bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Uvulopalatopharyngoplasty Success in the Treatment of Obstructive Sleep Apnea Syndrome
Authors: Valera Fabiana , Braga Adriano , Grechi Tais H. , Eckel Alan , Itikawa Carla E. , Trawitzk Luciana V. V. , Felicio Claudia M. 
Published: August 2013

Objectives:Uvulopalatopharyngoplasty (UPPP) has been described as an option for treating obstructive sleep apnea syndrome (OSAS), with variable success rates. The main purpose of this study is to correlate UPPP success to craniofacial bony structure and orofacial muscle function.Methods:Prospective longitudinal study in a tertiary clinical center. Fifty‐four patients who underwent UPPP in the last 7 years were followed, and UPPP succeeded or failed based on the results of pre‐operative and post‐operative polysomnography. Clinical variables’ body mass index (BMI), age, and pre‐operative apnea‐hypopnea index (AHI)’s cephalometric measurements (craniofacial region and hyoid bone position), and muscle function variables (clinical protocol and tongue strength measures) were evaluated and compared between the groups (failure or success after UPPP).Results:The variables BMI, pre‐operative AHI, and cephalometric measurements showed no influence on surgical success. The clinical muscle protocol was also similar between groups. However, the muscle strength of the anterior portion of the tongue was significantly greater in the group that showed surgical success compared to those with surgical failure. This movement is primarily performed by genioglossus muscle.Conclusions:OSAS is a multifactorial disease, and diagnostic symptom assessments should be individualized. In addition, special attention should be given to functional muscle alterations of the airways, because they might influence the evolution of the disease.
The Junior Resident's Perspective of Learning in a Simulation‐Based Otolaryngology Boot Camp
Authors: Zapanta Philip E. , Adler Jamie , Constant Joelle , Malekzadeh Sonya , Deutsch Ellen S. , Fung Kevin , Malloy Kelly M. 
Published: August 2013

Objectives:1) Determine what residents experience in an otolaryngology boot camp (OBC). 2) Understand how the individual resident's background influences learning.Methods:Using a qualitative phenomenological approach, investigators interviewed 36 junior otolaryngology residents who had participated in a one‐day simulation‐based OBC. The residents attended camps in Washington, DC (July 2012), or in London, Ontario (September 2012). A semi‐structured interview of each resident was recorded and transcribed. Using Moustakaa'ss analysis, the interviews were broken up into codes and clusters to create a codebook. To ensure trustworthiness of the qualitative data, investigators used upfront debriefing, investigator triangulation, epoche, reciprocal coding of transcripts, member checks, and thick, rich description.Results:Five learning themes emerged during OBC: 1) Residents aim to gain knowledge and experience to positively affect their performance and patient outcomes. 2) Prior clinical experience and OBC's realistic scenarios influenced resident learning. 3) The residents valued their development of leadership and teamwork. 4) Residents actively learn by synthesis and application of their knowledge. 5) The faculty plays a critical role in the boot camp.Conclusions:The Accreditation Council for Graduate Medical Education (ACGME) has specific core requirements to improve resident performance and competency. To address this, innovative otolaryngology faculty has developed specialty specific boot camps, and quantitative research has documented the learners’ performance gains. Using the residents’ own words, this qualitative research study shows how residents learn and why residents benefit from attending a simulation‐based otolaryngology boot camp. This research will help us better understand our learners and how we can improve their learning experience.
Transoral Robotic Surgery (TORS) for the Management of Obstructive Sleep Apnea from Tongue Base Hypertrophy
Authors: Ahn Jeffrey M. , Hsu Nicole M. 
Published: August 2013

