bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sinonasal Symptomatic Outcomes following Laser Treatment of Epistaxis Related to Hereditary Hemorrhagic Telangiectasias
Authors: Wu Edward C. , Peng Kevin A. , Thompson Christopher F. , Suh Jeffrey D. , Wang Marilene B. 
Published: September 2014

Objectives:(1) Characterize baseline sinonasal symptoms for hereditary hemorrhagic telangiectasia (HHT) patients. (2) Analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT.Methods:Retrospective chart review of sinonasal outcome test‐22 (SNOT‐22) scores before and after one or more laser surgical treatments for HHT‐related epistaxis between January 1, 2010, and December 31, 2013, in a tertiary academic medical center with an HHT Foundation‐approved Center of Excellence. All HHT patients who had undergone one or more laser surgical treatments by 1 of 2 otolaryngologists were included in the analysis. Preoperative and all subsequent postoperative SNOT‐22 scores were compared using unpaired t tests. Subgroup analysis was performed for patients who underwent more than 1 laser surgery.Results:A total of 21 consecutive HHT patients underwent laser surgery for recurrent epistaxis. Compared with preoperative scores, patients reported significantly improved (P <. 05) SNOT scores at 2 weeks postoperatively for dizziness, difficulty falling asleep, waking up at night, getting a good night's sleep, waking up tired, reduced concentration, feeling of frustration, and sadness. The same cohort reported significantly worse nasal obstruction at 2 weeks postoperatively. Patients who underwent more than one surgery experienced overall symptomatic improvement after the second surgery.Conclusions:HHT patients experienced a short‐term improvement in sinonasal symptoms, especially those producing social and emotional consequences, following laser surgery for HHT‐related epistaxis. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT.
Sinus Disease following Total Laryngectomy: A Radiographic Review
Authors: Kidwai Sarah M. , Parasher Arjun K. , Agbetoba Abib A. , Iloreta Alfred M. , Govindaraj Satish , Miles Brett A. 
Published: September 2014

Objectives:(1) Compare the incidence of radiographic sinus disease before and after laryngectomy by retrospective analysis of preoperative and postoperative computed tomography (CT) scans. (2) Analyze the change in pre‐existing radiographic sinus disease via a subset analysis.Methods:A single‐institution retrospective chart review was conducted. Patients who received a total laryngectomy or total laryngopharyngectomy between 2002 and 2012 with preoperative and postoperative CT scans were included. The Lund‐Mackay (LM) Scores for each sinus as well as the total LM score were recorded for both scans. The assessment of differences in these scores is based on McNemar's statistic for each sinus and on a paired t‐test for the total LM score.Results:Surgical removal of the larynx creates an anatomical disconnect between the sinonasal cavity and distal respiratory tract. Normal nasal airflow is disrupted, resulting in alterations to the nasal mucosa, mucociliary clearance, and nasal flora. While the incidence of sinonasal disease in patients undergoing total laryngectomy has been studied via subjective scoring methods, this study is the first to evaluate radiographic sinusitis via an objective measure by comparing Lund‐Mackay scores before and after total laryngectomy. There were no significant differences in the LM scores between preoperative and postoperative scans within each sinus (P value >.05) or in the total LM score (t statistic >0.56).Conclusions:In patients undergoing total laryngectomy, disruption in nasal airflow has been correlated with altered sino‐nasal physiology and decreased subjective symptoms. However, our study shows no significant change in radiographic evidence of sinonasal disease after laryngectomy.
Surgical Management of Spontaneous and Traumatic Anterior Skull Base Meningoceles: Technique and Pitfalls
Authors: Naseri Iman , Arnaoutakis Demetri , Petr Michael , Salem Whitney B. , Sandhu Sukhwinder J. , Tavanaiepour Daryoush 
Published: September 2014

