bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stapes Surgery: National Survey of British Otologists
Authors: Manickavasagam Jaiganesh , Lancer Hannah , Zaman Azrina , Lancer Jack 
Published: February 2015

ObjectiveNo standardized treatment protocols are available with regard to stapes surgery in the UK. We have therefore investigated individual stapes surgery practice.MethodPostal questionnaire to all stapes‐performing otologists in UK. Questionnaire designed to address the following issues with stapes surgery: preferred technique, hearing aid trial, unilateral and bilateral surgery, prosthesis type, daycase preference, use of laser, covering of fenestration, gusher management, revision surgery, postopeartive flying time, facial nerve overhanging issues,and training juniors.ResultsOf the questionnaires we received (182/197), 77 surgeons perform 6‐15 operations/year, most (107) under GA. 123 advise stapes surgery in unilateral disease. 119 always advise patients about trying a hearing aid. 130 perform second side stapes surgery and most wait for at least 6 months for second side surgery. Stapedotomy is preferred (123), stapedectomy (11). Cause prosthesis is the most common. 57 always, and 47 never use a vein‐graft. 67 use laser. 64 prefer daycase surgery. 37 would abandon surgery for a 50% or more overhanging facial nerve. 34 have encountered a “gusher.” 112 would recommend revision surgery. Most would advise patients “flying” after 6 weeks.ConclusionIn UK, the majority prefer GA, an overnight stay, a hearing aid trial, carrying out surgery in unilateral disease, 2nd side surgery, stapedotomy, inserting the prosthesis after removal of the stapes, advise revision surgery in conductive loss, and are willing to train trainees with an otological interest.
Epidemiology of Otorhinolaryngology Emergency Attendances
Authors: Andrade Jose S.C. , Albuquerque André M. S. , Penido Norma O. , Matos Rafaella C. , Godofredo Valéria R. 
Published: February 2015

ObjectiveTo evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital in Sao Paulo over a 12‐month period.MethodEpidemiological, cross‐sectional study, with data collection carried out from medical records of the emergency department of otorhinolaryngology of a high complexity hospital in Sao Paulo, for a period of 12 months. Data collected were: age, sex, clinical diagnosis, and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngoesthomatology, and head and neck surgery. Level of urgency/emergency, etiology, and monthly distribution of visits were evaluated.ResultsA total of 18,279 medical records were obtained, and 2639 were excluded. Of the 15,640 cases included, the average age was 36.3 years; 54.49% were women and 45.50% were men. A total of 9818 (62.77%) corresponded to cases considered as emergency/urgency. Among the urgency/emergency cases, 6422 (65.41%) were diagnosis in otology, 1767 (17.99%) in rhinology, 1453 (14.79%) in pharyngolaryngoesthomatology, and 176 (1.79%) in head and neck surgery. Inflammatory and infectious diseases comprised 65.04% among the urgency/emergency cases.ConclusionAmong the attendances in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty. Inflammatory and infectious diseases comprised most cases.
Attic Reconstruction in Pediatric Canal Wall‐up Mastoidectomy
Authors: Kanotra Sohit P. , James Adrian L. 
Published: February 2015

Objective1) To evaluate 3 methods: conchal cartilage, tragal cartilage, and bone pate, for primary attic reconstruction (scutumplasty) in pediatric canal wall‐up mastoidectomies in terms of recurrence rates and formation of retraction pockets.MethodAll patients undergoing attic reconstruction following a canal wall up mastoidectomy were evaluated from a single surgeon prospective pediatric otological database maintained over a 10‐year period. The reconstruction of the scutum defects was done using bone pate, conchal and tragal cartilage. The outcome measures were postoperative retraction pocket formation and recurrence of cholesteatoma.ResultsA total of 120 patients underwent primary attic reconstruction following canal wall‐up mastoidectomy over a 10‐year period. The overall recurrence rate was 9.83% (n = 12). Fifty‐one patients underwent attic reconstruction with tragal cartilage, while 33 were reconstructed using conchal cartilage and 36 with bone pate. The recurrence rate with various reconstruction methods was 5.8% (n = 2), 15.1% (n = 5), and 13.8% (n = 5) for tragal, conchal, and bone pate, respectively. Cholesteatoma recurrence rates with the use of tragal cartilage for reconstruction of the scutum were significantly lower as compared to that of conchal cartilage (P =. 034, chi square = 3.308) and bone pate (P =. 046, chi square = 2.834).ConclusionThe use of the tragal cartilage for scutum reconstruction is associated with the least recurrence rate for pediatric cholesteatoma. The easy accessibility, stability, and good long‐term results with the use of the tragal cartilage makes it an ideal material for outer attic wall reconstruction in pediatric canal wall up mastoidectomies.
Carotid Canal Injury and High‐Resolution Computed Tomography in Pediatric T‐Bone Fractures
Authors: Gale Derrick C. , Meier Jeremy D. 
Published: February 2015