Objectives:Obstructive sleep apnea (OSA) is a medical problem that afflicts millions of Americans with considerable sequelae. The base of tongue is recognized as a significant site of obstruction leading to hypopharyngeal collapse during sleep. Many existing procedures implemented for the management of OSA typically have restricted surgical access to the base of tongue. However, transoral robotic surgery (TORS) provides excellent exposure to the tongue base and lingual tonsils. We aim to assess the success of robotically assisted partial glossectomy for tongue base reduction in patients with OSA.Methods:Medical records of patients ages >18 who underwent TORS for surgical management of OSA from 2011 through 2012 were retrospectively reviewed. Pre‐operative and post‐operative polysomnography were performed, and the results were compared to assess for improvement in OSA.Results:Twenty‐one patients completed the pre‐ and post‐operative evaluations. The mean apnea hypopnea index (AHI) decreased from 37.0 pre‐operatively to 14.9 post‐operatively, with a mean AHI reduction of 22.1 (p = <0.01). The mean oxygen saturation nadir was 79.2% pre‐operatively and 83.3% post‐operatively, with a mean increase in oxygen saturation nadir of 4.1% (p = 0.04).Conclusions:TORS provides excellent surgical access to the tongue base, allowing for improved base of tongue reduction for the management of OSA. In our patients who underwent robotically assisted partial glossectomy for OSA, there was a significant reduction in AHI, as well as a significant increase in oxygen saturation nadir.
Nasal Valve Collapse: An Unrecognized Cause of Eustachian Tube Dysfunction
Authors: Dean Marc , Bowen Rebecca 
Published: August 2013

Objectives:1) Demonstrate that correction of nasal valve collapse leads to improvement in eustachian tube dysfunction. 2) Describe the relationship between eustachian tube dysfunction and nasal valve pathology.Methods:A retrospective analysis of patients who underwent surgical treatment for nasal valve collapse from 2010 to 2011 was undertaken looking for associated eustachian tube dysfunction (ETD) and the effect correction of the nasal valve had on ETD. Each chart was analyzed for preoperative otologic complaints consistent with ETD and the effect correction of nasal valve collapse had on these complaints.Results:Forty patients underwent surgical treatment of nasal valve collapse; 37.5% of these patients reported symptoms consistent with eustachian tube dysfunction. Of these patients 87% reported improvement of their otologic symptoms.Conclusions:The relationship between chronic sniffing and negative middle ear pressures has been well established. Chronic sniffing creates negative middle ear pressures leading to ETD. Nasal valve collapse creates a setting physiologically similar to the chronic sniffer; thus, we hypothesize that nasal valve collapse is as an unrecognized cause of ETD, and correction will improve symptoms of ETD. This study demonstrates that patient have significant improvement in ETD symptoms related to ETD after undergoing correction of nasal valve collapse. This study suggests that correction of nasal valve collapse improves symptoms of ETD. However, this study is limited due to the retrospective design and small sample size; further prospective analysis is needed to study the effect of the nasal valve on ETD.
Needle Aspiration versus Incision and Drainage for the Treatment of Peritonsillar Abscesses
Authors: Thamboo Andrew , Chang Brent , Diamond Christopher , Nunez Desmond A. 
Published: August 2013

Objectives:Peritonsillar abscesses are a common otolaryngological emergency. Needle aspiration and incision and drainage are the two main treatment modalities currently used. The effectiveness of one versus the other remains an area of debate among otolaryngologists. The objective of this review is to recognize whether needle aspiration or incision and drainage is the superior treatment for peritonsillar abscesses.Methods:We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); PubMed; EMBASE; Web of Science; ClinicalTrials.gov; and Google Scholar for relevant English studies. Selection criteria were applied to limit the review to randomized controlled trials comparing needle aspiration to incision and drainage in humans over the age of 12 years. The primary outcome studied was abscess recurrence rate.Results:Five studies were identified which compared needle aspiration to incision and drainage. All were of poor quality with no paper having a Jadad score above 2. One study reported a higher recurrence rate with needle aspiration and four no obvious difference in recurrence rate between the two techniques. Meta‐analysis was inappropriate.Conclusions:Currently, there is insufficient evidence to determine which if any of the two treatments is superior. A sufficiently powered, well‐designed randomized controlled clinical trial is required to compare the effectiveness of needle aspiration with incision and drainage for the treatment of peritonsillar abscesses.
Otolaryngology Education in the University of Calgary Undergraduate Medical Curriculum: A Needs Assessment Study
Authors: Liu C. Carrie , Hoy Monica , Marck Paul A. 
Published: August 2013

