bluuebunny/crossref_metadata_2025_split huggingface dataset:
EMLA Cream as Local Anesthetic for Endoscopic Radiofrequency Volumetric Inferior Turbinate Tissue Reduction
Authors: Martellucci Salvatore , Pagliuca Giulio , De Vincentiis Marco , Fusconi Massimo , Greco Antonio , Rosato Chiara , Gallo Andrea 
Published: August 2013

Objectives:Radiofrequency volumetric tissue reduction (RFVTR) is usually performed under local anesthesia. Although this is a simple procedure, patients often report perioperative discomfort. The aim of this prospective study was to determine the effectiveness of Lidocaine/prilocaine eutectic mixture (EMLATM cream) as a topical anesthetic for RFVTR. A comparison between EMLATM cream and lidocaine 10% in liquid formulation has also been made.Methods:200 consecutive patients undergoing RFVTR with topical anesthesia were enrolled in this randomized controlled trial from March 2010 to March 2012. The patients were divided into 2 groups: Group A included 100 patients treated with cotton pledgets soaked with lidocaine 10%, and Group B included 100 patients treated with EMLATM cream. Patients were evaluated before and after surgery using endoscopy and rhinomanometry. Four 10 cm Visual Analogue Scale (VAS) were submitted to each patient immediately after surgery and after 2 months to assess various aspects of perioperative discomfort.Results:A significant increase of nasal airflow and a subjective improvement of symptoms were observed without differences between the 2 groups. Subjective evaluation regarding perioperative discomfort showed a significant difference between Group A and Group B immediately after surgery and a slight but not significant difference after 2 months.Conclusions:RFVTR is an effective technique in the treatment of turbinate hypertrophy. The unintentional passage of anesthetic liquid into the pharynx is likely the cause of greater discomfort. The higher viscosity of the EMLATM cream provides greater permanence on the nasal mucosa and a more effective anesthesia.
Endoscopic Management of Antrochoanal Polyps: A Single UK Center Experience
Authors: Hariri Ahmad , Choudhury Natasha , Saleh Hesham 
Published: August 2013

Objectives:Antrochoanal polyps (ACP) are benign lesions originating from maxillary sinus mucosa extending into the nasal cavity and choana. They are typically unilateral and rarely arise from other sinus groups. Their treatment is surgical, with various approaches reported. We aimed to evaluate the following outcome measures: 1) Report the first UK series of ACP managed endoscopically; 2) Analyze the rates of recurrences of ACPs from our case series.Methods:A retrospective review of adult patients with ACPs managed under our care was conducted. Demographic and clinical patient data were reviewed. The main outcome parameter measured was signs of recurrence.Results:23 consecutive patients were studied from an 8 year period, 14 males and 9 females, with a mean age of 37.7 +/‐ 14.4 years. This included 22 patients with typical ACPs and 1 with a rare sphenochoanal polyp. Two patients within our group were referred with recurrent ACPS for revision surgery. The mean follow‐up was 14.8 +/‐ 15.3 months, with a follow‐up of 24 and 12 months for the two revision cases. There were no recurrences in any of our patients.Conclusions:We describe the first series of endoscopic sinus surgery for ACPs from the UK. We have had no recurrent cases, with a mean follow‐up period of 14.8 months. We review the literature in endoscopic management of adult ACPs and describe our own surgical technique. Our approach allows complete removal of the polyp, including its site of origin using angled endoscopes and instrumentation, to minimize recurrence.
Evaluation of Herpesviruses 1‐6 and Community‐Acquired Respiratory Viruses in Patients with Nasal Polyposis
Authors: Garzaro Massimiliano , Cavallo Rossana , Costa Cristina , Boggio Valeria , Raimondo Luca , Riva Giuseppe , Pecorari Giancarlo 
Published: August 2013

