bluuebunny/crossref_metadata_2025_split huggingface dataset:
WatchPAT versus Polysomnography: A Meta‐analysis
Authors: Camilon P. Ryan , Nguyen Shaun A. , Camilon Marc P. , Gillespie M. Boyd 
Published: September 2014

Objectives:Recognize the correlation between WatchPAT and Polysomnography (PSG) results including the apnea‐hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI).Methods:A systematic literature review was performed by searching Pubmed, OVID Medline, and the Cochrane database for articles from June 2000 comparing WatchPAT to PSG. Meta‐analysis of continuous measures using the fixed effect model was performed.Results:Twelve studies that directly compared the results of AHI, RDI, and ODI between WatchPAT and PSG were identified. Five of the 12 studies, involving a total of 476 patients, measured AHI. WatchPAT AHI was not found to be significantly different from PSG AHI (standardized mean difference [SMD], 0.10; 95% confidence interval [CI], –0.08 to 0.28). RDI values, obtained from 5 studies with a total of 612 patients, did not significantly differ between WatchPAT and PSG (SMD, 0.08; 95% CI, –0.07 to 0.24). No significant difference was found between WatchPAT ODI and PSG ODI values from 2 studies with a total of 298 patients (SMD, 0.11; 95% CI, –0.12 to 0.34).Conclusions:The respiratory indices provided by WatchPAT are comparable to those obtained by PSG. This meta‐analysis reinforces the validation of WatchPAT as an alternative to PSG in the diagnosis of obstructive sleep apnea (OSA). With WatchPAT, patients can be evaluated in their own habitual environment rather than in a sleep lab. Therefore, the use of WatchPAT provides a less stress‐inducing option for patients and a more financially efficient method for the evaluation of OSA.
Long‐term Outcomes of Treating Middle Ear Cholesteatoma with Intact‐Canal Wall and Scute Repairing Techniques
Authors: Du Lijun 
Published: September 2014

Objectives:Assess the long‐term outcomes of treating middle ear cholesteatoma with multiple techniques including intact‐canal wall and scute repairing techniques.Methods:One hundred thirteen patients had been treated between 2001 and 2006. Multiple techniques including harvesting bone chips with air drill, sculpting of autologous bone grafts, chorda tympani nerve tightening prosthesis, preventing adhesion with hyaluronic acid ester membrane, lesion cleaning, reconstruction of ear canal wall, re‐gasification of attic and/or mastoid cavity, and early catheterization of the Eustachian tube were performed.Results:One hundred twelve ears only received the operation once, and the preoperative air bone conduction gap (ABG) was 33.61 ± 12.35 dB, which was significantly higher than postoperative ABG (13.58 ± 9.27 Db, t = 18.35, P <. 01 [G1]). Success rate of the treatment was 85.48% (106/124), and the effective rate was 47.58% (59/124). Significant improvement in the bone conduction threshold was also found (17.3 ± 13 vs 15.15 ± 11.79 dB, t = 4.77, P <. 01). Twenty‐one ears (16.93%) had increased bone conduction, 61 ears (49.19%) had decreased bone conduction, and the other 42 ears (33.87) had no change in the bone conduction. The long‐term success rate was 83.87% (104/124), and the effective rate was 38.7% (48/124). No significant difference was found in the GAP, GAP change, and AC between the values measured at the last follow‐up of the long‐ and short‐term follow‐up study (P >. 05).Conclusions:Treating middle ear cholesteatoma with intact‐canal wall and scute repairing techniques is safe. These surgical procedures involve low relapse rate, and treating patients with relapsed cholesteatoma with these procedures could also result in good outcomes.
Microbial Flora and Antibiotic Resistance in Odontogenic Oral Abscesses in Upstate New York
Authors: Plum Ann W. , Mortelliti Anthony J. , Walsh Ronald 
Published: September 2014

