bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice: An Updated Study
Authors: Akst Lee M. , Haque Omar J. , Hillel Alexander T. , Best Simon R. , Altman Kenneth W. 
Published: September 2014

Objectives:(1) Understand evolving national trends in diagnosis and management of reflux disease. (2) Be able to analyze these by provider specialty.Methods:National Ambulatory Medical Care Survey (NAMCS) data for time periods 1998‐2001, 2002‐2005, and 2006‐2009 were reviewed for number of visits, provider type, and prescriptions provided.Results:Addition of 2 more 4‐year periods to previously reported data demonstrates increasing ambulatory visits for reflux across all races, sexes, and age groups. In 2006‐2009, there were 15,750,000 visits for reflux, representing 6.9 visits per 100 people on a population basis. Overall visits increased across each sequential time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, reflux visits increased from 1998‐2001 to 2002‐2005 but then decreased in 2006‐2009; percentage of reflux visits to otolaryngologists fell from 4.4% in 2002‐2005 to 2.9% in 2006‐2009. Approximately two‐thirds of reflux visits were among internal medicine and family practice providers. Among the 3 study periods, number of reflux prescriptions increased 233% with continuing trends toward increased proton pump inhibitor and reduced H2 antagonist use.Conclusions:Number of ambulatory visits for reflux continues to increase over time, across all demographic subgroups studied. Otolaryngologists are the only specialty who saw a decrease in overall reflux visits from 2002‐2005 through 2006‐2009; this may reflect real change in practice patterns, change in coding strategies or uncertainty in firmly establishing a reflux diagnosis. Understanding trends in this increasingly prevalent disease may focus attention on more precise diagnosis and improved treatment.
The Loop‐Type Maxillary Artery and Its Relationship with the Lateral Pterygoid Muscle
Authors: Salas Juan E. , Garza Luis M. 
Published: September 2014

Objectives:Determine the relationship between a loop‐type configuration of the third portion of maxillary artery and its position according to the inferior belly of the lateral pterygoid muscle.Methods:A descriptive transversal study in preserved cadaver head specimens, conducted between August and December of 2013, on a total of 23 hemi‐heads of Latin American origin, in which the second and third portions of the maxillary artery were dissected through an endoscopic transmaxillary approach to the pterygopalatine and infratemporal fossa.Results:A total of 23 maxillary arteries were dissected, of which 7 (30.4%) were found to be superficial to the inferior belly of the lateral pterygoid muscle (LPMib) and 16 (69.6%) were found to lie deep. A total of 16 arteries (69.5%) were found on a loop‐type configuration, and 7 (30.5%) were found on an ascending configuration. The loop type was found deep to the LPMib in 13 (81.3%) of the cases and superficial in 3 (18.8%) of them. The results were analyzed with Fisher's exact test with a P value of. 091.Conclusions:This study shows a tendency in the Latin American population to have maxillary arteries deep to the LPMib in loop configuration, which emphasizes the need to stay close to the pterigomaxillary fissure during surgical dissection when aiming to find the main trunk of this vessel in its transition point between its second and third portions. Although the results are promising, the results need to be confirmed in a larger sample.
Management of CRSwNPs Surgically
Authors: Masterson Liam M. , Egro Francesco M. , Bewick Jessica C. , Hopkins Claire , Philpott Carl M. 
Published: September 2014

Objectives:Long‐term follow‐up of 1045 patients with chronic rhinosinusitis with nasal polyposis (CRSwNPs) in the national Sinonasal Audit demonstrated that at 5 years 20.6% of patients had undergone revision surgery. The aim of this study was to see if the Chronic Rhinosinusitis Epidemiology Study (CRES) data reflected a continued burden of revision surgery in patients with CRSwNPs.Methods:A prospective questionnaire‐based study at 30 sites around the UK of patients with CRS presenting to secondary care between October 2007 and September 2013. This paper presents a specific analysis of patients with CRS who reported undergoing sinus surgery.Results:A total of 651 patients with CRSwNPs, 553 with CRSsNPs, and 45 with AFRS were included in the CRES. 365 (57%) of patients with CRSwNPs/AFRS reported undergoing endoscopic nasal polypectomy (ENP) in which 175 (25% or 48% of surgical cases) reported having received more than one ENP. The mean number of ENPs per patient in the revision group was 3.3 with a range of 2 to 30. Only 27.9% of patients reported concurrent endoscopic sinus surgery (n = 102). For comparison, patients with CRSsNPs reported ESS in 13% of cases with only 17% of those surgical cases reporting multiple procedures (chi‐squared P <. 001).Conclusions:This study demonstrated a significantly higher burden of both primary and revision surgery to the health care system for patients with CRSwNPs. Extrapolation of these findings to the HES data for 2011 and 2012 would suggest a bill of approximately £5.3 million per year spent on revision surgery.
Management of the Orbit during Endoscopic Sinonasal Tumor Resection
Authors: Christianson Brandon L. , Harrow Brian , Perez Carlos , Batra Pete S. 
Published: September 2014

