bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Surgical Treatment for Chronic Frontal Sinusitis: A Pilot Study
Authors: Becker Samuel S. , Han Joseph K. , Nguyen Thuy-Anh , Gross Charles W. 
Published: October 2014

Objectives: The initial surgical treatment for chronic frontal sinusitis is not well defined. Our objective was to determine the effectiveness of anterior ethmoidectomy for chronic frontal sinusitis. Methods: Patients with chronic frontal sinusitis who underwent anterior ethmoidectomy as initial surgical treatment were reviewed. Data were collected from computed tomography scans with use of the Lund-Mackay scale. Data on demographics, comorbidities, management, postoperative recovery, and follow-up were collected. Results: Seventy-seven patients representing 121 diseased frontal sinuses met the inclusion criteria. The respiratory comorbidities were asthma alone (8.3%), asthma and polyps (6.6%), aspirin triad (5.8%), and cystic fibrosis (0.8%). Nineteen of 121 frontal sinuses (15.7%) belonged to smokers. Fourteen of 121 frontal sinuses (11.5%) exhibited postoperative evidence of disease. Of these 14 frontal sinuses, 10 (8.3%) underwent revision surgery. Frontal sinuses of patients with aspirin triad, with both nasal polyposis and asthma, or with inter-frontal sinus septal cells were more likely to fail Draf I surgery (p < .05). Conclusions: Anterior ethmoidectomy for drainage of frontal sinuses appears to be effective initial surgical treatment for chronic frontal sinusitis. Patients with aspirin triad, both asthma and polyposis, or inter-frontal sinus septal cells are more likely to fail this procedure.
Etiology of Stridor in Infants
Authors: Zoumalan Richard , Maddalozzo John , Holinger Lauren D. 
Published: October 2014

Objectives: We undertook to identify data that facilitate determination of an accurate diagnosis of the cause of stridor in infants and to develop a framework to conceptualize the problem. Methods: We reviewed medical records of patients less than 1 year of age with the presenting symptom of stridor who were initially evaluated in the outpatient setting of a tertiary children's hospital. Infants with obvious congenital syndromes, cerebral palsy, or hypotonia were excluded. All infants underwent history-taking, physical examination, and when symptoms were mild, office flexible laryngoscopy. With moderate or severe stridor, a more complete endoscopic evaluation was undertaken in the operating room. Results: Of 202 patients, 119 (59%) were boys and 83 (41%) were girls. Their ages ranged from 3 days to 11 months; 175 (87%) were 6 months of age or younger. Congenital anomalies were diagnosed as the cause of stridor in 170 (84%). Congenital laryngeal anomalies caused stridor in 157 (78%); congenital tracheal abnormalities were the cause in 13 (6%). The most common congenital laryngeal anomaly was laryngomalacia (94%). Forty-two (21%) of the 202 patients had at least 1 other anomaly that contributed to airway compromise. Half of all patients had laryngopharyngeal reflux, the most common associated condition. Of patients referred with a presumptive diagnosis by non-otolaryngologists, 28 of 94 (30%) were referred with erroneous presumptive diagnoses for which they were being treated, the most common of which was tracheomalacia. Conclusions: A standard, rational approach to the evaluation of stridor in infants facilitates management. A framework for evaluation is presented.
Granuloma of the Membranous Vocal Fold: An Unusual Complication of Microlaryngoscopic Surgery
Authors: Sulica Lucian , Simpson C. Blake , Branski Ryan , McLaurin Colby 
Published: October 2014

