bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Polysomnography in the Development of an Algorithm for Planning Tracheostomy Decannulation
Authors: Mehta Deepak , Robison Jacob G. , Greenberg Laura , Maguire Raymond , Simons Jeffrey P. 
Published: August 2013

Objectives:Examine the role of polysomnography (PSG) in helping determine readiness of tracheostomized patients for decannulation. Study design: Retrospective medical record review of pediatric patients who underwent PSG with tracheostomy tube in place with the goal of decannulation.Methods:Thirty‐three tracheostomized patients who underwent PSG from January 2006 to March 2012 were included. Outcome measures were successful decannulation, PSG results, surgical procedures, and medical comorbidities.Results:Of the 33 patients, 23 (69.7%) were decannulated and 10 (30.3%) were not. One (3.0%) patient failed long‐term decannulation. The average apnea‐hypopnea index (AHI) with a capped tracheostomy for those successfully decannulated was 2.75 (range 0.6 to 7.6), while the AHI for those not decannulated was 15.99 (range 3.2 to 62). Factors associated with success or failure to decannulate were assessed and an algorithm was developed to plan for successful decannulation. Laryngotracheal reconstruction was found to be a significant factor in those successfully decannulated. Those who were not decannulated were found to have multiple medical comorbidities and multi‐level airway obstructions.Conclusions:PSG is a useful adjuvant study in the process of determining a patient's readiness for decannulation. Our current algorithm for decannulation includes upper airway endoscopy with identification of levels of obstruction followed by surgical correction of those obstructions; capped PSG to determine patency of airway and help assess lung function; overnight admission for capping trial, with decannulation the following day, if well tolerated.
Computed Tomography Scans as an Objective Measure of Disease Severity in Chronic Rhinosinusitis
Authors: Likness Micah M. , Pallanch John F. , Sherris David A. , Kita Hirohito , Mashtare Terry , Ponikau Jens U. 
Published: August 2013

Objectives:A truly objective method of measuring disease severity in CRS does not exist. We evaluated computed tomography (CT) scans of chronic rhinosinusitis (CRS) patients using a novel 3‐D computerized method and compared them to a 2‐D objective computerized analysis of a single coronal slice through the osteomeatal complex (OMC), and subjective methods including Lund‐Mackay and Zinreich's modification of Lund‐Mackay.Methods:Forty‐six adults with symptoms and endoscopy confirmation of CRS underwent CT examination and received a triamcinolone injection, followed by CT scan 4‐5 weeks later. Analyze software determined the 3‐D total volume of inflammatory mucosal thickening in all sinuses. The triamcinolone injection served as a tool to determine each method's sensitivity to a treatment intervention.Results:The Lin's concordance class correlation (CCC) of the OMC method revealed the best correlation to the 3‐D volumetric computerized values (0.915), followed by the Zinreich (0.904) and Lund‐Mackay methods (0.824). Post‐treatment results demonstrated that both the OMC (0.824) and Zinreich's (0.778) methods had strong agreement with the 3‐D volumetric methods and were very sensitive to change, whereas the Lund‐Mackay (0.545) only had moderate agreement.Conclusions:Computerized CT analysis provides the most comprehensive, objective, and reproducible method of measuring disease severity and is very sensitive to change induced by treatment intervention. A 2‐D coronal image through the OMC provides a valid, user‐friendly method of assessing CRS and is representative of CRS severity in all sinuses. Zinreich's subjective method correlated well overall, but Lund‐Mackay lagged behind in disease representation and sensitivity to change.
The Effectiveness of Diet Control in the Treatment of Food‐Induced Allergic Rhinitis
Authors: Tan Bernard 
Published: August 2013

