bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nasal Nitric Oxide Change after Functional Endoscopic Sinus Surgery
Authors: Fu Chia‐Hsiang , Lee Ta‐Jen , Huang Chi‐Che , Chang Po‐Hung , Chen Yi‐Wei 
Published: August 2013

Objectives:Evaluate the symptom scores and nasal nitric oxide (nNO) in patients with chronic rhinosinusitis (CRS) after functional endoscopic sinus surgery (FESS).Methods:Through a non‐invasive method, we prospectively collected pre‐ and post‐operative nNO 3 months after FESS. Basic demographic data of patients, underlying diseases, image / endoscopy scores, allergy tests, rhinometries, and pre‐ and post‐operative symptom scores (SNOT‐22 and RQLQ) were recorded and analyzed.Results:Twenty‐eight patients completed post‐operative evaluation, including 12 CRS without nasal polyps (CRSsNP) and 16 CRS with nasal polyps (CRSwNP). Pre‐operative nNO had no difference between two groups in our patients (P = 0.187). Other demographic and pre‐operative data had no difference between these two groups except Lund‐Mackey CT score (P < 0.001) and Lund‐Kennedy endoscopy score (P = 0.031). We found disease severity strongly correlated with nNO only in nonallergic patients (P = 0.006 and <0.001 for CT score and endoscopy score, respectively). However, subjective symptoms did not correlate well with nNO. As to post‐op nNO, the significant elevation was only detected in the CRSwNP group (P = 0.005). Several factors were found to correlate with post‐operative nNO change, but all in nonallergic patients, including the existence of nasal polyps, Lund‐Mackey score, asthma, and pre‐operative nNO level.Conclusions:Collection of nNO is a quick, non‐invasive method for evaluating sinus status. We may expect the nNO change after FESS is performed, especially in nonallergic patients, as another reference for outcome prediction before sinus surgery scheduled.
New Landmark for the Endoscopic Endonasal Transsphenoidal Approach of Pituitary Surgery
Authors: Cho Jin‐Hee , Kim Young‐Ha , Yu Byung Jae , Kim Ju Eun 
Published: August 2013

Objectives:Clarify the anatomical correlations of the sphenoid sinus with surrounding structures in the normal Korean population, and identify surgical landmarks for safe sellar floor dissection in the anterior skull base by endoscopy and microscopy.Methods:We reviewed the 196 brain magnetic resonance imaging (MRI) findings showing a normal appearance and measured the distances between anatomical landmarks.Results:The mean distances from the base of the columella to the anterior wall of the sphenoid sinus, and the sellar floor were 69.71±4.25 mm and 86.26±4.57 mm, respectively, in the over 15 age group and showed the smallest degree of variation among the measurements. The mean angles between the floor of the nasal cavity and the straight line connecting the base of the columella and the sellar floor were 29.45°±3.25° and 24.75°±4.00° in the over 15 and under 15 age groups, respectively. The mean values of both distances and angles increased with age until 15 years, after which no further increases were evident. There were no significant differences in the measurements between males and females or among subjects with different degrees of pneumatization in the over 15 age group.Conclusions:The distances from the base of the columella to the sellar floor and the anterior wall of the sphenoid sinus, which were consistent among individuals, could be used as a surgical indicator to investigate the sellar floor in endoscopic or microscopic transsphenoidal approaches.
Outpatient Treatment of Post Endoscopic Sinus Surgery Adhesions: How We Do It
Authors: Lee Yi‐Jie , Lo Stephen , Yeak Samuel 
Published: August 2013

