bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flaps for Craniofacial Reconstruction
Authors: Chaaban Mohamad R. , Chaudhry Ajaz , Woodworth Bradford A. 
Published: February 2015

ObjectiveSkull base reconstruction is one of the most challenging aspects of anterior skull base surgery, especially in the context of previous radiation treatment. The objective of the current study is to describe a novel strategy utilizing pericranial flap (PCF) and nasoseptal flap (NSF) closure following endoscopic‐assisted craniofacial resection (EA‐CFR) of sinus/skull base tumors.MethodReview of a prospectively collected database containing patients treated with combined PCF/NSF closure was performed between January 2008 and December 2011 at the University of Alabama at Birmingham. Demographics, pathology, surgical goals, location, technique, length of hospital stay, adjuvant treatments, and clinical status were assessed.ResultsFour patients (average age 42.7 ± 5.2 years) had EA‐CFRs utilizing the PCF/NSF reconstructive technique. Tumor histopathology included esthesioneuroblastoma (n = 2), mixed adenocarcinoma/esthesioneuroblastoma (n = 1), and sinonasal undifferentiated carcinoma (n = 1). Surgical goals were curative intent in all patients. The average length of stay following surgery was 3 days (range of 2‐4). There were no postoperative CSF leaks or other complications. Three patients had received neoadjuvant chemo/radiation therapy. The NSF was utilized to cover the PCF at the junction of the planum sphenoidale and PCF in all patients. All patients have complete locoregional control with an average follow up of 26 months (17‐41), although 1 patient is alive with metastases.ConclusionReconstruction of anterior skull base defects following EA‐CFR utilizing the combined PCF/NSF technique resulted in effective closure in all patients in this series. Providing a double layer of vascularized tissue is a reasonable strategy particularly in the setting of neoadjuvant radiation treatment.
Histopathological Characteristics of Nasal Polyps in Smokers
Authors: Kule Zeynep G. , Habesoglu Tulay E. , Somay Adnan , Deveci Hande S. , Kule Mustafa , Gursel Ali O. 
Published: February 2015

ObjectiveCigarette smoking causes squamous metaplasia in upper and lower airways. We hypothesized that in patients with nasal polyposis, nasal polyps of smokers might reveal histopathological changes, and there might be an increased neoplasia risk. Therefore, we aimed to explore the effects of smoking on nasal polyp histopathology and clinical measures.MethodThis retrospective chart review consists of 30 smoker and 47 nonsmoker patients with nasal polyposis who underwent endoscopic sinus surgery between 2007 and 2011. We aimed to assess the effect of smoking on histopathological characteristics of nasal polyps and clinical measures. They were compared according to light microscopic findings.ResultsNo statistically significant differences were found between smoker and nonsmoker groups with regard to histopathological findings (P >. 05). Also, there were no significant correlation defined by endoscopy, computed tomography, and Nasal Obstruction Symptom Evaluation (NOSE) scores of patients between the 2 groups (P >. 05). Smoking did not have significant effect on the presence of allergy or asthma. But blood eosinophil levels were found to be significantly higher in the smoker group (P <. 05).ConclusionThis is the first clinical study that investigates the effect of smoking on nasal polyp histopathology. In spite of the fact that smoking is associated with histopathological changes in respiratory mucosa, we did not find any significant change in histopathological characteristics of nasal polyps in smokers.
Is MRI Indicated in the Workup of Olfactory Loss?
Authors: Hoekman Peter K. , Houlton Jeffrey J. , Seiden Allen M. 
Published: February 2015

