low.
Concurrent Superselective Intra-Arterial Chemotherapy and Radiotherapy for Late-Stage Squamous Cell Carcinoma of the Temporal Bone
Authors: Sugimoto Hisashi , Ito Makoto , Yoshida Shinya , Hatano Miyako , Yoshizaki Tomokazu 
Published: October 2014

Objectives: This study evaluated the efficacy of concurrent superselective intra-arterial chemotherapy and radiotherapy without surgery for late-stage squamous cell carcinoma of the temporal bone, which typically has a poor prognosis. Methods: The subjects were 5 patients treated at our hospital between 2007 and 2010 for primary cancer of the temporal bone. One patient had a stage T3 tumor, and 4 patients had T4 tumors, according to the Pittsburgh staging system. All patients received irradiation with a conventional once-daily fraction of 2 Gy, and the total dose ranged from 60 to 66 Gy. Intra-arterial cisplatin via transfemoral catheterization and intravenous sodium thiosulfate were administered. The contribution of each vessel in supplying blood to the primary tumor was determined by real-time computed tomographic angiography. Results: Three patients obtained a complete response. The same 3 patients remain alive without local recurrence (mean survival, 28 months), 1 patient died of distant metastasis without local recurrence after 19 months, and 1 patient remains alive with local recurrence. Conclusions: Although the small number of patients prevents comparisons with other treatments, the present study obtained good results. This may become an effective treatment for patients with late-stage squamous cell carcinoma of the temporal bone.
Comparison of Nasal Sound Spectral Analysis and Peak Nasal Inspiratory Flow before and after Decongestion in Patients with Nasal Obstruction
Authors: Choi Hyuk , Park Il-Ho , Yoon Hu Geun , Lee Heung-Man 
Published: October 2014

Objectives: We compared the results of nasal sound spectral analysis (NSSA) with the results of peak nasal inspiratory flow (PNIF) testing and use of a visual analog scale in patients with allergic rhinitis with nasal obstruction. Methods: We performed NSSA and PNIF testing on 38 patients with allergic rhinitis and 35 healthy subjects. A diagnostic decongestion test was performed on the patients (not on the control subjects). Twenty minutes after decongestant was sprayed into the nostrils, NSSA and PNIF testing were performed again. Results: There was a significant difference in the PNIF values and the nasal inspiratory sound intensities before and after decongestion (p < 0.001). There was a correlation between the NSSA results at the frequency range of 2 to 4 kHz and the PNIF results. The calculated cutoffs between normal and pathological values were 14.8 dB (2 to 4 kHz) for NSSA and 116 ± 14.1 L/min for PNIF testing. No significant differences were computed between NSSA and PNIF testing in terms of sensitivity (0.71 versus 0.76) or specificity (0.74 versus 0.80). Conclusions: Use of NSSA and PNIF testing together for assessment of nasal obstruction in allergic rhinitis provides clinical relevance in that it allows a fair degree of reliability. Such testing can be performed as a surrogate for rhinomanometry.
Orbitocranial Approach for Treatment of Adenoid Cystic Carcinoma of the Lacrimal Gland
Authors: Wilson Kevin F. , Ward P. Daniel , Spector Matthew E. , Marentette Lawrence J. 
Published: October 2014

Objectives: Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach. Methods: We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland. Results: All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease. Conclusions: The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.
Management and Outcomes of Laryngeal Injuries in the Pediatric Population
Authors: Sidell Douglas , Mendelsohn Abie H. , Shapiro Nina L. , St. John Maie 
Published: October 2014

Objectives: Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature. Methods: The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted. Results: There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge. Conclusions: Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.
Congenital Laryngomalacia: Symptom Duration and Need for Surgical Intervention
Authors: Wright Charles T. , Goudy Steven L. 
Published: October 2014

