bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foreign Body as Initial Symptom of Eosinophilic Esophagitis
Authors: Hudson Scott K. , Sampson Chris , Muntz Harlan R. , Grimmer Fredrick , Park Albert H. , Jackson W. Daniel , Smith Marshall 
Published: February 2015

Objective1) Determine characteristics common in the presentation of esophageal foreign body that indicate presence of underlying esophageal pathology. 2) Provide clinical guidelines to consider esophageal mucosal biopsy during foreign body removal.MethodThree hundred twelve cases of pediatric patients with an esophageal foreign body requiring esophagoscopy for removal were reviewed. Patients were excluded if a history of esophageal surgery or pathology was present. Factors common to those patients subsequently diagnosed with eosinophilic esophagitis (EE) were identified.ResultsEligibility criteria were met in 271 cases. Of these, 27 underwent esophageal biopsy and 18 were diagnosed with EE. The following factors were compared between the EE population and the group as a whole: food impaction (89% of EE patients, 11% of non‐EE patients), older age (average EE age 11.9, overall average age 4.5), atopic disease (61.1% of EE, 17.0% non‐EE), abnormalities on esophagoscopy (94.4% of EE, 8.9% overall), and previous esophageal foreign body or frequent dysphagia (83.3% of EE, 5.9% non‐EE). Eighteen percent of EE patients had 2 or more impactions requiring esophagoscopy prior to a biopsy being taken.ConclusionOlder age, food impaction, history of atopic disease or previous esophageal foreign body, and abnormalities on esophagoscopy are all associated with EE. Patients meeting these criteria should be strongly considered for mucosal biopsy during foreign body removal. Failure to do so may lead to repeated foreign body events.
Sensorineural Hearing Loss with Neomycin Ear Drops
Authors: Winterstein Almut G. , Antonelli Patrick J. , Xu Dandan , Liu Wei 
Published: February 2015

ObjectiveNeomycin ear drops are contraindicated with non‐intact TMs (NITM), either perforation (TMP) or tube (TT) because of the risk of ototoxicity. The aim of this study was to evaluate the comparative risk of sensorineural hearing loss (SNHL) with neomycin and quinolone ear drops and NITMs.MethodPediatric Medicaid beneficiaries from 29 states, 1999‐2006, were studied if they received a study drug within 12 months of TMP or TT, and were continuously enrolled ≥6 months before and 12 months after first dispensing. We compared the 12‐month risk of SNHL using Cox regression adjusted for SNHL risk factors.ResultsWe found 1935 SNHL cases in 139,906 children treated with neomycin or quinolone eardrops (1‐year incidence = 1.38). Within those with neomycin, 76.3% received 1 dose and 17.4% received 2. The adjusted hazard ratio (HR) for 1, 2, and ≥3 prescriptions of neomycin was 0.99 (95% CI 0.89‐1.12), 1.32 (1.05‐1.67), and 1.34 (0.89‐2.01), respectively, when adjusted for SNHL risk factors and total number of otic antimicrobial prescriptions.ConclusionShort‐term use of neomycin ear drops in patients with NITMs does not appear to carry a significant risk of SNHL. Repeated doses of topical neomycin are associated with an increased SNHL risk.
Supraglottic Appearance and Severity in Laryngomalacia
Authors: Landry April M. , Rutter Michael J. , Cotton Robin T. , Thompson Dana M. 
Published: February 2015

Objective1) Compare flexible laryngoscopy findings between infants presenting with mild, moderate, and severe laryngomalacia. 2) Examine and understand the predictive valve of the initial laryngoscopy exam in those infants whose disease increases in severity from initial presentation.MethodThe flexible laryngoscopy exams of 201 infants with laryngomalacia from 2 separate institutions were recorded. The laryngeal findings were graded by the senior examiners. The infants were stratified into mild, moderate, and severe groups based on clinical severity. Laryngeal findings were then compared between the 3 groups.ResultsThe mild group had 15.0% incidence of tight omega epiglottis while there was 27.7% and 34.2% in moderate and severe groups, respectively (P >. 05). A retroflexed epiglottis seen in 39.5% of severe group, but 2.5% and 9.6% of mild and moderate, respectively (P <. 05). Good visualization of vocal cords was seen in 35% of mild but 7.2% and 0% of moderate and severe, respectively (P <. 05). Ventricular effacement was seen in 20.0% of mild group but 85.5% of moderate group (P <. 05). The 47 infants with increasing severity of disease had the following rates: tight epiglottis, 31.9%; retroflexed epiglottis, 12.6%; good cord visualization, 10.6%; and ventricular effacement, 63.8%.ConclusionThe laryngoscopic findings differ with disease severity. The infants who increased in severity had characterics associated with a higher severity of disease at initial presentation. The flexible laryngoscopic exam may be helpful in predicting which infants need will have an increase in severity of their disease and warrant closer follow‐up.
The Segmental Mandibular Critical Size Defect in the Rat
Authors: DeConde Adam S. , Sidell Douglas R. , Aghaloo Tara , Bezouglaia Olga , Lee Min , Tetradis Sotirios , St. John Maie 
Published: February 2015