Objective1) Review the incidence of carotid canal involvement in pediatric temporal bone fractures. 2) Determine the benefit of temporal bone high‐resolution computed tomography (HRCT) in identifying carotid canal fractures (CCF). 3) Evaluate if the mechanism of injury (MOI) predicts the likelihood of CCF.MethodA retrospective case series was reviewed from 2008 to 2011 in a tertiary children’s hospital. A database including all patients admitted for trauma was searched to identify children with temporal bone fractures and an otolaryngology consultation. Patient age, MOI, and standard head CT and HRCT reports were collected.ResultsA total of 140 temporal bone fractures in 129 pediatric patients were identified. The average age was 9.0 ± 0.4 years. The most common MOI included falls (24%), sports (17%), bicycle (16%), off‐road vehicle (12%), motor vehicle (9%), and pedestrian (8%). CCF was identified in 16.2% of the temporal bone fractures. Although nearly half of the CCF were not clearly seen on the CT head, only 9% of all the HRCT ordered identified a previously undetected CCF. A CCF was seen in 60% of pedestrian accidents, while only 3% of falls had an associated CCF (P <. 05).ConclusionA minority of temporal bone fractures have associated CCF. Although there are other indications for HRCT with temporal bone fractures, routine HRCT infrequently identifies undetected CCF. MOI may help predict temporal bone fractures at higher risk for CCF and suggest when HRCT would help identify CCF and reduce unnecessary HRCT.
Eustachian Tube Function following Total Laryngectomy
Authors: Meric Aysenur , Dogan Remzi , Kahya Volkan , Yilmaz Fahrettin , Ozturan Orhan 
Published: February 2015

ObjectiveThe function of the Eustachian tube has been investigated in various conditions. However, its status has not been evaluated in total laryngectomized patients. This study was designed to investigate short‐ and long‐term changes of the Eustachian tube that occur following total laryngectomy.MethodWe enrolled 53 total laryngectomy patients. These patients were divided into 2 groups (within 2 years and more than 2 years after surgery). Fifty‐one healthy volunteers were studied as a control. The functions of the Eustachian tube were evaluated using the P1(resting), P2 (Toynbee maneuver), and P3 (Valsalva maneuver) tympanometric measurement.ResultsAll groups were evaluated using intergroup comparisons in terms of right‐side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1‐P2, Pmax‐Pmin values (respectively, P =. 329, P =. 474, P =. 487). All groups were evaluated using intergroup comparisons in terms of left‐side Eustachian tube functions. No significant difference was found between the groups in terms of P2, P1‐P2, Pmax‐Pmin values (respectively, P =. 562, P =. 400, P =. 151).ConclusionWe determined that the functions of Eustachian tubes were not different between the patients who underwent total laryngectomy and the healthy volunteers. The lack of active airflow in the upper respiratory tract following total laryngectomy has no effect on the function of the Eustachian tube in the short and long term.
ENT Aspects of Sudden Infant Death Syndrome
Authors: Marom Tal , Cinamon Udi , Castellanos Paul , Cohen Marta 
Published: February 2015

ObjectiveTo address sudden infant death syndrome from the otolaryngologist’s perspective, describe relevant pathologies, discuss controversies, and suggest preventive measures in high‐risk populations.MethodA MEDLINE search and hand search were conducted to identify reports published between 1969 and 2011 in the English language on the pathophysiology of SIDS related to the head and neck organs. Search terms included SIDS (MeSH term), SIDS and pathophysiology (text words), and SIDS and autopsy (text words).ResultsA growing number of reports suggested head and neck organ involvement in SIDS autopsies. Laryngeal, oropharyngeal, maxillofacial, otologic, cervical vascular abnormalities, and infectious etiologies were recognized and discussed.ConclusionOtolaryngologists should be aware of relevant pathologies, as some are treatable, if identified early enough in infancy. A proactive risk‐management approach is warranted in infants presenting with certain abnormalities reviewed here.
National Trends in Feeding Interventions for Cleft Palate
Authors: Scott Andrew R. , Lander Lina , Shah Rahul K. 
Published: February 2015

