bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial Biofilms and Increased Bacterial Counts Are Associated with Airway Stenosis
Authors: Mazhar Kashif , Gunawardana Manjula , Webster Paul , Hochstim Christian , Koempel Jeffrey A. , Rice Dale H. , Baum Marc 
Published: August 2013

Objectives:The majority of airway stenoses are acquired secondary to the use of prolonged endotracheal intubation (ETT). Pressure exerted on the tracheal mucosa by the presence of ETT leads to irritation, ulceration, and granulation tissue formation and eventual fibrosis. An excess of granulation tissue promotes excess wound contracture. Antibiotics have been shown to decrease local inflammation and granulation tissue formation in the trachea. However, antibiotic therapy is not 100% effective in preventing or treating granulation tissue formation. Development of bacterial biofilms may explain this finding. This study was done to evaluate the difference between stenotic segment and normal trachea in terms of 1) presence of bacterial biofilms; 2) quantitative analysis of bacterial count; 3) inflammatory markers within tracheal tissue.Methods:Institutional review board approved case‐control study, where cases were patients with airway stenosis and controls were patients without airway stenosis. We performed scanning electron microscopy (SEM) for biofilm, quantitative polymerase chain reaction (qPCR) for quantitative analysis of bacterial count, and immunohistochemistry (IHC) for inflammatory markers.Results:SEM showed presence of biofilm in cases compared to controls. The number of 16S rRNA gene copies using qPCR, a surrogate for the number of bacterial cells, was significantly higher in cases (mean=198) compared to controls (mean=30) (P < 0.05). Pediatric cases showed a significantly higher bacterial count than adult cases. IHC showed stronger staining for SMAD3 and transforming growth factor β (TGF‐β).Conclusions:Biofilms are present in airway stenotic segments, and there exists a difference in tracheal microbiomes and inflammatory markers between patients with airway stenosis and normal controls.
Microdebrider Complications in Laryngologic and Tracheal Surgery
Authors: Solowski Nancy , Belafsky Peter C. , Courey Mark S. , Merati Albert L. , Rosen Clark A. , Weinberger Paul M. , Postma Gregory N. 
Published: August 2013

Objectives:There is no formal body of literature focusing on complications in laryngologic and airway surgery performed with microdebriders. Attendees can expect to: 1) Describe potential complications that may occur with microdebrider use during laryngologic and airway surgery. 2) Recognize which clinical situations are better suited to the use of the microdebrider. 3) Implement changes in clinical practice to improve operative safety when using the microdebrider in laryngologic and airway surgery.Methods:A literature review of microdebrider complications in otolaryngologic surgery was performed. A series of exemplary and illustrative cases seen by various surgeons in selected high volume laryngologic centers was confidentially solicited and is described.Results:Significant microdebrider complications are described, including severe hemorrhage, extensive tissue loss, and airway perforation, as well as ways to prevent and treat these complications.Conclusions:A thorough understanding of the microdebrider and its potential complications will improve surgical outcomes. Implications for Practice: Awareness of the risks and knowing when to use the microdebrider will allow the surgeon to successfully use this device in a safe and efficient manner.
Restoration of Recurrent‐Laryngeal‐Nerve Function after Injury in a Rat Model
Authors: Mor Niv , Naggar Isaac , Das Olipriya , Nakase Ko , Silverman Joshua B. , Sundaram Krishnamurthi , Kollmar Richard 
Published: August 2013

Objectives:Recurrent laryngeal nerve (RLN) injury occurs in 4‐10% of thyroid surgeries. Spontaneous RLN regeneration takes months and is often incomplete. Lithium promotes neuronal growth in vitro. We developed methods to objectively detect vocal‐fold impairment in the rat and tested whether systemic lithium enhances recovery after RLN injury.Methods:The right RLN was crushed in eight adult rats, and osmotic pumps releasing either lithium or water were implanted. Eight sham‐operated animals were also implanted with either lithium or water pumps. Vocal‐fold motion was captured by microsuspension laryngoscopy and was measured quantitatively by image analysis at the time of surgery and at one and four weeks. Vocalizations, breathing patterns, and laryngeal electromyography were assessed at four weeks.Results:Cessation of unilateral vocal‐fold motion was observed simultaneously with every RLN crush. One week after surgery, 50% of “Crush/Water” animals exhibited full vocal‐fold motion, compared to 75% of “Crush/Lithium” and 100% of the sham‐operated animals. In animals with unilateral vocal‐fold immobility, the quantitative analysis also revealed a subtle decrease of vocal‐fold movement on the non‐operated side. At four weeks after surgery, vocalizations, breathing patterns, vocal‐fold motion, and electromyograms were indistinguishable among all groups. Lithium‐treated animals weighed 5% less than water‐treated controls.Conclusions:Quantitative endoscopy is a sensitive and efficient tool for detecting vocal‐fold impairment in rats. While our results might suggest enhanced recovery in lithium treated animals, all animals showed a rapid return of vocal‐fold motion. Perhaps more severe nerve injury is necessary to uncover an effect of lithium on nerve regeneration.
Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube
Authors: Silvola Juha T. , Kivekäs Ilkka , Poe Dennis S. 
Published: August 2013