Objectives:(1) Identify the most common bacteria in odontogenic oral abscesses over the past decade. (2) Identify the prevalence of antibiotic resistance of pathogens responsible for odontogenic oral abscesses to guide initial antibiotic treatment.Methods:This is a retrospective chart review conducted at a single tertiary academic medical center of adult and pediatric patients who underwent drainage of oral abscesses caused by odontogenic sources (n = 129), during which cultures of the abscess were obtained. The cultures were analyzed for type of pathogen and antibiotic sensitivities. Medical comorbidities and drainage techniques were reviewed.Results:Multiple bacteria species were identified in 59.69% of odontogenic abscesses and single bacteria species in 34.11%. The most common bacteria were alpha hemolytic streptococci (34.11%), streptococcus milleri (32.56%), prevotella strains (19.38%), and coagulase negative staphylococcus (14.73%). Clindamycin resistance was identified in stomatococcus (50%), lactobacillus (33.33%), streptococcus milleri (33.33%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Penicillin resistance was identified in stomatococcus (50%) and lactobacillus (33.33%). Methicillin resistance was identified in staphylococcus (10%). Erythromycin resistance was identified in streptococcus milleri (35.71%), staphylococcus (10%), corynebacterium (8.33%), and alpha hemolytic streptococcus (2.27%). Strepto‐coccus milleri was also resistant to tetracycline (2.38%), and morganella morganii was resistant to ampicillin (100%) and cefazolin (100%).Conclusions:Most oral odontogenic abscesses were polymicrobial, with the most common pathogens being alpha hemolytic streptococcus, streptococcus milleri, prevotella, and coagulase negative staphylococcus. The most common antibiotic resistances were to clindamycin and erythromycin, which should be considered when deciding initial antibiotic therapy.
Minimal Invasive Nasal Valve Repair in Treatment of Nasal Valve Obstruction
Authors: Said Said M. 
Published: September 2014

Objectives:Nasal obstruction is known to be associated with a major decrease in disease‐specific quality of life, and nasal valve dysfunction can play a considerable role in nasal airflow obstruction. There are many procedures for treating this type of nasal obstruction. Aim: Evaluate the efficiency of minimally invasive valve repair for the treatment of nasal obstruction due to nasal valve stenosis in comparison with the reduction of the size of inferior turbinate by coblation and sub mucosal diathermy (SMD).Methods:This is a cross sectional study conducted atl–erbil from November 20, 2011, to September 19, 2013. The study included 43 patients suffering from nasal obstruction for more than 6 months. The patients were divided into 3 groups according to the type of surgery carried out (minimally invasive valve repair, coblation and submucosal diathermy [SMD] of inferior turbinate). Patients were followed for 3 months, and the data were statistically analyzed.Results:Patients showed highly significant differences between pre‐ and 1st, 30th, and 90th days postoperative total nose scale scores (P =. 0001). The difference between 1st and 30th and 90th days total score was also significant. While patients treated by coblation and SMD showed no significant difference in the mean nose score (P =. 705 and P =. 2), postoperative morbidity was less in the minimal invasive valve repair group compared with coblation and SMD groups.Conclusions:Minimal invasive valve repair had more rapid improvement and less postoperative morbidity in comparison with coblation and SMD of inferior turbinate.
National Trends and Associated Factors of Endotracheal Intubation among Adult Inpatients with Peritonsillar Abscess
Authors: Qureshi Hannan A. , Tan Bruce K. , Chandra Rakesh K. , Kern Robert C. , Smith Stephanie S. 
Published: September 2014

Objectives:(1) Describe national trends in peritonsillar abscess (PTA) requiring endotracheal intubation (ETI). (2) Determine factors associated with ETI in patients with PTA.Methods:Years 2003 to 2010 of the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) were queried for PTA (ICD‐9 code: 475) and ETI (ICD‐9 code: 96.04) in adult patients (age ≥18 years old). Descriptive statistics and multivariate regression modeling were employed to identify factors associated with ETI.Results:From 2003 to 2010, 90,941 (95% CI:86, 433‐95, 449) admissions associated with a PTA were identified, of which 1357 (1.5%) underwent ETI. These patients had a higher prevalence of concurrently coded sepsis (7.3% vs 1.2%), severe sepsis (13.0% vs 0.2%), and death (7.9% vs 0.1%) compared with patients without ETI. Intubated patients were significantly (all P <. 001) older (45 vs 34 years old), had a longer hospital stay (10.8 vs 2.4 days), and had more procedures (5.4 vs 0.9). Multivariate regression analysis displayed factors associated with intubation included age group 65 and older (odds ratio [OR] = 6.408, P <. 001), transfer from another hospital (OR = 2.917, P =. 029), alcohol abuse (OR = 6.445, P <. 001), anemia (OR = 2.957, P =. 002), and obesity (OR = 3.301, P <. 001). When controlling for age, sex, hospital characteristics, and number of procedures, general linear modeling demonstrated intubation accounted for $24,374 (P <. 001) in excess total charges per patient. Overall charges for admissions with ETI accounted for $123 million over the study period.Conclusions:Patients with PTA undergoing ETI have worse in‐hospital outcomes along with higher hospital charges. This study identifies characteristics of a PTA patient in whom clinicians should be wary of respiratory decompensation.
The Negative Effect of Unsupervised Exercises on Patients with Facial Paresis
Authors: MacDowell Sara G. , Arriaga Moises A. 
Published: September 2014

