bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Technique for Endoscopic Type I Laryngeal Cleft Repair
Authors: Raol Nikhila P. , Rogers Derek J. , Hersh Cheryl , Hartnick Christopher J. 
Published: September 2014

Objectives:(1) Describe a novel technique for repair of type I laryngeal clefts. (2) Review the current literature on various techniques for repair of type I laryngeal clefts.Methods:A retrospective review of patients under 18 years with a type I laryngeal cleft who underwent endoscopic laryngeal cleft repair (LCR) by a single surgeon at a tertiary care otolaryngology specialty hospital using a successful novel technique from July 1, 2013, to February 14, 2014, was conducted. This technique uses electrocautery to demucosalize the cleft on a setting of 6, followed by repair of the cleft with 2 endoscopically placed sutures. Charts were assessed for age at surgery, comorbidities, diet, length of stay, complications, and outcomes.Results:Eleven patients were identified, with an average age of 28 months (range, 9‐68 months). Eight of 11 (73%) of patients were restricted to nectar thick‐diet preoperatively, 2 out of 11 (19%) to honey thick‐diet, and 1 out of 11 (9%) to half‐strength honey thick‐diet. Postoperative swallow results were available for 7 patients. Five of 7 patients demonstrated clinical or radiographic evidence of resolution of aspiration. One had improvement of aspiration but persistent penetration, and another had continued aspiration and is being evaluated for a neurologic disorder.Conclusions:Although type I laryngeal clefts have traditionally been endoscopically addressed using either a cold technique or a laser to demucosalize the cleft, our technique offers an advantage over cold knife by providing improved hemostasis and broader demucosalization. In addition, when compared with the laser technique, it offers similar broad demucosalization without deeper thermal damage.
Does Tube Type Matter in Posttympanostomy Tube Otorrhea?
Authors: Cheng Leah , Chen Sharon , Cheng Jeremiah 
Published: September 2014

Objectives:The objective of this study was to review consecutive tympanostomy tube surgeries for the past 8 years, paying particular attention to the type of tube inserted at the time of surgery.Methods:Retrospective chart analysis of the last 3046 consecutive ears for tympanostomy tube surgery from 2005 to 2013.Results:Out of 3046 total ears reviewed, the total rate of otorrhea was 3.78% with 0.0% otorrhea in titanium tubes, 0.0% otorrhea in Sheehy activent tubes, 2.19% otorrhea in Donaldson tubes, 2.72% otorrhea in Sheehy collar button tubes, 3.28% otorrhea in Shepard tubes, 3.88% otorrhea in fluoroplastic tubes, 6.9% otorrhea in stainless steel tubes, 18.52% otorrhea in Goode tubes, and 25.0% otorrhea in triune tubes.Conclusions:Early posttympanostomy tube otorrhea is a frequent complication of tympanostomy tube insertion with a complication rate of 3.8%, and the type of tubes placed at time of surgery seems to make a difference in the incidence of posttympanostomy otorrhea.
Optimizing Postoperative Analgesia for Children
Authors: Cheng Yew Song , Powell Catrin , Koch Hasnaa I. , Burgess Andrea 
Published: September 2014

Objectives:(1) Analyze the difference between prescribed doses and manufacturer recommended doses of acetaminophen and ibuprofen for pediatric otolaryngology patients in the postoperative setting. (2) Highlight a problem with manufacturer dosing advice for over‐the‐counter analgesics.Methods:We selected 53 consecutive children who had otolaryngology operations requiring general anesthesia in 2013. These children were discharged with instructions to use over‐the‐counter analgesia, as per current departmental practice. We compared the manufacturer recommended doses of generic over‐the‐counter acetaminophen and ibuprofen with doses of the same analgesics that they would have had as inpatients during the postoperative period.Results:Manufacturers often recommend a range of doses. With acetaminophen, even when assuming the highest recommended doses were used, we found that children would have received on average 16% less acetaminophen than they would have had in hospital. (P =. 048). With ibuprofen, assuming the lowest recommended doses were used, children would receive 25% less ibuprofen than as inpatients (P =. 037). If the highest recommended doses were used, they would have taken 7% more ibuprofen than we would have found safe to prescribe (P =. 06).Conclusions:Over‐the‐counter acetaminophen and ibuprofen come with dosing advice guided by age. Our analysis demonstrated that this could often be substantially different from the ideal dose, which is based on the child's weight. With the global trend of increasing body weight, we can expect this disparity to get bigger in the future. Good pain management is important in pediatric otolaryngology, but this result is relevant to all clinicians caring for children.
Safety and Efficacy of Infant Transoral Flexible Laryngoscopy in the Office Setting
Authors: Wexler Sonya J. , Isaacson Glenn C. 
Published: September 2014