Objective1) To determine national trends in the rates of failure to thrive (FTT) and subsequent gastrostomy tube placement in infants with cleft palate. 2) To identify risk factors for developing FTT and/or gastrostomy tube placement in the setting of underlying dysphagia related to cleft palate.MethodRetrospective series. The Kids’ Inpatient Database 2006 was analyzed for children under 1 year of age with any form of cleft palate with and without the diagnosis of FTT. The cohort of children with cleft palate and FTT were analyzed for procedure codes indicating gastrostomy placement during admission.ResultsIn total, 12,067 children under 1 year of age with cleft palate were identified. Of these, 2,085 (17%) also had the diagnosis of FTT. Children with cleft palate and FTT had a g‐tube placement rate of 18%, with the overall rate of g‐tube placement for any infant with cleft palate being 3%. Odds of FTT among infants with cleft palate were significantly elevated for those with reflux, musculoskeletal anomalies, atrial or ventricular septal defect, circulatory system anomalies, and respiratory problems. Similar concurrent diagnoses increased the odds ratios for g‐tube placement in infants with cleft palate and FTT.ConclusionFailure to thrive among infants with cleft palate approaches 20%. Children with gastrointestinal, cardiac, and respiratory comorbidies are particularly at risk and gastrostomy tube placement for feeding supplementation may be required. Infants without these comorbidities may benefit from longer trials of conservative feeding interventions prior to surgical intervention.
Pan American Guideline on Tonsillitis and Adenoid Hypertrophy
Authors: De La Torre Gonzalez Carlos , Mayorga Butron Jose L. , Macías Fernández Luis A. , Sih Tania M. , Chaverri‐Polini Julian , Melendez‐Medina Amarilis M. , Mocellin Marcos 
Published: February 2015

ObjectiveThis evidence‐based clinical practice guideline (CPG) aims to improve clinical decision making of general practitioners and specialists in the treatment of acute tonsillitis and adenoid hypertrophy and supports clinicians in clinical decision making for medical treatment, targeting the pathophysiological process and evidence‐based efficacy, safety, and tolerability.MethodPan‐American Association of Otorhinolaryngology and Head and Neck Surgery in partnership with Ibero American Agency for Development and Assessment of Health Technologies developed a clinical practice guideline on medical management of acute tonsillitis and adenoid hypertrophy in children. This document provides punctual evidence‐based recommendations for primary care physicians and otolaryngologists on the medical management of these conditions and complies with evidence‐based medicine fundamentals and with well‐validated guidelines methodology as recommended by the National Institute for Clinical Excellence, the National Institutes of Health, and the Scottish Intercollegiate Guidelines Network.ResultsThis document provides from A Grade to D Grade of clinical recommendations for treatment of these conditions. The Guideline Development Group made recommendations based on well‐designed randomized controlled trials and systematic reviews. Some clinical questions could not be answered by high‐quality research and for these questions a Panel Delphi was conducted to provide clinical guidance. Overall there is a need for well‐designed RCTs and economic assessments to answer most of the gaps of knowledge for the treatment of acute tonsillitis and adenoid hypertrophy.ConclusionThis clinical practice guideline provides guidance for the medical treatment of children with acute tonsillitis and adenoid hypertrophy.
Pediatric Epiglottitis: Predictors of Conservative Treatment
Authors: Neidich Marci J. , Black Angela P. , Hart Catherine K. , Lander Lina , Shah Rahul K. , Johnson Kaalan E. 
Published: February 2015

