bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vestibular Dysfunction in Patients with Enlarged Vestibular Aqueduct
Authors: Chien Wade W. , Zalewski Chris K. , King Kelly A. , Muskett Julie A. , Butman John A. , Brewer Carmen C. , Griffith Andrew J. 
Published: September 2014

Objectives:Enlarged vestibular aqueduct (EVA) is the most common inner ear malformation. While a strong correlative relationship between EVA and hearing loss exists, its association with vestibular dysfunction is less well established. In this study, we characterize the vestibular phenotype in patients with EVA.Methods:This was a prospective, cross‐sectional study of 106 patients with unilateral (n = 26) or bilateral (n = 80) EVA, defined as a midpoint diameter greater than 1.5 mm, who were referred or self‐referred to participate in a study of the clinical and molecular analysis of EVA at the National Institutes of Health. We obtained a clinical history focused on vestibular dysfunction, and specifically asked about age of independent walking, history of vertigo, head tilt with vomiting, and clumsiness. Based on tolerance and availability, participants underwent videonystagmography (VNG), cervical vestibular evoked myogenic potentials (cVEMP), and rotary vestibular chair testing (RVT) to objectively assess their vestibular function.Results:Forty‐five percent of patients with EVA reported vestibular symptoms. A total of 44% (28 out of 66) of those completing VNG testing had abnormal results, as defined by abnormalities in caloric, ocular motor, and positional testing. An increased number of vestibular symptoms is correlated with the presence of bilateral (rather than unilateral) EVA (P =. 008) and a history of head injury (P <. 001). Abnormal VNG results also correlated with a history of head injury (P =. 01).Conclusions:Vestibular dysfunction is common in patients with EVA. To our knowledge, this is one of the largest prospective EVA studies which specifically address the vestibular manifestations.
Button Battery Injuries in the Pediatric Aerodigestive Tract
Authors: Ettyreddy Abhinav R. , Georg Matthew W. , Mehta Deepak , Chi David H. , Yellon Robert F. , Gaines Barbara A. , Simons Jeffrey P. 
Published: September 2014

Objectives:(1) Describe the clinical presentation, management, and complications associated with button battery impaction in the aerodigestive tract in children. (2) Evaluate the long‐term morbidity associated with button battery impaction.Methods:This study is a retrospective medical record review involving 23 consecutive patients who presented to a tertiary care childrens hospital between January 1, 2000, and July 31, 2013, with button batteries impacted in the nasal cavity (n = 7), esophagus (n = 9), and stomach (n = 7). Battery type/size, duration of impaction, presenting symptoms, treatment, and outcomes were examined.Results:Average time of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. 3V lithium batteries accounted for 84% of battery injuries and were responsible for all cases of esophageal impaction. Most common presenting symptoms were vomiting (30.4%), fever (26%), and cough (21%). Presenting signs and symptoms did not predict severity of injury or outcomes. Average length of hospitalization was greater for esophageal impactions (43.0 days) than for nasal or stomach impactions (2.0 days; P =. 009). Batteries in the esophagus for >15 hours led to a longer postoperative hospital course and were associated with higher rates of transmural necrosis compared with those impacted for <15 hours (P =. 04). Esophageal complications included perforation (n = 3), tracheoesophageal fistula formation (n = 2), and strictures (n = 4).Conclusions:Button battery impactions in children present with nonspecific symptoms that may account for the delay in medical care. Clinicians must consider battery impaction in the upper aerodigestive tract as a surgical emergency that may lead to significant long‐term morbidity.
Does Montelukast Have an Effect on Posttonsillectomy Pain Control in Children?
Authors: Ince Ilker , Yoruk Ozgur , Ahıskalıoglu Ali , Aksoy Mehmet , Dostbil Aysenur , Celik Mine 
Published: September 2014