Objectives: We undertook to characterize the natural course and duration of stridor and other symptoms associated with laryngomalacia and determine the need for surgical intervention. Methods: A retrospective observational study was performed at a tertiary children's hospital of 120 consecutive cases of congenital laryngomalacia diagnosed and treated by the senior author between July 2005 and June 2009. The patients' symptoms, associated symptoms, and required interventions were recorded. Results: In 115 cases that were managed without surgery, stridor resolved at a mean patient age of 7.6 months. Five patients (4.2%) required supraglottoplasty to resolve their airway obstruction. The patients who required surgery presented emergently to the hospital 80% of the time, and at a younger mean age (45 days) than did patients who did not require surgery (95 days; p = 0.13); these findings suggest the severe nature of their symptoms. Presenting symptoms of dyspnea or accessory muscle use, feeding difficulties, apnea, cyanosis, oxygen desaturation, and failure to thrive were significantly associated with the requirement for operative intervention (all p values less than 0.02). Nonoperative management included placement of a nasogastric tube due to aspiration in 3 patients. Conclusions: The stridor resolved at an average age of 7.6 months of age in patients with laryngomalacia managed without surgery. A young age at presentation and emergent evaluation in the hospital are associated with a higher degree of symptom severity and a higher rate of surgical intervention. Surgical intervention was necessary to treat laryngomalacia in 4.2% of patients in this study population.
Nasal Floor Free Mucosal Graft for Skull Base Reconstruction and Cerebrospinal Fluid Leak Repair
Authors: Suh Jeffrey D. , Ramakrishnan Vijay R. , DeConde Adam S. 
Published: October 2014

Objectives: Donor sites for free mucosal grafts for endoscopic endonasal reconstruction of the skull base have traditionally included the middle turbinate, the inferior turbinate, and the nasal septum. The aim of this study was to demonstrate a free mucoperiosteal graft from the nasal cavity floor as a simple alternative donor site for mucosal grafts. Methods: In a cadaver study with clinical correlation, we performed endoscopic endonasal harvest of the nasal floor free mucosal graft on two sides of a cadaveric nasal cavity. We also describe the cases of two patients in whom a nasal floor free mucosal graft was used to repair a skull base defect. Results: The harvest of a nasal floor free mucosal graft is a quick, potentially less morbid method of obtaining free mucosal grafts. In the cases examined, use of this graft carried minimal morbidity and allowed for successful reconstruction of a skull base defect. Conclusions: Harvest of nasal floor mucosa is a technically simple method of obtaining free mucoperiosteum for reconstruction of the skull base.
Assessment of a Neurophysiological Model of the Mandibular Branch of the Facial Nerve in Rats by Electromyography
Authors: Salomone Raquel , Costa Heloisa Juliana Zabeu Rossi , Rodrigues José Ricardo Ferreira , Reis e Silva Samanta Marques , Orando Patricia Camacho , Bento Ricardo Ferreira 
Published: October 2014

Objectives: Our objective was to develop an experimental model for the noninvasive and objective evaluation of facial nerve regeneration in rats using a motor nerve conduction test (electromyography). Methods: Twenty-two rats were submitted to neurophysiological evaluation using motor nerve conduction of the mandibular branch of the facial nerve to obtain the compound muscle action potentials (CMAPs). To record the CMAPs, we used two needle electrodes that were inserted into the lower lip muscle of the rat. A supramaximal electrical stimulus was applied, and the values of CMAP latency, amplitude, length, area, and stimulus intensity obtained from each side were compared by use of the Wilcoxon test. Results: There was no significant difference (all p > 0.05) in latency, amplitude, duration, area, or intensity of stimuli between the two sides. The amplitudes ranged between 1.61 and 8.30 mV, the latencies between 1.03 and 1.97 ms, and the stimulus intensities between 1.50 and 2.90 mA. Conclusions: This is a noninvasive, easy, and highly reproducible method that contributes to an improvement of the techniques previously described and may contribute to future studies of the degeneration and regeneration of the facial nerve.
Modified Osteoplastic Flap Approach for Frontal Sinus Disease
Authors: Al-Qudah Mohannad , Graham Scott M. 
Published: October 2014