Objectives: We describe the clinical features of granuloma of the membranous vocal fold (as opposed to granuloma of the vocal process, or “contact granuloma”), a poorly recognized sequela of microlaryngoscopic surgery. Membranous vocal fold granuloma may mimic the initial lesion in appearance, and thus be mistaken for recurrence. Methods: We performed a retrospective review of cases from 2 institutions. Results: Fifteen cases of membranous vocal fold granuloma from 2 institutions were identified. In all but 1 case, granuloma developed in the early postoperative period, within 8 weeks. Of the 15 cases, 10 followed laser resection of carcinoma. Five were noted following cold steel resection of benign lesions (2 papillomas, 2 cysts, 1 Reinke's edema). Technical aspects of these cases suggest that membranous vocal fold granulomas result from surgical violation of deep tissue planes and/or epithelial defects. All patients were treated with proton pump inhibitors. In 12 cases, the granulomas proved self-limited, resolving over weeks to months following surgery. Three patients underwent surgical removal of the lesion, which confirmed the diagnosis. One of these cases recurred and was treated nonsurgically. Conclusions: Granuloma should be suspected when a mass lesion appears at the surgical site early in the postoperative course. Surgical excision is generally not necessary and may provoke further growth of granulation tissue.
Intranasal Fungi and Chronic Rhinosinusitis: What is the Relationship?
Authors: Tosun Fuat , Hidir Yusuf , Saracli Mehmet A. , Caliskaner Zafer , Sengul Ali 
Published: October 2014

Objectives: The aim of this study was to investigate the effects of intranasal fungi on chronic rhinosinusitis (CRS). Methods: Forty-one patients with CRS were included in the study. The patients were put into 2 groups, with and without intranasal fungi as detected by polymerase chain reaction, and were compared in terms of different laboratory and clinical parameters of CRS. A χ2 test was used to analyze statistical differences between the 2 groups. Results: Serum eosinophilia, eosinophilia in the nasal mucus, prick and intradermal test positivity for fungi, elevated total IgE, fungal-specific IgE, prevalence of symptoms, frequency of bronchial asthma, aspirin sensitivity, and nasal polyposis did not differ significantly between the 2 groups of patients (p < .05). Conclusions: The findings of this study failed to reveal a clear correlation between the presence of fungi in the nasal passage and various factors that are assumed to be involved in the pathogenesis or clinical course of CRS. If fungi have a role in the pathogenesis of CRS, it may be via other mediators and reactions rather than IgE and type I hypersensitivity. However, the sample size was relatively small, and further studies with more cases are needed on the same topic.
Arytenoid Abduction for Dynamic Rehabilitation of Bilateral Laryngeal Paralysis
Authors: Woodson Gayle , Weiss Todd 
Published: October 2014

Objectives: Bilateral laryngeal paralysis results in airway obstruction, but the voice is often nearly normal. Tracheotomy provides an airway and preserves voice. Surgical procedures to statically enlarge the glottis can permit decannulation, but do so at the expense of the voice. Motion analysis in cadaver larynges has demonstrated that adductor and abductor muscles rotate the arytenoid cartilage around different axes. We sought to determine whether external rotation of the arytenoid cartilage could enlarge the airway without abolishing residual phonatory adduction. Methods: We performed arytenoid abduction in 6 patients with obstructing laryngeal paralysis. A suture was placed in the muscular process and posterior-inferior traction was applied, anchoring the suture to the inferior cornu of the thyroid cartilage. Outcomes were evaluated by assessing airway symptoms, by assessing the voice, and by documentation of laryngeal motion via videolaryngoscopy. Results: Three patients with severe stridor had marked relief of symptoms, and 2 of the 3 tracheotomy-dependent patients were decannulated. Three patients had good voices, 2 had mild breathiness, and 1 was very breathy. Conclusions: Arytenoid abduction is a promising treatment for relieving airway obstruction in patients with laryngeal paralysis. It has the potential to preserve voice in patients with residual phonatory adduction.
Isolated Cochlear Nerve Hypoplasia with Various Internal Auditory Meatus Deformities in Children
Authors: Ito Ken , Ishimoto Shin-Ich , Karino Shotaro 
Published: October 2014