Objectives:Studies of Balloon Eustachian tuboplasty (BET) have shown encouraging results with short follow‐up in small series. We present long‐term results of a prospective study in which subjects act as their own controls. Our pilot study showed patients with prolonged otitis media with effusion (OME) or tendency to atelectatic tympanic membrane (TM) clearly benefit from BET. We chose this patient group for long‐term follow‐up.Methods:Out of 80 patients with BET, 42 consecutive adult patients were included. Subjects’ inclusion criteria were OME and/or tendency to atelectasis, type B or C tympanograms, and inability to inflate their middle ears by Valsalva maneuver. All patients had a longstanding ET dysfunction relieved only by repeated tympanostomies. Outcomes included ability to perform a Valsalva maneuver, audiometry, tympanometry, videoendoscopy of the ET with mucosal inflammation rating scores, and otomicroscopy.Results:All cases were dilated successfully, without major complications. Follow‐up was 1‐3.5 years. Eighty‐one percent (34/42) of patients were able to do a Valsalva maneuver after balloon dilation. Tympanometry Results showed clear improvement even though many patients have permanent damages in their TMs after longstanding ME ventilation problems. The successful patients did not need new tympanostomy tubes. Also, subjective symptoms were relieved. For 19% (8/42) the ET function did not recover.Conclusions:There is accumulating evidence that BET effectively improves ET function in ears with OME or atelectasis. The procedure is well tolerated and without significant complications. The follow‐up continues for these patients, and we investigate possible reasons for negative results.
Does Residual Spiral Ganglion Cell Count Predict Performance in Patients with Bilateral Multichannel Cochlear Implants?
Authors: Seyyedi Mohammad , Nadol Joseph B. 
Published: August 2013

Objectives:Although published reports have not demonstrated a positive correlation between residual spiral ganglion cells (SGC) and word recognition in patients with unilateral multichannel cochlear implants, this study was designed to determine whether word recognition scores after implantation are a function of residual SGCs in patients with bilateral multichannel cochlear implants.Methods:Study Design: Retrospective case series. Setting: Temporal bone banks of Massachusetts Eye and Ear Infirmary and House Research Institute. All subjects with bilateral multichannel cochlear implants who were deafened bilaterally by the same etiology were studied. A total of 8 temporal bones from 4 subjects were identified and processed after death for histology. The SGCs were counted by standard techniques. The differences between the better and worse SGC counts as well as the differences in Consonant Nucleus Consonant (CNC) scores were calculated for each subject. Correlation analysis was then performed between the differences of SGC counts and the differences of CNC scores. Statistical power was calculated to illustrate how the results can be used to estimate the sample size as a function of effect size.Results:Differences in SGC counts were highly correlated with the differences in CNC word scores (Pearson's correlation = 0.972, P = 0.028) such that with a power of 95% and α = 0.05, only 4 cases were needed to show the same effect size.Conclusions:This study suggests the higher residual SGCs predicted better performance after implantation. The results also justify any attempts to reduce the effect of insertional trauma which may adversely affect SGC count.
Ischemic Preconditioning (IPC) with Resveratrol on Epigastric Rat Flap
Authors: Petrone Paolo , Quaranta Nicola , Fiorella Maria‐Luisa , Armenio Andrea , Pascone Michele 
Published: August 2013