Objectives: We review the use and outcomes of osteoplastic flap surgery in the current era of almost entirely endoscopic management of frontal sinus disease. Methods: A retrospective review was performed of 312 consecutive sinus surgeries performed for frontal sinus disease at the University of Iowa Hospitals and Clinics from July 2002 to July 2008. Results: Seventeen subjects (10 men and 7 women; mean age, 56 years) were identified. The indications for osteoplastic flap surgery were laterally located mucoceles in 8 patients, tumors in 7 patients, and osteomyelitis in 2 patients. Ten patients had skull base erosion, and 5 underwent cranialization for large posterior frontal bone defects. The average blood loss was 175 mL, and the average hospital stay was 3 days. There were no major intraoperative or perioperative complications. Two patients with mucoceles required revision surgery for disease recurrence. The mean follow-up was 25 months (range, 6 to 66 months). Conclusions: Osteoplastic flap surgery is an uncommon procedure in the modern endoscopic era of sinus surgery. In our series it was most commonly indicated for laterally located disease. Osteoplastic flap surgery is relatively safe and effective for a wide range of recalcitrant and complicated frontal sinus disorders.
DFNA5, a Gene Involved in Hearing Loss and Cancer: A Review
Authors: Op de Beeck Ken , Van Laer Lut , Van Camp Guy 
Published: October 2014

Objectives: The DFNA5 gene was identified in 1998 as a gene that causes an autosomal dominant form of hearing impairment. Five different DFNA5 mutations have been found; each results in skipping of exon 8 at the messenger RNA level. This finding indicates that DFNA5-associated hearing loss is attributable to a highly specific gain-of-function mutation. Interestingly, later reports revealed that DFNA5 also plays a role in tumor biology. Methods: Recent data have shed more light on the biological function of DFNA5. Through a literature search, the current knowledge of this gene is reviewed. Results: DFNA5 is the first gene for monogenic deafness that is known to involve apoptosis as a disease mechanism — A mechanism that was shown to be involved in frequent types of hearing loss caused by age, noise, or drugs. In line with its apoptosis-inducing properties, DFNA5 is a tumor suppressor gene with an important role in major types of tumors. Conclusions: DFNA5 is a tumor suppressor gene that is involved in apoptosis pathways and as such performs a basic role in cell survival. In view of the known role of apoptosis in several forms of hearing loss, DFNA5 may be a player in the underlying disease mechanisms.
Vocal Fold Vibratory Behavior Changes following Surgical Treatment of Polyps Investigated with High-Speed Videoendoscopy and Phonovibrography
Authors: Kunduk Melda , Döllinger Michael , McWhorter Andrew J. , Švec Jan G. , Lohscheller Jörg 
Published: October 2014

Objectives: The goal of this study was to objectively quantify the changes in vocal fold vibratory characteristics before and after surgery with high-speed videoendoscopy and the image analysis tool phonovibrography. Methods: High-speed videoendoscopic data, audio recordings, and Voice Handicap Index scores were collected from 8 subjects with a diagnosis of unilateral vocal fold polyps, before operation and at 1 week and 1 to 3 months after operation. We then analyzed the objective phonovibrographic patterns and parameters describing the vocal fold vibratory behavior. Results: On phonovibrography, the visual representations of the vocal fold vibratory characteristics, from both the individual and the group data, demonstrated very different patterns before surgery and both 1 week and 1 to 3 months after surgery. The individual phonovibrograms obtained from the left and right true vocal folds clearly demonstrated the lesion site and its effects on the vocal fold vibratory characteristics for each subject. The improvements in amplitude and symmetry (relative vibratory amplitude and vibration amplitude symmetry) of vocal fold vibration were quantified; the difference was greatest between data from before surgery and data from 1 week after surgery. Conclusions: The visual phonovibrographic patterns and quantitative data revealed marked changes in vocal fold vibratory patterns after operation and continued improvement at 1 to 3 months.
Transoral Laser Microsurgery of Recurrent Early Glottic Cancer after Radiation Therapy: Clinical Feasibility and Limitations
Authors: Han Young Jin , Lee Hyoung Shin , Kim Sung Won , Hong Jong Chul , Kim Seung Tae , Park Hyo Sang , Lee Kang Dae 
Published: October 2014