Objectives:The primary aim of the study was to evaluate intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors.Methods:Retrospective chart review and prospective imaging assessment was performed of 215 cases managed at a tertiary care referral center between July 2009 and December 2012.Results:A total of 41 patients met predetermined criteria for inclusion. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign pathologies, respectively. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) most commonly demonstrated lamina papyracea erosion (78.1%), followed by extension into the periorbita (43.9%), lacrimal system (24.4%), orbit (14.6%), and orbital apex (7.3%). Procedures performed to address orbital involvement included endoscopic resection of lamina papyracea (85.3%), dacryocystorhinostomy (DCR) (26.8%), optic nerve decompression (7.3%), and orbital exenteration (4.8%). Ophthalmologic involvement was required in 31.7% of cases; anterior orbitotomy (26.8%) and open DCR (17.1%) were the most common adjunct open procedures. Orbital complications most commonly included epiphora (7.3%) and diplopia (5.1%), with no cases of change in visual acuity or orbital hematoma. CT reliably predicted invasion of the lamina papyracea and lacrimal system (P <. 05), while MRI reliably predicted invasion of the periorbita (P <. 05). Irregular tumor margin along the periorbita on MRI was statistically significant (P <. 05) for ophthalmologic involvement.Conclusions:CT and MR imaging provide complementary information for assessment of tumor extension to the orbit. This typically requires endoscopic and adjunct open approaches for effective tumor extirpation and can be achieved safely with low rate of complications.
Measurement of Nasal Polyp Patient Symptomatology over Time Using the Sinonasogram: Initial Validation
Authors: Albergotti William G. , Lee Stella , Ferguson Berrylin J. 
Published: September 2014

Objectives:Chronic rhinosinusitis with nasal polyps is a common disorder that requires multiple methods to monitor disease burden. There is no validated questionnaire to monitor nasal polyp patient symptoms over time. We describe a novel 10‐item questionnaire (Sinonasogram) which is currently used in clinical practice to evaluate current and 4‐week symptoms that are common to patients with chronic rhinosinusitis.Methods:Twenty‐five consecutive patients with nasal polyps seen in a university setting were included in this retrospective review. Patients were included if they had multiple visits to clinic and filled out the Sinonasogram questionnaire at each visit. Nasal polyp score was graded on a (0‐5) scale. Statistical analysis was performed to determine correlation between changes in current, 4‐week, and total Sinonasogram score and changes in nasal polyp score and to determine internal consistency.Results:Twenty‐five patients were included for analysis with a total of 81 clinic visits. Changes in total and current Sinonasogram scores were significantly correlated with changes in nasal polyp scores (P =. 004, P =. 002). Individual symptom scores best predicting nasal polyp size were nasal obstruction, hyposmia, and anterior rhinorrhea (P <. 001, P <. 001, P <. 001). Cronbach's alpha test for internal consistency was 0.8244 for current Sinonasogram score and 0.8878 for 4‐week Sinonasogram score.Conclusions:The Sinonasogram is a valid tool for monitoring nasal polyp symptoms and can predict changes in nasal polyp size. Symptoms that were found to be most associated with nasal polyps were nasal obstruction, hyposmia, and anterior rhinorrhea.
Nasal Mucus Glucose and Chronic Rhinosinusitis
Authors: Hatten Kyle M. , Palmer James N. , Lee Robert J. , Adappa Nithin D. , Kennedy David W. , Cohen Noam A. 
Published: September 2014