Objectives:The formation of intra‐nasal adhesions following endoscopic sinus surgery (ESS) is a well‐known cause of surgical failure. These arise from raw wound edges resulting in progressive nasal obstruction and leading to closure of recess openings. Many publications discuss various intra‐operative nasal packing or hemostatic agents with regard to post‐operative hemostasis and wound healing but not affecting adhesion formation. The difficulty lies with maintaining airway patency post‐operatively, as adhesion recurrence rate is high.Methods:A retrospective study on all patients operated by the authors who had ESS for chronic sinusitis or nasal polyposis between January 2011 and December 2011 revealed 16 nasal cavities that developed post‐operative intra‐nasal adhesions. Adhesiolysis was performed under local anesthesia in the outpatient department. Gelfoam was placed over the raw edges as a hemostatic aid and to avoid reformation of adhesions. This was repeated weekly until the edges healed.Results:All patients (100%) were treated successfully with no adhesion recurrence after 6 months. The longest outpatient treatment was for 8 weeks with the mean at 5 weeks.Conclusions:Adhesions are well known complications following ESS reducing surgical efficacy. Repeated surgeries for adhesiolysis are usually unsuccessful, as recurrences are common. This is the first study describing the use of Gelfoam for treatment of post‐operative intra‐nasal adhesion formation with 100% success rate and no recurrences. This can be easily performed under local anesthesia in the outpatient setting. This avoids unnecessary inpatient admissions or the risk of general anesthesia, providing safer and better quality care for patients.
Preapproval of Sinus Computed Tomography for Evaluation of Chronic Rhinosinusitis Does Not Save Healthcare Costs
Authors: Sedaghat Ahmad R. , Gray Stacey T. , Kieff David A. 
Published: August 2013

Objectives:Evaluate cost effectiveness of required pre‐approval for computed tomography (CT) of the sinuses for chronic rhinosinusitis (CRS) evaluation by weighing the associated cost of pre‐approval against savings from rejected claims. Study design: Retrospective analysis of prospectively collected data. Setting: An academic otolaryngology practice.Methods:Over a 6‐month period, all sinus CT scans ordered and requiring pre‐approval by a third‐party payer were tabulated. Characteristics of the pre‐approval process that were recorded and analyzed included time spent by office administrative staff, need for peer‐to peer review, and time spent by the ordering physician.Results:All 111 sinus CT scans ordered required pre‐approval based on insurer requirements—38 performed by computer, 71 by telephone, and 2 required both–costing an average of 8.1 minutes per scan by administrative staff (range: 2.0 – 20.0 minutes). 13 pre‐approvals required peer‐to‐peer telephone interaction by the ordering physician, using an average of 7.7 minutes (range 5 – 12 minutes). In no case was the insurance company “peer” an otolaryngologist. Moreover, no sinus CT scan pre‐approval was ultimately rejected by the third party payer.Conclusions:Pre‐approval for sinus CTs ordered by otolaryngologists neither saves costs for third‐party payers nor leads to appropriate rejection of scan requests because sinus CT for the evaluation of CRS is well‐established and the standard of care. However, pre‐approval in this context comes at the expense of practice administrative and physicians’ time. Pre‐approval for sinus CT scans ordered by an otolaryngologist for evaluation of CRS is an unnecessary and costly requirement.
Prevalence of Respiratory Viruses in Chronic Rhinosinusitis and Its Influence on the Mucosa
Authors: Anselmo Lima Wilma T. , Paula Flavia E. , Lima Jesse , Modena Jose L. Proença , Arruda Eurico , Valera Fabiana , Tamashiro Edwin 
Published: August 2013

Objectives:Find a correlation between the presence of respiratory viruses and the pathogenesis of chronic rhinosinusitis (CRS).Methods:Prospective cross‐sectional study. Genomes of respiratory viruses in patients were analyzed by real‐time polymerase chain reaction (PCR) in samples of nasal washes and nasal tissue samples obtained from both CRS with polyps (CRSwNP) and without nasal polyps (CRSsNP). Histological analysis was also performed to quantify eosinophils, neutrophils, and lymphocytes.Results:A total of 132 patients were evaluated, 31 controls, 31 patients with CRSsNP, and 70 patients with CRSwNP. Considering all samples together, human metapneumovirus (HMPV) and human rhinovirus (HRV) were the most frequently detected virus genomes found in CRS patients, present in respectively 19 of 70 and 16 of 70 of patients with CRSwNP, as opposed to 5 of 31 of HMPV and 4 of 31 of HRV in those with CRSsNP. In CRSsNP the virus presence was associated with a lower count of lymphocytes and neutrophils, but not to eosinophils count. In CRSwNP group, the virus presence was associated to a higher count of lymphocytes and neutrophils and to a lower count of eosinophils. Regarding rhinovirus presence, no cell count was associated with its presence in CRSwNP, and in CRSsNP the rhinovirus presence was associated only with a lower count of lymphocytes.Conclusions:The high detection of respiratory viruses in these patients highlights the need for further studies detailing possible roles that these ubiquitous respiratory agents may have in the pathogenesis of CRS.
Removal of a BB from the Nasofrontal Outflow Tract Using a Urologic Basket
Authors: Shipchandler Taha Z. , Taraska Allison K. 
Published: August 2013