Objectives:Investigate the efficacy of preemptive montelukast, which is leukotreine receptor blocker for pediatric posttonsillectomy pain management. This is the first time montelucast has been used in posttonsillectomy pain control.Methods:A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist (ASA) class I‐II, scheduled for elective tonsillectomy were enrolled in this double‐blinded and controlled study from April of 2013 until January of 2014. The patients were randomized into 2 groups: Montelukast group (Group M, n:30) and control group (Group C, n:30). Group M received 5 mg oral montelukast tablet and Group C received placebo at 24:00 pm the night before surgery. The posttonsillectomy pain was evaluated with Wong‐Baker Face Scale during the 24 hours after surgery. Postoperative complications were recorded. The data were analyzed using the Student t test. Data were presented as a mean + SD, and differences were considered significant at P <. 05.Results:There were statistically significant differences between Wong‐Baker Face Scale scores of the Group C and Group M (P <. 05). The first time, analgesic requirement was higher in group C than in group M (P <. 05). There was no significant difference in demographic parameters and postoperative complications (P >. 05 for both).Conclusions:Preemptive montelukast usage is more effective than the control group in posttonsillectomy pain relief.
Incidence and Grading of Subglottic Stenosis and Associated GERD/LPR in Recurrent Croup
Authors: Hodnett Benjamin L. , Katherine Riera , Mehta Deepak , Simons Jeffrey P. , Maguire Raymond C. 
Published: September 2014

Objectives:(1) Determine incidence/grading of subglottic stenosis on endoscopic evaluation in recurrent croup. (2) Determine incidence of reflux on bronchoalveolar lavage (BAL) and esophageal biopsy (EBx) in pediatric population of recurrent croup.Methods:A retrospective chart review was conducted of pediatric patients (age ≤ 18 years) who underwent endoscopic evaluation with a diagnosis of recurrent croup over a 10‐year period (2002‐2012). A total of 1825 charts were reviewed, of which 269 were identified for inclusion, with preliminary results completed for the first 80 patients. Endoscopic findings, BAL cytology results, and EBx pathology were collected. Subglottic stenosis (SGS) was graded on Myer‐Cotton scale. Lipid‐laden macrophages (LLM) on BAL were noted as none/small/moderate/large with evidence of reflux noted as moderate or large. Bx specimens were evaluated for evidence of reflux esophagitis.Results:Mean age at endoscopy was 56 ± 5 months. SGS was noted in 19 of 80 patients (24%) and all were grade I. Moderate‐large LLM were noted on 0 out of 14 BAL in SGS group. Moderate‐large LLM were noted on 5 out of 48 BAL (10%) in non‐SGS group. Evidence of reflux was noted on 6 out of 19 (32%) EBx in SGS group. Evidence of reflux was noted on 5 out of 57 (9%) EBx in non‐SGS group. There was no difference between the groups on preliminary data analysis (LLM P =. 58, EBx P =. 07).Conclusions:Recurrent croup is a risk factor for subglottic stenosis. Evidence of reflux may be noted on BAL or esophageal biopsy but this may not correlate with SGS in recurrent croup patients.
iPad Audiometry in Canada's North: A Portable and Cost‐Effective Method for Hearing Screening
Authors: Rourke Ryan , Bromwich Matthew , Chan David 
Published: September 2014

Objectives:Access to hearing health care is limited in many parts of the world. Specifically, many risk factors for hearing loss are present in the First Nations people of Canada's North. No research has been done to assess this populations hearing in over 3 decades. The aims of the study were: (1) Determine the prevalence of hearing loss in children in Baffin Island. (2) Demonstrate the use of asynchronous tele‐audiometry. (3) Conduct a cost‐benefit analysis of iPad audiometry in the Canadian Arctic.Methods:iPad audiometers were used to test hearing in 220 children ages 5‐11 years in Iqaluit, Nunavut, during 1 week in January 2014. Air conduction pure tones were obtained from each ear at frequencies of 500, 1000, 2000, and 4000 Hz. Children with hearing loss greater than 25 dB in at least 1 frequency were considered to have failed the hearing test and will be further tested with standard sound booth audiometry.Results:Preliminary analysis reveals a hearing loss prevalence of 15.5%. These children then received standard testing by an audiologist using standard sound booth audiometry and the results analyzed. A cost‐benefit analysis assessed the use of iPad audiometry in this remote location.Conclusions:This is the first study in over 30 years assessing the hearing of children in this region, and the first telemedicine audiometry in Canada using iPads. This type of testing is valuable for providing hearing health care for high risk populations in rural and remote areas at an affordable cost.
Pediatric Tympanostomy Tube Removal: Does Technique Affect the Rate of Persistent Tympanic Membrane Perforation?
Authors: Vercillo Natalie , Agrawal Nidhi , Nardone Heather C. 
Published: September 2014

