bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Management of Invasive Fungal Sinisitis
Authors: Takahashi Hirotaka 
Published: February 2015

ObjectiveInvasive fungal sinusitis (IFS) has increased in recent years with the use of steroids and onset of diabetes mellitus. The most frequently observed fungal sinusitis infections are typically associated with Aspergillus. Although most cases of fungal sinusitis are noninvasive, the infection occasionally develops into an invasive type, particularly in immunocompromised patients.MethodBecause of its progressive nature, IFS is a potentially fatal disease with a relatively high overall mortality rate. Once manifested, the fungus frequently involves the orbit of the eye and intracranial area. Although optimum treatment methodologies are still controversial, early diagnosis and treatment of the disease is generally accepted as essential to achieving a positive patient outcome. Several recent reports have claimed successful management of IFS by systemic administration of new anti‐fungal agents such as voriconazole, or combination therapy using debridement and anti‐fungal agents.ResultsHere, we report on the clinical features and outcomes of 4 patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of anti fungal agents and surgical intervention is discussed. Strategic treatment employing both surgery and systemic administration of antifungal agents was performed in all patients. One patient with invasion into the cavernous sinus died of brain infarction. The remaining three patients are still alive.ConclusionObservations of patients in the present case study suggest that early diagnosis and strategic treatment may contribute to improvement in the prognosis of IFS.
Effects of a TNF‐α Antagonist on Rhinosinusitis Model
Authors: Yeo Sang‐Won , Bae Seong‐Cheon , Kim Dong‐Hyun , Jeon Eun‐Ju , Park Shi‐Nae , Park Kyoung‐Ho 
Published: February 2015

ObjectiveTumor necrosis factor (TNF) is an important mediator of inflammation and is produced by macrophages in response to stimuli such as bacterial lipopolysaccharide (LPS) and viruses. This study examined the effects of a TNF‐α antagonist on the LPS‐induced inflammatory response in the nasal cavity and sinus of rats.MethodExperimental groups received an instillation of lipopolysaccharide (LPS) plus an intramuscular injection of amoxicillin/clavulanate (antibiotic group), an instillation of sTNFRI (sTNFRI group), an instillation of sTNFRI and an injection of amoxicillin/clavulanate (sTNFRI/antibiotic group), or no additional treatment (LPS group). Histopathological changes were determined using hematoxylin‐eosin and periodic acid‐Schiff (PAS) staining. Leakage of exudate was determined using fluorescence microscopy. Vascular permeability was measured using the Evans blue dye technique. Expression of MUC5AC was measured using reverse transcriptase PCR.ResultsThe sTNFRI, antibiotic, and sTNFRI/antibiotic groups had significantly less capillary permeability, mucosal edema, PAS staining, and expression of MUC5AC than the LPS group. There were no differences in capillary permeability, mucosal edema, PAS staining, and MUC5AC expression between the sTNFRI and sTNFRI/antibiotic groups. The antibiotic group had PAS staining similar to that of the sTNFRI and sTNFRI/antibiotic groups but had a greater increase in capillary permeability, mucosal edema, and MUC5AC expression.ConclusionIntranasal administration of sTNFRI reduces inflammatory activity, including elevated microvascular permeability and tissue edema, and mucus hypersecretion, including production of mucosubstance and expression of MUC5AC, in LPS‐induced rhinosinusitis in rats. Results demonstrate that intranasal administration of sTNFRI reduces inflammatory activity and mucus hypersecretion in LPS‐induced rhinosinusitis in rats.
Impact of a Yearly Head and Neck Surgery Trip to Rural Kenya
Authors: Pearce Elizabeth C. , Mainthia Rajshri , Netterville James L. , Rohde Sarah L. 
Published: February 2015