Objectives:Describe diet control as a novel treatment modality for allergic rhinitis that is likely to be food induced and analyze its efficacy.Methods:Prospective study conducted from 1995 to 2010. 449 patients with the diagnosis of allergic rhinitis refractory to conventional treatment (oral antihistamines and/or intranasal steroids) were recruited from the Ear, Nose & Throat & Allergy Clinic. A thorough history and ear, nose, and throat (ENT) examination identified each patient's symptoms of allergic rhinitis, treatment history, and concomitant atopic diseases. IgE mediated allergy to common inhalant allergens was tested by measuring serum specific IgE levels using specific IgE fluorescence enzyme‐labeled assays (ImmunoCAP), while hypersensitivity to common food and inhalant allergens was tested for using intradermal progressive dilution food test (IDPFT). With the help of dieticians, patients underwent 1 month of diet control therapy, and their symptoms after therapy were recorded.Results:After 1 month of diet control, 304 (67.7%) patients experienced >50% improvement in their AR symptoms. Patients allergic to malt, Baker's yeast, oyster, tea, tomato, and sesame were more likely to experience symptomatic improvement. Presence of concurrent IgE mediated allergies to common inhalant allergens did not influence the outcome (p=0.418). Addition of conventional therapy to the diet control therapy further improved the likelihood of a therapeutic outcome (p=0.011).Conclusions:Diet control therapy for a month can bring symptomatic relief to some patients with food‐induced allergic rhinitis.
Endoscopic Sinus Surgery Provides Effective Relief as Demonstrated by Pre‐ and Post‐operative Healthcare Use
Authors: Benninger Michael S. , Holy Chantal E. 
Published: August 2013

Objectives:Analyze the impact of endoscopic sinus surgery (ESS) on overall healthcare use for treatment of chronic rhinosinusitis (CRS), and evaluate the effectiveness of ESS based on pre‐ and post‐operative healthcare use.Methods:A retrospective database analysis was conducted using Marketscan. All patients with ESS (CPT 31254‐31288) in 2008 and at least 5 years continuous medical and drug plan enrollment were included (n=8,827). In‐ and outpatient medical history including prescriptions but excluding pain medication (potentially less disease‐specific) for all sinonasal procedures or diagnoses was analyzed. All costs were determined on a per‐patient, per‐quarter basis, from 4 quarters pre‐surgery to 8 quarters post‐surgery.Results:During the 4th quarter pre‐surgery (9‐12 months pre‐operative), healthcare use included ~1.95 prescriptions (95% confidence interval [CI] 1.89‐2.00), 1.92 visits or procedures per patient (95%CI: 1.83‐2.01), and total average cost of US$ 399.10 (95%CI: US$391.24‐US$406.96). These costs increased significantly within 2 months pre‐operatively to $1,523.41, including 3.75 prescriptions (95%CI: 3.68‐3.81). The cost of ESS and related medical care for 90‐day post‐op averaged $8,521.87 (95%CI: $8,505.16‐$8,538.58). By the 15th month post‐operative, healthcare costs dropped to $363.68 (95%CI: $355.77‐371.59), with 1.98 prescriptions (95% CI: 1.93‐2.04) and remained flat for the remainder of the follow‐up period. Cost of all drug categories declined post‐operatively, except for leukotriene modifiers.Conclusions:Immediately prior to ESS, patients’ healthcare needs increased approximately 4‐fold. Within 15 months post‐surgery, however, costs were statistically lower than observed 12 months pre‐surgery. These findings suggest that ESS may have provided timely management of a severe and unsustainable disease state.
Interrater and Intrarater Reliability of Philpott‐Javer and Kupferberg Staging following Sinus Surgery Based on Training
Authors: Parhar Harman S. , Thamboo Andrew , Habib Al‐Rahim , Chang Brent , Gan Eng C. , Javer Amin R. 
Published: August 2013

Objectives:The Philpott‐Javer and Kupferberg endoscopic mucosal staging systems for allergic fungal rhinosinusitis have previously demonstrated acceptable inter‐rater reliability among rhinologists. There are, however, numerous learners involved in patient care at tertiary centers. This study aims to 1) Analyze the inter‐rater and intra‐rater reliability of the Philpott‐Javer and Kupferberg scoring systems among otorhinolaryngology learners at different stages in training; 2) Analyze whether the Philpott‐Javer scoring system can be used reliably by learners compared to an experienced rhinologist.Methods:This retrospective study examined the endoscopic photographs of patients who had undergone post‐surgical endoscopy at a tertiary sinus center in January 2013. 150 Images (3 images randomly selected from 50 patients) were played twice, one week apart, in a randomized loop and scored according to Philpott‐Javer and Kupferberg criteria by a staff rhinologist, a rhinology fellow, a senior otorhinolaryngology resident, a junior otorhinolaryngology resident, and a medical student.Results:The inter‐class correlation between the 5 raters was 0.7600 (95% CI: 0.6917, 0.8161) and 0.6679 (95% CI: 0.5997, 0.7312) for the Philpott‐Javer and Kupferberg scoring systems respectively, suggesting substantial reliability. Intra‐rater data showed substantial reliability (kappa values between 0.588 and 0.844) among all raters using both systems. There was also moderate to substantial agreement between the learners and the staff rhinologist (kappa values between 0.534 and 0.710).Conclusions:Results suggest that both the Philpott‐Javer and Kupferberg staging systems have acceptable intra‐rater and inter‐rater reliability among learners of differing levels of clinical experience and are suitable for evaluating progress following endoscopic surgery.
Porcine Small Intestine Submucosal Grafts for Post‐tumor Resection Orbital Reconstruction
Authors: Phillips James D. , Riley Kristen O. , Woodworth Bradford A. 
Published: August 2013