Objectives:Investigate the effects of ischemic preconditioning (IPC) plus resveratrol on the viability of epigastric rat flaps for reconstructive microsurgery.Methods:Fifteen Sprague‐Dawley rats were used from September 2011 to December 2011. Superficial epigastric artery‐ and vein‐based island flaps (control flap and resveratrol flap) were used. IPC was applied to both flaps for 60 minutes. Therefore we administered 0.2 cc of resveratrol in the artery of the resveratrol Flap. On day 14, viable flap areas were measured, and taken for histological examinations with hematoxylin‐eosin staining and CD34+ hematopoietic progenitor cells analysis.Results:We described destruction of skin and subcutaneous tissues in all control flaps, with hypoxic and ischemic areas and exudative phlogosis. The CD34 analysis was negative. The resveratrol flaps description was completely different. The necrosis and the acute inflammation were minimal. Instead, there was an important angiogenesis. Three rat flaps failed. However, there was angiogenesis also in the failed flaps, although reduced. In all resveratrol flaps there was large lymphoplasmacytic infiltrate, typical of chronic reparative processes, a good indicator of the end of acute inflammatory process.Conclusions:The IPC and the resveratrol made a significant contribution to the flap viability. The results of this study will contribute to the literature about the hemodynamics of rat flaps and guide further studies on the issue for the free flap in the reconstructive microsurgery.
Meta‐analysis of Meniett Therapy for Ménière's Disease
Authors: Ahsan Syed F. , Standring Robert T. 
Published: August 2013

Objectives:Evaluate the efficacy of Meniett micropressure treatment for Ménière's disease by performing a meta‐analysis of all relevant treatment studies.Methods:Systematic review of the English literature using Medline, Ovid, and Cochrane library from January 1996 to December 2012. We selected all studies for which the Meniett micropressure device was used to treat patients with definitive unilateral Ménière's disease. We did not include isolated case reports and general reviews. Random and fixed models were used to estimate overall effect size.Results:Of 80 abstracts screened for relevancy, 18 studies were selected for further review. For hearing, only 9 studies reported pure tone average (PTA) pre‐ and post‐Meniett application. The difference in PTA between pre‐ and post‐micropressure device application was not significant (P = 0.72). Seven studies reported American Academy of Otolaryngology (AAO) functional score pre‐ and post‐treatment. Analysis shows significant improvement of AAO functional score after treatment (P = 0.04). Eight studies reported frequency of vertigo before and after treatment. The treatment was found to be significant in reducing frequency of vertigo (P < 0.0001).Conclusions:The Meniett device appears to be a safe, non‐destructive treatment alternative for patients refractory to initial medical therapy for Ménière's disease. The overall body of literature on the efficacy of the Meniett device is sparse and is an obvious limitation of this analysis, yet the data obtained will help to enlighten practitioners on the usefulness of the Meniett device.
Care of Pediatric Tracheostomy in the Immediate Postoperative Period and Timing the First Tube Change
Authors: Lippert Dylan C. , Dang Phat , Kille Tony 
Published: August 2013

Objectives:1) Analyze the impact of a new postoperative care protocol on complications, including skin breakdown. 2) Analyze the safety of performing the first tracheostomy tube change prior to postoperative day 5.Methods:Retrospective case series in an academic medical center. Patients: Pediatric patients undergoing tracheostomy from February 2010 to February 2013. Intervention: In 2012 a new protocol was instituted for pediatric tracheostomy care in the immediate postoperative period that included: 1) securing tracheostomy tubes with Velcro straps rather than twill ties, 2) placing a clean drain sponge around the tracheostomy tube daily, and 3) performing the first tracheostomy tube change on postoperative day 3 or 4. Outcome Measures: 1) Rate of complications, including skin breakdown, related to the tracheostomy tube and securing straps. 2) Presence of a mature stoma allowing for a safe first tracheostomy tube change.Results:37 patients in the pre‐protocol group and 16 in the post‐protocol group were analyzed. Rate of skin breakdown related to the tracheostomy tube or securing straps was significantly higher in the pre‐protocol group (32.40% vs. 0%, P = 0.01). There was a trend towards a higher overall complication rate change in the pre‐protocol group, but this was not statistically different (18.90% vs. 0%, P = 0.062). In the post‐protocol group, all tube changes were safely performed on postoperative day three or four.Conclusions:This new care protocol for pediatric tracheostomies resulted in decreased rates of skin breakdown. In addition, pediatric tracheostomy tubes can be safely changed as early as 3 days postoperatively.
Orbital Fracture Repairs: A 5‐Year Institutional Analysis of Complications
Authors: Connor Matthew P. , Subramanian Meenakshisundar , Novak Joseph , Demartelaere Sheri , Brennan Joseph 
Published: August 2013