ObjectiveSurgical specialty trips to third world countries have been both praised and criticized for contributions to low‐resource regions. Our objective was to learn the impact of a yearly head and neck surgery trip through initial analysis of 2 years of patient data.MethodReview of a prospectively maintained data repository cataloging surgical patients treated on a yearly head and neck surgical trip to Malindi, Kenya, during 2010 to 2011. Basic demographics, distance traveled for care, access to physicians, preoperative diagnosis, surgical procedure(s), and pathology results were recorded for each patient.ResultsIn 2 years, 222 surgeries were performed. Age of patients ranged between 6 months and 85 years, and patient sex was evenly split. Half of the patients came from outside the town of Malindi, and a third traveled over 100 km for care. A total of 5.7% were known to be HIV positive. The majority reported access to a local physician, and two‐thirds were seen by one for their chief complaint, yet very few patients were offered prior surgical treatment. The most common surgeries performed were adenotonsillectomy, hemithyroidectomy, and biopsy/keloid/lipoma excision. A wide variety of cases were performed, and there were no immediate surgical complications.ConclusionAnnual surgical specialty trips to rural, resource‐limited regions are worthwhile and offer procedures not otherwise available. It is important to collect patient, surgical, and pathology data on such trips. By continuing to collect valuable data, surgeons can determine the best procedures to teach local physicians and provide needed resources.
Endoscopic Scoring after Endoscopic Sinus Surgery
Authors: Hinohira Yasuyuki , Tsuzuki Kenzo , Suzaki Harumi , Sakagami Masafumi 
Published: February 2015

Objective1) Propose a simple endoscopic scoring after endoscopic sinus surgery (ESS). 2) Show the usefulness of the scoring in the postoperative evaluation.MethodEight‐six patients with chronic sinusitis who underwent ESS were enrolled. The patients consisted of 65 men and 21 women, and the mean age was 52.7 years. Fourteen patients with bronchial asthma were included. The postoperative endoscopic scoring (E score) was performed at 1 year after surgery in all patients.ResultsE score was assessed in a similar manner as Lund‐Mackay CT score. The physical findings of each sinus via the opening were scored; 2 points when the opening was closed, 1 point when the sinus was diseased, 0 point when normal. E score is expressed as a percentage of the maximum score possible. E scores in the patients showed a statistical correlation with the postoperative CT scores (P <. 001). The mean E score showed 22.5%, and was close to the postoperative CT score (20.5%). The mean E score in patients without asthma showed statistically better outcomes than with asthma.ConclusionA simple endoscopic scoring after ESS has been required although several evaluation methods were advocated. E score is a simple and useful postoperative evaluation method as same as Lund‐Mackay CT score in patients after ESS.
Evaluation of Nasal Patency with 4‐Phase Rhinomanometry
Authors: Lee Heung‐Man , Hong Sung M. , Choi Hyuk , Cho Jung S. , Lee Hye R. , Kang Ju H. , Um Ji Y. 
Published: February 2015

ObjectiveObjective assessment of nasal patency in patients with nasal septal deviation should be required to determine the severity of the symptoms. The purpose of this study was to compare results of nasal sound spectral analysis (NSSA) with results of 4‐phase rhinomanometry.MethodNSSA and 4‐phase rhinomanometry were performed on 53 patients with nasal septal deviation and 55 healthy subjects. Cutoffs for NSSA and 4‐phase rhinomanometry were defined by receiver operating characteristic analysis.ResultsA significant difference was observed in either NSSA values or 4‐phase rhinomanometry values between the nasal deviated patients and the control group (P <. 001). A correlation was observed in patients between NSSA results of nasal intensity (dB) and its frequency (Hz) at a frequency range of 2 to 4 kHz and 4‐phase results of effective resistance and verteresistance. No significant differences in terms of sensitivity of NSSA and 4‐phase rhinomanometry (79.3% versus 75.5%), specificity (80.0% versus 85.5%) and diagnostic accuracy (79.6% versus 80.6%) were found.ConclusionUse of NSSA and the 4‐phase rhinomanometry both for assessment of patients with nasal septal deviation provides objective information to aid in clinical decision making.
Frontal Sinus Cholesteatoma
Authors: Rangel Leonardo G. , Fleming Flavia P. , Augé Luciana B. , Chaves Eliza B. , Almeida Guilherme C. D. 
Published: February 2015