Objectives:Compare facial function at onset of skilled facial rehabilitation of patients with facial paresis performing unsupervised facial exercise routine and patients with no previous intervention.Methods:Retrospective chart review at a tertiary referral center including all patients from our institution who had >1/6 House Brackman score and were referred to physical therapy for facial retraining from 2012 to 2013. Patients were excluded from the study if they had a facial reanimation procedure or electrical stimulation prior to onset of physical therapy. The study used House Brackman (HB) and Facial Grading System (FGS) with 3 subscales: resting symmetry (rFGS), voluntary movement (mFGS), and synkinesis (sFGS).Results:Fourteen patients were referred to facial retraining therapy and met the specified inclusion and exclusion criteria. The medical diagnoses included postoperative acoustic neuroma resection, Bell's palsy, and Ramsay Hunt Syndrome. Eight patients did not participate in exercise prior to physical therapy evaluation and 6 patients were issued unsupervised facial exercise prior to therapy. Patients who participated in an unsupervised facial exercise program had a significantly higher sFGS score of 6.83 ± 2.23 at initial physical therapy evaluation than those who did not participate in exercises, with a score of 3.75 ± 2.61 (P =. 038). There were no significant differences between HB, FGS, rFGS, or mFGS.Conclusions:Patients who participated in unsupervised facial exercises had more synkinesis than those patients who did not. Generic facial exercises prior to formal individualized facial retraining therapy may be counterproductive. Further investigation is necessary to determine if initial synkinesis score impacts overall patient outcomes following intervention.
Risk of Secondary Surgery after Tonsillotomy versus Tonsillectomy: A Population Study in Sweden 2000‐2012
Authors: Odhagen Erik , Hemlin Claes , Ericsson Elisabeth , Söderman Anne‐Charlotte Hessén , Hultcrantz Elisabeth , Sunnergren Ola , Stalfors Joacim 
Published: September 2014

Objectives:In Sweden, tonsillotomy has for a decade been the favored surgical method for reducing airway obstruction from enlarged tonsils. Less postoperative morbidity with comparative symptom relief are the advantages seen. The concern has been raised that tonsillotomy increases risk of secondary tonsil surgery compared with tonsillectomy. The study aimed to evaluate the risk of secondary tonsil surgery following tonsillotomy and tonsillectomy in the Swedish population.Methods:This is a retrospective register‐study including all patients registered in the National Patient Register from 2000 until 2012 who underwent tonsil surgery. Personal identity numbers make it possible to follow patients over time in the register. All patients who underwent tonsillectomy and tonsillotomy, with or without simultaneous adenoidectomy, without previous history of tonsil surgery were included in the study. Individual information on demographic data, diagnoses, and surgery performed were recorded.Results:A total of 120,719 tonsil surgeries were identified, out of which 98,717 were tonsillectomies and 22,002 were tonsillotomies. A total of 1409 events of revision surgery were identified of which 40.3% were after primary tonsillectomy and 59.7% were after primary tonsillotomy. Tonsillotomy showed a 7‐times higher risk of secondary tonsil surgery. The accumulated risks of secondary tonsil surgery after 5 and 10 years in the tonsillectomy group were 0.6% and 0.8%, respectively. In the tonsillotomy group, the accumulated risks were 6.1% and 7.2%, respectively.Conclusions:The risk of secondary tonsil surgery in the Swedish population is 7 times higher after tonsillotomy compared with tonsillectomy. When interpreting this result the differences in postoperative morbidity between tonsillotomy and tonsillectomy must be considered.
Time to Competency: Reliability of Flexible Transnasal Laryngoscopy by Resident Training Level
Authors: Brook Christopher , Platt Michael P. , Cabral Howard , Russell Kimberly , Grillone Gregory A. , Aliphas Avner , Noordzij J. P. 
Published: September 2014

