bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of Various Common Surgical Instruments for Pediatric Adenotonsillectomy: Analysis of Time, Hemorrhage, and Cost
Authors: Thottam Prasad J. , Christenson Jennifer R. , Cohen David S. , Metz Christopher M. , Haupert Michael S. , Saraiya Sonal 
Published: September 2014

Objectives:Evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage and associated health care cost for pediatric adenotonsillectomy.Methods:Retrospective chart analysis from a tertiary care pediatric hospital of patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and chi‐square analysis was used to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.Results:A total of 1280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the 3 instrumentation groups. When examining the various instruments’ effects on procedure time in minutes, univariate ANOVA did demonstrate a significant difference overall between the 3 groups (F = 8.79; P <. 001). Post hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either both PlasmaBlade (P =. 03) or radiofrequency ablation (P <. 001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ2 = 2.36; P =. 31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated as $30.04 for monopolar cautery, $246.95 for PlasmaBlade and $244.32 for radiofrequency ablation.Conclusions:The ideal surgical instrumentation would be efficient, have a low complication rate, and be relatively inexpensive. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
Weight Gain after Tonsillectomy and Adenotonsillectomy: A Case Control Study
Authors: Lewis Travis L. , Johnson Romaine F. , Choi Jonathan , Mitchell Ron B. 
Published: September 2014

Objectives:(1) Compare height and weight changes of children who underwent tonsillectomy and adenotonsillectomy (T&A) with a control group. (2) Analyze differences in growth based on starting weight class.Methods:A total of 154 children who underwent T&A between December 2010 and March 2011 were included. They were compared with 182 children with similar demographics who were seen in primary care clinics (control). Height and weight were compared at 6‐month intervals over a 24‐month period. Patients were divided into normal weight, overweight, and obese based on Centers for Disease Control and Prevention criteria. A multilevel regression model was used for analysis. Significance was set at P =. 05.Results:There were no differences in average starting weight, age, or sex between surgical and nonsurgical groups. Average starting weight was 47.6 kg (confidence interval [CI] 42.0‐53.2) and 48.1 kg (CI 41.8‐54.3) for the obese surgical and obese control groups respectively. There was no difference in weight gain at 6 months. However at 12, 18, and 24 months, the obese surgical group had a significant weight increase over and above the obese control group (P <. 001). An average of 14.3 kg weight gain at 24 months was seen in obese children who underwent T&A compared to 10.1 kg for controls (a difference of 4.2 kg (±2.9)). There were no differences in weight changes between the normal and overweight groups or in height for any of the groups.Conclusions:T&A leads to significant increase in weight in obese but not in normal or overweight children. Efforts should be made to provide weight reduction counseling prior to T&A in obese children.
Allergic Fungal Sinusitis Infratemporal Fossa Involvement: Saudi Experience
Authors: Al Dousary Surayie H. 
Published: September 2014

Objectives:Allergic fungal rhinosinusitis (AFRS) is well known to expand and to extend to the surrounding structures like the orbit and the brain; however, it has not been reported to extend to the infratemporal fossa (ITF). Because of the difficulty of accessing the ITF, we report our experience over 5 years.Methods:One hundred one patients with AFRS were operated upon by the author between 2008 and 2013.Results:All of these patients had preoperative computed tomography scans (CTs), and all but 2 had postoperative CT of the paranasal sinus. Twelve had expansion or extension of the disease into the ITF: 8 males and 4 females, their ages ranged from 10 to 34 years with mean of 20.4 years. Four of them were children below 15 years of age. Three patients had bilateral disease and 9 had unilateral sinus involvement. Seven cases had expansion of the posterior wall of the maxillary sinus into the ITF, which was unilateral and mil; however, extension from the sphenoid sinus was more extensive in most of the cases; bilateral in 2 and unilateral in the others.Conclusions:ITF extension from the sphenoid sinus is more extensive than from the maxillary sinus. In a pediatric population, because of the incomplete fusion of the suture line, the disease expanded and eroded into the ITF. In adults, the opticocarotid recess is the weakest area and the disease can expand through it into the ITF. Posterior wall of maxillary sinus expansion into the ITF is mild in all cases, and all the ITF extensions were cured endoscopically.
Analysis of Potential Determinants of a Reduced Intercarotid Distance in Patients Undergoing Endoscopic Transsphenoidal Surgery
Authors: Mascarella Marco A. , Forghani Reza , Sirhan Denis , Maio Salvatore Di , Mohr Gerard , Zeitouni Anthony G. , Tewfik Marc A. 
Published: September 2014