Objectives:A majority of anterior skull base meningoceles are often managed via the endoscopic endonasal approach (EEA) for the excision and repair of the cerebrospinal fluid (CSF) leak, in addition to the reconstruction of the skull base defect. The aim of the study was evaluation of an institutional case series to identify specific risks and strategies for successful management of anterior skull base meningoceles.Methods:Case series review of all surgical cases involving repair of any anterior skull base meningocele spanning 3 years.Results:A total of 18 patients were managed surgically for repair of meningocele with or without CSF rhinorrhea. All patients had postoperative follow‐up to one year. EEA was used in 17 patients, and one had a combined transcranial with endoscopic approach. Four patients had meningoceles with a larger than 1.0‐cm bony skull base defect. Large spontaneous meningoceles along the ethmoid were likely to include cerebrovascular structures within their intranasal component. Nasal airway obstruction was the initial presenting symptom in all large spontaneous ethmoid meningoceles, rather than CSF rhinorrhea (present in all large traumatic ones).Conclusions:The endoscopic technique is a safe and effective approach to repair of anterior skull base defects involving both ethmoid and sphenoid regions. Successful repair of lateral sphenoid wall defects depends on gaining sufficient access via incorporating extended approaches, such as trans‐pterygopalatine approach. Preoperative angiography may be warranted, especially in spontaneously appearing anterior skull base meningoceles with a bony defect larger than 1.0 cm.
Transorbital Transnasal Endoscopic Combined Approach to Anterior and Middle Skull Base: Laboratory Investigation
Authors: Alqahtani Abdulaziz A. , Dallan Iacopo , Castelnuovo Paolo 
Published: September 2014

Objectives:Orbital approaches provide significant trajectory to the skull base and are used with different designed pathways. The aim of this study is to investigate the feasibility of a combined endoscopic transorbital and transnasal approach to the anterior and middle cranial fossa.Methods:Cadaveric dissection of 5 silicon‐injected heads. A total of 10 bilateral transorbital approaches and 5 extended endonasal approaches were performed. Identification of the surgical landmarks, main anatomical structures, feasibility of combined approach, and reconstruction of the superior orbital defect were examined. Rod lens endoscope (with 0° and 45° lenses) and endoscopic instruments were used to complete the dissection.Results:The transorbital approach showed great versatility and provided the surgeon a direct route to the anterior and middle cranial fossa. Anterior/posterior ethmoid arteries, optic nerve, and superior orbital fissure were the landmarks for the superior orbital wall craniectomy. Transorbital avascular plane showed no conflict with major nerves or vessels. Large exposure area from crista galli to the third ventricle was demonstrated with significant control of different neurovascular structures. The combined transorbital transnasal approach provided considerable value in form of extent of the exposure and the free hand movement of the 2 surgeons.Conclusions:Combined transorbital transnasal approach demonstrates better visualization and control of the ventral skull base and can overcome the current surgical limits of a single approach. Combination of these 2 minimally invasive approaches should reduce the overall morbidity. Clinical trials are needed to evaluate the virtual applications of this approach.
Adjustable Minimally Invasive Hyoid Myotomy and Suspension with Uvulopalatopharyngoplasty for the Treatment of Obstructive Sleep Apnea
Authors: Van Tassel Jason R. 
Published: September 2014

Objectives:Examine the efficacy of minimally invasive hyoid myotomy and mandibular suspension with adjustable tensioning for hypopharyngeal obstruction in conjunction with uvulopalatopharyngoplasty in the surgical treatment of obstructive sleep apnea.Methods:Retrospective chart review in a private practice. Twenty consecutive patients with multilevel obstructive sleep apnea over a 12‐month period were included. Patients underwent hyoid myotomy and suspension and uvulopalatopharyngoplasty with or without tonsillectomy either staged or performed at the same time for those patients who had not undergone uvulopalatopharyngoplasty previously. The hyoid was suspended to the posterior surface of the mandible using the Siesta Encore system and desired tension set through a single small submental incision. Patients underwent clinical examination and sleep study prior to surgery and approximately 3 months postoperatively. The primary outcome was a successful surgical result, defined as respiratory distress index lower than 20, and 50% or greater decline in respiratory distress index, and no oxygen desaturations below 85% on the postoperative sleep study.Results:Nineteen (95%) of 20 patients achieved a successful outcome. The average preoperative respiratory disturbance index (RDI) was 52.7. The average postoperative RDI was 11.8 (P <. 005). The average preoperative body mass index was 27.3. The average decrease in the RDI was 78%. All patients in the study reported clinical improvement of symptoms. There were 2 minor wound complications and no major complications.Conclusions:For patients with multilevel obstructive sleep apnea, minimally‐invasive mandibular hyoid suspension appears to be highly efficacious for the treatment of hypopharyngeal airway obstruction when performed in conjunction with uvulopalatopharyngoplasty.
The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Patient Adherence
Authors: Ayers Christopher M. , Lohia Shivangi , Nguyen Shaun A. , Gillespie M. Boyd 
Published: September 2014