Objectives:1) Describe a novel approach to BB removal from the nasofrontal outflow tract. 2) Present pre‐, intra‐, and post‐operative photographs and imaging to illustrate surgical technique. 3) Review other techniques described for similar foreign bodies.Methods:Case report of patient receiving treatment in November 2012. The patient presented with a history of BB trauma to the forehead eight months prior. Imaging revealed a BB lodged in the right nasofrontal outflow tract. Symptoms reported since the trauma included headache and facial pain.Results:This case resulted in successful removal of the BB using a Lynch incision approach and retrieval of the BB with a urologic basket device. The incision was made through the scar that resulted from the initial trauma. The frontal sinus was entered using a standard otologic drill. The BB was noted to be lodged in the nasofrontal outflow tract. A urologic basket was used to grasp the BB and remove it from the tract. This resulted in removal with minimal tissue trauma. The patient reported improvement in symptoms following the procedure.Conclusions:There are several case reports in the literature involving endoscopic or external approaches to foreign body removal within the frontal sinus. In these cases standard instruments such as hemostats were used for retrieval. The location within the nasofrontal outflow tract is unique and emphasizes the importance of removal with minimal tissue trauma to prevent stenosis. This case illustrates an opportunity to use seemingly unrelated surgical equipment to accomplish impacted foreign body removal with minimal trauma to surrounding tissues.
Sinonasal Mucosal Melanoma: 20‐Year Experience at a Tertiary Referral Center
Authors: Vorasubin Nopawan , Peng Kevin , Sanaiha Yas , Suh Jeffrey D. , Wang Marilene 
Published: August 2013

Objectives:Sinonasal melanoma (SNM) is a rare cancer with extremely poor prognosis. Detecting melanoma on frozen section has historically been considered to be unreliable. A review of cases of SNM treated at a tertiary referral center was conducted with emphasis on investigating the correlation between detecting melanoma on frozen section and permanent analysis.Methods:An institutional review board (IRB)‐approved search of the pathology database for cases of primary SNM treated between 1991‐2011 was performed. The medical charts were then reviewed.Results:Fourteen cases of SNM were identified. Eleven arose from the nasal cavity, 2 arose from the maxillary sinus, and 1 from bilateral ethmoids. At average follow‐up period of 22 mos (2‐85 mos), 13 patients were alive. Five cases were free of disease (NED), 6 had recurrent disease (RD), and 3 had unknown disease status. Patients with NED presented at an average age 67 years (47‐82 years). On pathological analysis, average melanoma size was 5.2cm (2‐9cm), all had clear margins, 2 had perineural invasion (PNI), and 1 had lymphovascular invasion (LVI). Four received adjuvant radiation (XRT). Of the RD patients, average age was 63.7 years. On pathologic analysis, average size of the tumor was 2.3cm (0.5‐3.5cm); margin status was positive in 2, clear in 2, and not evaluated in 2 cases. Ten cases had evaluation of intraoperative frozen sections. When compared with final pathology, FS correlated with permanent section 100% cases. One had LVI with PNI, and 5 cases received XRT.Conclusions:Based on this series, intraoperative frozen section analysis of SNM correlates well with final pathology.
Integrative Analysis Identifies Genes Disrupted by DNA Methylation in Oral Cancer Progression
Authors: Towle Rebecca , Poh Catherine F. , Garnis Cathie 
Published: August 2013

Objectives:1) Identify genes deregulated through altered DNA methylation in oral cancer. 2) Gain a better understanding of pathways involved in OSCC progression.Methods:Multiple biopsies were obtained from an oral cancer (OC) field exhibiting hyperplasia, dysplasia, and carcinoma in situ (CIS)/squamous cell carcinoma (SCC) from ten patients. DNA and RNA from microdissected tissue samples were extracted. Methylation levels were obtained using the Illumina Infinium HumanMethylation27K microarray, and gene expression levels were assessed using the Agilent Human Gene Expression 4x44k microarray. Significant genes were identified using a Wilcoxon signed rank test. Data from both platforms were integrated and candidate genes identified.Results:We identify numerous genes that exhibit both aberrant methylation and matched altered gene expression. In oral dysplasias we identify PEG10 and SOX17 as being frequently deregulated. These genes have roles in the TGFbeta and WNT signal transduction pathways, respectively, and crosstalk between these two pathways has been observed previously in tumorigenesis. In the CIS/SCC biopsies, we observe 67 genes hypermethylated and 113 hypomethylated in at least 30% of cases with matched altered gene expression.Conclusions:This is the first report integrating profiles of DNA methylation and gene expression data for different histological stages of OC. Given the frequency of methylation and expression correlating with one another, we demonstrate that methylation is one of the critical mechanisms in OC progression.
Toxic Shock Syndrome following Septoplasty: Report of 2 Cases and Literature Review
Authors: Gurunathan Ramesh K. , McCadden Luke , Nadig Shrinath 
Published: August 2013