Objectives:(1) Evaluate the anatomic variability of the distance between the internal carotid arteries (ICA) at the paraclival, intracavernous, and paraclinoid segments in normal variants and in patients with sellar or parasellar lesions. (2) Identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and identify subgroups at higher risk for ICA injury during endoscopic skull base surgery.Methods:A retrospective case‐control study was performed at an academic tertiary care center. The smallest distance between the ICAs at the paraclival, intracavernous. and paraclinoid segments on coronal T2‐weighted magnetic resonance imaging was measured in patients with sellar or parasellar tumors and in nontumor controls. Factors such as demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential predictors of the ICD.Results:In total, 154 cases and 34 controls were analyzed. Patients with growth hormone (GH) secreting adenomas had a markedly reduced ICD at the paraclival segment as compared to controls (1.59 cm and 1.77 cm, respectively; P =. 02; 95% confidence interval [CI] [0.03‐0.32]). The paraclinoid ICD was reduced in patients with a planum sphenoidale meningioma (1.09 cm and 1.33 cm, respectively; P =. 04; 95% CI [0.01‐0.45]). The transverse dimension of pituitary adenomas was linearly correlated to the ICD (P <. 001). No narrowing of the ICD was associated with sphenoid configuration or cephalometric measurements.Conclusions:Patients with a GH secreting adenoma or planum sphenoidale meningioma had a reduced ICD. Identifying these populations can help surgeons recognize constraints imposed by a reduced ICD to endoscopic access of the skull base and avoid inadvertent ICA injury.
Effect of Strong Fragrance on Olfactory Detection Thresholds of Health Workers at UCH Ibadan, Nigeria
Authors: Fasunla Ayotunde J. , Douglas David D. , Adeosun Aderemi A. , Steinbach Silke , Nwaorgu Onyekwere G. 
Published: September 2014

Objectives:Assess the effect of perfume on olfactory detection thresholds of health workers at the University College Hospital, Ibadan.Methods:This was a quasi‐experimental study on olfactory detection thresholds of one hundred healthy health workers in a tertiary health institution from September 2013‐November 2013. A structured questionnaire was administered to participants to obtain information on sociodemographics, occupation, ability to perceive smell, use of perfume, effects of perfume on appetite and self‐confidence, history of allergy, and previous nasal surgery. Participants subjectively rated their olfactory performance and thereafter had olfactory detection threshold testing done with varied concentrations of n‐butanol in a forced triple response and staircase fashion. Olfactory detection thresholds at baseline and after exposure to Lynx perfume were determined and compared.Results:Thirty‐seven males and 63 females were evaluated. Their ages ranged from 19‐59 years with a mean age 31 years ± 8. Subjectively, 94% participants had excellent olfactory function. In the pre‐exposure forced triple response, 88% participants were able to detect the odor at ≤0.25 mmol/L concentrations while in the post‐exposure forced triple response, only 66% participants were able to detect the odor at ≤0.25 mmol/L concentrations. There was also a statistically significant difference in the olfactory detection threshold score between the pre‐exposure and post‐exposure period in the participants (P <. 05).Conclusions:Use of fragrance affects the olfactory detection threshold. Therefore, wearers should be aware of this and its implications on test of olfaction.
Interrelation between Symptoms and Nasal Endoscopic Findings in the Diagnosis of Chronic Rhinosinusitis
Authors: Kim Kyung‐Su , Park Do Yang , Lee Eun Jung , Kim J. I. Hoon 
Published: September 2014