ObjectiveAdvances in tissue engineering offer potential alternatives to current mandibular reconstructive techniques. However, prior to clinical translation of this technology, a relevant animal model must be used to validate possible interventions. This study aims to establish the critical size segmental mandibular defect that does not heal spontaneously in the rat.MethodThirty rats underwent creation of 1 of 4 segmental mandibular defects: 0 mm, 2 mm, 3 mm, and 5 mm. All mandibular wounds were internally fixated with 1‐mm microplates and screws. Rats were allowed to heal for 12 weeks, and then all mandibles were analyzed with micro‐computed tomography (CT).ResultsOne rat was exsanguinated intraoperatively, and 1 mandible was fractured by the drill and the animal was euthanized. This resulted in 7 animals per group. No 5‐mm segmental defects successfully healed, whereas all 0‐mm and 1‐mm defects had continuous bony growth across the original defect on micro‐CT. Three of the 3‐mm defects had bony continuity, and 3 had no healing of the bony wound.ConclusionThe rat animal model cannot heal a 5‐mm segmental mandibular defect. Successful healing of 0‐, 1‐, and 3‐mm defects confirms adequate stabilization of bony wounds with internal fixation with 1‐mm microplates. The rat segmental mandibular critical size defect provides a clinically relevant testing ground for translatable mandibular tissue engineering efforts.
A Snapshot of Endoscopic Sinus Surgery in the Western US
Authors: Sewell Ryan K. , Roberson David W. , Zappia John J. , Troxel David , Shah Rahul K. 
Published: February 2015

ObjectiveEndoscopic sinus surgery is a commonly performed procedure. Despite its prevalence, few data exist regarding the characteristics of the typical endoscopic sinus surgery. At the conclusion of the presentation participants should be able to discuss the following: 1) typical patient characteristics, and 2) types of cases being performed by otolaryngologists.MethodA survey was mailed by The Doctors Company to 500 insured otolaryngologists in the western United States. The survey queried characteristics of the last endoscopic sinus surgery performed.ResultsOne hundred ninety‐six surveys were returned. Chronic sinusitis was the predominant indication for surgery (89%). Revision cases constituted 18% of the cases. Maxillary antrostomies and ethmoidectomies (partial or total) were performed in 94% and 90% of cases, respectively. Powered instrumentation was utilized in 77% of the cases. The majority (71%) did not use image guidance. The surgeon rated the case as technically difficult in 25% of cases. Complications included bleeding (3), septal hematoma (1), check numbness (1), recurrence of polyposis (1), pneumonia (1), and entry into medial orbit (1). Physician reports of technical difficulty did not correlate with reported complications.ConclusionThe present study provides insight into “typical” endoscopic sinus surgery performed in the western United States. The typical patient has chronic sinusitis and is undergoing an initial procedure that involves at least the maxillary and ethmoid sinuses. Further research into practice patterns and risk stratification in endoscopic sinus surgery is warranted.
Drug‐Eluting Catheter as Treatment of Sinonasal Polyposis
Authors: Plaza Guillermo , Eisenberg Gustavo , Onrubia Tomas , Montojo Jose , O’Connor‐Reina Carlos‐Luis 
Published: February 2015