Objectives:Evaluate human herpesviruses 1‐6 and community‐acquired respiratory virus (CARV) prevalence in nasal polyps, adjacent turbinates, and pre‐ and post‐operative cytological specimens from patients undergoing functional endoscopic sinus surgery (FESS) and to investigate cytomegalovirus (CMV)‐ and Epstein‐Barr virus (EBV)‐specific cellular immune response.Methods:Viral occurrence was evaluated in 35 consecutive patients, enrolled between September 2011 and October 2012, at different time points by molecular methods. CMV‐ and EBV‐immune response was evaluated by Elispot assay.Results:Overall, 21 patients (60%) were positive for at least one virus in at least one specimen; in particular, 12.1% of all specimens for HHV‐6 and 10.5% for EBV, followed by CMV and HSV‐1 (both 1.6%). EBV‐positivity tended to be higher in polyps, as well as HHV‐6 in turbinate mucosa, although no significant association was found. Only one pre‐operative cytological specimen was positive to parainfluenza virus‐1. As regards immune response, 63.2% of patients displayed a CMV‐responder status, whereas only 11.2% were EBV‐responders.Conclusions:The frequent detection of HHV‐6 in normal nasal mucosa could be explained by its diffusion in different tissues, whereas the higher EBV frequency in polyps could support a causative role or persistence in the inflammatory lymphoid tissue. No association between the development of nasal polyps, other herpesviruses, and CARVs seems to exist. Preliminary data suggest an altered immune response pattern to CMV and, particularly, EBV. The potential implications in CRSwNP remain to be defined.
FESS versus Balloon Sinuplasty as Long‐term Treatment for Pediatric Chronic Rhinosinusitis: A 2‐Year Postoperative Analysis
Authors: Thottam Prasad J. , Kieu Monica C. , Al Barazi Randa , Saraiya Sonal , Dworkin James P. , Belenky Walter M. 
Published: August 2013

Objectives:Chronic rhinosinusitis (CRS) is a common pediatric disease. For those affected, functional endoscopic sinus surgery (FESS) and balloon sinuplasty are surgical options for long‐term relief. Our objective was to examine the efficacy of these treatments in overall symptom improvement >2‐years post‐operatively.Methods:A 2‐group prospective blinded survey was conducted with 10 pediatric patients who underwent FESS and 11 treated with balloon sinuplasty from 2007‐2010. All had previously been reviewed in a 6‐month post‐operative comparative study and were diagnosed with CRS through CT scans and symptomatology. At >2‐years post‐surgery, symptoms and medications were compared using 1‐tailed independent t‐tests.Results:Mean age at time of procedure was 9.9 years (range 4.1 – 16.0); 65% were male. Both groups had similar Lund‐Mackay scores (FESS: Mean = 12.63; Balloon: Mean = 12.27) and overall symptoms prior to procedure (FESS: Mean = 4.78, SD = 2.73; Balloon: Mean = 4.60, SD = 1.26). Greater than 2‐year post‐operative follow‐up surveys demonstrated a statistically significant long‐term decrease in symptoms for balloon and FESS treatments (t = 4.34, P = <0.001). Balloon demonstrated a significant decrease in individual sinus symptoms (t=4.80, P = 0.001) when compared to FESS. Overall, a reduction in antibiotics and topical nasal spray was identified in both groups.Conclusions:FESS and balloon are both effective long‐term options in the treatment of pediatric CRS. Both procedures can be performed with minimal short‐ and long‐term complications. At >2‐years post‐sinus surgery, individuals who underwent balloon sinuplasty reported a greater decrease in overall sinus complaints when compared to FESS.
Impact of Endoscopic Sinus Surgery on Healthcare Use for Patients with Co‐morbidities
Authors: Benninger Michael S. , Holy Chantal E. 
Published: August 2013

Objectives:1) Analyze healthcare use of chronic rhinosinusitis (CRS) patients requiring endoscopic sinus surgery (ESS) based on co‐morbidities (asthma, polyposis, and prior surgery) in an all‐comer population. 2) Evaluate the effectiveness of ESS by sub‐populations, using healthcare use pre‐ and post‐surgery as a proxy for improvement.Methods:A retrospective database analysis was conducted using Marketscan. All patients with ESS (CPT 31254‐31288) in 2008 and at least 5 years continuous enrollment (medical and drug coverage) were included (n=8,827). Patients were grouped based on diagnoses of asthma, polyposis, or prior surgery. In‐ and outpatient medical and prescription history for all sinonasal procedures or diagnoses was analyzed. All costs were calculated on a per‐patient, per‐quarter basis.Results:Total cost of care 9‐12 months prior to surgery was: No comorbidity (NC): $195 (95% Confidence interval (95%CI) $178.24‐$205.13), Polyps (P): $183.60 (95%CI $164.17‐$203.03), Asthma (A): $484.56 (95%CI $443.30‐$525.82), Asthma and Polyps (AP): $534 (95%CI $460.10‐$609.80), and Revisions (R): $1,234.52 (95% CI $853.02‐$1,616.01). Costs increased 1.5‐3.5 fold prior to surgery (NC: $1,310.27, P: $1,358.11; A: $1,738.84, AP: $1,894.31, R: $1,782.03) and were followed by surgical costs ranging from $7,187.35‐$9,650.83. ESS was consistently followed by significant drops in costs, which remained stable thereafter. Ongoing CRS disease costs at 2‐year post‐operative averaged between $195.36 (NC ‐ 95%CI $172.66‐$218.06) and $669.35 (AP ‐ 95%CI $546.75‐$791.94).Conclusions:Patients with asthma and polyps have ongoing disease costs approximately 3‐fold greater than patients without those comorbidities. Prior to ESS, use increased significantly, reflecting unmanageable disease states in all patient subpopulations.
Improvement in Olfaction following Modified Endoscopic Lothrop Procedure
Authors: Tan Neil C.W. , Drilling Amanda , Jardeleza Camille , Wormald Peter J. 
Published: August 2013