Objectives:Determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training.Methods:Prospective study of flexible transnasal laryngoscopy interpretations. Seventeen otolaryngology residents from PGY‐1 to PGY‐5 and 3 attending otolaryngologists viewed 25 selected and digitally‐recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class, and competency compared to attending interpretations.Results:Intraclass correlation of residents compared with attending physicians demonstrated significant improvements by year for left vocal fold immobility (ICC 0.85‐0.96), right vocal cord immobility (ICC 0.80‐0.97), subglottic stenosis (ICC 0.70‐0.97), and level of concern (ICC 0.72‐0.87). There were no trends for base of tongue abnormalities, pharyngeal abnormalities, pharyngeal masses, and hypopharyngeal masses. For vocal cord immobility, subglottic stenosis, and level of concern, resident reliability was found to be statistically similar to attending physicians in all categories by PGY‐3.Conclusions:Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by PGY‐3 over key facets of the examination. Flexible laryngoscopy may be a useful metric for procedural competency assessment during residency training.
The Application of Epiglottic Laryngoplasty after Partial Laryngectomy
Authors: Qin Yong 
Published: September 2014

Objectives:Observe the applied value of epiglottis in laryngeal function reconstruction after partial laryngectomy.Methods:From April 1997 to December 2008, there were 295 patients with laryngeal carcinomas who were operated on in our department. There were 40 patients who had partial laryngectomy and laryngeal function was reconstructed using epiglottis with or without other materials. The 40 cases were followed up and the oncologic and functional results were retrospectively analyzed. We calculated the 3‐ and 5‐year tumor‐free survival rates and evaluated the rehabilitation of laryngeal function.Results:The 3‐ and 5‐year tumor‐free survival rates were 82.9% and 75.7%, respectively. All of the patients with supraglottic carcinoma had tumor‐free survival; in the 3 patients with subglottic carcinomas, only 1 patient had tumor‐free survival for 5 years; in the 34 patients with glottic carcinomas, 6 patients died, and 1 patient with local recurrence had a total laryngectomy. The total decannulation rate was 90%. Thirty‐nine patients rehabilitated normal peroral feeding. The mean time of removal of the nasogastric tube was 15.7 days. In the 40 cases, voice quality was good in 6 patients with a little hoarseness, 2 were worse, having only a whispered voice, and the others were moderate; the rate of vocal satisfaction was 95%.Conclusions:Using the epiglottis with or without other materials to reconstruct laryngeal function after partial laryngectomy is a useful alternative to total laryngectomy in laryngeal cancers, especially in selected advanced cases which improve the quality of life. The epiglottis is one of the ideal materials in laryngoplasty after partial laryngectomy.
Arrested Pneumatization of the Sphenoid: A Normal Variant Easily Mistaken for a Pathologic Entitity
Authors: Tummala Neelima , Waltonen Joshua D. , Clinger John D. , Lack Chris , Williams Dan 
Published: September 2014

Objectives:(1) Describe the radiologic findings of arrested pneumatization of the sphenoid sinus. (2) Recognize this benign developmental variant to prevent unnecessary surgical intervention.Methods:A case series. Between November 2012 to January 2014, 8 subjects presented with radiologic findings consistent with arrested pneumatization of the sphenoid bone, a benign developmental variant. In each case, review of imaging by a neuroradiologist confirmed this diagnosis using strict criteria. This series includes all cases encountered during routine clinical practice during this time period. Charts were reviewed for demographic, clinical, and radiologic data.Results:In all 8 cases, arrested pneumatization of the sphenoid sinus was an incidental finding. All subjects underwent computed tomography (CT) imaging as workup for a variety of otolaryngology‐related symptoms, including headache, hearing loss, facial trauma, and sinusitis. Two patients were referred after the finding of a sphenoid lesion was mistaken for a pathologic entity. Based on CT imaging, 7 subjects were recognized as having this benign developmental variant and were managed conservatively. One patient, whose imaging revealed what appeared to be an infiltrative, midline tumor of the sphenoid sinus, underwent surgical biopsy with benign results. Upon subsequent review of CT imaging at our institution, the lesion did appear to have features consistent with arrested pneumatization.Conclusions:Considering the frequency of identification of arrested pneumatization of the sphenoid, there is a paucity of information about this diagnosis within the otolaryngology literature. Familiarity with this entity may prevent additional costly workup or unnecessary surgical intervention.
Cancer of the Middle Ear: A Contemporary Review of the National Cancer Data Base, 1998‐2011
Authors: Nocon Cheryl C. , Liederbach Erik , Lapin Brittany , Gluth Michael B. , Shinners Michael J. , Bhayani Mihir K. 
Published: September 2014