Objectives:With sinonasal malignancy, removal of the medial orbital wall for tumor involvement is required to obtain complete oncologic resection. However, orbital fat herniation can produce significant morbidity, including enophthalmos and diplopia. The purpose of the current study was to evaluate outcomes following use of porcine small intestine submucosa (SIS) grafts for orbital reconstruction following extirpation of sinonasal malignancies.Methods:Review of prospectively collected data regarding orbital reconstruction using SIS was performed. Demographics, tumor histology, size of orbital defect, adjuvant treatment, clinical status, and complications were recorded.Results:Seventeen patients (average age 58, range 27‐82) had SIS grafting of the medial orbital wall over a five year period at our tertiary academic institution. Average orbital wall defect size was 1.6 x 2.1 cm (height vs. length). Tumor histopathology included esthesioneuroblastoma (n=5), squamous cell carcinoma (n=4), adenocarcinoma (n=2), sinonasal undifferentiated carcinoma (n=2), melanoma (n=3), and neuroendocrine carcinoma (n=1). Surgical goals were curative intent in all patients. Ten patients had postoperative radiation therapy, while 5 individuals had surgical extirpation following neoadjuvant chemotherapy and radiation. All patients had complete locoregional control at last clinical follow‐up (average 16 months, range 2‐54), although three patients developed distant metastases. The only orbital complications noted were enophthalmos (n=1), periorbital cellulitis (n=1), and orbital wall crusting (n=1).Conclusions:SIS reconstruction of orbital wall defects was effective in the current series of patients with only one patient developing noticeable enophthalmos and a low incidence of surgical complications.
Prevalence and Associations of Excessive Daytime Sleepiness in an Asian Multiethnic Adult Population
Authors: Ng Chew Lip , Liu Xuandao , Lim Fiona P. , Liang Fueng H.R. 
Published: August 2013

Objectives:Investigate the prevalence and associations of excessive daytime sleepiness (EDS) in a multi‐ethnic Asian adult population in Singapore.Methods:A cross‐sectional study was conducted in an urban town using an interviewer‐administered questionnaire in 2008. 1003 subjects over 40 years of age were selected after randomization. EDS was assessed using the Epworth Sleepiness Scale. A score of 10‐12 indicated mild‐moderate EDS; a score greater than 12 indicated severe EDS. Information on lifestyle, socio‐economic conditions and medical comorbidities were collected.Results:The prevalence of EDS was 21.43%. Increased risk of EDS was associated with larger housing types, Prevalence Ratio (PR) 2.21 (95% CI 1.73‐2.82); clinical depression, PR 1.95 (95% confidence interval [CI] 1.07‐3.59); monthly household income higher than US$4846 (S$6000), PR 1.79 (95% CI 1.27‐2.05); desk‐bound vocations, PR 1.77 (95% CI 1.39‐2.25); younger age (40‐49 years old), PR 1.67 (95% CI 1.23‐2.26); alcohol consumption, PR 1.62 (95% CI 1.23‐2.14); employment, PR 1.61 (95% CI 1.27‐2.05); working night shift, PR 1.60 (95% CI 1.09‐2.36); tertiary education, PR 1.50 (95% CI 1.15‐1.93); male gender, PR 1.49 (95% CI 1.13‐1.95); and presence of 2 or more symptoms of depression PR 1.39 (95% CI 1.00‐1.93).Conclusions:The prevalence of EDS is comparable to the levels in the United States. EDS was associated with socioeconomic, lifestyle factors, depression, and depressive symptoms. Ethnicity, body‐mass‐index, and waist circumference were not found to be significant.
Role of FOXP3+ CD4+ and FOXP3+ CD8+ T Regulatory Cells in Obstructive Sleep Apnea
Authors: Anderson Martin E. , Buchwald Zachary , Sanford Thomas R. , Aurora Rajeev 
Published: August 2013