ObjectiveTo understand the utility and cost‐effectiveness of magnetic resonance imaging (MRI) in the evaluation of patients with postviral and idiopathic olfactory loss.MethodA retrospective review of consecutive patients presenting with olfactory disorders at a university‐based taste and smell center from July 1998 through October 2011 was performed in an attempt to identify patients with postviral and idiopathic olfactory loss and to determine the diagnostic utility of MRI in their evaluation.ResultsEight hundred thirty‐nine patients (average age 53 years, 62% female gender) presented with olfactory loss with a mean University of Pennsylvania Smell Identification Test (UPSIT) score of 21.0. The most common etiologies were postviral (27%), obstructive (13%), traumatic (10%), and idiopathic (29%) olfactory loss. MRI was used in the evaluation of idiopathic and postviral loss 54.9% and 26.4% of the time, respectively, and abnormalities were identified in 4.6% and 3.4% of patients. However, only 2.3% and 1.7% of patients had olfactory loss attributable to imaging abnormalities on MRI.ConclusionThe most commonly identifiable etiology of olfactory loss in this series was viral infection; the cause often remained unknown. Brain MRI, though frequently performed, demonstrated a very low diagnostic yield. Based on these data, we recommend against the routine use of MRI in patients with idiopathic and postviral olfactory loss.
Microbial Contaminants in Irrigation Devices
Authors: Nguyen Shaun A. , Psaltis Alkis J. , Schlosser Rodney J. 
Published: February 2015

ObjectiveIrrigation devices used by patients suffering from chronic rhinosinusitis become contaminated after use. The purpose of this study was to see whether such devices can also become contaminated when used by patients with allergic rhinitis (AR).MethodTen AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus irrigation system and instructed on its proper use, cleaning, and storage. Bottles were analyzed at 4 weeks and 8 weeks for microbial growth.ResultsIrrigation devices (14/20) from all individuals in this study grew bacteria commonly in the nozzles. Twenty‐five bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus. No fungal organisms were cultured using the above techniques. In addition no correlation was apparent between the length of bottle use and the degree of contamination. During the study period, no patient developed acute sinus infections.ConclusionBacterial contamination of the irrigation system occurs commonly, even in uninfected AR patients; however, no evidence exists linking this to sinus cross‐infection.
Oral Itraconazole as an Adjunct to Steroids in AFRS
Authors: Panda Naresh K. , Francis Abhilash A. , Chakrabarti Arunaloke , Virk Ramandeep S. 
Published: February 2015

ObjectiveTo evaluate itraconazole therapy in allergic fungal rhinosinusitis.MethodProspective randomized study in 75 cases of allergic fungal rhinosinusitis. The subjects were randomized to 2 groups. All the patients were subjected to endoscopic sinus surgery. The specimen was analyzed for mycological profile and histopathological characteristics. Those assigned to group A were given oral steroids and those in group B were given oral steroids and itraconazole for 3 months. These patients underwent follow‐up examination at 6 weeks, 12 weeks, and 24 weeks with postoperative nasal endoscopic examination and computerized tomography. Random blood sugar estimation and liver function tests were done to watch for side effects. Ten patients were lost to follow‐up during the study period. Hence statistical analysis was done in 65 patients; 39 subjects in group A and 26 in group B.ResultsFungal smear was positive in 84.6% of subjects. Aspergillus flavus was commonly isolated. Patients receiving adjunct itraconazole therapy had a better cavity healing at 12‐24 weeks of follow‐up compared to those receiving steroids (P =. 027). Patients with intraorbital extension had lesser chance of recurrences on oral itraconazole compared to steroids (P =. 018). Itraconazole therapy was found to be beneficial in recalcitrant cases (P =. 050). No side effects were observed with itraconazole.ConclusionItraconazole as an adjunct to corticosteroids has no advantage at 6 months of follow‐up. However, it results in better cavity healing. Itraconazole was found to be beneficial in preventing recurrences in recalcitrant cases and patients with intraorbital extension.
Quality of Life after Balloon Sinuplasty
Authors: El‐Guindy Ahmed S. 
Published: February 2015