Objectives:The Modified Endoscopic Lothrop Procedure (MELP) is performed for severe cases of chronic rhinosinusitis (CRS) refractory to standard medical and surgical treatments. It involves creating a wide neo‐ostium connecting both frontal ostia and the removal of bone between the frontal beak and the olfactory fossa. The posterior margins of dissection are the fibers of the first olfactory neurons; therefore, this procedure may influence sense of smell. The aim of this study was to assess the objective sense of smell pre‐ and post‐MELP.Methods:A prospective study of 20 patients with severe recalcitrant CRS undergoing MELP. Preoperative and postoperative sense of smell was assessed with the University of Pennsylvania Smell Inventory Test (UPSIT).Results:Mean UPSIT scores improved from 19.8 to 25.5 following MELP (p=0.0277, t‐test). The greatest improvement was seen in patients with a poor sense of smell preoperatively; mean UPSIT 11.6 to 22.4 (p=0.0026, t‐test). In patients with a good sense of smell preoperatively, this was not affected negatively by MELP; mean UPSIT 29.25 to 29 (p=0.9351, t‐test).Conclusions:Modified Endoscopic Lothrop Procedure can have a beneficial effect on postoperative sense of smell, and importantly, the operation does not cause any disturbance in sense of smell following surgery in this cohort of patients.
Self‐fabricated Pressure Clips for the Treatment of Ear Keloid
Authors: Hooda Anita , Yadav Samar Pal S. 
Published: August 2013

Objectives:Pressure therapy is an integral part of keloid treatment; however, because of its complex and peculiar shape it is not amenable to pressure therapy. A self fabricated pressure device can provide accurate pressure resulting in equal pressure distribution over the keloid. Moreover, the pressure adjustments can be made as the wire is bent in the middle like a safety pin.Methods:Study design: A prospective study. The study was undertaken from August 2009 to November 2012. Subjects studied: Eight cases of either sex in the age group of 15‐50 years. Setting: Pt. BDS Post graduate Institute Medical Sciences Rohtak, India, a tertiary care center. Interventions: Pressure clips were used for ear lobe keloids both in the pre‐operative and post‐operative period. The pressure clips were fabricated using poly(methyl methacrylate) and consisted of two parts for the medial and lateral surface of the external ear and were joined together with 19 gauge orthodontic wires shaped like a safety pin. The shape and size of the clip was in accordance to the size and shape of the keloid in the pre‐operative period, while in the post‐operative period they were according to the size shape of the post‐operative scar area. Outcome Measurements: Keloid recurrence. Independent Variables: Age, sex, size, and location of the keloid.Results:In the preoperative period the pressure applied by the loop helped to reduce the size of the keloid. In the follow‐up post‐operative period the pressure applied by the loop showed very encouraging results with no recurrence seen over a follow‐up period of one year.Conclusions:Pressure clips in the preoperative period help to reduce the size of keloid, while in the follow‐up post‐operative period, it prevents recurrence of keloid.
Induced Hypotension for Nasal Surgery: Remifentanil versus Esmolol
Authors: Basyoni M.A. , Alsarraf Abdulmohsin J. 
Published: August 2013

Objectives:Compare the efficiency and safety of using remifentanil versus esmolol infusion for induction and maintenance of controlled hypotension. The study evaluates this effect on the quality and dryness of the operative field in endoscopic sinus surgery (FESS). Design: Prospective, randomized, patient‐ and observer‐blinded study.Methods:Thirty patients undergoing FESS were randomly assigned to receive either remifentanil or esmolol for inducing controlled hypotension. The same surgeon blinded to the hypotensive agent used and hemodynamic variables performed all operations. He used a six point scale of 0‐5 to assess the surgical field (0= bloodless and 5= uncontrolled bleeding).Results:Controlled hypotension was achieved at the target mean pressure of 50‐55 mmHg for both remifentanil and esmolol groups. There were no statistical differences between the groups in duration of anesthesia, duration of hypotension, hemodynamic changes, or PaCo2 or PaO2 measurements. Category scale values for surgical conditions were ideal in both groups: 2.61±0.32 in the remifentanil group and 2.48±0.21 in the esmolol group, with no significant difference between the two groups.Conclusions:Both remifentanil and esmolol infusion provide consistent and sustained controlled hypotension, and both are effective in providing a dry surgical field during functional endoscopic sinus surgery.
Olfactory Bulb Volume in Nasal Polyposis
Authors: Amali Amin , Sadeghi Mohammad , Sazgar Amir A. , Langroudi Maziar M. , Farshchi Samireh 
Published: August 2013