Objectives:Toxic shock syndrome (TSS) is a rare but potentially life‐threatening multisystem disease. Reported incidence after nasal surgery is 16.5 per 100,000 operations. We report 2 such cases from Northern Ireland occurred over last 8 years (2006 and 2012). Diagnostic criteria, pathogenesis, and management of TSS are discussed.Methods:Case 1: A 19‐year‐old man developed sudden severe facial swelling, fever, diffuse erythroderma, tachycardia, and hypotension 16 hours after routine septoplasty and cautery to inferior turbinates. He had sialastic internal nasal splints and calcium alginate packing. Initially anaphylaxis to latex or diclofenac was suspected but disproved by lab investigations. He had surgical tracheotomy to protect airway from progressive facial cellulitis. Nasal swab confirmed grown staphylococcus aureus (TSST‐1 producing‐strain), and he recovered slowly with antibiotics. Case 2: A 24 year‐ old man developed a mild form of TSS 36 hours post‐surgery after routine septopasty and Merocel packing, with nausea, hypotension, tachycardia, fever, and erythroderma. TSS was promptly suspected. The patient moved to intensive care for supportive care of refractory hypotension, and he made a slow recovery with antibiotics. Nasal swab had grown staphylococcus aureus. (TSST‐1 strain).Results:TSS cases following nasal surgery have been associated with nasal packing, mucosal barrier violation, and prior colonization of toxic‐shock‐syndrome‐toxin‐1 (TSST‐1) strain as well as low antitoxin antibody levels. Hence TSS requires nasal carriage of a toxigenic strain of staphylococcus aureus by a susceptible patient. Topical or systemic antibiotics did not have a demonstrable protective effect.Conclusions:Early recognition and prompt intervention minimize the morbidity and mortality associated with this disease.
Indications and Safety of Up‐to‐Date Lingual Tonsillectomy
Authors: Siupsinskiene Nora 
Published: August 2013

Objectives:To describe the main indications for lingual tonsillectomy (LT) and to analyze the safety and post‐operative morbidity of LT with laryngoscopic approach.Methods:In this prospective observational study, 70 consecutive adult patients (31 males and 39 females) with hypertrophic lingual tonsils proven by fibronasolaryngoscopy during April 2009 to December 2012 operated at a university hospital were selected. LT was performed under general anesthesia and direct micropharyngoscopy with laryngeal microinstruments and electrocoagulator. Indications for operation, procedure time, intraoperative blood loss, post‐operative pain measured using 100‐mm visual analogue scale (0– no pain, 100– extreme pain), complications (post‐operative bleeding, edema of epiglottis and infection), and length of stay in the hospital were assessed.Results:Dysphagia in relation to laryngopharyngeal reflux (55.7% of cases) and sleep‐disordered breathing (38.6% of cases) were the main indications for LT. Mean procedure time was 41.1+/‐ 10.2 min. with an average intraoperative blood loss of 21.9+/‐ 11.1 ml. Post‐operative pain score for the first two days was mild and ranged from 0 to 51 points (mean 27.8+/‐ 9.8 points). There was no post‐operative bleeding. Three patients (4.3%) had slight edema of epiglottis. Mean discharge time was 2.4 days. Post‐operative pain was positively moderately related to procedure time, amount of intraoperative blood loss, and degree of lingual tonsil hypertrophy (p<0.01).Conclusions:Lingual tonsillectomy using laryngoscopic approach is a safe method with minimal post‐operative morbidity and could be routinely used in clinical practice.
Obstructive Sleep Apnea and Its Comorbidities: A Study of 100 Patients
Authors: Pinto Jose A. , Mizoguchi Elcio I. , Ribeiro Renata C. , Martins Laila P. M. , Dias Seliram B. F. , Gomes Leonardo M. 
Published: August 2013