ObjectiveChronic rhinosinusitis with polyposis is currently treated with intranasal steroids. The study objective was to assess the safety and effectiveness of a drug‐eluting catheter to be inserted into the ethmoid sinuses to release triamcinolone during FESS in patients with sinonasal polyposis.MethodsPreliminary results from a prospective, randomized, double blinded, clinical trial enrolling 40 patients. In every case, after polypectomy was done to expose the ethmoid bulla, a drug‐eluting catheter to deliver triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional functional endoscopic sinus surgery. Outcome measures were visual analogue scales, RSDI, endoscopy, and olfactometry assessment at baseline and 3 months. Safety assessment included ocular exams at baseline and 30 days.ResultsAfter randomization was performed, unilateral devices were successfully placed in all patients, and they were also easily removed after 4 weeks. When comparing both nasal fossae, mean inflammation scores were minimal at all time points. At 3 months, the prevalence of polypoid edema, adhesions and rhinorrhea was statistically similar in both sides. Changes from baseline in patient‐reported outcomes were statistically significant (P <. 0001). No clinically significant changes from baseline in intraocular pressure occurred. CT imaging will be done after 12 months of follow‐up.ConclusionThis randomized controlled trial provides clinical evidence of the safety, effectiveness, and clinical utility of a drug‐eluting catheter in patients with nasal polyposis.
Extended Inferior Turbinate Flap for Skull Base Defects
Authors: Choby Garret W. , Pinheiro‐Neto Carlos , Wang Eric W. , Fernandez‐Miranda Juan , Gardner Paul , Snyderman Carl H. 
Published: February 2015

Objective1) Develop a novel extended inferior turbinate flap (EITF) for endoscopic skull base reconstruction when the nasoseptal flap is unavailable. 2) Describe the anatomic and reconstructive limits of this flap. 3) Understand what types of skull base defects would benefit from this flap.MethodThe EITF was designed for harvest in cadaveric specimens based on the inferior turbinate (IT) artery, a terminal branch of the sphenopalatine artery. The anatomical limits of the EITF were assessed. The arc of rotation and reach for reconstruction of ventral skull base defects were assessed in the cadaver.ResultsThe average width of the flap was 55.8 ± 4.1 mm. The average length of the flap was 52.5 ± 5.5 mm. The average surface area was 29.3 ± 4.4 cm2. The flap was rotated with the turbinate surface at the inferior aspect of the clival defect, and the extended mucosa of the floor was able to cover the upper portion of the defect. Thus, the angle of rotation was smaller when compared to the 180° angle necessary for the traditional ITF to reach the clivus. The EITF was sufficient to cover defects extending between the paraclival internal carotid arteries.ConclusionThe EITF presents an additional option for reconstruction of skull base defects when the nasoseptal flap is unavailable or fails. In contrast to the traditionally described ITF, the EITF provides a greater surface area and better arc of rotation.
Use of SMAS Flap and Fat Graft: Viability and Effectiveness
Authors: Goodstein Lindsay , Ambro Bryan T. , Morales Robert E. , Taylor Rodney J. 
Published: February 2015

Objective1) Evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. 2) Evaluate the long‐term viability of the free fat graft, including in the setting of postoperative radiation.MethodA prospective, consecutive analysis of patients undergoing parotidectomy for benign and malignant disease from 2006‐2011 was performed at an academic university setting. The main outcome measures were the effectiveness of achieving symmetric volume of the ipsilateral parotid defect, long‐term viability of the free fat graft, and presence of Frey’s syndrome.ResultsTwenty‐four consecutive patients received parotidectomy with SMAS flap and free fat graft from 2006‐2011. The average age was 56 (range 16‐84). Nineteen patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. Five procedures were done for malignant disease, and, in each instance, postoperative radiation was administered. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. MRI imaging confirmed graft viability even in the setting of postoperative radiation. There was 1 case of Frey’s syndrome and no instances of long‐term facial weakness among the patients.ConclusionThe SMAS flap and free fat graft are an effective approach to reconstructing the parotidectomy defect with minimal morbidity and complication. This study demonstrates long‐term viability of the free fat graft in the setting of postoperative radiation. Reconstruction reduces the rate of Frey’s syndrome compared to historic rates following surgery.
Navigational Balloon Sinuplasty
Authors: Kao Yi H. , Pallanch John F. 
Published: February 2015