Objectives:1) Examine the immune responses which may underlie adenotonsillar hypertrophy (ATH) associated with obstructive sleep apnea (OSA). 2) Discuss the role of effector and regulatory T‐cells in the inflammatory process within the tonsil and its association with apnea‐hypopnea index (AHI).Methods:Prospective tonsil specimens were collected from patients undergoing tonsillectomy for OSA at a tertiary‐care pediatric hospital between October 2012 and January 2013. Single cell suspensions of the tonsil samples were stained with fluor‐conjugated antibodies against CD3, CD4, CD8, FoxP3 (a regulatory T‐cell marker), and CD45RO (an activated effector T‐cell marker). The stained cells were then analyzed by flow cytometry. The levels of effector and regulatory T‐cells were then correlated with severity of disease, as quantified by AHI determined from polysomnography.Results:CD4 effector T‐cells (CD4 T‐eff) were significantly upregulated in pediatric patients with an AHI 5 relative to those with AHI < 5. This result, calculated by Mann‐Whitney two‐tailed test, indicates that the fraction of activated T‐cells increased with elevated AHI (P < 0.0095). FoxP3+ CD8 T‐cells (CD8 TcReg) were present at lower levels in patients with an elevated AHI. When these data were plotted as the ratio of CD8 T‐eff to CD8 TcReg versus AHI, a correlation coefficient of 0.67 was observed.Conclusions:The significant upregulation of CD4 T‐eff and the increased ratio of CD8 T‐eff to CD8 TcReg in relation to elevated AHI both suggest a immunologically‐driven response that is contributing to ATH and the development of OSA.
ZPPP Combined with Endoscopic Coblator Open Tongue Base Resection for Severe OSAHS
Authors: Lin Hsin‐Ching , Friedman Michael 
Published: August 2013

Objectives:Retrospectively investigate the safety and outcomes of Z‐palatopharyngoplasty (ZPPP) combined with endoscopic coblator open tongue base resection (ECO‐TBR) for the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods:Thirty‐five consecutive patients with severe OSAHS who had multilevel obstruction, failed continuous positive airway pressure therapy, and then underwent ZPPP combined with ECO‐TBR were enrolled in this study. The subjective symptoms and objective PSG parameters were collected preoperatively and at a minimum of 3 months postoperatively. Statistical analysis was determined by Wilcoxon signed rank test.Results:Three female and 32 male patients (mean, 42 years) had a minimum follow‐up of 3 months and complete data available for analysis. None of the patients had perioperative or postoperative complications. No long‐term obvious velopharyngeal insufficiency was encountered. The classical success rate was 62.9% (22/35). Three months postoperatively, the Epworth sleepiness scale decreased from 11.0 ± 4.2 to 8.7 ± 4.3 (p = 0.0006). The apnea/hypopnea index (/hr.), lowest oxygen saturation (%), and bed partner evaluation of patient's snoring visual analog scale (0‐10) decreased from 50.6±16.6 to 26.5 ± 23.5, 70.4 ± 9.9 to 80.1 ± 11.3, 9.86 ± 0.69 to 3.27 ± 1.96, respectively (all p<0.0001).Conclusions:This study shows the significant benefits of ZPPP plus ECO‐TBR in severe OSAHS patients.
Submandibular Gland Transfer in the Treatment of Refractory Xerophthalmia
Authors: Quintanilla‐Dieck Lourdes , Pittman Amy , Wax Mark K. 
Published: August 2013