Objectives:The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) criteria are the most commonly used criteria in the diagnosis of chronic rhinosinusitis (CRS) in Korea. Symptom‐based EP3OS criteria are used in epidemiological studies, but its reliability and the best composition of criteria have not been thoroughly examined. Therefore, we aimed to verify its reliability and search the best combination of criteria to diagnose CRS in a large scale.Methods:The 2009 and 2010 data (15,445 people) on Korean National Health & Nutrition Examination Survey symptom questionnaire and nasal endoscopic findings were analyzed. EP3OS criteria composed of major and minor symptoms were used to define symptom‐based CRS. Either mucopurulent rhinorrhea from middle meatus or nasal polyp was the definition of endoscopy‐based CRS. The correlation between these definitions of CRS and the relative importance of symptoms, and the best combination of symptoms were analyzed.Results:The symptom‐based definition of CRS showed statistically significant correlation with the endoscopy‐based definition of CRS (Pearson r =0.120, P <. 001). As to the correlation between symptoms and positive endoscopic finding, hyposmia or anosmia was the most correlated symptom (Pearson r = 0.134, P <. 001). The most reliable symptom‐based definition of CRS was +one of major symptoms + hyposmia or anosmia.Conclusions:Because the symptom‐based definition didn't show strong correlation with the endoscopy‐based definition, the combination of both definitions is essential in the diagnosis of CRS. If symptom‐based definition is used, one of major symptoms + hyposmia or anosmia is the most reliable criterion in the diagnosis of CRS.
Meet the Sac: Endoscopists’ Road Map
Authors: Kurien Mary , Tyagi Amit , Shyam Aparna , Holla Sunil 
Published: September 2014

Objectives:Ideal mucosal incision followed by adequate osteotomy is the key to successful endonasal endoscopic dacryocystorhinostomy. Hence anatomical correlation of intranasal lateral nasal wall landmarks to lacrimal sac and duct was done with secondary computed tomography (CT) correlation.Methods:A descriptive study of 10 adult cadaver head sections fixed with 10% formaldehyde solution was done in the anatomy and radiology departments of a tertiary hospital from 2010 to 2011. Following CT scan, these were sagittally sectioned to 10 right and left specimens. Measurement of anatomical landmarks in CT and dissection were taken by metric ruler and digital calipers respectively. With application of paired t test, mean was calculated.Results:Maxillary line was clearly identified in 75% of cadavers, the majority overlapping the lacrimal sac. In all cadavers superior end of lacrimal sac was above the axilla, distance between them being 8.88 mm. Length of lacrimal sac was 11.72 mm. These showed positive correlation with CT scan. Distance between anterior edge of lacrimal sac and axilla was 10.58 mm. Genu was at or posterior to nasolacrimal duct in the majority, the length of duct being 10.27 mm. This showed positive correlation with CT.Conclusions:Important endonasal landmarks are of middle turbinate—axilla and genu (bony), and maxillary line (mucosal). Mucosal Incision, 9 to 10 mm above axilla, anterior to maxillary line and genu, 10 to 11mm long to just above level of genu, is sufficient to expose lacrimal sac up to its inferior limit. Preoperative CT scan can be reserved for revision or post‐traumatic nasolacrimal sac pathology.
Secondary Nasoseptal Flaps for Endoscopic Skull Base Reconstruction: Proof of Concept and Evaluation of Outcomes
Authors: Choby Garret W. , Mattos Jose L. , Sahu Nivedita , Gardner Paul , Fernandez‐Miranda Juan , Snyderman Carl H. , Wang Eric W. 
Published: September 2014