ObjectiveTo compare the quality of life of chronic sinusitis patients treated with FESS and those treated by balloon sinuplasty through a randomized prospective study.MethodStudy design: prospective cohort. Time frame: August 2009 to December 2011. Disease: Chronic rhinosinusitis. Setting: Tanta University Hospitals. Subjects and methods: Twenty patients suffering from chronic rhinosinusitis were randomly distributed into 2 equal groups: group A treated with FESS and group B treated with balloon sinuplasty. Outcome measurements: Preoperative and postoperative evaluation by SNOT‐20 questionnaire, endoscopic examination, and Lund‐Mackay CT staging.ResultsThe balloon catheters dilated all ostia successfully (17 maxillary, 5 sphenoid, and 3 frontal recesses). No adverse effects were recorded. At 12 months, overall patency in 88%, non‐patency rate of 4%, and “indeterminate” in 8%. In 2 sinuses, a revision procedure was required (8%) based on clinical and CT findings, compared to 3 sinuses in FESS group. There was a significant improvement over baseline measures in the SNOT‐20 in both procedures. As for the patients satisfaction with the interventions; 100% answered “yes, they would undergo the procedure again,” for sinuplasty, against 40% of the patients submitted to FESS.ConclusionBalloon sinuplasty is safe and effective and improves patients’ quality of life. It may be used as a stand‐alone or as a hybrid procedure. Candidates are patients with chronic sinusitis limited mostly to ostial obstruction. Cases of isolated sphenoid, maxillary, and frontal sinusitis are particularly attractive to avoid resection of normal ethmoid sinuses.
Validating the Sheep Model in Rhinology Skills Training
Authors: Awad Zaid , Arora Asit , Touska Philip , Tolley Neil S. , Darzi Ara 
Published: February 2015

Objective1) Investigate face and content validity of the sheep model in operative rhinology skills training. 2) Investigate the applicability and transferability of skills acquired in otolaryngology training curriculum.MethodAn evaluation study conducted in February 2012. Fifteen otolaryngology trainees (level: 3‐5) and 5 experts completed 9 operative rhinology tasks on a pre‐prepared sheep model and assessed face and content validity using a Likert scale across 20‐item questionnaire. Participants also evaluated the model in teaching individual tasks and globally as training tool.ResultsThe model achieved face validity of 4.1 with no significant difference between expert and intermediate groups (4.0 and 4.3, Wilcoxon P =. 14). Content validity score was 4.2, with experts scoring higher than the intermediate group (4.0 and 4.5, Wlicoxon P =. 043). The highest scoring skills were improving hand‐eye‐coordination and operative skills (4.7 and 4.6), and the worst was anatomy teaching (3.4). The highest scoring tasks were foreign‐body removal and cerebrospinal fluid leak repair (4.4 and 4.0), and the worst was middle‐meatal‐antrostomy and septoplasty (3.3 and 3.6). Two data points were missing (99.5% completion). All agreed on transferability, incorporation into curriculum, and recommending to colleagues (4.2, 4.5, and 4.4).ConclusionThe sheep model achieved face and content validity and is recommended by experts and trainees for teaching rhinology skills. Advantages include availability, realism, and applicability of acquired skills in rhinology procedures. The model achieved >4/5 Likert scale in teaching endoscopic examination, foreign‐body removal, cerebrospinal fluid leak repair, and sphenopalatine artery ligation.
Effects of Surgery on Quality of Life in Obstructive Sleep Apnea Syndrome
Authors: Kizilbulut Gultekin , Ark Nebil , Ugur Kadriye S. , Yuksel Alper , Kurtaran Hanifi , Gunduz Mehmet 
Published: February 2015

ObjectiveTo understand the influence of surgical treatment on quality of life and depression score in simple snorers and in mild, moderate, severe obstructive sleep apnea syndrome (OSAS) patients.MethodThis prospective cohort study involved 65 patients who underwent surgery with the diagnosis of simple snoring and OSAS between years 2007‐2011. Short‐form health survey (SF‐36) and Beck Depression Inventory were used before and 18 months following surgery together with nocturnal polysomnography. Kruskal‐Wallis test was used for statistical analysis.ResultsThere was a statistically significant difference in apnea‐hypopnea indexes (AHI) of moderate and severe apnea groups following surgery (P <. 001). There was an increase in general health level of SF36 in mild apnea group (P =. 009). There were increases in general health level and vitality level of SF36 in the moderate apnea group (P <. 001). There was no difference among groups in Beck Depression Inventory scores postoperatively (P >. 0125).ConclusionDespite the favorable differences in apnea‐hypopnea index scores, there is a limited favorable effect of surgical treatment on quality of life scores and no influence on depression scores in simple snorers and OSAS patients.
Friedman Staging for Sleep Surgery: Meta‐analysis
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G. 
Published: February 2015