Objectives:There is still a debate about the relation of olfactory bulb volume (OBV) to olfactory function. Many studies suggest that olfactory deprivation decreases olfactory bulb volume. The aim of this study was to compare the olfactory threshold and olfactory bulb volume of patients with nasal polyps and healthy individuals.Methods:This was a case control study that was carried out in Valiasr hospital of Tehran University of Medical Sciences in 2010‐2011. 22 patients with nasal polyps were compared with 37 healthy individuals. Olfactory threshold test and magnetic resonance imaging (MRI) were performed in all participants. Age, gender, left OBV, right OBV, total OBV, and olfactory threshold were recorded.Results:There was no significant difference between the age, gender, and olfactory bulb volume of patients of the two groups (P > 0.05). However, the difference between olfactory threshold of the two groups was significant (P < 0.0001). Also, olfactory function and threshold showed no significant relation with olfactory bulb volume (P > 0.05).Conclusions:The results of this study show that MRI and OBV cannot be trusted in determining the olfactory function of patients with nasal polyps. However, further research needs to be done in order to establish this relationship. Also, considering the duration of olfactory dysfunction may be helpful in this research.
Preoperative Concerns in Patients Undergoing Endoscopic Sinus Surgery: A Multi‐institutional, Prospective Study
Authors: Yeung Jeff , Brandt Michael G. , Rotenberg Brian , Franklin Jason H. , Kilty Shaun , Doyle Philip 
Published: August 2013

Objectives:Patient‐centered care is recognized as being fundamental to successful medical practice. The effectiveness of patient‐centered care has classically been measured by post‐treatment outcomes, such as patient compliance and psychosocial responses. To date, systematic assessment of patient concerns prior to treatment has been limited. Functional endoscopic sinus surgery (FESS) is an elective surgery for chronic sinusitis that carries a clear, defined set of risks. This study aimed to determine the concerns of patients undergoing FESS for chronic sinusitis.Methods:Study Design: Multi‐institutional, prospective survey of patient concerns. Methods: Two hundred patients undergoing endoscopic sinus surgery for chronic rhinosinusitis with or without polyposis were recruited. They completed a validated survey assessing their concerns regarding the risks and outcomes of surgery. Data were analyzed using descriptive statistics.Results:Generally, patients had a low degree of concern prior to undergoing surgery, though significant individual variability existed. Subjects felt the greatest level of concern regarding potential need for revision surgery and wait time for surgery. Additionally, rare post‐operative complications, such as orbital injury and cerebrospinal fluid leak, generated higher levels of concern.Conclusions:Patient concern prior to undergoing elective surgery is generally low. However, patients’ areas of greatest concern may not align with those perceived by the physician. Our findings highlight topics that require careful discussion during the informed consent process for patients undergoing FESS.
Preservation of Bilateral Nasoseptal Flap Vascular Pedicles: Rescue Flap Modification for Endonasal Skull Base Surgery
Authors: Griffiths Chester F. , Cutler Aaron , Duong Huy , Karimi Kian , Barkhoudarian Garni , Carrau Ricardo , Kelly Daniel 
Published: August 2013