Objectives:1) Analyze the complications associated with orbital fracture repair. 2) Recognize the potential benefit of an interdisciplinary approach for complicated cases.Methods:Five‐year retrospective chart review of all orbital fractures treated at a military Level I Trauma Center from January 1, 2007, through January 1, 2012. All operative reports, inpatient and clinic notes were reviewed, and a database was created detailing patient demographics, nature of injury, and the surgical service and techniques used for each case. The otolaryngology, ophthalmology, and oral and maxillofacial surgery (OMFS) departments collaborated on the analysis of all cases and complications.Results:A total of 107 cases met inclusion criteria. 54 cases were treated with operative repair. The otolaryngology service performed 20 operations and had 6 complications with 3 patients requiring surgical revision. These complications included 3 cases of entropion and 3 cases of ectropion. The OMFS service performed 19 operations and had 6 complications with 4 patients requiring surgical revision. These complications included 3 cases of entropion and 5 cases of postoperative diplopia. The ophthalmology service performed 5 operations and had 1 complication of diplopia that required surgical revision. A total of 11 cases were treated by the otolaryngology and/or OMFS service in conjunction with ophthalmology as a team approach. None of these cases experienced a postoperative complication.Conclusions:Surgical treatment of orbital fractures can have serious complications that often require surgical revision. An interdisciplinary team approach has proved effective at our institution and should be considered for any complicated case.
Impact of Otitis Media Severity on Children's Quality of Life
Authors: Grindler David J. , Blank Sarah I. , Lieu Judith E.C. 
Published: August 2013

Objectives:Children with otitis media suffer sleep disturbances, loss of appetite, earache, and psychosocial and behavioral problems. Our objective was to describe the impact of otitis media severity on infant quality of life (QoL).Methods:Study Design: Multi‐institutional prospective cross‐sectional study. Setting: otolaryngology, family practice, and pediatric outpatient clinics. Subjects: Children 6‐24 months of age with and without a primary diagnosis of recurrent otitis media. Data were collected from providers and parents, including relevant patient history, a Family Information Form, the PedsQL Infant quality of life survey, and the 6‐item child with OM QoL survey (OM‐6).Results:A total of 2414 patients were enrolled. The average age was 16 months, and 58% were male. The mean OM‐6 score was 3.26, slightly more severe than the reported 2.8 for the average child with OM. The mean PedsQL Infant scores were 77 for children less than 1 year old, and 79 for children >1 year. These values indicate worse QoL compared to the reported average scores for healthy and acutely ill infants, 82.47 and 79.46, respectively. Higher OM‐6 scores were significantly correlated with worse PedsQL Infant scores, Pearson r values ‐0.602 and ‐0.563, P < 0.01. Other factors that correlate with QoL in this population will be discussed.Conclusions:Children 6‐24 months of age with recurrent OM had a mean PedsQL score significantly worse than similarly aged healthy children. Worse PedsQL Infant scores were highly correlated with elevated OM‐6 scores, suggesting that severity of OM significantly affects child QoL.
Incidence and Risk Factors for Central Sleep Apnea in Infants with Laryngomalacia
Authors: Tanphaichitr Archwin , Tanphaichitr Pattraporn , Apiwattanasawee Polporn , Rutter Michael J. , Simakajornboon Narong 
Published: August 2013

Objectives:Identify the incidence of and risk factors for central sleep apnea in infants diagnosed with laryngomalacia.Methods:We conducted a retrospective study in infants with laryngomalacia. All infants had diagnostic polysomnography (PSG) performed during 2003‐2012. Infants who underwent supraglottoplasty or other upper airway surgery prior to PSG were excluded. Central sleep apnea (CSA) was defined as central apnea index ≥ 5. Demographic data, underlying diseases, and PSG data were reviewed and analyzed.Results:Fifty‐four patients met the inclusion criteria. The mean age at the date PSG was performed was 3.35±2.69 months. The incidence of central sleep apnea in infants with laryngomalacia was 46.30%. There was a significantly higher incidence of CSA in patients with the following conditions: underlying neurologic disease or hypotonia (61.11% vs. 38.89%, P = 0.0029), premature infants (62.5% vs. 43.48%, P = 0.0045), history of apparent life threatening events (66.67% vs. 42.22%, P = 0.0006), and age less than 3 months (54.84% vs. 34.78%, P = 0.0068). Severity of obstructive sleep apnea, history of gastroesophageal reflux, pulmonary disease, and symptom severity were not significantly associated with increased risk for CSA. Analysis of sleep architecture revealed a decrease in total sleep time (345.38 ± 70.61 minutes vs. 393.45 ± 68.25 minutes, P = 0.02) and sleep efficiency (67.69 ± 8.93% vs. 75.22 ± 9.28%, P = 0.004) in the CSA group.Conclusions:Central sleep apnea is relatively common in infants with laryngomalacia, especially in high risk groups as described above. The presence of CSA can lead to alteration in sleep architecture. In addition to clinical evaluation, polysomnography may be warranted for the evaluation of infants with laryngomalacia and associated complex medical conditions.
Minimally Invasive, Image‐Guided Cochlear Implantation for Pediatric Patients: A Clinical Feasibility Study
Authors: Labadie Robert F. , Reda Fitsum A. , Noble Jack H. , Blachon Gregoire , Dawant Benoit M. , Fitzpatrick J. Michael , Balachandran Ramya 
Published: August 2013