Objectives:The technique of transoral infant laryngoscopy was described a decade ago, but has not gained wide acceptance. We present a 10‐year experience with the method as an alternative to transnasal examination in newborns and edentulous infants, focusing on practicality, safety, and quality of examination.Methods:We queried a prospectively accrued database of 22,000 office examinations to identify all transoral flexible laryngoscopy examinations performed from 2001 to 2011 by the senior author. Records were reviewed for patient age, indication for laryngoscopy, diagnoses, and adverse events.Results:One hundred forty infants, aged 2 days to 10 months, were evaluated. Fifty‐seven patients were female and 83 were male. Stridor was the most common indication for laryngoscopy (90.7%) and 89 (63.6%) patients were diagnosed with laryngomalacia. The larynx was well seen in 99.3% of examinations. There were no episodes of airway obstruction or bleeding. Two children experienced emesis (1.4%).Conclusions:Transoral flexible laryngoscopy is a safe method for examining the infant larynx. It permits rapid, comfortable examination using a conventional‐sized office fiberscope in most infants prior to dental eruption. It avoids the need for topical anesthesia, vasoconstrictors, sedation, or general anesthesia for most children. Office examination is not advised for infants with severe upper airway obstruction.
Surgical Intervention for Congenital Absent Oval Window
Authors: Eu Donovan , Loh Woei Shyang , Yeo Seng Beng 
Published: September 2014

Objectives:Congenital absent oval window is an uncommon condition that results in significant conductive hearing loss in the pediatric population. Treatment outcomes and results following surgery are still not well established in light of the limited cases that have been published in the literature. This study aims to evaluate the outcomes following surgical intervention of patients with congenital absent oval window in a single institution.Methods:This is a retrospective review of patients who underwent surgical exploration and treatment for congenital absent oval window from 2000 to 2013 in a single institution.Results:Twelve patients were diagnosed with congenital absent oval window. Six of these patients were affected bilaterally. Of the 19 ears affected, 13 were operated on. Eight ears were successfully treated following stapedotomy and insertion of prosthesis. The average pure‐tone audiogram for these patients was 62.6 prior to the operation. Following surgery, the average pure‐tone level was 22.4. Five of the ears that were operated on showed minimal improvement. Of these 5 ears, 3 were unsuitable for insertion of prosthesis due to unfavorable position of the incus. Two patients underwent stapedotomy with Teflon wire prosthesis insertion. However, this failed to improve hearing levels.Conclusions:Congenital absence of oval window is an uncommon condition that can lead to significant disruption to hearing. Surgical intervention by means of stapedotomy and prosthesis insertion may lead to significant improvement in hearing levels selected patients. However, it may be technically unsuitable for others.
Effects of Oral Prednisolone on Recovery after Tonsillectomy
Authors: Choi Young Seok 
Published: September 2014

Objectives:Evaluate the effects of postoperative steroids compared with no steroids following tonsillectomy.Methods:This study was a prospective double‐blinded, randomized trial from April 2013 to September 2013. Forty patients age 5 years or older who were scheduled for elective tonsillectomy with or without adenoidectomy were enrolled. Patients were randomly assigned to receive a postoperative course of prednisolone powder or tablet over 7 days (dosage: 0.25 mg/kg/d). The primary outcomes of this study were comparing degree of postoperative pain using a validated pain scale and estimation of healing process based on the percentage of total area of reepithelization of tonsillar area. The second day outcomes were comparing bleeding rate, presence and severity of nausea and vomiting, returning to a normal diet, returning to normal daily activity, and sleep disturbance.Results:Mean ages were 23.55 (prednisolone group) and 25.25 (control group). Postoperative pain score showed no difference at day 1 and 14, but much less pain in the prednisolone group at day 7 (P =. 056). Mean percentage of reepithelization area was higher in the prednisolone group (P <. 001). There were significant differences in the bleeding rate, severity of nausea and vomiting, and sleep disturbance. But there was a significant difference in the rate of return to eating a normal diet and normal daily activities.Conclusions:Oral prednisolone may offer improvement in the recovery phase from tonsillectomy without serious complications.
Bilateral Encephaloceles and CSF Rhinorrhea after Facial Advancement in Craniofacial Dysostoses: Considerations for Repair
Authors: Panuganti Bharat A. , Leach Matthew E. , Antisdel Jastin L. 
Published: September 2014