Objectives: Transoral laser microsurgery (TLM) is an accepted alternative to open partial laryngectomy for selected glottic cancers, but its role in salvage of radiation failure is debated. Methods: The records of 18 patients treated by TLM for rT1 and rT2 glottic cancer after curative radiation therapy from 2002 to 2007 were retrospectively analyzed. Results: Of the 18 patients, 10 (56%) remained free of disease after the first TLM. The 5-year local control and laryngeal preservation rates showed better outcomes in rpT1 tumors than in rpT2 tumors (87.5% versus 16.6%, p = 0.02; and 87.5% versus 33.3%, p = 0.03, respectively). However, the 5-year overall survival and disease-specific survival rates showed no significant difference between rpT1 and rpT2 tumors. Conclusions: TLM can be a relatively safe and effective salvage option for rT1 glottic cancer. However, because of its high local recurrence rate, TLM may not be generally recommended for rT2 glottic cancer.
Bilateral Vestibulopathy with Dissociated Deficits in the Superior and Inferior Vestibular Systems
Authors: Fujimoto Chisato , Murofushi Toshihisa , Sugasawa Keiko , Chihara Yasuhiro , Ushio Muentaka , Yamasoba Tatsuya , Iwasaki Shinichi 
Published: October 2014

Objectives: The aim of this study was to reveal the clinical characteristics of dissociated bilateral vestibulopathy (BV) affecting the superior vestibular nerve system on one side and the inferior vestibular nerve system on the other side. It is probable that BV does not always show bilateral deficits of the same vestibular nerve system. Methods: In a retrospective study of 2,752 consecutive new patients, 1,560 patients had undergone both caloric testing and cervical vestibular evoked myogenic potential testing. All 1,560 patients had also undergone a battery of tests including standardized neurologic, neuro-otologic, neuro-ophthalmologic, and audiological examinations. Results: Forty-three patients (2.8% of 1,560 patients) were given a diagnosis of dissociated BV. Among them, 10 patients (23%) had Meniere's disease and 6 patients (14%) had vestibular neuritis. Eighteen patients (42%) did not have any identifiable disease involving the peripheral vestibule, and 9 patients (21%) could be regarded as having a novel subtype of idiopathic BV. Conclusions: Although dissociated BV might be induced by some of the same causes that provoke bilateral vestibular dysfunction, a definite proportion of the patients did not have any identifiable causes of dissociated vestibular dysfunction. Idiopathic cases could be categorized into a novel subtype of idiopathic BV.
Outcomes of Balloon Dilation in Pediatric Subglottic Stenosis
Authors: Whigham Amy S. , Howell Rebecca , Choi Sukgi , Peña Maria , Zalzal George , Preciado Diego 
Published: October 2014

Objectives: We report outcomes of balloon dilation in the endoscopic management of pediatric subglottic stenosis (SGS) and discuss the role of balloon dilation in both primary and adjuvant therapy. Methods: We performed a retrospective review of treatment with noncompliant, high-pressure balloons for SGS in the past 2 years at a tertiary pediatric hospital. Fifty-one dilations were performed in 28 children with SGS. The children's mean age was 42 months. The mean SGS grade was 2.46. Results: Fifteen children had primary balloon dilation, and 13 had adjuvant balloon dilation. Overall, 16 children (57.1%) had successful balloon dilation. Of those who underwent primary dilation, 9 (60.0%) were able to avoid open reconstruction or tracheotomy and 6 had their symptoms temporarily improved (average, 36 days) until definitive open reconstruction. Of the patients who underwent adjuvant dilation, 7 (53.8%) were successfully decannulated. Nine of the 12 failed balloon dilations were in children who had concomitant airway disorders; in contrast, only 6 of 16 children in whom treatment was successful had concomitant airway disorders (p = 0.048). There was no statistical association between successful versus failed treatment and age (51.6 versus 27.9 months; p = 0.23), degree of stenosis (grade 2.3 versus grade 2.6; p = 0.41), presence of lung disease (33.3% versus 70%; p = 0.07), or soft versus firm stenosis (60.0% versus 53.1%; p = 0.71). Conclusions: Balloon dilation plays an important role in the primary and adjuvant management of pediatric SGS. The presence of concomitant airway lesions is significantly associated with failure of balloon dilation treatment. Meticulous surveillance of the dilated airway is necessary, given this failure rate.