Objectives: We report neuro-otological findings in isolated congenital cochlear nerve hypoplasia with various bony deformities and evaluate relationships between functional impairment and the radiologic dimensions of the internal auditory meatus (IAM). Methods: We performed imaging and functional analyses on consecutive juvenile or adolescent patients between 2001 and 2005 with “isolated” unilateral hypoplasia of the cochlear nerve, without inner ear anomaly or other deformities. Results: Among 20 patients with unilateral profound deafness who underwent imaging studies, 10 (50%) passed the inclusion criteria. In all affected ears, auditory brain stem responses were absent and the speech discrimination score was very poor (0% to 5%). Distortion product otoacoustic emissions were good in 2 ears, fair in 1 ear, and poor in 7 ears. Caloric responses were absent in 2 ears, reduced in 3 ears, and normal in 5 ears. Inferior vestibular nerve function and facial nerve function were normal in all ears. Distortion product otoacoustic emissions and caloric responses tended to be better in ears with less severe narrowing of the IAM. Conclusions: The risk of co-involvement of the inner ear and superior vestibular nerve functions is higher in the presence of a narrower bony IAM. Cochlear nerve hypoplasia is proposed as one of the most important causes of juvenile unilateral deafness because of its unexpectedly high incidence.
Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study
Authors: Yetiser Sertac , Karapinar Ugur 
Published: October 2014

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.
Up-Regulation of Protease-Activated Receptor 2 in Allergic Rhinitis
Authors: Lee Heung-Man , Kim Hyo Yeol , Kang Hee Joon , Woo Jeong Soo , Chae Sung Won , Lee Sang Hag , Hwang Soon Jae 
Published: October 2014

Objectives: We compared the patterns of PAR-2 messenger RNA (mRNA) and protein expression in the nasal mucosa of subjects with and without allergic rhinitis. Methods: Biopsy specimens were obtained from 10 patients with allergic rhinitis and 10 normal controls. RNA was extracted from the nasal mucosa, and semiquantitative reverse transcription-polymerase chain reaction was performed for PAR-2. Tissue sections were immunostained for PAR-2 by use of specific antibody. Results: The expression levels of PAR-2 mRNA in allergic rhinitis nasal mucosa were significantly up-regulated as compared with those in normal nasal mucosa. PAR-2 immunoreactivity was observed in the epithelium and submucosal glands in both normal controls and subjects with allergic rhinitis. Stronger immunoreactivity for PAR-2 was observed in allergic rhinitis nasal mucosa as compared with normal nasal mucosa. Conclusions: These results suggest that PAR-2 may be involved in allergic nasal inflammation.
Contribution of Vision to Balance in Children Four to Eight Years of Age
Authors: Casselbrant Margaretha L. , Mandel Ellen M. , Sparto Patrick J. , Redfern Mark S. , Furman Joseph M. 
Published: October 2014

Objectives: The use of sensory feedback for postural control develops throughout childhood. The aim of this study was to determine how children use cues from anterior-posterior optic flow for balance from 4 to 8 years of age. Methods: One hundred forty-eight children were enrolled. The subjects had yearly otologic and posturographic examinations between the ages of 4 and 8 years. Balance was assessed only if the subject had no evidence of middle ear effusion. The subject stood for 30 seconds with eyes open without optic flow and for 30 seconds while viewing 0.1, 0.25, and 0.4 Hz anterior-posterior optic flow. The center of pressure (COP) was recorded from the force platform. The root-mean-square of the COP during the periods of quiet stance and with optic flow was computed. Results: The root-mean-square COP was significantly larger during the optic flow stimulation as compared with during quiet stance. The subjects had a significant decrease in COP during optic flow from year 5 to year 6 of life (p = 005). Conclusions: A change in the response to optic flow was seen from age 5 to age 6. This change is consistent with transitional changes in postural responses that have been observed during quiet standing.
Anatomy of the Bony Portion of the Eustachian Tube in Tubal Stenosis: Multiplanar Reconstruction Approach
Authors: Yoshida Haruo , Takahashi Haruo , Morikawa Minoru , Kobayashi Toshimitsu 
Published: October 2014