Objectives:Middle ear cancer is a rare condition with limited data regarding incidence and outcomes. We used the National Cancer Data Base (NCDB) to describe the patient characteristics, treatment patterns, and outcomes of these uncommon malignancies.Methods:A total of 458 cancers coded as having the middle ear as their primary site were selected from the NCDB between 1998 and 2011 and analyzed using chi‐square tests and Cox regression.Results:Median age at diagnosis was 64 years (range, 18‐90 years) and most patients were white (79.7%). Histologic subtypes included squamous cell carcinoma (57.8%), adenocarcinoma (12.7%), other carcinoma (15.3%), and non‐carcinoma (14.2%). Of the 209 patients with documented tumor extension, 38.8%, 55.5%, and 5.7% had local, regional, and distant disease, respectively. Treatment included surgery alone (41.3%), surgery and adjuvant therapy (40.9%), and nonsurgical therapy alone (17.8%). In patients from 1998‐2006 with local and regional disease, the 5‐year survival rates were 52%, 27%, and 22% for these treatment groups, respectively. After risk‐adjustment, surgery alone had better survival compared with surgery and adjuvant therapy (hazard ratio [HR] =1.66, 95% confidence interval [CI] = 1.01, 2.73, P =. 045). Although not statistically significant, nonsurgical therapy trended toward worse survival (HR = 1.66, 95% CI = 0.95, 2.91, P =. 075).Conclusions:Patients with local and regional disease treated with surgery alone have the best survival, perhaps because of localized disease originating in the external auditory canal with minimal extension into the middle ear. Although the cases may be originating within the temporal bone, the true site of origin for middle ear cancers is ambiguous and a stricter coding system is needed.
Cervical Sympathetic Chain Schwannomas: A Global Systematic Review Provides Insight on Diagnosis, Treatment, and Outcomes
Authors: Setzen Gavin , Keefe Michael A. , Sharghi Leighla H. , Cho‐Reyes Soojin , Howie Benjamin A. , Navaie Maryam 
Published: September 2014

Objectives:Systematically evaluate the diagnosis, treatment, and outcomes of globally published cases of cervical sympathetic chain schwannomas (CSCS) to guide clinical decision making.Methods:Using Medline, EMBASE, and Cochrane databases, 89 CSCS case reports/series were identified from 1997 to 2013. Most cases were treated internationally (82%), predominantly in Asia (50%) and Europe (27%). Demographic, clinical, and outcomes data were extracted by 2 independent reviewers with high interrater reliability (k = 0.79). P <. 05 denoted statistical significance.Results:On average, patients were 42.6 years old (SD = 13.3) and had a 2 to 4‐cm (52.7%) or >4‐cm (43.2%) neck mass. Nearly 70% of cases were asymptomatic. Presurgical diagnosis relied heavily on computed tomography (63.4%), magnetic resonance imaging (MRI; 59.8%), or both (20%), supplemented by cytology (47.6%). US‐treated cases were significantly more likely to receive pre‐surgical MRI than internationally treated cases, but less likely to have cytology or histopathology (P <. 05). Presurgical diagnosis accuracy was only 11% as confirmed postsurgically. Extracapsular (complete) resection was more commonly performed than intracapsular resection (87.6%), irrespective of mass size and treatment country. Postsurgical adverse events (AEs) were more common with the extracapsular approach and when mass size was >4 cm. Reported AEs included Horner's syndrome (89.9%), First Bite syndrome (21.1%), or both (15.7%). AEs persisted in 81.1% of cases, with 28.8 months (SD = 27.1) average follow‐up time.Conclusions:Given the typical CSCS patient is young and asymptomatic, presurgical diagnostic accuracy is very low, and the likelihood of persistent postsurgical morbidity is high with aggressive extracapsular surgery, less invasive approaches to differentially manage CSCS are warranted.