Objectives:(1) Assess secondary nasoseptal flaps (NSF) as a viable reconstructive option. (2) Evaluate postoperative vascularity of secondary NSFs. (3) Compare cerebrospinal fluid (CSF) leaks and complication rates of secondary NSFs to primary NSFs.Methods:This is a retrospective review of patients from 2009 to 2013 undergoing transsellar approaches for skull base tumors at the University of Pittsburgh Medical Center. In cases where the necessity of a vascularized reconstructive flap was made evident only after tumor resection, the NSF was raised after the tumor had been resected and/or CSF leak had developed (secondary NSF). Outcome measures include postoperative magnetic resonance imaging (MRI) findings, CSF leak rates, and complication rates.Results:Transsellar approaches were performed in 436 patients during this timeframe. Primary NSFs were used to reconstruct 178 patients while 32 patients had secondary NSFs. Postoperative MRI scans were available in 29 of 32 secondary NSF patients; all maintained vascularity on examination of T1 post‐contrast images (mean time to MRI 4.9 months). There was no significant difference in CSF leak rate between primary NSFs (3.4%) and secondary NSFs (3.1%) (P =. 95). Primary NSFs had a higher overall complication rate (11.7%) compared to secondary NSFs (3.1%), but this was not statistically significant (P =. 142). Logistic regression analysis demonstrated no significant effect of flap type, age, or sex on CSF leak rates.Conclusions:Secondary NSFs are a viable reconstructive option for sellar skull base defects. They maintain vascularity as evidenced on postoperative MRI imaging and compare favorably to primary NSFs in regard to CSF leak rates and complication rates.
Sinonasal Outcomes Test‐22 as a Tool to Identify Chronic Rhinosinusitis among Adults with Cystic Fibrosis
Authors: Habib Al‐Rahim , Alsaleh Saad , Manji Jamil , Quon Bradley , Buxton Jane , Javer Amin R. 
Published: September 2014

Objectives:(1) Investigate the ability of a sinus‐specific health‐related quality of life questionnaire (HRQoL) to distinguish clinically significant chronic rhinosinusitis (CRS) among adults with cystic fibrosis (CF). (2) Determine an appropriate cutoff score on the Sinonasal Outcomes Test‐22 (SNOT‐22) with sufficient test sensitivity and specificity, to assist caregivers in identifying adults with CF who may warrant specialist referral and treatment.Methods:Participants were enrolled at an adult‐specific CF clinic in a tertiary academic hospital in Vancouver, Canada. Subjects completed the SNOT‐22 followed by endoscopic assessment by otolaryngologists. The Canadian Clinical Practice Guidelines for Chronic Rhinosinusitis were used to confirm diagnosis of CRS.Results:To date, 52 of 80 individuals with a confirmed diagnosis of CF have participated in this study. Thirty‐nine (75.0%) individuals were identified with CRS, 12 (30.8%) of whom presented with nasal polyposis. Aggregate SNOT‐22 scores were significantly higher among individuals with CRS compared to non‐CRS counterparts (39.4 ± 20.0 vs 22.7 ± 8.7, P =. 007, 95% confidence interval [CI] for mean difference: 4.7, 28.7). A SNOT‐22 score >26 was found to have a test sensitivity of 74.4% and specificity of 66.7% for diagnosis of CRS (AUC = 0.77, P <. 01). Using SNOT‐22 scores related to rhinological symptoms increased the likelihood ratio of a positive test when compared to aggregate scores (8.3 vs 2.2, respectively).Conclusions:The SNOT‐22 significantly discriminates between CF adults with and CF adults without CRS. Using rhinological symptom scores increases the likelihood of detecting true CRS cases. The use of this questionnaire may assist specialists in identifying individuals who have clinically significant CRS, warranting specialist referral and treatment.
Cleft Repair: Medical Mission Trips versus Empowering Local Surgeons in Developing Countries
Authors: Opsahl Courtney , Sidman James D. 
Published: September 2014