Objectives:Determine whether various techniques used to promote tympanic membrane (TM) perforation closure at the time of ventilation tube removal impact the likelihood of TM perforation healing in children.Methods:A retrospective chart review was conducted of 265 children (341 ears) who underwent tympanostomy tube removal at a tertiary care pediatric hospital between January 2010 and November 2013. Techniques performed at the time of ventilation tube removal included tube removal only, freshening the perforation edges, performing paper patch myringoplasty, or both freshening edges and paper patch myringoplasty.Results:The persistent TM perforation rate was 9.97% (34/341). Technique was not found to significantly influence the likelihood for the TM to heal (P =. 81), with 11/86 (12.7%) having persistent perforations with tube removal only, 6/62 (9.7%) with freshened perforation edges, 7/50 (14.0%) with paper patch myringoplasty and 10/109 (9.2%) with both edges freshened and paper patch myringoplasty. There was no significant interaction between technique and age, tube retention length, number of previous ventilation tubes placed, or type of tube removed. Additionally, no significant difference in TM perforation rate was observed for number of previous tympanostomy tubes, tube duration, previous adenoidectomy, or indication for tube removal. Factors associated with higher rates of persistent perforation included older age, longer‐acting ventilation tubes, and trisomy 21.Conclusions:There is no reduction in persistent TM perforation rate following ventilation tube removal if edges are freshened and/or a paper patch myringoplasty is performed. Increased pediatric age, longer‐acting tympanostomy tubes and history of trisomy 21 may negatively influence the likelihood of closure.
The Role and Function of the Vegf Pathway during Palate Development
Authors: Jacobs Britni H. , Goudy Steven L. , Hill Cynthia A. 
Published: September 2014

Objectives:(1) Define the evolution of palatal vascularization during palatal shelf formation and effects of vascular endothelial growth factor (Vegf) deletion in the cranial neural crest. (2) Determine downstream mediators of Vegf signaling.Methods:Conditional deletion of Vegf using Wnt1‐Cre; Vegf F/F mice (VegfCKO) led to a cleft palate phenotype. PECAM staining was used to determine vascular patterning in the VegfCKO developing palate daily from E13.5 to E16.5 compared to controls. The VegfCKO palate shelves at E13.5 and E14.5 were analyzed using quantitative PCR (qPCR) to assess mediators and targets of Vegf signaling.Results:VegfCKO had aberrant vascular branching via PECAM staining in comparison to controls. In E13.5 VegfCKO mice, there were no significant differences in mediators and targets of VEGF signaling measured by qPCR. However, at E14.5, VegfCKO palates demonstrated significant reductions in pyruvate dehydrogenase kinase (PDK4) (P =. 045), which is a glycolytic gene, and stromal cell‐derived factor 1 (SDF1) (P =. 036), which induces endothelial migration.Conclusions:Vegf was required for palatal vascularization and palatal elongation. During palatal development Vegf was upstream of SDF1, a cytokine necessary for endothelial progenitor cell recruitment and migration. Vegf also modulates glycolysis through variations in PDK4, a protein involved in glucose metabolism.
Safety and Perioperative Complications in Pediatric Otologic Surgery
Authors: Roxbury Christopher , Yang Jingyan , Salazar Jose H. , Goldstein Seth , Abdullah Fizan , Shah Rahul K. , Boss Emily F. 
Published: September 2014