Objectives: We sought to clarify possible pathological conditions of the bony portion of the eustachian tube (ET) in patients with ET stenosis. Methods: We measured the total length, the cross-sectional area of the bony frame, and the air space of the ET lumen at an interval of 1 mm on the reconstructed computed tomographic images of the ET using a multiplanar reconstruction method on 20 normal subjects (control group) and 25 patients with stenotic ET judged by the inflation test (stenotic group). Results: In the cross-sectional areas, both the bony frame and air space were significantly smaller in the stenotic group than in the control group. The soft tissue ratio was significantly greater in most parts of the mid-bony portion and the tympanic orifice of the stenotic group than in those of the control group. At the anterior tip of the bony portion, only the bony frame was found to be significantly smaller in the stenotic group than in the control group. Conclusions: We suggest that a smaller framework of the bony ET may possibly be related to the pathogenesis of ET stenosis.
Invasive Tracheal Aspergillosis Treated Successfully with Voriconazole: Clinical Report and Review of the Literature
Authors: Warman Meir , Lahav Jonathan , Feldberg Edit , Halperin Doron 
Published: October 2014

Objectives: Invasive tracheal aspergillosis is a rare and highly fatal fungal infection that manifests as a progressive airway obstruction in immunocompromised patients. Otolaryngologists should be familiar with the entity of invasive necrotizing tracheal aspergillosis. Methods: In this report we describe a young patient with acute myeloid leukemia who was affected by invasive tracheal aspergillosis. This entity and the relevant literature are reviewed. Results: On the basis of the presented clinical report, we discuss the clinical and pathologic characteristics of invasive tracheal aspergillosis as an opportunistic infection. The classic symptoms are of progressive dyspnea in an immunosuppressed patient. Diagnosis is via pathological evidence of fungal hyphae invading the endoluminal upper respiratory tree. The present patient was successfully treated with an azole antifungal agent, combined with tracheostomy for airway control. Conclusions: Invasive tracheal aspergillosis is a life-threatening fungal infection that affects immunosuppressed patients. Because the mortality rate is high, awareness of this entity is essential for early diagnosis and treatment. A favorable outcome in this type of invasive aspergillosis correlates with resolution of the bone marrow suppression and early antifungal medical therapy combined with aggressive surgical intervention for airway control, if needed.
Prediction of Difficult Laryngoscopy: Does Obesity Play a Role?
Authors: Hekiert Adrianna M. , Mick Rosemarie , Mirza Natasha 
Published: October 2014

Objectives: This study was intended to 1) identify preoperative predictors of difficult laryngoscopy and 2) determine the role of obesity in difficulty of obtaining adequate laryngeal exposure. Methods: A prospective study was undertaken of 63 patients who were undergoing elective direct laryngoscopy. Thirty-six patients met the obesity criteria (body mass index of at least 30 kg/m2). Measurements of height, weight, and neck circumference and Mallampati and Cormack-Lehane scores were obtained. The ease of laryngeal exposure was recorded by the attending surgeon on a visual analog scale (VAS; 1 to 10). Difficult laryngeal exposure (DLE) was defined as a VAS score of at least 3. The candidate morphological predictors were investigated. Results: Obesity and Mallampati score were found to be predictors of DLE (p < .001). The VAS score was positively correlated with body mass index (p = .007), weight (p = .05), Mallampati score (p < .001), and Cormack-Lehane score (p < .001). Among obese patients, the VAS score was correlated with the Cormack-Lehane score (p = .01), whereas in nonobese patients the VAS score showed a significant association with both the Mallampati (p = .02) and Cormack-Lehane (p = .01) scores. Conclusions: Obese patients and those with a Mallampati score of at least 2 posed a significantly higher risk of DLE. Preoperative identification of a potentially difficult airway may aid surgical planning and allow more effective communication with a collaborating anesthesiologist.
Acoustic Rhinometry in Healthy Humans: Accuracy of Area Estimates and Ability to Quantify Certain Anatomic Structures in the Nasal Cavity
Authors: Cankurtaran Mehmet , Çelik Huseyin , Coşkun Mehmet , Hizal Evren , Cakmak Ozcan 
Published: October 2014