Objectives:Minimally‐invasive, image‐guided cochlear implantation (CI) involves accessing the cochlea via a linear path from the lateral skull to the cochlea avoiding vital structures, including the facial nerve. Herein, we describe and demonstrate the feasibility of the technique for pediatric patients.Methods:Thirteen pediatric patients (1.5 to 8 years) undergoing traditional CI in a children's hospital participated in this institutional review board‐approved study. Three fiducial markers were bone‐implanted surrounding the ear, and a computed tomography (CT) scan was acquired. The CT scan was processed to identify the marker locations and critical structures of the temporal bone. A safe linear path was then determined to target the cochlea, avoiding damage to vital structures. A custom microstereotactic frame was then fabricated that would mount on the fiducial markers and constrain a tool to the desired trajectory. After traditional mastoidectomy and prior to cochleostomy, the custom microstereotactic frame was mounted on the bone‐implanted markers to confirm that the achieved trajectory is safe and accurately accesses the cochlea.Results:For all the 13 patients, it was possible to determine a safe trajectory to the cochlea. Custom microstereotactic frames were fabricated for the desired trajectory and validated successfully on nine patients. Two of these patients had inner ear malformation, and this technique helped the surgeon identify the location for cochleostomy. For patients with normal anatomy, the closest distance of the trajectory to facial nerve and chorda tympani were 1.26 ± 0.32 mm and 0.97 ± 0.40 mm, respectively.Conclusions:Minimally‐invasive, image‐guided cochlear implantation is feasible for pediatric patients.
Outcomes of Cricotracheal Resection in Airway Reconstruction for Expanded Indications
Authors: Myer Charles M. , Hart Catherine K. , Tabangin Meredith , Heubi Christine H. , Rutter Michael J. , Cotton Robin T. , de Alarcon Alessandro 
Published: August 2013

Objectives:1) Describe expanded indications of cricotracheal resection (CTR) in airway reconstruction, including revision reconstruction and young age. 2) Define outcomes associated with expanded indications of CTR.Methods:Retrospective review of patients undergoing CTR at a tertiary care hospital from January 1, 2005, to December 31, 2011. Primary outcomes included decannulation rates and surgical success, defined as absence of symptoms at last follow‐up. Logistic regression was used to examine age as a predictor of surgical success. Eighty patients were identified, with 68 patients having complete records available for review. Forty‐nine patients were under 21 years of age.Results:In pediatric patients, surgical indications included stenosis (n = 43, 87.76%), A‐frame deformity (n = 5, 10.2%), and laryngeal atresia (n = 1, 2%). Patients with subglottic stenosis (SGS) included 4 (9.3%) grade II, 34 (79.07%) grade III, and 5 (11.63%) grade IV. Thirty‐eight patients (77.55%) were tracheostomy‐dependent. Thirty‐one patients (63.27%) had a history of prior airway surgery. Decannulation was achieved in 40 patients (81.63%); 36 patients (73.47%) were asymptomatic at last follow‐up. Eight patients required additional open operation. Logistic regression analysis of pediatric patients showed over‐all surgical success was associated with increased age (P =. 02). Success rates between primary surgery and revisions were similar (67% vs. 77%, Fisher's exact test, P =. 51).Conclusions:In our pediatric cohort, we found success of CTR is associated with older age at time of reconstruction. There was no association between success and primary surgery, suggesting CTR remains a viable option in revision cases.