Objective1) Review the available literature reporting on the success of single and multi‐level sleep surgery in relation to Friedman Anatomical Staging (FAS). 2) Combine statistical outcomes of multiple studies (where appropriate) to determine surgical success rates (defined by postoperative apnea‐hypopnea index [AHI] <20 and 50% reduction) for each clinical stage.MethodPubMed, MEDLINE, and Cochrane Trial Registry (through 12/2011) were searched, combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the success of sleep surgery in relation to FAS were performed. Outcomes are reported as proportional success rates.ResultsSix studies met inclusion criteria and had data suitable for pooling (521 patients). Success rate (SR) for single‐level palatal surgery with FAS‐1 was. 806 (.630,. 910; P =. 002). Multi‐level surgical data for FAS‐1 yielded SR. 706 (.458,. 872; P =. 1). Single‐level surgery for FAS‐2 yielded SR. 379 (.224,. 564; P =. 197). Multi‐level surgical data for FAS‐2 yields SR. 647 (.527,. 751; P =. 017). Single‐level surgery for FAS‐3 yields SR. 081 (.037,. 169; P <. 001). Multi‐level surgery for FAS‐3 yields SR. 412 (.254,. 591; P =. 334). Analysis of publication bias yielded non‐significant Egger’s regression intercepts for studies reporting FAS‐2/3 success. Too few studies reported FAS‐1 success to allow statistical analysis of publication bias.ConclusionThese findings demonstrate the utility of FAS in predicting the success of OSA surgery. Findings further reinforce the value of OSA surgery in patients with FAS‐1 regardless of disease severity. In addition, they add to the evidence that multi‐level surgery is often necessary to treat patients with more advanced staging.
Balloon Catheter Endoscopic Dacryocystorhinostomy
Authors: Ragab Sameh M. 
Published: February 2015

ObjectiveConduct the first prospective randomized controlled study investigating the safety and efficacy of endocanalicular high pressure 5‐mm balloon catheter endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction.MethodThis prospective randomized controlled study was conducted between 2004 and 2009 including 70 procedures of endoscopic dacryocystorhinostomy. They were prospectively equally randomized into 2 groups; endocanalicular high‐pressure 5‐mm balloon catheter endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Statistical analysis was done using SPSS for Windows. The primary end point was determined to be the success of the surgery as defined by the subjective disappearance of symptoms.ResultsBoth groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in the endocanalicular balloon catheter endoscopic DCR group.ConclusionThe endocanalicular balloon catheter endoscopic DCR shares the benefits and success rate of conventional endoscopic DCR. In addition, it is simpler, requires less manipulation, consumes a shorter operative time, has a better safety profile, and can be totally utilized under local anesthesia with minimal sedation.
Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma
Authors: Gao Xia 
Published: February 2015

ObjectiveJuvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. External or intraoral incisions are standard open approaches, now endonasal endoscope surgery is widely accepted for its low invasion and high success rate. The purpose of this article is to present our experience with 16 patients diagnosed with JNA who were resected with endonasal endoscope surgery.MethodRecords of 16 patients aged 11 to 32 with a mean age of 19.5 years treated by endoscopic surgery in our department between 2003 and 2010 were reviewed retrospectively. All patients were male. Preoperative radiological evaluation included both high resolution computed tomography with 1‐mm cuts, and magnetic resonance imaging (MRI). According to Radkowski’s classification, 4 patients were stage Ia, 5 patients were stage Ib, 4 patients were stage IIa, and 3 patients were stage IIb. The tumor stages, feeding vessels, operating time, complications, and recurrence were observed and recorded. Eight patients received preoperative angiographic embolization, and 3 patients received intraoperative external carotid artery clamping. Transnasal or transpterygoid and posterolateral wall of maxillary sinus approaches are used for tumor resection.ResultsThe mean duration of the surgery was 2 hours. The mean intraoperative blood loss of patients who received preoperative hyperselective embolization was 470 mL, patients who received intraoperative external carotid artery clamping was 510 mL, and patients who did not receive arterial supply blocking was 930 mL. After surgery, CT scan or MR image showed total removal of the tumor was achieved in all patients. No postoperative complications were observed. All patients were followed‐up for 9 months to 3 years (mean 1.5 years), and no recurrence was founded.ConclusionEndoscopic resection of JNA is a difficult but effective operation. The key techniques to remove tumor are bleeding control, drilling‐out the bone that the tumor invaded. Endonasal surgery combined with a preoperative embolization of the arterial supply can control blood loss. For small and intermediate‐sized JNA (Radkowski Ia‐IIb), endoscopic surgery is an appropriate choice. If the tumor extends into lateral fossa infratemporalis or deep into the skull base,we do not recommend it.
Evidence‐Based Long‐term Outcomes in ESS
Authors: Hopp Martin L. , Vardanyan Narine , Nasseri Shawn 
Published: February 2015

Objective1) Analyze appropriateness of endoscopic sinus surgery. 2) Understand the long‐term results of endoscopic sinus surgery at an academic institution with an academic and private practice blend of patients using the Sino Nasal Outcome Test (“SNOT 22”) statistically validated tool.MethodIncluded consecutive patients undergoing sinus surgery at CSMC since January 2009 who were able to complete SNOT‐22 prior to surgery. Three hundred fifty patients were included from 17 physicians. Patients mailed the postop form 3, 6, and 12 months following surgery. Patients ranged from 22 years to 67 years split between 220 females and 330 males.ResultsThe results were quite impressive for patients from immediate to long‐term (12 month) postoperative results. The results were statistically significant in demonstrating an improvement of symptoms overall and in all 4 subcategories with a univariate analysis demonstrating P values of <.001. These results were very exciting due to the multi‐cultural and varied nature of the patients ranging from tertiary care academic referrals to community otolaryngology patients.ConclusionIt was concluded that endoscopic sinus surgery was effective with results reaching statistical significance in demonstrating an improvement of symptoms overall and in all 4 sub‐categories with a univariate analysis demonstrating P values of <.001. Scientific findings demonstrate that patients had major improvement scores 3, 6, and 12 months after surgery.
HAART: Presence of Oral Warts in an HIV‐Infected Population
Authors: Mahmoud Ali , Miziara Ivan D. , Weber Raimar , Gil Julio M. , Costa Katia C. 
Published: February 2015

ObjectiveTo investigate whether the use of HAART for patients with HIV/AIDS was associated with increased prevalence of oral warts in a tertiary care hospital in Brazil.MethodApproximately 1745 HIV patients (72.3% males) aged 2‐64 years (mean 33 years) treated at the Otorhinolaryngology department of a tertiary care hospital for a period of 12 years from 1993 to 2005. Patients were evaluated for the presence of oral lesions, recorded data about their medications, serum count of CD4+, and after 1996, plasma viral load. The diagnosis of oral warts was made through biopsy under local anesthesia, using 2% xylocaine. Polymerase chain reaction was used to detect and type HPV infection. Data were analyzed by dividing patients into 3 groups according to treatment: no treatment, antiretroviral therapy (ART), and HAART. The prevalence of oral warts was compared among groups using the chi‐square and Fisher exact tests.ResultsApproximately 77 patients (4.4%) had oral warts. About 2.8% of the 317 untreated patients, 4.0% of the 927 under ART, and 6.2% of 501 users of HAART had oral warts. The HPV infection rate of HPV6/11 was 45.2%.ConclusionThere is an increased frequency of oral warts due to HPV, even under improved immune status after HAART, with a prevalence of a low risk HPV6/11 infection.