Objectives: We evaluated the accuracy of acoustic rhinometry (AR) measurements in healthy humans and assessed the ability of AR in quantifying the dimensions of the paranasal sinuses and certain anatomic structures in the nasal cavity. Methods: Twenty nasal passages of 10 healthy adults were examined by AR and computed tomography (CT) before and after decongestion. Actual cross-sectional areas of the nasal cavity and actual locations of the nasal valve, the head of the inferior turbinate, the head of the middle turbinate, the ostia of the frontal and maxillary sinuses, and the choana were determined from CT sections perpendicular to the curved acoustic axis of the nasal passage. Results: The AR-measured cross-sectional areas in the anterior nasal cavity were in reasonable agreement with the corresponding areas determined from CT, whereas AR consistently overestimated the passage areas at locations posterior to the paranasal sinus ostia. The nasal valve was identified as a pronounced minimum on the AR area-distance curve. However, AR did not discretely identify the head of the inferior turbinate, the head of the middle turbinate, or the choana. Conclusions: The local minima on the AR area-distance curve beyond the nasal valve are caused by acoustic resonances in the nasal cavity, and do not correspond to any anatomic structure. The AR area overestimation beyond the paranasal sinus ostia is due to the interaction between the nasal cavity and the paranasal sinuses, rather than to sound loss into the sinuses. Acoustic rhinometry provides no quantitative information on ostium size or sinus volume in either non-decongested or decongested nasal cavities.
Aberrant Methylation of the HRPT2 Gene in Parathyroid Carcinoma
Authors: Hewitt Kimberly M. , Sharma Pramod K. , Samowitz Wade , Hobbs Maurine 
Published: October 2014

Objectives: The incidence of parathyroid carcinoma in hyperparathyroidism–jaw tumor syndrome (HPT-JT) is reported to be as high as 15%. We used a methylation-specific polymerase chain reaction (MS-PCR) technique to investigate whether hypermethylation is one mechanism of HRPT2 gene inactivation in parathyroid tumors. Methods: DNA was extracted from samples of parathyroid tumors embedded in paraffin. MS-PCR was performed on 11 parathyroid carcinomas, 37 sporadic parathyroid adenomas from control subjects, and 6 parathyroid adenomas from 3 patients with HPT-JT. Methylated and unmethylated PCR products from 2 tumors (Nos. 2 and 6) were cloned. Clones containing inserts were sequenced. Results: Two of 11 (18%) parathyroid carcinomas showed amplification patterns consistent with methylation, compared to 0 of 37 sporadic parathyroid adenomas, and 1 of 6 (17%) parathyroid tumor samples from 3 HPT-JT patients. These results were confirmed by sequencing multiple clones from each of these samples. Conclusions: There is increasing evidence that loss of HRPT2 gene expression is strongly associated with parathyroid carcinomas. Our data indicate that methylation of the HRPT2 promoter may be another mechanism by which HRPT2 gene inactivation gives rise to parathyroid carcinomas.
Sensorineural Hearing Impairment in Children with Chiari I Malformation
Authors: Simons Jeffrey P. , Ruscetta Melissa N. , Chi David H. 
Published: October 2014

Objectives: We describe the prevalance of Chiari I malformation in children presenting to a pediatric tertiary care hearing loss clinic, characterize the phenotype of hearing loss in children with Chiari I malformation, and discuss the potential pathophysiology of sensorineural hearing impairment (SNHI) related to Chiari I malformation. Methods: This study was a retrospective case series of patients seen in a pediatric tertiary care hearing loss clinic affiliated with an academic medical center. We considered 481 patients with SNHI who had radiographic imaging as part of the evaluation for the cause of their hearing impairment. Hearing impairment was determined by behavioral audiogram and/or auditory brain stem response testing. Radiographic imaging was performed with computed tomography and/or magnetic resonance imaging. Results: Six children with SNHI also had a diagnosis of Chiari I malformation. Four of these 6 children had unilateral hearing impairment. One child had asymmetric bilateral impairment; 1 child had symmetric bilateral impairment. The severity of hearing impairment varied from mild to profound. All children were referred to the neurosurgery department. None underwent surgical decompression. Conclusions: Chiari I malformation may be associated with SNHI. Central nervous system imaging for the evaluation of children with SNHI may be indicated, particularly in individuals with negative results on temporal bone computed tomography and genetic testing.