Objectives:(1) Describe the first reported case in otolaryngology literature of a patient with Crouzon syndrome with late cerebrospinal fluid (CSF) rhinorrhea and encephalocele formation after prior Le Fort III facial advancement surgery. (2) Review the literature pertaining to the incidence and management of this complication in craniofacial dysostoses (CD). (3) Analyze issues surrounding repair of these complications, including occult elevations in intracranial pressure (ICP), the use of perioperative CSF shunts, and the importance of considering alternative repair schemes.Methods:Literature review of studies describing CSF rhinorrhea and encephalocele formation following facial advancement in CD, focusing on management strategies.Results:CSF rhinorrhea and encephalocele formation are rare complications of craniofacial advancement procedures. Occult elevations in ICP complicate the prospect of permanent surgical repair, necessitating the use of transcranial repair and CSF shunts in addition to the now more common endoscopic approach. Though no consensus exists regarding the use of perioperative CSF drains, strong associations exist between elevated ICP and failed surgical repair. Additionally, the anatomic changes in the frontal and ethmoid sinuses after facial advancement present a challenge to endoscopic management.Conclusions:Otolaryngologists should be aware of the possibility of occult elevations in ICP as well as sinonasal anatomic abnormalities when repairing CSF rhinorrhea in patients with CD. Clinicians should consider CSF shunt placement and carefully weigh the advantages of the open, transcranial approach versus endonasal, endoscopic techniques.
The Effect of Adipose Tissue on Atrophic Rhinitis: An Animal Model
Authors: Balur Mehmet B. , Oktay Mehmet F. , Taskin Umit , Aydin Salih , Yucebas Kadir , Altnay Serdar , Celik Duygu S. 
Published: September 2014

Objectives:Investigate the histopathological effects of fat grafting harvested from lipoaspirate adipose tissue on atrophic rhinitis in an animal model.Methods:An animal model of atrophic rhinitis was obtained by application of pasturella multocida toxin diluted with 0.9% NaCl into nasal cavities for 3 weeks. Eleven Wistar Hanover rats were included in this study and divided into 2 groups. The study group was composed of one side of nasal cavity with atrophic rhinitis. The fat grafting harvested from lipoaspirate adipose tissue was applied into nasal cavity submucosally. After 2 weeks of follow‐up, rats were decapitated and nasal cavities were resected totally. A histopathological examination was done.Results:There was a significant improvement in the study group compared with other groups according to basal membrane degeneration and glandular atrophy. The vacuolar degeneration, squamous metaplasia, keratinization, vascular proliferation, inflammatory infiltration, and congestion were not significantly different between groups.Conclusions:Our study showed that fat grafting harvested from lipoaspirate adipose tissue has a positive healing effect over degenerated mucosa on atrophic rhinitis, in addition to the volume enhancer effect of tissue itself. The adipose tissue may normalize the volume of large nasal cavities caused by atrophic rhinitis. In addition, histopathological disorders of atrophic rhinitis, such as glandular atrophy and basal membrane degeneration, are reversed significantly.
The Effect of Smoking on Eosinophilic Rhinosinusitis with Nasal Polyp in Mouse Model
Authors: Lee Ki , Mo Ji‐Hun 
Published: September 2014

Objectives:Chronic rhinosinusitis with nasal polyp is a clinically common disease, and cigarette smoking is a major risk factor for airway inflammation. However, little is known about the effects of smoking on eosinophilic rhinosinusitis (ERS) with nasal polyp. A histopathologic and molecular study was performed to investigate the effects of smoking using mouse model of ERS with nasal polyp.Methods:Mice were divided into 4 groups: control group, smoking group, ERS group, and ERS + smoking group (N = 8, each). Histopathologic changes were investigated using several special stainings: Hemotoxylin and eosin for overall inflammation and polyp‐like lesions, Sirius red for eosinophils, Toluidine blue for mast cells, Alcian blue for secretory goblet cells, and Masson's trichrome for collagen fiber. Serum IgE levels and systemic cytokines were determined using enzyme‐linked immunosorbent assay. The expression of vascular endothelial growth factor (VEGF) and HIF‐1a were evaluated by immunohistochemical staining.Results:Smoking enhanced the degree of polyp‐like lesions, eosinophil infiltrations, goblet cell deposition, and subepithelial fibrosis in ERS model. Total and OVA‐specific IgE levels were increased in both ERS groups, however, smoking had no additive effect on them. The systemic cytokines (IL‐4, IL‐6, IL‐17, and IFN‐γ) were also elevated significantly by smoking. Smoking enhanced VEGF expression in nasal epithelial cells, suggesting underlying mechanism of increased polyp formation.Conclusions:Smoking exposure had additive effects on experimental ERS. It resulted from increased local and systemic inflammation, and airway remodeling. Increased VEGF might be its underlying mechanism.
Evaluation of Subjective Voice Changes in Seasonal Allergic Rhinitis
Authors: Uyar Yavuz , Salturk Ziya , Atar Yavuz , Kumral Tolgar L. , Yildirim Guven , Aydogdu Imran , Atac Enes 
Published: September 2014