Objective1) To evaluate predictors of conservative management in pediatric patients with epiglottitis. 2) To use national trends, variances, and outcomes to better understand current management trends of this rare though highly morbid disease.MethodThe Kids’ Inpatient Databases (2006 and 2009) were searched using ICD‐9 CM codes for acute epiglottitis with (464.30) and without (464.31) obstruction. Demographics and hospital characteristics of pediatric patients who required airway intervention (defined as intubation or tracheotomy) were compared with those who were managed conservatively without airway intervention.ResultsA total of 820 patients were included in the analysis, and 115 (14%) required intervention and 86% were managed conservatively. Mortality was less than 10 patients. There were no significant differences between groups with respect to age, gender, or race. Characteristics predictive of conservative management include urgent admission type (vs emergent, P =. 015), urban nonteaching hospital (vs urban teaching, P =. 002), nonchildren’s hospital (vs children’s unit or children’s hospital, P <. 0001) and small/medium‐sized hospital (vs large, P =. 03). Length of hospital stay was shorter (mean 3.65 days vs 10.87 days, P =. 01) and cost was lower in patients who were managed conservatively (mean $18,487 vs $83,037, P <. 0001).ConclusionThe majority of pediatric epiglottitis patients are currently managed without intubation or tracheotomy with low mortality. Conservatively managed admissions are more likely for nonemergent presentations at nonpediatric, nonteaching, small/medium‐sized hospitals, and are lower in cost. Additional studies are needed to further characterize patients which would be appropriate for conservative management.
Gesture‐Controlled Interactive 3‐Dimensional Anatomy
Authors: Hochman Jordan B. , Unger Bert , Kraut Jay , Klonish Sabine H. 
Published: February 2015

ObjectiveThe creation of a novel 3‐dimensional (3D) teaching tool was generated with the employment of the Microsoft Kinect. Within this construct, 3D temporal bone anatomy is manipulated with the use of hand gestures, in the absence of mouse or keyboard.MethodCT temporal bone data are imported into an image processing program and segmented. This information is then exported in a polygonal mesh format to a proprietary 3D graphics engine with an integrated Microsoft Kinect. Motion in the virtual environment is undertaken by tracking hand position relative to the user’s left shoulder.ResultsThe construct successfully tracked scene depth and user joint locations. This permitted gesture‐based control over the entire 3D environment. Stereoscopy was deemed appropriate with significant object projection while still maintaining the operator’s ability to resolve the image as singular. Specific anatomic structures can be selected from within the larger virtual environment. These graphic representations can be extracted and rotated at the discretion of the user. Voice command employing the Kinect’s intrinsic speech library works, yet is easily confused by environmental noise.ConclusionThere is a need for the development of virtual anatomy models to complement traditional education. Initial development is time intensive, and the constructed images are a stylized abstraction. Nonetheless, our novel gesture‐ controlled interactive 3D model of the temporal bone represents a promising teaching tool.
Resident and Attending Tube Placement: Is There a Difference?
Authors: Goyal Neerav , Carr Michele M. 
Published: February 2015

ObjectiveTo determine if there is a difference in patient outcomes between resident and attending placed ventilation tubes.MethodCharts of pediatric patients who underwent tube placement between 2003 and 2010 at a tertiary referral center were reviewed. Patients served as self‐controls, with the resident and attending each having done one ear. Level of training, ear operated, patient age, operative findings, and findings at first follow‐up were recorded.ResultsOf 1488 pediatric patients, 809 met inclusion and exclusion criteria. A total of 59% were boys and residents preferentially operated on the left ear (86%). A total of 160 patients did not follow up in the first 10 weeks. There were no significant differences between attending and resident operated ears with respect to operative findings (P =. 09), or findings at first follow‐up (P =. 35). There was no significance for each operative finding: tube extrusion (P =. 32), blocked tube (P =. 15), otorrhea (P =. 82), and patent tube (P =. 09). Comparing the PGY2 residents to the attending also failed to reveal significant differences (P =. 30), with a power of greater than 80%.ConclusionDifferences between tube outcomes between resident and attending placed ventilation tubes were not found to be statistically significant. This suggests that placement of ventilation tubes by resident surgeons can be performed in a safe manner without affecting patient safety or patient outcomes.
Resource Utilization in Primary Cleft Lip Repair
Authors: Owusu James A. , Liu Meixia , Sidman James D. , Scott Andrew R. 
Published: February 2015