ObjectiveTo describe a case of frontal sinus cholesteatoma and review the characteristics of this pathology.MethodCase report: 32‐year‐old white man. First symptoms: frontal pressure, proptosis of left eye with downward displacement (no visual symptoms or eye movement impairment). ENT examination and nasal endoscopy were normal. CT of paranasal sinuses: large mass in the left frontal sinus, with destruction of orbital and cranial blades.ResultsAn endoscopic approach of the frontal sinus was attempted with no success. Nothing could be extracted from the left frontal sinus. Therefore an open approach was attempted, an external approach, using a Lynch incision. By this method we were able to clear out the medial and lateral parts of the left frontal sinus, taking out enough material to be examined by the pathologist. What came out was a cheese‐like debris with a pearly aspect. The final histopathological analysis revealed that the mass was a cholesteatoma of the frontal sinus.ConclusionCholesteatoma is a common pathology of the middle ear. There are few cases reported in the paranasal sinuses. The cholesteatoma is a benign tumor that can become locally aggressive when it promotes erosion of the bone by pressure and also by the production of proteolytic substances, invading the surrounding structures.
Olfactory Disorders in HIV Positive Patients
Authors: Amali Amin , Sazgar Amir Arvin , Langeroudi Maziar Motiee , Saedi Babak 
Published: February 2015

ObjectiveChemosensory disorder in HIV‐infected patients can lead to lack of intake and subsequently malnutrition, weight loss, and wasting. In this study we aimed to evaluate the prevalence and probable associated factors of olfactory disorder in HIV‐positive patients.MethodThis case‐control study was conducted in Tehran, Imam Khomeini Hospital on 70 HIV‐positive patients and 70 control subjects in 2011. Variables of age, gender, route of transmission, duration of infection, last CD4 count, opportunistic infection, drug history, HCV concurrent infection, patient’s self‐evaluation of his own olfactory function, and threshold test were extracted and evaluated.ResultsMale to female ratio in case and control groups was 0.89 and 1.69, respectively. Age was 43 ± 15 years and 35 ± 7 years in case and control groups, respectively. Case groups showed a significant lower result in threshold test scores, considering smoking cofounder effect. Independent variables of gender, antiretroviral therapy, and duration of infection have significant effect on threshold test scores.ConclusionOlfactory threshold test disorders are common in HIV‐positive patients. Age, gender, and smoking are probably effective on threshold test scores. CD4 count most likely does not have effect on threshold test. Recommendation on the effect of antiretroviral‐therapy, duration of infection, route of transmission, opportunistic infection and HCV co‐infection needs further investigations.
Incidence of Trismus in Head and Neck Cancer
Authors: Finizia Caterina A. 
Published: February 2015

ObjectiveTo investigate the incidence of trismus and to analyze the impact on health‐related quality of life (HRQL) in patients with trismus undergoing treatment for head and neck (H&N) cancer.MethodThis prospective study assesses the incidence of trismus (≤35 mm) and HRQL in H&N cancer patients during 2007 in a university hospital setting. Maximum interincisal opening was measured in 127 patients during the study year, and the EORTC HRQL questionnaires and Gothenburg Trismus Questionnaire (GTQ) were used.ResultsIn the present study the incidence of trismus was 9% pre‐treatment, and the highest incidence (38%) was found 6 months posttreatment. Patients with tumors of the tonsils were the most prone to develop trismus. The trismus patients reported negatively affected HRQL in terms of ability to work and affected social and family life than those without trismus. Furthermore, all patients with H&N malignancies had severe problems with deteriorated HRQL parameters, especially at 3 months posttreatment.ConclusionThe incidence of trismus in patients with H&N cancer is non‐negligible. Trismus severely impairs HRQL and daily life activities in H&N cancer patients.
Systematic Review to Improve FESS Outcomes in Cystic Fibrosis Patients
Authors: Crockett David , Meier Jeremy D. 
Published: February 2015