Objectives:Voice is a person's main communication tool and affected by many factors, including the upper respiratory tract. The upper respiratory tract influences mainly resonation, and the nose is one of the key points. Seasonal allergic rhinitis may affect voice quality via changing resonation. This study aims to evaluate the possible changes on voice caused by seasonal allergic rhinitis subjectively.Methods:Between October 15, 2013, and January 15, 2014, 28 patients who applied to our out‐patient clinic and diagnosed with seasonal allergic rhinitis were included in the study. Mean age of the patients was 28.4 and all were female. Patients were asked to complete voice handicap index 30. Control group was composed of 30 female patients who did not have seasonal allergic rhinitis. Values were analyzed in statistically nonpaired samples using Student t test.Results:The mean voice handicap index score was 16.4 in the study group and 5.5 in the control group. There was a statistically significant difference between the 2 groups (P <. 05).Conclusions:Seasonal allergic rhinitis has an adverse affect on vocal quality, subjectively.
Ethnic Disparities in Myringoplasty Surgery in New Zealand
Authors: Kwon Hyok Jun , Dowley Andrew , Mason Paul 
Published: September 2014

Objectives:(1) Examine and analyze whether there are ethnic disparities in myringoplasty rates and outcomes in New Zealand.Methods:Prospective cohort of 167 consecutive myringoplasty surgeries performed at the only public regional hospital in a district of New Zealand between 2003 and 2012. Basic patient demographics including ethnicity and nature of perforation (size, location, and active infection) were recorded preoperatively. Primary outcomes were of successful perforation repair on postoperative review, hearing improvement on pre‐ and postoperative audiograms, and prevention of recurrent infections of the middle ear.Results:In our cohort, the native Maori of New Zealand have disproportionately high incidences of myringoplasty surgery compared with the majority Europeans (28.7/100,000 vs 6.2/100,000 persons/year, P =. 0001). Maori patients tend to be younger on average (16.80 vs 23.4 years old, P =. 001) with larger perforations (25.9% vs 24.3%, P =. 029), but there were no significant ethnic disparities in primary surgical outcomes.Conclusions:Our study supports the hypothesis that native Maori of New Zealand have a greater burden of middle ear disease compared with the majority Europeans but shows that Maori are just as likely to benefit from myringoplasty surgery. Further population‐level studies are required to verify this.
Importance of Human Papillomavirus Integration in Malignant Transformation of Inverted Papilloma
Authors: Suzuki Mikio , Deng Zeyi , Hasegawa Masahiro 
Published: September 2014

Objectives:This study investigated the role of human papillomavirus (HPV) in malignant transformation of paranasal inverted papilloma (IP).Methods:HPV presence and viral load and physical status of HPV‐16 were examined by polymerase chain reaction‐based methods using fresh frozen samples or paraffin‐embedded samples obtained from 17 patients with IP (IP group), 5 with IP and squamous cell carcinoma (IP+SCC group), 16 with SCC (SCC group), and 67 with chronic inflammatory lesions (inflammatory group).Results:The presence of the HPV genome was detected in 29.4%, 40.0%, 25.0%, and 6.0% of patients in the IP, IP+SCC, SCC, and inflammatory groups, respectively. The IP group showed significantly higher HPV‐positive rates than the inflammatory group. All types of HPV detected were high‐risk HPV, especially HPV‐16. The relative HPV‐16 copy numbers varied from 2.5 to 7953 per 50 ng genomic DNA. Viral load was higher in the IP+SCC group than in the inflammatory group. In the IP group, no significant relationship was found between HPV‐16 viral load and clinical characteristics. All patients with IP+SCC and SCC showed integration of HPV‐16.Conclusions:High viral load and integration of HPV have an important role in malignant lesion in association with IP.
Inverted Papillomas: Retrospective Review
Authors: Moura Ivo M. , Soares Mafalda , Delgado Inés P. , Gabriel Teresa , Cardoso Marta , Leandro João Pedro , Veiga Gabão 
Published: September 2014