Objectives:Determine whether it is more cost beneficial to partake in a medical mission trip to developing countries to complete cleft repairs or to support medical professionals in providing local care.Methods:Retrospective analysis of surgical costs per patient of different types of US‐based charitable organizations. We compared financial information of 3 separate 501(c)(3)s for fiscal years 2011 and 2012. Cost per surgery was determined through expenses and total number of surgeries. Two organizations focus on service‐based missions (typically US‐trained surgeons and other clinicians traveling to developing countries to complete surgeries over a 1‐2 week period). The third organization focuses on funding local surgeons (who are already trained and have proven expertise) to complete cleft repairs. This organization pays local clinicians to complete surgeries, and in return, surgeons upload results to an electronic medical record system so outcomes and progress can be tracked.Results:The cost per patient is significantly lower when local surgeons are paid to complete cleft repair cases than when entire teams of clinicians partake in service‐based missions for cleft repairs. While different from country to country, the typical cost for locally provided care is as low as $250/patient. When relying on service‐based missions, the average cost is above $500.Conclusions:It is more cost beneficial to empower local surgeons in developing countries to complete cleft repairs.
Sinus Headaches: Otolaryngology Treatment or Neurology Referral: Analysis of Efficacy and Cost‐Effectiveness of Migraine Treatment
Authors: Daraei Pedram , Gross Jennifer H. , Delgaudio John M. 
Published: September 2014

Objectives:Evaluate the efficacy and cost‐effectiveness of empiric treatment of sinus headaches/migraines initiated by an otolaryngologist versus referral to a neurologist for treatment.Methods:Retrospective chart review from 1998 to 2013 of patients with ICD‐9 codes for headache or atypical facial pain at an academic medical center. Comparison of cost of workup and treatment initiated by an otolaryngologist was compared with that of patients referred to neurology. Length of delay in treatment was also calculated for patients referred to neurology.Results:Of 797 patients reviewed, 57 patients were primarily treated by otolaryngology, and 104 patients were referred to neurology for treatment. Success of patients treated by otolaryngology was 78.9% versus 81.8% for neurology‐treated patients (P =. 77). The average wait for an appointment with a neurologist specializing in headache was 57.9 days. Forty‐two patients had a history of chronic rhinosinusitis, with 18 in the otolaryngology‐treated group and 24 in the neurology referral group (P =. 25). Cost analysis showed that there was a significant increase in health care costs when patients were referred to neurology for diagnosis and treatment, with the referred patients accruing higher health care costs in the form of office visits, medications, and imaging techniques.Conclusions:Recognition of sinus headaches as migraines by the otolaryngologist and initiation of treatment allows for earlier improvement of symptoms, improved quality of life, and decreased health care costs, with equal success rates to that of patients treated by neurology.
Transcriptional Activity of HPV in Inverted Papilloma Demonstrated by In Situ Hybridization of HPV mRNA
Authors: Stoddard David G. , Keeney Michael G. , Garcia Joaquin J. , O'Brien Erin K. 
Published: September 2014

Objectives:(1) Demonstrate the incidence of human papillomavirus (HPV) transcriptional activity in inverted Schneiderian papilloma (IP). (2) Evaluate the role of HPV in the pathogenesis of IP and its rare progression to malignancy. (3) Support the consideration of RNAscope in diagnosis and management of IP.Methods:Retrospective clinical and histopathologic review of 20 cases of IP who underwent surgical excision at a tertiary referral center between 1995 and 2013. Surgical pathology archival material was re‐examined histopathologically using H&E slides. Formalin‐fixed paraffin‐embedded material from each case was further evaluated using immunohistochemical staining for p16 as well as in situ hybridization (ISH) for HPV E6/E7 mRNA (RNAscope).Results:Patients were 40% female with average age 53.7 years (range, 23‐82 years). Three had evidence of malignancy at the time of excision, and 5 demonstrated recurrence of IP. Average follow‐up was 48 months (range, 0‐200 months), and one patient died from squamous cell carcinoma (SCC) arising from the IP. HPV transcriptional activity noted by RNAscope within specimens is reported.Conclusions:These data serve to aid in clarification of conflicting prior research attempting to establish a connection between the presence of HPV and development of IP. By demonstrating transcriptional activity of HPV in IP, this connection is rendered more definitive. Further studies are necessary to elucidate the mechanism by which this process occurs, and what, if any, impact HPV status has on progression from IP to SCC.