Objective1) Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF).MethodA systematic review of the literature was performed. PubMed was searched from 1970‐2011 using the terms “sinus surgery” and “cystic fibrosis” with papers limited to English. Abstracts were reviewed to identify relevant original and review manuscripts. Bibliographies of review articles were examined to identify additional manuscripts.ResultsThe initial PubMed search identified 183 articles. After reviewing the abstracts, selected studies were examined in detail and the bibliographies of review articles checked to identify any additional articles. Intraoperative techniques included medial maxillectomy, image guidance, and intraoperative antibiotic irrigation. Postoperative management included nasal saline irrigation, dornase alfa inhalation, and serial antibiotic lavage. Most studies were limited to case reviews with relatively small numbers of patients. Very few randomized controlled studies were identified.ConclusionDespite the prevalence of recurrent sinonasal disease after FESS in CF patients, sparse Level I data exists to support perioperative techniques that improve outcomes in this population. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in CF patients are warranted.
Irrigation Device for Duct Dilatation during Sialoendoscopy
Authors: Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Greco Antonio , Fusconi Massimo , Pagliuca Giulio 
Published: February 2015

ObjectiveDuring sialendoscopic procedures a constant irrigation of saline is required to achieve an effective dilatation of the ducts. The aim of this study is to evaluate the efficacy and safety of a technique to dilate the duct using a cost‐effective device that allows a continuous irrigation at a constant pressure.MethodIn this prospective study 18 consecutive patients with submandibular or parotid sialadenitis were included. In Group A, 9 patients underwent dilatation of the duct using a balloon inflation device, while in Group B dilatations were performed using a manual irrigation. After each procedure, the surgical team expressed an overall evaluation.ResultsSialoliths, strictures, and mucous plugs were visualized and managed in all patients. Any kind of complication was recorded. The technique of irrigation adopted in Group A obtained a subjective assessment higher than that used in Group B.ConclusionThis irrigation device allows a simple, safe, and cost‐effective dilation ensuring good visualization of the salivary duct lumen during sialoendoscopy.
The Role of SEB on the Differentiation of T Cells in CRS
Authors: Kim Yong Min , Yoon Young‐Hoon 
Published: February 2015

ObjectiveRecent studies indicate that there is a subset of CD4+CD25+FoxP3+ T cells (Treg cells) that express interleukin (IL)‐17 and the cells might be new proinflammatory cells because of the expression of IL‐17. The aim of this study was to investigate the role of SEB on the differentiation of regulatory T cells to cells that express retinoic acid related orphan receptor gamma (RORγ) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP).MethodImmunohistochemical stains for SEB, FOXP3, and RORC were conducted in the tissues from 13 control subjects and 20 patients with nasal polyposis. PBMCs were separated from the patients and control subjects and incubated with SEB (1 µL/mL) for 24 hours and 48 hours, and the percentage of the various T cell subsets and cytokine profiles by using flow cytometry.ResultsThe cells that express both SEB and FOXP3 or RORC and FOXP3 were higher in nasal polyps, especially eosinophilic polyps compared with control mucosa. CD4+CD25+FOXP3+ T cells, CD4+CD25+FOXP3+RORγt+ T cells, and CD4+CD25+FOXP3+RORγt‐ T cells are significantly increased (p <. 05) in NP patients compared with control subjects.ConclusionThis result indicated that SEB may be involved in differentiation of regulatory T cell to RORγ+Treg cells and these cells might be involved in tissue inflammation in CRS with nasal polyposis patients.
Key Role for Otolaryngology in a Hereditary Hemorrhagic Telangectasia Center of Excellence
Authors: Thompson Christopher F. , Kim Brandon , Suh Jeffrey D. , Duckwiler Gary , McWilliams Justin , Wang Marilene B. 
Published: February 2015