Objectives:Inverted papillomas are benign sinonasal tumors arising from Schneiderian mucosa. The inverted papillomas represent 0.5% to 4% of all sinonasal tumors. The purpose of this review was to analyze the patients with inverted papilloma treated in Hospital Prof. Doutor Fernando Fonseca, Portugal.Methods:A retrospective review was performed of patients with inverted papilloma over a 10‐year period.Results:The authors found 12 cases of inverted papilloma, mean age of 63 years old with male predominance. In collaboration with the neuroradiology department, the authors found 1 case in Stage I, 4 cases in stage II, 5 cases in stage III, and 2 cases in stage IV of Krouse's Staging System. The endoscopic surgical approach was used in 11 cases (combined with external approach in 7 cases) and isolated external approach in 1 case. The meantime of follow‐up was 28 months. There was recurrence in 4 cases and 1 had malignant transformation.Conclusions:The treatment of inverted papilloma is surgical, with the endoscopic approach the choice in the majority of the cases. A follow‐up for a long period is necessary. A larger number of cases for analysis would be necessary to confirm the review's results.
Maintaining Favorable Middle Turbinate Position after Endoscopic Sinus Surgery
Authors: Torres Lisa , Shaari Christopher M. , Ghalili Andrew 
Published: September 2014

Objectives:(1) Analyze the safety of using Propel mesh implant in revision sinus surgery. (2) Analyze the efficacy of maintaining a medial position of the middle turbinate without synechiae in the postoperative period.Methods:This was a retrospective study between July 2012 and February 2014 in 16 patients with chronic rhinosinusitis undergoing revision sinus surgery and who underwent placement of a Propel mometasone implant into the ethmoid bowl at end of the procedure. Placement of the Propel was unilateral in some or bilateral in others. Surgery was conducted at outpatient surgical centers. Safety measures included incidence of bleeding, orbital migration of mesh, and chronic scabbing. Efficacy measures included incidence of synechiae and maintenance of medial position of the middle turbinate.Results:A total of 26 Propel implants were placed. The incidence of complications from the implant was zero and the efficacy of maintaining a medialized middle turbinate without synechiae was 100%.Conclusions:In selected patients with chronic rhinosinusitis undergoing revision sinus surgery, the placement of a Propel mometasone implant into the ethmoid bowl is safe and effective at maintaining a medialized position of the middle turbinate without synechiae formation.
Operative Interventions for Clivus Osteoradionecrosis with CSF Leak following Stereotactic Radiosurgery for Nasopharyngeal Carcinoma
Authors: Oliveira Vitor M. , Campelo Paula , Silva Deodato , Escada Pedro A. , De Almeida Gonçalo Neto , Carmo Diogo O. , Paco Joao‐Carlos L. S. 
Published: September 2014

Objectives:Nasopharyngeal carcinoma (NPC) local recurrence still represents a major clinical challenge and a high mortality and morbidity cause. The authors report a case of a 44‐year‐old male with clivus osteoradionecrosis (ORN) and dural radionecrosis who presented with cerebrospinal fluid (CSF) leak, 6 months after a boost of stereotactic radiosurgery using gamma knife for the treatment of locally recurrent NPC, following conventional external beam radiotherapy (EBRT) with chemotherapy.Methods:A direct transnasal endoscopic‐assisted approach with multiple reconstructive pedicled flap technique was used to achieve watertight dural reconstruction.Results:Despite CSF leak recurrence, after the second attempt we achieved a successful clivus reconstruction using a bilateral posterior pedicle inferior turbinate flap (PPITF). The reconstruction withstood a watertight seal for 1 month, until patient death from cardiopulmonary arrest as a result of ventilator‐associated pneumonia.Conclusions:We recommend an early diagnosis and surgical intervention in the setting of clivus ORN. Local debridement of necrotic bone is critical for local nasal graft adherence and survival. The evidence of dural radionecrosis is a predictor of bad prognosis. As a result, broad dural defect exposition should be the standard procedure with the use of a multi‐layered technique combined with vascularized pedicle flaps regardless of the dural tear dimension.