Objectives:(1) Determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP) pressure by systematic review and meta‐analysis. (2) Determine if a decrease in CPAP pressure from UAS could increase CPAP adherence.Methods:A systematic review and meta‐analysis was performed. Studies were eligible for inclusion if a CPAP titration was performed both prior and following upper airway surgery in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after upper airway surgery were included to evaluate the secondary objective.Results:A total of 11 articles involving 323 patients were included in the review. There was a mean reduction in CPAP pressure of 1.44 cmH2O [95% confidence interval [CI], –2.09 to 0.78], indicating that UAS reduced CPAP pressure on average. Four of the 11 papers with a total of 80 patients evaluated CPAP adherence. CPAP adherence was improved by 0.62 hours on average [95% CI, 0.22 to 1.01].Conclusions:CPAP remains the mainstay treatment of moderate to severe OSA, but due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea‐hypopnea index, improves symptoms, and modestly reduces CPAP pressure while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an important adjunctive role on the management of OSA.
Effects of Obstruction Length and Height on Predicting Velopharyngeal Surgery Outcome in Obstructive Sleep Apnea
Authors: Ye Jingying , Zhang Peng , Pan Chuxiong , Sun Nian , Kang Dan , Li Jingjing , Zhang Yuhuan 
Published: September 2014

Objectives:Measure obstruction length and height using drug‐induced sleep endoscopy (DISE) in obstructive sleep apnea syndrome (OSA) patients and to evaluate their effects on predicting velopharyngeal surgery.Methods:A single institution, prospective, nonrandomized trial of DISE in a consecutive group of patients undergoing velopharyngeal surgical procedure, which consisted of revised uvulopalatopharyngoplasty with uvula preservation and transpalatal advancement pharyngoplasty between July 1, 2012, and June 30, 2013. Eighty patients with OSA diagnosed by polysomnography were evaluated by DISE using dexmedetomidine before surgery. Obstruction length (defined as the distance from the most superior point of the collapse to the most inferior point of the collapse) and obstruction height (the distance from the posterior border of the nasal septum to the most proximal point of the collapse) were measured.Results:Out of 80 subjects studied, the mean obstruction length and obstruction height was 1.6 ± 0.8 (range was 0.4‐3.8) cm, and 3.4 ± 1.0 (range was 1.1‐5.0) cm, respectively. The obstruction length had correlations with body mass index (BMI), CT90, and lowest oxygen saturation (r = 0.247, 0.302, and –0.297, respectively, P <. 05). Forty‐three patients had postoperative polysomnography a ≥3 months. Preprocedure mean apnea hypopnea index (AHI) was 57.2 ± 17.3 per hour. Postoperative AHI was 22.7 ± 20.1 per hour. Twenty‐six patients (60.5%) were responders, and seventeen were nonresponders (39.5%). Multivariate logistic regression analysis revealed that obstruction length and height were the only independent predictors of upper airway surgery failure.Conclusions:Obstruction length and height can be accurately measured while apnea occurs during the patient's drug‐induced sleep. They are useful to help predict outcome to upper airway surgery in OSA.
First Use of Long‐Range Optical Coherence Tomography to Image Airway Structure in Awake Children
Authors: Lazarow Frances , Ahuja Gurpreet S. , Sharma Giriraj , Wang Alex , Su Erica , Chen Zhongping , Wong Brian J. F. 
Published: September 2014