Objective1) Learn about the initial experiences of a Hereditary Hemorrhagic Telangectasia (HHT) Center of Excellence. 2) Understand which HHT patients require otolaryngologic evaluation and interventions, and review other common clinical manifestations of the disease.MethodWe performed a retrospective review of all patients from the Southwestern United States referred to our HHT Center of Excellence from its inception in May 2010 through February 2012. Clinical presentation, radiographic imaging, genetic testing, otolaryngologic treatments, and other operative interventions were analyzed.ResultsIn 2010 a dedicated center was started at our tertiary medical center to manage patients with HHT, an autosomal dominant disease with a prevalence of 1:5000. Of the 159 patients referred, 86 have HHT based on genetic testing or Curacao clinical criteria. Seventy‐three do not have HHT or are undergoing further workup. Fourteen patients have sought otolaryngologic evaluation for relentless epistaxis or oral bleeding, with 50% of these requiring KTP laser ablation for symptomatic nasal and oral telangectasias. Additionally, 21 patients have required embolization, neurosurgical clipping, or radiation for enlarging or symptomatic arteriovenous malformations in the lung, brain, and abdomen.ConclusionAn HHT Center of Excellence is important in providing comprehensive care for patients with this rare disease with significant clinical sequelae. Otolaryngologists are critical members of this multidisciplinary team performing interventions in the clinic and operating room to improve quality of life for these patients.
p53 Mutation in HPV Positive Oral Squamous Cell Carcinoma
Authors: Ali Adnan M. , Awan Sohail M. , Pervez Shahid 
Published: February 2015

Objective1) To determine whether p53 protein overexpression and human papillomavirus (HPV) infection coexist in a high‐ risk Pakistani population. 2) Learn the correlation with smoking, chewing habits, and histological variables such as grade and stage of tumor in these patients.MethodThis study is based on samples retrospectively collected from patients with oral squamous cell carcinoma (OSCC) who were diagnosed and treated during the period of January 2009 to December 2010. Ninety‐five known HPV‐infected OSCC were used as the research material. TP53 protein overexpression was investigated by means of immunohistochemistry.ResultsPatient ages ranged from 20 to 78 years with a median of 50 years. Sixty‐two patients (65%) were men, and 33 (35%) were women. As expected the majority of the patients exhibited a significant history of smoking and chewing tobacco in different combinations and betel‐quid consumption. Out of 95 patients, 19 patients presented with stage I disease; 27 patients with stage II, 29 patients with stage III, and 20 with stage IV disease according to AJCC staging. Out of 95 HPV positive oral squamous cell carcinomas, 50 (53%) were p53 positive and 45 (47%) were p53 negative.ConclusionThis work confirms some previous studies that HPV infection and p53 mutation coexisted in the oral squamous cell carcinoma. However, p53 overexpression was not significantly associated with HPV infection. Nevertheless, further studies with large numbers of cases and detection on premalignant lesions are needed to validate these findings.
Percutaneous vs Open Tracheostomy for Critical Care Patients
Authors: Naseri Iman 
Published: February 2015

Objective1) Evaluate the indications for performing a tracheostomy across the spectrum of all trauma and pulmonary critical care patients. 2) Understand the existing contraindications used in the decision against performing a percutaneous dilatational tracheostomy. 3) Examine outcomes among the 2 modes of tracheotomy procedures.MethodA retrospective review identifying all patients who underwent open surgical or percutaneous dilatational tracheostomy procedure spanning 3 years (from 2008) within a tertiary hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related ER visits, and other complications.ResultsA total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open surgical versus 881 (66%) percutaneous dilatational techniques. There was no significant difference in age between the 2 groups (53 years). The average length of hospital stay was 21 days, indifferent among the 2 groups. The majority of the total tracheostomies were performed by the surgical services, in comparison to the pulmonary critical care service, 1080 (81%) versus 253 (19%), respectively. Approximately 26% of all discharged patients had a related ER visit (respiratory or tracheostomy‐related) within a year.ConclusionA majority of tracheostomies at our tertiary care trauma hospital are performed via the percutaneous technique. Both groups have similar short‐term safety and complication rates. Our surprisingly high ER return rate suggests possible deficiency in pre‐discharge teaching and care arrangements. Prospective studies are needed to determine long‐term complications.