Objectives:Evaluate the main comorbidities associated with obstructive sleep apnea (OSA) and its prevalence in a group of patients diagnosed with OSA by polysomnography.Methods:Patients with symptoms suggestive of sleep disorder underwent full‐ night attended polysomnography. Retrospective study of 100 charts of patients previously diagnosed OSA in our service between October 2010 to January 2013. We classified the degree of apnea according to the values of the apnea hypopnea index (AHI) by polysomnography: mild (5 to 15 events/ hour), moderate (15 to 30 events/ hour), and severe (more than 30 events/ hour).Results:A total of 100 patients, 84 men and 16 women, mean age 50.05 years ranging from 19 to 75 years. The prevalence of comorbidities were: arterial hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (18%), diabetes mellitus (15%), hypercholesterolemia (10%), and asthma (4%), and 33 patients had no comorbidities. The comorbidities occurred in 56.2% of patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% with severe OSA.Conclusions:Patients with OSA present a high prevalence of several comorbidities. Patients with moderate and severe OSA presented more comorbidities than patients with mild OSA.
The Prevalence and Topography of Multiple Level Obstruction in Cases of Obstructive Sleep Apnea
Authors: Hennawi DIiaa Mohamed El , Madian Yasser T. , Tabbakh Mohamed T. , Rashwan Mohamed S. 
Published: August 2013

Objectives:Determine the prevalence of multiple level obstruction and the frequency of their sites in cases of obstructive sleep apnea.Methods:The sample size of this descriptive cross sectional study was an inclusive sample including all patients presenting to the outpatient clinic of Suez Canal University Hospital, Ismaila Egypt complaining of snoring with or without obstructive sleep apnea (OSA) between January 1 and December 31. All patients were evaluated by Müller maneuver followed by polysomnography. Patients diagnosed with OSA were subjected to drug induced sleep endoscopy (DISE). Grades and patterns of obstruction were evaluated by NOHL classification.Results:Of thirty patients, nine (33%) showed multiple levels of obstructions. One had 25‐50% obstruction in the oropharynx, 50‐75 % obstruction in the hypopharynx, and a flappy epiglottis. Two had 50‐75% obstruction in the oropharynx, different degrees of obstructions in the oropharynx, and a flappy epiglottis. Six had 75‐100% of obstructions at both oropharynx and hypopharynx.Conclusions:From the above results management strategy of OSA should be reformed to improve the quality of management.
Prospective Analysis of Sleep Stages, Obstructive Sleep Apnea Status, and Head and Neck Anatomy
Authors: Dion Gregory R. , Chapa Emily , Dodge Ross , O'Connor Peter 
Published: August 2013

Objectives:1) Determine if time in each sleep stage correlates to presence and severity of obstructive sleep apnea (OSA). 2) Analyze anatomy from nasopharyngoscopy and an otolaryngology exam for correlation with sleep stages. 3) Compare Epworth sleepiness scale (ESS), Nasal Obstruction and Septoplasty Effectiveness (NOSE) survey, and the Calgary Sleep Apnea Quality of Life Index (SAQLI) with sleep stages and OSA.Methods:Twenty‐one subjects referred for polysomnography (PSG) by a primary care provider to the Wilford Hall Ambulatory Surgery Sleep Center prospectively underwent PSG, completed three surveys (ESS, SAQLI, and NOSE), and had a head and neck examination to include Fujita and Mallampati classification, tonsil size, palatal phenotype, and percent glottis visible at rest and on jaw jet on nasopharyngoscopy. In addition to demographics and standard PSG data (AHI, RDI, RERA, and lowest oxygen saturation), time in each sleep stage was calculated. Regression modeling was used for analysis.Results:Nine of twenty‐one subjects had OSA (7 mild and 2 severe). Initial regression analysis revealed trends towards increased Stage I and II sleep and decreased stage III and rapid eye movement (REM) sleep with OSA. SAQLI scores correlated with Stage I and II sleep and inversely with Stage III and REM sleep. No anatomic data trended towards significance between OSA or primary snoring subjects.Conclusion:This pilot study suggests subjects with OSA are less likely to achieve deep sleep and have worse quality of life scores. Typical anatomy used in sleep surgery did not correlate with time in sleep stages.