Objectives:Respiratory secretion glucose concentration is tightly regulated and contributes to airway innate immunity. Thus, we set out to quantify nasal mucus glucose concentration in chronic rhinosinusitis (CRS) patients and correlate these values to CRS symptoms.Methods:Prospective, single‐center study measuring nasal mucus glucose concentration in patients diagnosed with chronic rhinosinusitis and age/race matched controls from July 1, 2013, to January 1, 2014. Enrollment included subjects >18 years of age evaluated in academic otolaryngology practice. Subjects completed questionnaires including extensive history of medical and surgical therapies as well as CRS‐specific quality of life measurements (SNOT‐22). Subjects underwent nasal secretion sampling with sterilized Pope ear wicks. The nasal glucose concentrations of controls and subjects were analyzed with multivariate analysis to assess for confounding variables including systemic and topical glucocorticoid treatment.Results:Ninety‐five patients enrolled, and 3 patients were excluded because of history of sinonasal radiation. A statistically significant difference was measured between mean nasal glucose secretions of control subjects, 11.1 mg/dL (±1.0 mg/dL), compared to patients diagnosed with CRS, 18.4 mg/dL (±1.6 mg/dL) (P <. 01). No significant correlation was evident comparing nasal glucose concentrations to SNOT‐22 nor use of glucocorticoid (topical or systemic) therapy.Conclusions:CRS patients demonstrate elevated nasal glucose concentrations independent of therapeutic glucocorticoid use. However, nasal mucus glucose concentrations do not appear to correlate to CRS symptoms. The role of nasal mucus glucose concentrations in CRS pathophysiology has yet to be determined.
Nasoseptal Flap Reconstruction of Pediatric Sellar Defects: A Radiographic Feasibility Study
Authors: Purcell Patricia L. , Shinn Justin , Davis Greg E. , Otto Randolph , Parikh Sanjay R. 
Published: September 2014

Objectives:Computed tomography (CT) measurements were used to investigate the feasibility of performing vascularized nasoseptal flap reconstruction of sellar defects in children.Methods:Ten CT scans from children of each year of age from birth to 18 were obtained for 190 total subjects. Patients with incomplete pneumatization were excluded from analysis. Measurements of nasoseptal flap and sellar defect length were obtained for each subject using OSIRIX radiology software. Reconstruction was presumed feasible if the ratio of nasoseptal flap length to associated sellar defect length was greater than 1.Results:Of the 190 CT studies, 125 displayed complete pneumatization. Of these, 120 (96%) displayed a ratio of nasoseptal flap length to sellar defect length greater than 1, suggesting feasibility of flap reconstruction. Mean ratio of nasoseptal flap length to sellar defect length for all subjects was 1.47 (SD = 0.33) with 95% CI [1.41, 1.53]. Only 5 patients (4%) had inadequate nasoseptal flaps; mean age for these patients was 14.8 years (SD = 2.9), which is older than mean age of 11.6 years (SD = 4) for subjects with adequate measurements. The mean age difference did not meet significance with t‐test (P =. 069), likely due to the small number of patients with inadequate flaps. An inverse relationship was identified between age and ratio of nasoseptal flap length to sellar defect length (Pearson correlation coefficient –0.49).Conclusions:Flap length is not a limiting factor in nasoseptal flap reconstruction of sellar defects in children. Younger patients have higher ratios of nasoseptal flap length to sellar defect length than older patients.
Outcomes of Pressure‐Induced Cranial Neuropathies from Allergic Fungal Rhinosinusitis
Authors: Illing Elisa A. , Dunlap Quinn , Woodworth Bradford A. 
Published: September 2014

Objectives:Allergic fungal rhinosinusitis (AFRS) may present with significant bone erosion of the orbital walls or cranial base. Although proptosis is fairly common, cranial neuropathies are rarely reported. The objectives of this study are to describe strategies for AFRS‐induced neuropathies and evaluate ophthalmologic outcomes following endoscopic sinus surgery.Methods:A retrospective review of patients treated from January 2009 to December 2012 for AFRS‐induced cranial neuropathies was performed. Data regarding patient demographics, preoperative imaging, ophthalmologic symptoms, surgical intervention, histopathologic findings, and postoperative sinonasal and ophthalmologic outcomes were recorded.Results:Eight patients (average age 38 years; range, 18‐84 years) with AFRS presented with optic neuropathy or abducens nerve palsy. Subjects presented with unilateral visual loss secondary to optic nerve compression (n = 4), diplopia from unilateral (n = 2) or bilateral (n = 1) abducens nerve palsy, and bitemporal hemianopsia secondary to optic chiasm compression (n = 1). On average, the duration of ocular symptoms was 17 days (range, 2‐60 days). All patients underwent endoscopic surgical decompression of the sinuses and oral steroid therapy. Two individuals had an additional optic nerve decompression at the time of surgery. Six patients had complete return of nerve function, while 2 had partial recovery at an average of 5 weeks following surgery (range, 2‐12 weeks).Conclusions:Bone erosion of the sphenoid sinus walls by AFRS can lead to compression of surrounding neural structures producing cranial neuropathies. Identification of these symptoms and prompt surgical decompression and removal of disease along with aggressive medical therapy provided excellent outcomes in the current series of patients.
Experience in Training ICU Nurses to Perform Free Flap Monitoring to Accommodate Work Hour Restrictions
Authors: Khariwala Samir S. , Yueh Bevan 
Published: September 2014