Objectives:There is a paucity of data regarding postoperative complications associated with pediatric otologic procedures. We describe safety and postoperative sequelae of these procedures using data from the largest quality improvement initiative in pediatric surgery, the American College of Surgeons National Surgery Quality Improvement Program‐Pediatric (NSQIP‐P). This study is the first to assess safety of pediatric otologic surgery using NSQIP‐P data.Methods:We identified children who underwent outpatient otologic surgery using current procedural terminology codes. Variables of interest included patient demographics and 30‐day unplanned postoperative events including reoperation, readmission, and wound complication. Adverse event rates were determined and prevalence of events was compared by procedure type and within patient subgroups.Results:Of 37,319 pediatric surgical cases, 2410 were otologic procedures. The most common procedure was tympanoplasty (N = 836, 34.7%), followed by myringoplasty (N = 741, 30.7%), tympanomastoidectomy (N = 630, 26.1%), and cochlear implantation (N = 464, 19.3%). There were 7 reoperations (0.3%), 30 readmissions (1.2%), and 17 wound complications (0.6%). Cochlear implantation had the highest readmission and reoperation rates (12/464, 2.6% and 3/464, 0.7%) of the procedures studied, followed by tympanomastoidectomy (8/630, 1.3% and 3/630, 0.5%). There was not enough power to determine statistical significance of patient characteristics that increased risk of adverse event.Conclusions:Pediatric otologic procedures are commonly performed and have extremely low rates of postoperative 30‐day complications. Although NSQIP‐P is a powerful, nationally recognized quality platform, optimization is necessary for assessment of meaningful procedure‐specific outcomes in pediatric otologic surgery. Analysis of pooled NSQIP‐P data across future years may guide determination of predictive factors for an adverse event.
Treatment of Bilateral Severe Bronchomalacia with 3‐Dimensionally Printed Patient‐Specific External Bronchial Splints
Authors: Morrison Robert J. , Nasser Hassan B. , Jensen Daniel R. , Park Albert H. , Ohye Richard G. , Hollister Scott J. , Green Glenn E. 
Published: September 2014

Objectives:(1) Describe the treatment options for severe bronchomalacia. (2) Learn about a novel technology for treatment of severe bronchomalacia using a 3‐dimensionally (3D) printed patient‐specific external bronchial splint.Methods:A 16‐month‐old patient previously underwent tracheostomy for severe bronchomalacia but had been unable to be discharged home since birth because of persistent high ventilatory requirements (PEEP 20). Despite high ventilatory settings and intravenous sedatives, respiratory events required prolonged intensive care unit (ICU) care and intermittent comas. Endoscopic examination demonstrated focal bilateral mainstem bronchomalacia. DICOM CT images of the patient's airway were imported into a computer‐aided modeling program and custom 3D external bronchial splints were created utilizing image‐based Boolean design. The splints were 3D printed using poly‐L‐caprolactone. Institutional Review Board and Food and Drug Administration emergency‐use exemption was granted and the patient was implanted with the custom devices.Results:Subsequent bronchoscopy revealed patency of both mainstem bronchi and normal ventilatory variation in both lungs. Peak end‐expiratory pressure (PEEP) was immediately weaned from 20 to 10 mm Hg and tidal volumes immediately improved from 5 to 10 cc/kg. The patient is actively being weaned from ventilator support. Respiratory parameters, endoscopy, and dynamic imaging are being actively studied during the patient's recovery.Conclusions:This patient demonstrates a clinical scenario of bilateral bronchomalacia who had exhausted conventional treatment options but necessitated prolonged ICU‐level support. The creation of 3D‐printed external bronchial splints has alleviated the critical nature of the bronchomalacia and represents the first time this technology has been used in a patient with bilateral disease.
Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children
Authors: Marom Tal , Alvarez Pedro E. , Jennings Kristofer , Patel Janak A. , McCormick David , Chonmaitree Tasnee 
Published: September 2014

Objectives:(1) Analyze the clinical characteristics of upper respiratory infections (URIs) complicated by acute bacterial sinusitis (ABS) in young children. (2) Describe the bacteria and viruses isolated in nasopharyngeal specimens in children with ABS.Methods:We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (aged 6‐35 months at enrollment), who were followed up for one year to capture all URI episodes and complications. At the initial URI visit (median day = 4), nasopharyngeal samples were obtained for bacterial cultures and viral studies. The study was conducted at the University of Texas Medical Branch, Galveston, during 2003‐2007.Results:Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. The average age was 18.8 ± 7.2 months; white children were more likely to have ABS episodes than blacks (P =. 01). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS (P =. 01). Bacterial cultures were positive in 82/83 (99%) available samples; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with ABS risk (P =. 04 for both).Conclusions:ABS complicates 8% of URIs in children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M catarrhalis during URI are positively correlated with ABS risk.
Antigen‐Specific Immunoglobulin Production in Ethmoid Mucosa in Refractory Chronic Rhinosinusitis with Nasal Polyps
Authors: Matsune Shoji , Wakayama Nozomu , Yamaguchi Satoshi , Sekine Kuwon , Ishida Mariko , Yoshioka Yuma , Okubo Kimihiro 
Published: September 2014