Objectives:Identifying the appropriate operation(s) for children with sleep‐disordered breathing (SDB) remains a challenge, and current imaging modalities have major shortcomings. We have pioneered the use of long‐range optical coherence tomography (LR‐OCT) to provide real‐time images of the upper airway (UA) during sleep and wakefulness. Here we present our first use of LR‐OCT to image the UA of awake children. (1) Understand how LR‐OCT produces high‐resolution structural images by acting as an optical range‐finder. (2) Recognize how LR‐OCT can identify strictures and real‐time collapse of the airway.Methods:This study builds upon our experience using LR‐OCT to image 58 children under sedation. Here 10 awake children (SDB, 4‐15 years) underwent nasal endoscopy and LR‐OCT. We designed a high‐speed Fourier domain LR‐OCT system. Imaging probe and fiberscope were transnasally inserted in tandem and axial images were rapidly acquired (spiral scan, 500‐700 images, 30‐40 seconds). 3D models of each airway were reconstructed.Results:Five airways yielded data suitable for 3D volumetric reconstruction, and identified the dominant site of airway obstruction as well as structure of the tonsils, adenoids, base of tongue, and epiglottis. Cross‐sectional area of the axial airway level corresponding to these structures was calculated. Dynamic changes in 3D airway structure were visualized.Conclusions:The feasibility of LR‐OCT to identify regions of stricture and collapse in children's airways was established. Hence, patient‐specific surgical treatments can be developed for children with SDB. The next step is to transition to imaging children during sleep, as we have in adults.
The Influence of Drug‐Induced Sleep Endoscopy on Determining Candidacy for Upper Airway Stimulation Therapy
Authors: Ayers Christopher M. , Kezirian Eric J. , Woodson B. Tucker , de Vries Nico , Nguyen Shaun A. , Gillespie M. Boyd 
Published: September 2014

Objectives:(1) Determine the influence of drug‐induced sleep endoscopy (DISE) on the surgical decision for upper airway stimulation (UAS) therapy. (2) Learn the limitations of drug induced sleep endoscopy.Methods:This was a single‐blinded cross‐sectional study in which 4 surgeons with extensive experience with DISE reviewed blinded DISE video clips from 63 patients who were screened for participation in the STAR (Stimulation Therapy for Apnea Reduction) trial, a phase III trial of upper airway stimulation (UAS) of the hypoglossal nerve for moderate‐to‐severe sleep apnea (OSA). Each DISE clip was independently reviewed and graded by a surgeon who then predicted whether the patient was a candidate for UAS therapy.Results:Evaluators demonstrated a high level of 100% agreement with regard to the presence of palatal collapse in 81% of cases, but less complete agreement concerning hypopharyngeal collapse (64% of cases). The viewers had complete agreement with regards to the presence or absence of circumferential airway collapse in 59% of cases. The surgeons had a low level of complete agreement (44% of cases; mean kappa 0.343) as to whether a given case was a good candidate for UAS therapy.Conclusions:DISE continues to be a highly subjective study. Previous evidence found that patients with circumferential airway collapse on DISE respond poorly to UAS. Additional training will be necessary in the future in order to increase agreement among surgeons as to which patients are the best candidates for UAS therapy.
Postoperative Complications in Obstructive Sleep Apnea Patients: A Comparison between Single and Multilevel Surgery
Authors: Chan Ching Yee , Han Hong Juan , Toh Song Tar 
Published: September 2014

Objectives:Evaluate the difference in the postoperative complication rate between single and multilevel surgery performed on patients with obstructive sleep apnea (OSA).Methods:A retrospective outcomes analysis was performed on 238 patients with OSA who underwent surgery from January 2011 to December 2013 under the care of the third author in a tertiary referral center. Complications were defined as unexpected events needing additional medical attention within 30 days of surgery. These included but were not limited to: emergency department visits, nasal packing, cautery in the outpatient setting, hospitalization, and need for return to the operating room. Early complications were those occurring within the first 24 hours of surgery while late complications were defined as those occurring after 24 hours.Results:Of 238 patients, 88 underwent single level surgery and 150 underwent multilevel surgery. There were none lost to follow‐up. The main complication was bleeding. The complication rate was 5.7% in the single level group and 14.7% in the multilevel group. The difference in complication rate was significant, with P <. 05. The confidence interval was from 1.04 to 7.83 and the odds ratio was 2.85.Conclusions:There is an overall higher complication rate in obstructive sleep apnea patients undergoing multilevel surgery. However, the overall risk remains low and most complications are minor. This reminds us to be cautious in the management of such patients, especially if they have had multiple procedures performed.
Randomized Treatment Withdrawal of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
Authors: Woodson B. Tucker , Gillespie M. Boyd , Lin Ho‐Sheng , Baskin Jonathan Z. , Padhya Tapan A. , Soose Ryan J. , de Vries Nico 
Published: September 2014