Objectives:The nasoseptal flap (NSF) has significantly reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks in endoscopic skull base surgery. In the traditional endonasal approach, the NSF vascular pedicle is frequently sacrificed during the sphenoidotomy, thus eliminating the flap as a reconstruction option should a large CSF leak be encountered. In addition, extensive mucosal removal may result in postoperative crusting, hyposmia, or anosmia.Methods:Introduce the concept and surgical technique of bilateral mucosal and septal olfactory strip (SOS)‐preserving rescue flaps, ensuring availability of both vascular pedicles while also promoting rapid healing and reducing the risk of postoperative epistaxis and olfactory dysfunction. Retrospective analysis of patient records who underwent endoscopic tumor/cyst removal with bilateral nasoseptal rescue flaps from August 2011 until December 2012 (15 months).Results:In total, 95 (80%) of 118 patients (mean age 51 years; 78 pituitary adenomas, 7 RCC, 10 other pathologies), including 20 (21%) with prior surgery, underwent bilateral rescue flaps. Unencumbered visualization, mobility of the endoscope and instruments, and access to the sphenoid sinus/parasellar region was experienced in all cases. One patient underwent conversion to a formal NSF without complication. No patient had postoperative arterial epistaxis.Conclusions:This modification of the nasoseptal rescue flap technique is an effective bilateral mucosal preserving approach. In addition to maintaining both vascular pedicles, it likely reduces the risk of major postoperative epistaxis, preserves olfaction by maintaining the SOS, and promotes rapid mucosal healing while not hindering exposure or limiting instrument maneuverability.
Prospective Study of the Impact of Thyroid Hormone Replacement on Nasal Functions in Hypothyroid Patients
Authors: Akbarov Elnur , Birkent Hakan , Karacalioglu Ozgur , Karakoc Omer , Akcam Murat T. , Gerek Mustafa 
Published: August 2013

Objectives:Thyroid hormone deficiency is known to have many systemic effects on the human body. Although some of these manifestations are very well known, its effect on nasal functions has not been studied thoroughly. In this paper, evaluation of nasal functions in hypothyroid patients was performed, and their subsequent response to thyroid hormone replacement was prospectively studied.Methods:Prospective evaluation of nasal functions and concurrent determination of serum thyroid status was executed in a cohort of post‐operative total thyroidectomy patients prior to and following thyroid hormone replacement therapy. Nasal function parameters, including nasalance, nasal resistance, mucociliary transport, and olfaction, are compared before and after treatment using paired samples t‐test.Results:Twenty‐four post‐thyroidectomy patients (15 female, 9 male; mean age 34.96±12.47) were included in the study. All subjects were hypothyroid (mean TSH 129.2±64.46 mIU/L) prior to replacement. Following hormone therapy, their mean TSH dropped to 1.58±0.88 mIU/L. Nasalance showed a significant increase from 45.67±8.41 to 49.63±9.26 (p=0.0069) after replacement. Change in total nasal resistance from 0.28±0.16 Pa/cm3/s to 0.29±0.13 Pa/cm3/s was non‐significant (P = 0.7747). Mucociliary transport time decreased significantly from 9.62±4.00 min to 5.70±2.07 min after replacement (P < 0.0001). Olfaction was measured by a visual analog scale (VAS) and Brief Smell Identification Test (B‐SIT). VAS showed a significant improvement from 7.12±2.30 to 8.66±0.96 (P < 0.0001), and B‐SIT also revealed a significant improvement from 35.08±31.34 to 80.17±23.52 (P < 0.0001) after replacement.Conclusions:Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on nasalance, mucociliary transport, and olfaction in hypothyroid patients.
Exploring the Clinical Value and Implications of Routine Pathological Examination of Turbinate Specimens
Authors: Haffey Timothy M. , Rajasekaran Karthik , Sindwani Raj 
Published: August 2013

Objectives:Inferior turbinate surgery for nasal obstruction can be performed in a variety of ways. Only a few of these methods produce tissue that can be sent for pathologic analysis. According to the College of American Pathologists (CAP), turbinate tissues are not exempt from pathology evaluation. Our objectives were to evaluate the clinical value and implications of routine pathological examination of turbinate specimens.Methods:A retrospective chart review was performed between January 2008 and August 2011 at a tertiary medical center for patients who underwent an inferior turbinate reduction procedure for nasal obstruction.Results:1,300 consecutive cases from 17 surgeons were identified. Among these patients, 223 (17%) underwent an isolated turbinate reduction procedure and 505 (39%) underwent a reduction procedure in conjunction with a septoplasty. The remaining had a turbinate reduction procedure in addition to another head and neck procedure. 591 (45%) of the turbinate reduction procedures were performed by methods that were tissue producing. Only 137 (23%) of these specimens were sent for pathologic analysis. All received a ‘gross’ examination and 123 (90%) also underwent histologic analysis. No abnormalities were reported in any of these specimens.Conclusions:In the majority of turbinate reduction procedures, there is no specimen produced for pathologic analysis. We found that most surgeons do not submit turbinate tissues for pathologic examination even when a specimen is produced, demonstrating a lack of clarity in the policy regarding the handling of turbinate tissues. We found no abnormal pathology results, which challenges the clinical utility in analyzing turbinate tissues removed in turbinate surgery for nasal obstruction.