Objectives:Perform a needs assessment study on otolaryngology teaching in pre‐clerkship medical students. Secondary outcomes include evaluating the quantity and nature of, as well as student perceptions of, current otolaryngology teaching at the University of Calgary.Methods:This is a survey based cohort study of first and second year medical students at the University of Calgary, completed in January and February 2013. The survey was based on the otolaryngology competencies outlined by the national medical board (MCCQE Part I objectives).Results:There were 150 responses (response rate of 42.9%). Thirty‐eight (74.5%) of first year respondents have had less than 10 hours of otolaryngology teaching, and of these experiences, 19 (50%) were with family physicians and only 2 (5%) were with otolaryngology staff. For the second year class, 60 (60.6%) have had less than 10 hours of otolaryngology teaching, 24 (24.2%) have had between 10‐24 hours, and 15 (15.2%) have had greater than 24 hours. Forty‐eight students (48.5%) received teaching by otolaryngology staff/residents and 19 (19.2%) by family physicians. Low confidence was expressed by both cohorts in performing head and neck exams as well as approaching common otolaryngology pathologies.Conclusions:There is a perceived deficiency in the otolaryngology component of the undergraduate medical curriculum, especially in the areas of performing otolaryngologic physical examinations and approaching otolaryngologic pathologies. Learning strategies perceived to have high educational value include physical exam sessions and small group case‐based learning sessions facilitated by an otolaryngology staff or resident, as well as attending otolaryngology clinics.
Say What? Disparity between Resident and Faculty Perceptions of Immediate Postoperative Feedback
Authors: Meyers Jason A. , Yueh Bevan , Gladding Sophia , Boyer Holly 
Published: August 2013

Objectives:1) Investigate differing perceptions between otolaryngology residents and faculty regarding immediate post‐operative feedback. We hypothesized that residents would be less satisfied with the degree of feedback. 2) Identify factors that might explain observed differences between perceptions.Methods:Prospective observational study of residents and faculty for one month during a university based otolaryngology residency rotation. Immediately following each operation, the faculty surgeon provided the resident surgeon with post‐operative feedback. Both then independently completed an identical confidential survey. Both surgeons were asked to address the amount, quality, content, and satisfaction about the immediate feedback and rate the resident's operative performance in 9 core areas on a 5 point Likert scale. Wilcoxon signed‐rank test was used to determine significance.Results:To date, 142 surveys were completed by 22 faculty and 16 residents following 71 operations. Contrary to expectations, the faculty were less satisfied with overall feedback given (4.06 vs 4.45; P < 0.001), sufficiency of feedback given (4.04 vs 4.45; P < 0.001), and specificity of feedback given (4.06 vs 4.39; P < 0.005). Compared to faculty evaluations, the residents rated their surgical performance lower in all 9 core areas and overall assessment of operative ability (4.17 vs 3.77; P < 0.001). Senior faculty level described fewer differences in perception of surgical performance.Conclusions:Faculty were less satisfied with the post‐operative feedback they provided, while residents were more critical of their own operative performance. These results will direct future efforts to improve educational feedback within our specialty.
Survival Outcome and Treatment Strategies in Advanced Stage (III‐IV) Laryngeal Cancers at Two European Centers
Authors: Karlsson Therese R. , Al‐Azzawe Mohammed , Aziz Luaay , Hurman David C. , Finizia Caterina A. 
Published: August 2013

Objectives:In light of continued uncertainty regarding efficacy of treatment of stage III and stage IV laryngeal tumors, this study aims to evaluate organ preservation strategies, comprising radiotherapy and chemoradiotherapy versus surgical treatment (laryngectomy± adjuvant treatment) by encompassing the long‐established practice at two internationally acclaimed tertiary centers not previously presented in published literature.Methods:Retrospective review of non‐randomized prospectively maintained patient databases at two tertiary centers from 1998‐2008; Sahlgrenska University Hospital (SU) in Gothenburg, Sweden, and Aberdeen Royal Infirmary (ARI) in Aberdeen, Scotland. Patients with stage III and IV disease were included in the study. Primary outcome measures included 3‐year overall and disease‐specific survival depending on treatment.Results:A total of 176 patients were identified, of whom 83% were male and 17% were female with an average age of 65. Sixty‐five patients (37%) presented with stage III tumors, of which 51 patients received organ‐preserving treatment and 14 patients underwent total laryngectomy. Corresponding figures for the 111 patients (63%) presenting with stage IV disease were 42 and 69. Three‐year overall and disease‐specific survival for stage III were 58% and 73% respectively. Corresponding figures for stage IV disease were 42% and 53%. Choice of treatment did not significantly influence survival for stage III (P = 0.56) or IV (P = 0.93) disease.Conclusions:Choice of treatment, whether it be organ preservation or surgery, does not significantly influence overall or disease‐specific survival. Therefore, other factors such as quality of life and voice and efficacy of salvage treatments are perhaps more likely to indicate preferred treatment options.
Tonsillar Biopsy as Diagnostic Choice in Variant Creutzfeldt‐Jakob Disease
Authors: Setabutr Dhave , Fornadley John A. , Goldman John N. 
Published: August 2013