Objectives:Describe the therapeutic effect of upper airway stimulation (UAS) therapy withdrawal on objective and subjective measures of sleep apnea severity.Methods:From a cohort of 126 participants in a prospective therapy effectiveness trial, 46 subjects were randomized to therapy “ON” and “OFF” groups. Primary outcomes measures were apnea‐hypopnea index (AHI) and oxygen desaturation index (ODI) changes and secondary outcome measures included Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), sleep architecture, hypoxemia, snoring, and blood pressure.Results:Groups did not differ at pretreatment baseline or at 12 months of therapy in polysomnography or self‐reported measures. Following randomized controlled trial (RCT) therapy withdrawal, change in AHI and ODI significantly differed in “ON” and “OFF” groups (1.7 versus 18.2 and 1.6 versus 17.0 events/hour P <. 0001). Therapy withdrawal worsened ESS, FOSQ, snoring, hypoxemia, and arousal index in the therapy “OFF” but no change was observed in the “ON” group (P <. 001). The therapy “ON” group demonstrated a reduction in blood pressure at 12 months compared to baseline which was maintained through the RCT.Conclusions:Withdrawal of therapeutic UAS results in relapse of both subjective and objective measures of OSA.
Early versus Late Tracheostomy: A Systematic Review and Meta‐analysis
Authors: Liu C. Carrie , Livingstone Devon , Dixon Elijah , Dort Joseph C. 
Published: September 2014

Objectives:(1) Describe the outcomes of early versus late tracheostomy in the critically ill patient population. (2) Apply these findings to the clinical setting when deciding on the timing of tracheostomy.Methods:A systematic search was performed of the Medline, PubMed, and Embase databases, as well as the Cochrane Central Register of Controlled Trials. Randomized controlled studies investigating the outcomes of early versus late tracheostomies were included. The primary outcome of interest was the length of mechanical ventilation. Secondary outcomes include intensive care unit length of stay, incidence of pneumonia, and hospital mortality. The meta‐analysis was completed using RevMan 5.2 (Cochrane Collaboration, Oxford).Results:The systematic search yielded 14 studies. There was no significant difference in the length of mechanical ventilation, with a weighted mean difference of –7.28 days (95% confidence interval [CI] –17.66 to 3.10). There was a significant decrease in the length of intensive care unit (ICU) stay with a weighted mean difference of –12.1 days (95% CI –21.7 to –2.52). The weighted risk ratio for pneumonia was 0.79 (95% CI 0.65 to 0.97) and for hospital mortality was 0.84 (95% CI 0.64 to 1.09).Conclusions:Performing a tracheostomy within 8 days of intubation significantly decreased the length of ICU stay. It may also be associated with a modest decrease in the incidence of pneumonia. No difference was found in the length of mechanical ventilation or hospital mortality.
Effect of Symbiotic Treatment in Patients with Recurrent Aphthous Stomatitis
Authors: Mimura Maria A. M. , Hirata Cleonice H. , Borra Ricardo C. , Penido Norma O. 
Published: September 2014

Objectives:The recurrent aphthous stomatitis (RAS) is a chronic oral inflammatory disease and it still poses as a clinical problem without satisfactory treatment. The aims of the study were: (1) Evaluate the clinical outcome of RAS patients towards the use of symbiotic Lactofos/Simbioflora, analyzing symptoms, seizure frequency, number, duration, and size of the lesions. (2) Compare the immune profile of RAS patients through cytokine levels with each other and controls before and after treatment.Methods:We conducted double blind randomized clinical trial placebo controlled study with 60 patients with RAS and 30 controls in a period of 2 years (2011‐2012).Results:The symbiotic group showed improvement in pain compared with placebo (P =. 027), with no statistical difference for the other clinical variables assessed. The side effects observed were similar in both groups, but flatulence (P =. 003) and diarrhea (P =. 04) were significant for the symbiotic group. Significant differences were found in cytokine IFN‐Y, IL‐4, and IL‐6 in serum of peripheral blood mononuclear cells (PBMCs) of patients when compared with control and RAS groups. Regarding treatment over time we observed that IFN‐Y (P =. 023), IL‐4 (P =. 045), IL‐10 (P =. 000), and IL‐12p70 (P =. 027) showed significant difference or between treatments or during the time line.Conclusions:The symbiotic was effective in improving pain compared with placebo. Patients with RAS have a mixed profile of Th1/Th2 immune response when compared with the control group at baseline. The symbiotic induced Th1 and Th2 responses by increasing IL‐12 and IFN‐Y and IL‐4 and IL‐10, respectively.