Objective1) Use computer navigation to preplan sinuplasty. 2) To evaluate the success rate of cannulation with real time computer guidance.MethodIRB approved prospective study at a community hospital and surgicenter using Paint software with Brainlab computer navigation for 2 years. Patients with recurrent and chronic sinusitis are selected. Balloon sinuplasty is used in conjunction with FESS in a “hybrid” procedure. Sinus ostia on CT scans are colorized. Guides are calibrated then directed to the selected sinus ostia with real time navigation for deployment of the catheter. Cannulation rates, complications, and SNOT scores are measured.ResultsWe report a 99% cannulation rate for frontal and sphenoid sinuses with no major complications in 200 patients. SNOT scores decreased from over 2 to under 1. Both cases of failure to cannulate were for repeat frontal sinus surgeries.ConclusionReal time navigation with preop colorization of the sinuses allowed for high success rate of cannulation and increased patient satisfaction according to SNOT scores with no major complications when using balloon sinuplasty in conjunction with FESS.
Quality of Life Changes after Endoscopic Pituitary Surgery
Authors: Zimmer Lee A. , Shah Ojas , Theodosopoulos Philip 
Published: February 2015

ObjectiveGiven that the transnasal endoscopic approach to the sella involves resection of nasal cavity and sinus anatomy, the effect of surgery on sinonasal quality of life was tested.MethodCase series with planned data collection at a single tertiary care institution. Adults with a pituitary mass scheduled for transnasal endoscopic resection underwent preoperative testing using the Sinonasal Outcome Test‐22 (SNOT‐22). Repeat testing was performed 1 and 3 months postoperatively. Paired Student t tests and confidence intervals compared pre‐ and postoperative scores.ResultsThirty‐nine consecutive patients were enrolled. Thirty‐seven patients (19 males, 18 females) completed testing at 1 month. Thirty‐four (17 males, 17 females) completed a 3‐month evaluation. The average score (out of 120) was 23.9 preoperatively, 27.5 at 1 month, and 15.3 at 3 months. A significant improvement was found between preoperative and 3‐month scores (P =. 03), but no change was found at 1 month (P =. 4). Emotional well‐being questions such as sadness, frustration, concentration, productivity, and fatigue significantly improved 3 months after surgery (P <. 05). Physiological questions such as olfaction, obstruction, and postnasal drainage decreased at 1 month (<.05) and normalized at 3 months.ConclusionNo difference was found between total preoperative and 1 month SNOT‐22 scores. At 3 months clinically significant improvement was seen in SNOT‐22 scores. Analysis of individual SNOT‐22 questions shows marked improvement in emotional well‐being and temporary physiologic changes after endoscopic pituitary surgery.
Reducing Radiation Exposure and Standardizing Sinus CT
Authors: Holmes Janalee K. , Ruggieri Paul , Sindwani Raj 
Published: February 2015

ObjectiveComputed tomography (CT) is the standard imaging modality for the sinuses. Patients frequently undergo multiple scans from diagnosis to image‐guided surgery, and incorrect scans necessitate repeat imaging. A protocol was established to reduce the number of scans obtained and to limit radiation exposure to our sinus patients.MethodWe designed a single isotropic study for diagnosis and surgical navigation. Reductions in kVp were made that would not compromise image detail or navigation fidelity. Two hundred adult CT sagittal sinus topograms were analyzed to determine how much cranial vertex could be eliminated from the imaged field.ResultsThe total radiation dose during image capture was reduced from 120 to 100 kVp without an appreciable change in detail. Average distance from supraorbital rim to the cephalad aspect of the frontal sinus was 1.4 (0‐3.5) cm, and from the cephalad aspect to the vertex was 6.8 (3.9‐10) cm. It was conservatively calculated that 3.0 cm of vertex could be cropped without compromising the frontal sinuses and would permit successful placement of the navigation headset. These changes resulted in approximately 30% reduction in radiation exposure per scan. This standardized sinus CT replaced other options, reducing the need for repeat imaging.ConclusionReducing dose, eliminating the vertex of the head, and offering only 1 multipurpose sinus CT results in significant reductions in radiation exposure without compromising diagnostic or navigational functionality. This new sinus CT protocol has been successfully implemented throughout our healthcare system.
Symptom Score for Allergic Rhinitis
Authors: Ologe Foluwasayo E. , Adebola Stephen O. , Alabi Biodun S. , Nwabuisi Charles 
Published: February 2015