Objectives:We attempt to publish the first U.S. report of proceeding with biopsy of tonsillar tissue to diagnose vCJD and review the literature.Methods:We review an interesting case of a patient who underwent tonsillectomy to potentially diagnose a variant of Creutzfeldt‐Jakob disease (vCJD) in November of 2012. Variant Creutzfeldt‐Jakob disease (vCJD) has impacted the British medical community for some time now. In the appropriate clinical context, a tonsil biopsy sample that is positive for PrPSc, variant CJD could be diagnosed, which obviates the need for a brain biopsy sample to be taken.Results:From other studies conducted in the British literature, tonsillar biopsy has been advocated for the diagnosis of a variant of Creutzfeldt‐Jakob disease preventing unnecessary morbidity from brain biopsy. The patient we reviewed was a young male who presented to the Emergency Room with a weeklong history of worsening headache. Magnetic resonance imaging (MRI) of the brain revealed signs consistent with encephalitis while electroencephalogram ruled out seizure activity and spinal fluid specimen was negative for meningitis. Infectious disease was consulted and recommended tonsillar biopsy to rule out variant Creutzfeldt‐Jakob disease. We review the literature on the utility of tonsillar biopsy for diagnosis of Creutzfeldt‐Jakob disease and report the first published report of this diagnostic modality in the United States.Conclusions:Tonsillar biopsy can safely be used in the diagnosis of variant Creutzfeldt‐Jakob disease obviating the need for more invasive procedures and at this time while disposal of instrumentation used for the tonsillectomy is the current recommended practice.
Tube Education Device (TED) Simulator for Myringotomy with Tube Insertion for Resident Training Purposes
Authors: Son Eugene L. , Pine Harold S. , Mukerji Shraddha S. , Young Dayton L. 
Published: August 2013

Objectives:1) Implement a training device to train otolaryngology residents to perform myringotomy with tube insertion. 2) Analyze data on the performance of medical students with this device.Methods:After approval by University of Texas Medical Branch Institutional Review Board, medical students were recruited to partake in the study from June 2012 to present. An instructional video on this procedure was shown to each subject before each trial. In the operating room, the subjects performed the procedure 5 consecutive times while being recorded through the ear microscope. An otolaryngology resident performed the duties of a surgical tech. The videos were then all randomized and reviewed by 3 attending otolaryngologists with the following criteria: average time, number of errors, and subjective numerical grading of each attempt.Results:To date, 7 subjects have participated. From the first attempt to the fifth attempt, the average time for procedure decreased from 160 seconds to 80 seconds. The average times the myringotomy knife touched the sides of the simulated ear canal dropped from over 2.6 to 0.7 times. The average percentage of instances the grader would allow the subject to perform procedure on a real patient increased from 38% to 91%. The success of the procedure determined by the grader increased from 52% to 95%.Conclusions:No standardized training is available for myringotomy with tube insertion. Training with this device can decrease procedure time by 50%, reduce errors, and increase the confidence of attending otolaryngologists of trainees. These results show potential benefits to translate to real patients.
Does Correction of Caudal Septal Deflection Affect Nasal Angle Parameters?
Authors: Kim Kyung Su 
Published: August 2013