Objectives:(1) Understand difficulties associated with free flap monitoring and duty hour restrictions. (2) Describe techniques used to train intensive care unit (ICU) nurses to conduct free flap monitoring. The implementation of resident duty hour restrictions has resulted in a variety of modifications to residency training programs in otolaryngology–head and neck surgery. In those programs using a home call system, monitoring of free flaps in the postoperative period can be associated with difficulties in resident duty hour compliance. We sought to use a carefully constructed training program to transition a portion of free flap monitoring to a skilled group of ICU nurses.Methods:A written reference manual describing the basic concepts behind free tissue transfer and normal free flap physiology was distributed. Nurses received a PowerPoint presentation and completed an online module designed to consolidate the didactic training. Finally, the responsibility of on‐the‐job training of the nurses was given to the otolaryngology house staff such that each nurse logged and documented 10 flap checks in the presence of a resident.Results:Thirty patients receiving free flaps were monitored by the ICU nursing team resulting in 100% flap survival.Conclusions:Transitioning the monitoring of free flaps in the perioperative period to ICU nurses can be accomplished through the following principles: (1) Leadership and participation by the microvascular surgeons at a given institution. (2) Faculty‐led didactic and web‐based training modules prior to actual training. (3) Significant involvement of the otolaryngology house staff, allowing the ICU nurses to gain proficiency.
Preliminary Findings: The Feasibility Study for a Randomized Controlled Trial of Clarithromycin in Chronic Rhinosinusitis
Authors: Bewick Jessica C. , Egro Francesco M. , Masterson Liam M. , Philpott Carl M. 
Published: September 2014

Objectives:There is currently conflicting level 1 evidence in the use of long‐term antibiotics for chronic rhinosinusitis. The primary aim of this study was to look at recruitment and retention of patients in preparation for a formal trial. The aim of this paper is to describe the preliminary outcomes in terms of symptomatic relief in patients with CRSsNP.Methods:Adult patients fulfilling the EPOS criteria for CRSsNPs with no prior surgery were recruited in 6 UK centers during 2013. Participants received a 12‐week course of clarithromycin 250 mg alongside topical mometasone and nasal douching, all twice daily. Follow‐up was at 3 months and 6 months. For the purpose of this analysis, the Sinonasal Outcome Test (SNOT‐22) score was recorded at baseline and both follow‐up assessments.Results:Preliminary data from 29 patients at 3 months and 24 patients at 6 months showed significant symptomatic improvement in mean SNOT‐22 scores on paired t tests at 3 months (40.4 to 33.7, P =. 026), which was sustained at 6 months (30, P =. 02). The number of subjects showing ≥9 point reduction in SNOT‐22 scores was 45% (n = 13), increasing to 58% at 6 months (n = 14). Nine patients have been listed for surgery to date.Conclusions:While the results here do not have the power of the full randomized controlled trial, the findings suggest that long‐term macrolides have the potential to achieve significant symptomatic reduction in approximately 50% of patients with CRSsNPs.
Radiofrequency Coblation versus Intramural Bipolar Cautery for the Treatment of Inferior Turbinate Hypertrophy
Authors: Shah Anil N. , Brewster Douglas , Mitzen Kelly , Mullin David P. 
Published: September 2014