ObjectiveTo determine the prevalence of allergic rhinitis; and the correlation between Score for Allergic Rhinitis (SFAR) and nasal smear eosinophil count among patients with nasal symptoms.MethodThis cross‐sectional prospective study was conducted on patients attending ENT clinic, University of Ilorin Teaching Hospital, Nigeria. Information on the 8 parameters symptom score were collected using semi‐structured questionnaire by interview. Nasal smear slides were air‐dried, fixed with 95% alcohol, stained using May‐Grünwald‐Giemsa stain, and examined under light microscope.ResultsOf 275 participants seen during the 1‐year study, 116 (42.2%) were males. The mean age was 38.5 years; range being 14 to 75 years. Eighty‐one (29.5%) were diagnosed with allergic rhinitis using nasal smear eosinophil count. The most common symptom was excessive sneezing, involving 93% of allergic rhinitis patients (P‐value. 001). The prevalence of allergic rhinitis using SFAR was 31.6%. The SFAR cut‐off was set at 8 and above (P‐value. 001). The sensitivity and specificity for SFAR was 94.8% (CI 90.5, 97.4) and 95.1% (CI 87.2, 98.4), respectively. A high Spearman correlation, 0.88, was obtained for SFAR when correlated with nasal smear eosinophil count.ConclusionThe prevalence of allergic rhinitis using SFAR was 31.6%. The study shows that SFAR can be used as a simple, valid diagnostic tool in allergic rhinitis. This is important in rural settings where access to laboratory investigations might not be readily available.
The Role of Clarithromycin in Recurrent CRSwNP
Authors: Bezerra Thiago , Soter Ana C. , Abdo Tatiana , Pezato Rogerio , Pinna Fabio D. R. , Voegels Richard L. 
Published: February 2015

Objective1) Evaluate the role of clarithromycin in recurrent CRSwNP. 2) Evaluate the factors related to clinical improvement after clarithromycin in recurrent CRSwNP.MethodThis was an open label study conducted in a tertiary setting in 2011 on patients with CRSwNP recurrent after surgery. Patients received clarithromycin for 12 weeks. Outcome measures included the SNOT‐20, NOSE, and Lund‐Kennedy scores. Blood testing at enrollment in the study included serum C3, C4, IgG, IgA, IgE, IgM, and eosinophil count.ResultsA total of 45 patients were enrolled. The patients showed a statistically significant improvement in SNOT‐20, NOSE, and Lund‐Kennedy scores after clarithromycin trial (P. 001), but only 46.7% of patients showed a clinically meaningful difference in SNOT‐20 higher than 0.8. There was statistically significant difference in serum IgG count between groups (P. 001). The analysis of this group of patients revealed a statistically insignificant difference in serum C3, C4, IgA, IgE, and IgM.ConclusionOur group of patients presents an improvement of QoL after clarithromycin treatment, and it was clinically meaningful in 46.7% of patients. This group showed a higher serum IgG, and perhaps this immunological imbalance is partially responsible for poor response in this group of patients.
Three‐Dimensional Imaging for Sinus Surgery Informed Consent
Authors: Victores Andrew J. , Huynh Nancy , Butler E. B. , Takashima Masayoshi 
Published: February 2015

Objective1) Compare the efficacy of using standard 2‐dimensional computed tomography (CT) and magnetic resonance imaging (MRI) against 3‐dimensional reconstruction during the informed consent process of sinus surgery. 2) Determine whether 3D visualization technology affects patient anxiety prior to sinus surgery.MethodA randomized, controlled prospective study of patients undergoing sinus surgery was conducted at a tertiary academic center from 2011‐2012. Patients were assigned to receive preoperative informed consent with the assistance of 2‐dimensional CT/MRI or 3D reconstruction. Questionnaires were administered and compared to assess understanding, satisfaction, and anxiety during the process.ResultsThirty‐four patients were enrolled in this study. There was no significant variation of age, gender, or education level between the groups. The 3D reconstruction group demonstrated significant improvement in the perceived understanding of their condition, the operation, and the potential complications from the procedure as compared to the 2‐dimensional CT/MRI group (P <. 05). Patients in the 3D reconstruction group were also more satisfied with the informed consent process as a whole. Preoperative anxiety did not vary significantly between the groups.ConclusionThree‐dimensional reconstruction technology is an effective tool to improve patient understanding and satisfaction during the informed consent process prior to sinus surgery.