Objectives:Verify whether one's external appearance may change after correction of caudal septal deflection by estimating nasal angle parameters.Methods:Correction of caudal septal deflection was performed by first releasing the caudal septal cartilage along the maxillary crest and excising excessive portions. The incised cartilage was sutured, and the detached ventral cartilage of caudal septum was fixed at the midline. Preoperative and postoperative photographs (lateral view) were taken at postoperative 6 months. Nasolabial angle (NLA) and nasal tip angle (NTA), as well as the angle between the columella and a perpendicular line to the Frankfort line (CFL), were evaluated. The visual analogue score (VAS) for nasal obstruction was evaluated at pre‐ and post‐operation.Results:A total of 35 patients per protocol were included in this study. The mean preoperative NLA was 98.67±9.17° and the mean NLA at postoperative 6 months was 98.64±9.27°; the NTA changed from 84.41±6.96° to 84.33±7.07°; the CFL changed from 80.06±7.91° to 80.08±8.02°. All parameters showed no significant change between pre‐ and post‐operation. Subjective saddle nose or other external deformities were not reported. VAS score of subjective nasal obstruction decreased significantly from 7.89±1.37 to 1.80±1.05.Conclusions:After correction of caudal septal deflection, nasal angle parameters were not changed and VAS score was significantly improved. Therefore, caudal septal deflection can be safely and satisfactorily corrected through proper surgical methods.
Voice Rehabilitation: Is It Effective in the Patient's Point of View?
Authors: Tuomi Lisa 
Published: August 2013

Objectives:Investigate the patient's self perceived efficacy of voice rehabilitation after laryngeal cancer.Methods:All patients who were diagnosed with laryngeal cancer during the years 2000 through 2011 were asked to participate in a randomized study on voice rehabilitation with a speech language pathologist. 79 patients agreed to participate. 37 of the patients underwent voice rehabilitation after completion of radiotherapy, and 42 worked as a control group. The study group filled in the Swedish version of the Self Evaluation of Communication Experiences after Laryngeal cancer (S‐SECEL) before and after voice rehabilitation, the control group at parallel times.Results:81% of the study group experienced an improvement of voice and communication measured with the S‐SECEL. In the control group 33% improved during the same period. In the study group 16% reported a worse perceived vocal function; in the control group corresponding values were 47%. 5% of the patients in the control group did not report any difference. Measurements from 1 and 6 patients in the study group and control group are missing respectively. The difference in mean values between the first and second measurement improved for the study group by 8.4 points. For the control group a deterioration of 4.4 was seen.Conclusions:Voice rehabilitation gives the patient a better self‐perceived communication and voice function. Some patients who did not receive vocal rehabilitation experienced improved voice function, but for the patients who received voice rehabilitation improvement was seen in a majority of the cases.
Wand Malposition during Inferior Turbinate Coblation Using Rhinoscopy or External View
Authors: Dion Gregory R. , Willson Thomas J. , O'Connor Peter , Weitzel Erik K. , Barrera Jose E. 
Published: August 2013

Objectives:1) Analyze differences in inferior turbinate coblation wand angles in correct and incorrect positions. 2) Determine whether rhinoscopy images of the coblation wand in the head of the inferior turbinate are adequate to determine distal tip position. 3) Determine whether viewing the coblation wand externally, such as is done by instructors during training, is adequate to determine distal tip position.Methods:Arthrocare Reflex Ultra 45 Plasma Wands were placed in inferior turbinates of cadaver specimens in three configurations: 1) ideal location for inferior turbinate reduction; 2) with distal tip where sphenopalatine artery (SPA) enters the nasal cavity; 3) with distal tip in nasal septum. Photos were taken of wand position from external views and an endoscopy view at the nasal vestibule. Angles from midline, the Frankfort horizontal line, and a mid‐sagittal line were calculated under each condition. Images from the three conditions were shown to otolaryngologists to determine if the correct position could be selected.Results:Wand angles, in each dimension, varied an average of 12 degrees (SD 10.1 deg). Shifting the wand 12 degrees in any direction corresponds to 4mm motion of the proximal wand with the distal end moving 1cm. Providers trained in facial plastic surgery, rhinology, and sleep medicine identified the correct coblation wand position 33 percent of the time.Conclusions:Inferior turbinate coblation is a common office and operating room procedure. Wand malposition using an external viewpoint or rhinoscopy may result in suboptimal turbinate reduction or epistaxis. Placement verification may be beneficial.