Objectives:(1) Compare intramural bipolar electrocautery and radiofrequency coblation in the treatment of inferior turbinate hypertrophy with regard to objective and subjective improvement in nasal obstruction, rate and type of complications, experience during the procedure, and rate of recovery. (2) Describe 2 minimally invasive techniques in the management of turbinate hypertrophy with a comprehensive literature review of the efficacy of these methods.Methods:A prospective, randomized, single blinded study from 2008 to 2010 at a single tertiary medical center. Adult patients with inferior turbinate hypertrophy refractory to medical management were randomized to 2 groups based on which nostril they felt to be more obstructed. Patients were then treated with radiofrequency coblation in one nostril and intramural bipolar cautery in the other. Subjective and objective data, including use of a visual analog scale (VAS) for subjective outcomes, acoustic rhinometry, and nasal endoscopy, were then obtained from each patient comparing the 2 techniques.Results:Radiofrequency coblation was significantly less painful than intramural bipolar cautery for the early postoperative period (P <. 02), was considered less painful during the procedure (P =.03), and produced less crusting at 3 weeks (P =. 009). Both interventions were similar in subjective and objective improvements in nasal obstruction as measured by acoustic rhinometry and subjective VAS outcomes.Conclusions:Radiofrequency coblation seems to offer an equivalent alternative to bipolar electrocautery for the treatment of inferior turbinate hypertrophy with less discomfort during the procedure and early postoperative period.
Relationship between Pediatric Concha Bullosa and Septal Deviation
Authors: Amali Amin , Sazgar Amir A. , Sadeghi Mohammad , Saedi Babak , Langeroudi Maziar M. , Jafari Mehrdad , Hagh Ali B. 
Published: September 2014

Objectives:Investigate the frequency of pediatric middle turbinate pneumatization and present its possible effect on septal deviation.Methods:Computed tomography (CT) scans of 152 children (younger than 16 years old) were analyzed for the presence of middle turbinate pneumatization and nasal septal deviation.Results:The incidences of lamellar, bulbous, and extensive concha bullosa were 29.6%, 14.5%, and 7.2%, respectively. The data revealed that 53 patients (67.9%) with concha bullosa also had septal deviation as opposed to 50% (37 out of 74 cases) frequency of septal deviation in patients without concha bullosa. Among the 37 patients with right side concha bullosa, 59.5% had a deviated septum to their left side while 21.6% had a deviation to the right side. Out of those patients with concha bullosa on the left side (38 cases), 44.7% had a right side septal deviation and 13.2% had a left‐side septal deviation that revealed a significant relationship between the position of concha bullosa and the side where the septum deviated (P <. 001). The comparison of these ratios showed a significant relationship between the occurrence of septal deviation and concha bullosa (P =. 024).Conclusions:A possible relationship was found between middle turbinate pneumatization and the mechanism of development of septal deviation in children.
Self‐Crosslinked Hyaluronic Acid Hydrogel (PureRegen Gel Sinus) in Ethmoidectomy: A Randomized, Controlled Trial
Authors: Matheny Keith E. , Tseng Ewen , Carter Kenny B. , Cobb William B. , Fong Karen J. 
Published: September 2014

Objectives:Evaluate the safety and efficacy of a novel, self‐crosslinked hyaluronic acid (HA) hydrogel (PureRegen Gel Sinus) compared with carboxymethylcellulose (CMC) viscous foam (Stammberger SinuFoam) in promoting healing when applied following ethmoidectomy.Methods:Prospective, randomized, controlled, double‐blinded clinical trial, with 4 surgeons operating in 2 community hospitals. Thirty patients with bilateral chronic rhinosinusitis underwent bilateral ethmoidectomy. Intraoperatively, each patient received 2 mL of HA hydrogel in one ethmoid cavity, and 2 mL of CMC contralaterally. The material applied within each ethmoid cavity was randomly assigned before surgery. A fifth independent surgeon, blinded to the material used to treat each ethmoid cavity, evaluated postoperative endoscopic video at 1 and 2 weeks for edema, crusting, and mucopurulence and at 6 and 12 weeks for re‐mucosalization and scarring/synechiae. SinoNasal Outcome Test (SNOT‐20) data were collected preoperatively and at each postoperative visit. A small sample of the cohort underwent endoscopic mucosal biopsy for histologic analysis.Results:Twenty‐nine of 30 patients completed the protocol. The difference in edema, crusting, and mucopurulence at 1 and 2 weeks was not statistically significant; however, at 6 and 12 weeks, the HA hydrogel showed statistically significant reduction in synechiae formation (P <. 05), with a trend toward superiority in re‐mucosalization (P =. 08). Histologic analysis of 6 subjects at 12 weeks also showed a trend toward a greater amount of regenerated cilia present in the HA hydrogel‐treated ethmoid cavities (P =. 22). The cohort showed a 75.18% improvement in SNOT‐20 analysis.Conclusions:Self‐crosslinked hyaluronic acid hydrogel provides superior wound healing to carboxymethylcellulose after ethmoidectomy.