Objective1) To estimate the current incidence of cleft lip in the United States and whether any regional variations exist. 2) To determine national variations in resource utilization in the primary repair of cleft lip and identify patient and institutional factors associated with increased resource use.MethodRetrospective analysis of a national, pediatric database (2009 Kids Inpatient Database (KID)). Patients aged 1 year and below were selected using diagnoses codes for cleft lip and procedure codes for lip repair. A number of demographic variables were analyzed and hospital charges were considered as a measure of resource utilization.ResultsThere were 1318 patients identified. Overall incidence nationwide was 0.09% with male to female ratio of 1.8:1. Regional incidence varied from 0.07% (Northeast) to 0.10% (West). The mean age at surgery was 4.2 months. The average length of stay was 1.4 days, with minimal regional variation. The average total charge nationwide was $20,147, ranging from $14,635 (South) to $23,663 (West). Average charge in a teaching institution was $9764 higher than for nonteaching institutions. The strongest predictor of charge was length of stay, increasing by $8102 for every additional hospital day (P <. 01).ConclusionRegional variations exist in resource utilization for primary cleft lip repair. Resource use is higher in the West and among teaching institutions. These results show that whiles length of stay is a key determinant of charge; other factors also play a role.
Rhabdomyosarcoma of Head and Neck in Children
Authors: Reilly Brian K. , Pena Maria T. , Kim Aerang , Choi Sukgi S. 
Published: February 2015

ObjectiveReview the clinical presentation, histological subtypes, staging, treatment modalities, and survival rates for non‐orbital pediatric head and neck rhabdomyosarcoma (RMS).MethodA retrospective chart review of patients treated from 1996 to 2011 for nonorbital primary head and neck RMS at a pediatric tertiary care center. Baseline demographics, clinical presentation, staging, histology, treatment modalities, and survival outcome were analyzed.ResultsSixteen patients (7 M) were diagnosed with primary head and neck RMS, median age of 6.9 years (range, <1‐19 years). The majority of tumors were of parameningeal location (11/16). Fifty‐six percent (9/16) were metastatic at presentation (stage at diagnosis: 1, n = 1; 2, n = 2; 3, n = 4; 4, n = 9). Nine had skull base erosion and/or cranial nerve deficits. Ten patients had embryonal and sihad alveolar histology. Upfront resection gross resection was feasible in 4 patients (3 of which were non‐parameningeal), all with positive margins. All patients received chemotherapy combined with radiotherapy. Second look surgery was performed in 2 patients.ConclusionMost patients presented with advanced disease in our series. Majority were parameningeal, thus limiting the role to biopsy only. Primary excision for non‐paramenigeal RMS is ideal. The role of second look surgery after chemotherapy and radiation is still unknown; however, it was successful in 2 patients in our small review.
The National Tonsil Surgery Register in Sweden
Authors: Stalfors Joacim , Ericsson Elisabeth , Hemlin Claes , Hultcrantz Elisabeth , Roos Kristian , Sunnergren Ola , Hessen‐Söderman Lotta 
Published: February 2015

ObjectiveThe purpose of the National Tonsil Surgery Register is to compile outcome data with regard to tonsil surgery for description of the activities of respectively clinic, clinical improvement programs and research. The aim of this paper is to describe age, gender, indications with respect to surgical methods and techniques.MethodAll patients registered in the registry between March 2009 to January 2012 were analyzed with respect to demographics, indication for surgery, surgical method and surgical techniques. A total of 24,084 patients were registered, representing 62% completeness and 86 % coverage.ResultsThe most common indication for tonsillar surgery was Z upper airway obstruction registered for 59% of the patients (median age, 5 years, 56% boys). The indicated infection‐ related symptoms were registered for 38% of the patients (median age, 19 years, 61% girls). The most commonly used surgical procedure for patients with obstruction were tonsillotomy + adenoidectomy (TT+A, 46%), tonsillectomy + adenoidectomy (TE+A, 23%), and tonsillectomy (TE, 20%). TE dominated for patients operated for infection‐related symptoms (89%). Regardless of indication TE and TE+A procedures were performed with cold steel (94%) while TT and TT+A was performed with radiofrequency techniques (97%).ConclusionIn Sweden, tonsil surgery for obstructive symptoms are typically performed in preschool age with TT/TT+A and radiofrequency and affects more boys than girls. Tonsil surgery for infection‐related indications is typically performed in the late teens with TE using cold steel, and girls are affected more often.