Objectives:For the past few decades, endoscopic sinus surgery (ESS) combined with medication therapy has improved the prognosis of chronic rhinosinusitis with nasal polyps (CRSwNP). However, we sometimes encounter refractory CRSwNP complicated with nonatopic asthma and tremendous eosinophil infiltration in nasal polyps. Recently, enterotoxin of Staphylococcus aureus (S aureus) and fungi have been thought to contribute to the pathology of refractory CRSwNP, while its pathophysiology in detail is still controversial. Aim of study: In order to elucidate the pathology of refractory CRSwNP, antigen‐specific IgEs and IgGs to enterotoxin of S. aureus (SAE‐A, B) and fungi in ethmoid sinus mucosa, in addition to IgE and IgG analysis in blood serum and skin tests, were studied in operation cases with CRSwNP.Methods:Total IgE and IgG and SAE‐A, B, Aspergillus, Candida and Alternaria‐specific IgEs and IgGs production in ethmoid sinus mucosa were analyzed and compared to such data in blood serum and the results of skin tests in operation cases with CRSwNP in our university hospital. Ethmoid sinus mucosa was obtained during operation and kept in liquid nitrogen followed by mashing in 1 mL phosphate‐buffered saline (PBS). After centrifugation of this PBS, the supernatant was harvested in each case to analyze total and antigen‐specific IgEs and IgGs based on the weight correction of each sample.Results and Conclusions:In the skin tests, positive reaction was often observed only to Candida 48 hours after injection. While local fungi‐specific IgEs were little, local SAE‐A,‐B‐specific IgEs were apparently positive and local total IgE level was elevated. Candida specific Ig G and/or SAE‐A, ‐B specific IgE dependent reactions may play important roles in the pathophysiology of refractory CRSwNP.
Association between Physiologic Parameters and Anatomic Location in Spontaneous Cerebrospinal Fluid Leaks
Authors: Shargorodsky Josef , Xie Yanjun , Solomon David , Ishii Masaru , Gallia Gary , Reh Douglas D. , Lane Andrew P. 
Published: September 2014

Objectives:Although a relationship between elevated cerebrospinal fluid (CSF) pressure and spontaneous CSF leaks has been reported, analyses by anatomic sub‐site are lacking. This study seeks to elucidate the association between physiologic parameters and CSF leak location.Methods:Prospective case series of patients undergoing endoscopic endonasal repair of spontaneous CSF leak between 2004 and 2013. All participants had a lumbar drain placed for 24‐hour continuous preoperative pressure monitoring, and 24 hours of continuous monitoring starting 48 hours after the repair. In addition to patient characteristics, mean and peak CSF pressures by anatomic location were calculated and compared.Results:Twenty‐five patients underwent perioperative CSF pressure monitoring, with a mean follow‐up of 526 days. Nine patients had CSF leaks along the cribiform plate, 4 in the ethmoid roof, 8 in the sphenoid, 2 in the posterior table of the frontal sinus, and 2 with multiple leaks. Patients with cribiform leaks had the lowest mean body mass index (BMI) and prevalence of obstructive sleep apnea (22.2%), while those with multiple sites of leak had the highest mean BMI and prevalence of obstructive sleep apnea (50%). Patients with frontal sinus leaks had the highest postoperative mean (14.47 mmHg) and peak (42.5 mmHg) CSF pressures, while ethmoid roof had the lowest mean (0.43 mmHg) and peak (16.45 mmHg) CSF pressures.Conclusions:CSF pressure and other physiologic characteristics differ among patients with spontaneous CSF leaks by anatomic location. Understanding these differences may enable treatment approaches tailored by leak site, thereby improving repair outcomes.