Objectives:Dry eye syndrome is a very common condition characterized by ocular irritation due to a deficient tear film. In mild cases, patients present with an annoying foreign‐body sensation in the eyes. In its most severe form, it can cause ulceration of the cornea with spontaneous perforation and loss of the eye. There exists a small subpopulation of patients who suffer from extremely dry eyes. In these patients, routine surgical measures or medical management do not suffice to prevent complications. Submandibular gland transfer as a treatment for xerophthalmia has been studied and shown to be effective in other countries; however, the procedure is rarely used in the United States.Methods:We describe the procedure of microvascular submandibular gland transfer and discuss the outcomes in cases of submandibular gland transfer that have been performed at our institution to date.Results:In the series of patients reported from our institution, four procedures in three of the patients were successful, with improvement in epithelial defect on slit‐lamp examination and/or improvement in tear production. Two procedures in the fourth patient were unsuccessful; the first was complicated by scarring of the submandibular duct, which was unsalvageable with revision surgery. The gland was removed and replaced with the opposite submandibular gland, but the transplanted gland proved non‐viable.Conclusions:The technical expertise required for the transfer is readily available in almost all academic centers. The microvascular reconstructive surgeon has expertise in the harvesting of the flap, as well as in the transfer. When used, this technique provides an effective way to treat patients with refractory xerophthalmia.
Use of the Supraclavicular Artery Island Flap for Reconstruction of Cervico‐facial Defects
Authors: Kokot Niels C. , Mazhar Kashif , Reder Lindsay , Lee Peng Grace , Sinha Uttam K. 
Published: August 2013

Objectives:Describe the supraclavicular artery island (SAI) flap as an alternative flap for reconstruction of cervico‐facial defects.Methods:Retrospective chart review in an academic, tertiary referral center of our first 18 consecutive patients undergoing SAI flap reconstruction for cervico‐facial defects between 2010‐2012. Outcome measures included size and location of the defect, time to raise the flap, flap size and viability, and complications. Statistical analysis was performed using SAS 9.1.Results:Defects of the temporal bone (n=5), and cervical skin (n=13) were reconstructed. Mean flap width was 6.1cm (range 5‐9cm). Mean flap length was 21.7 cm (range 16‐28cm), with the proximal portion of the flap de‐epithelialized to match the defect resulting in a mean skin paddle length of 10.3 cm (range 5‐18cm). Minor donor site dehiscence occurred in 2 patients. Partial skin flap necrosis occurred in 2 patients, while 1 patient had complete loss of the skin paddle. There was a significant correlation between flap length greater than 22 cm and flap necrosis (chi‐sq p=0.01). No significant correlation between flap location and flap necrosis or dehiscence was found. 17 patients were happy with the cosmetic outcome of the flap.Conclusions:The SAI flap is a viable alternative to microvascular reconstruction of cervico‐facial defects in select cases. This flap is reliable, easy to harvest, and versatile. It provides a good color match in the region. Flap complications and donor site morbidity were minimal and resolve with conservative measures. Flaps longer than 22 cm have a higher risk of skin necrosis.
Venous Anastomosis with Microvascular Coupler in Head and Neck Reconstruction: Experience in 200 Consecutive Procedures
Authors: Robb Philip , Tulunay‐Ugur Ozlem E. , Suen James Y. , Moreno Mauricio A. 
Published: August 2013

Objectives:There is a scarcity of data on outcomes when GEM microvascular coupler is used for head and neck reconstruction. We sought to review our experience in a large, contemporary series.Methods:Retrospective chart review of 201 consecutive flaps performed in 193 patients between September 2009 and January 2013 in a tertiary academic setting.Results:The cohort consisted of 125 males with a mean age of 64 years (range 3‐83). A double free flap was performed in 8 cases. The most common defect locations were mandible (n = 62, 30.8%); oral cavity (n = 27, 13.4%), and cutaneous (n = 24, 11.9%). Flaps included anterolateral thigh (n = 85, 42.3%); fibula (n = 53, 26.4%); radial forearm (n = 37,18.4%); scapula, latissimus, and rectus (n=5, 2.5% respectively); iliac crest and vastus (n = 4, 2% respectively); and other (n = 3, 1.5%). A double venous anastomosis was performed in 26 flaps. The entire range of couplers (1‐4mm) was used, but the 2.5mm was the most commonly used (n = 83, 36.6%) followed by the 2.0mm (n = 47, 20.7%). Facial (n = 134, 59%), External jugular (n = 32, 14.1%), and superficial temporal (n = 22; 9.7%) were the most common recipient vessels. Seven cases underwent microvascular revision yielding arterial thrombosis in 1 case, pedicle torsion in 1 case, and venous thrombosis in 5 cases. The flap was successfully salvaged in 3 cases. A delayed failure in another patient yielded an overall flap success rate of 97.5%. None of the tested variables reached statistical significance for venous thrombosis or flap survival.Conclusions:The microvascular coupler is a reliable alternative for venous anastomosis in head and neck flaps. Given the low failure rate, a multi‐institutional study could help elucidate outcome predictors in this setting.