bluuebunny/crossref_metadata_2025_split huggingface dataset:
Awareness of General Practitioners of the Current Recommended Management Guidelines for Allergic Rhinitis
Authors: Okpala Nnaemeka C. 
Published: September 2014

Objectives:(1) Determine general practitioners’ (GP) awareness of the guidelines for allergic rhinitis (AR) and identify any factors influencing their awareness of the guidelines. (2) Assess their diagnosis, treatment protocol, and understanding of co‐morbidities of AR.Methods:A cross‐sectional questionnaire‐based study was performed between November 2012 and July 2013. One hundred one GPs from 23 practices completed questionnaires as part of educational briefing with a response rate of 97% (101/104). One hundred copies met the criteria.Results:Only 7 out of 100 GPs (7%) were aware of the Allergic Rhinitis and its Impact on Asthma (ARIA) or related AR guidelines; therefore, the prevalence of awareness of the guidelines is 0.07 (95% confidence interval 0.03 to 0.14). A further 13% (13/100) knew of local guidelines which were not for AR. Most GPs knew the treatment for mild and moderate‐severe AR (93% and 77% respectively). A higher percentage of GPs with previous ear, nose, and throat (ENT) experience (97% and 84% for mild and moderate‐severe respectively) were aware of the treatment. Forty‐one percent of GPs did not know the link between AR and asthma. A significant number of GPs with previous ENT experience (P <. 05) knew the co‐morbidities: 89% (33/37), compared to 68% (43/63) of those without ENT experience; they were also more aware of the link with asthma: 65% (24/37) compared to 56% (35/63) of those without ENT experience.Conclusions:Education of GPs, including more ENT experience and workshops, is required to increase awareness of the guidelines. These will improve management of AR.
Chronic Rhinosinusitis and Mood Disturbance
Authors: Erskine Sally , Philpott Carl M. 
Published: September 2014

Objectives:This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS). The aim of this analysis is to determine the number of patients consulting with their family physician about anxiety or depression among those with CRS and controls.Methods:CRES is a mixed methods study of patients with CRS including qualitative interviews and study‐specific questionnaires. This analysis considers only the questionnaires. These included comprehensive questions about demographic and socioeconomic factors and past medical history as well as SNOT‐22 (nasal symptom score) and SF‐36 (quality of life tool). Questionnaires were distributed to patients with CRS attending general ENT and rhinology clinics within the National Health Service and private sector and to a control population across many centers in the United Kingdom from 2004 to 2013.Results:A total of 1519 participants, including 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Self‐reported consultation with family physician for depression was 9 out of 57 (15.8%), 132 out of 659 (20.0%), 142 out of 577 (24.6%), and 36 out of 226 (15.9%), respectively. P <. 02 for differences between participant subgroups. For anxiety: AFRS 10 out of 57 (17.5%), CRSwNP 105 out of 659 (15.9%), CRSsNP 130 out of 577 (22.5%), controls 39 out of 236 (16.5%), P =. 04 between groups.Conclusions:There are differences in rates of consulting with family physicians for depression and anxiety disease between those with different types of CRS and controls; those with CRS without polyps were most likely to have consulted. This may influence management strategies for patients with different nasal pathologies.
Contemporary Management of Frontal Osteomyelitis
Authors: Kejner Alexandra E. , Guillot Lori M. , Woodworth Bradford A. 
Published: September 2014

Objectives:Frontal sinus osteomyelitis is a severe complication that can result from chronic rhinosinusitis, from trauma, or as a complication of reconstruction or obliteration of the frontal sinus. The objective of the current study is to evaluate the contemporary management of frontal sinus osteomyelitis in light of recent pervasive advancements in endoscopic experience.Methods:Review of a prospectively collected database of patients with frontal sinus pathology was performed from 2008‐2013, and data from individuals with frontal sinus osteomyelitis were collected regarding demographics, etiology, surgical technique, adjunctive medical treatments, complications, and clinical follow‐up.Results:Eleven patients (average age, 43.6 years; range, 8‐84 years) were included in the study. An open approach was used in 5 patients (2 osteoplastic flaps, 2 Reidel procedures, 1 cranialization). Four patients underwent completely endoscopic approaches (2 Draf IIB, 2 Draf III), while 2 individuals had combined procedures (Lynch/Draf III, osteoplastic flap/Draf III). Osteomyelitis was secondary to complications from previous surgery (n = 6) and acute/chronic rhinosinusitis (n = 5). An open approach was used in all cases of osteomyelitis that formed as a result of prior surgery. All patients received 6 weeks of intravenous antibiotics. Average clinical follow‐up was 8 months with no revision procedures.Conclusions:Endoscopic, endoscopic‐assisted, and open approaches were used successfully in the current series of patients with osteomyelitis of the frontal bone. While the advent of endoscopic techniques allows an additional surgical treatment option, it is important to select patients appropriately as open procedures continue to have a role in the treatment algorithm.
Applicant Opinions of Task Simulation Exercises as Part of the Otolaryngology Resident Interview Process
Authors: Giliberto John P. , Myer Charles M. , Hendricks Brian L. , Myer Charles M. 
Published: September 2014

Objectives:(1) Characterize opinions of applicants participating in simulation during an otolaryngology interview process. (2) Describe the effect of task simulation on applicant impression of the host program. (3) Evaluate correlation between objective simulation performance and traditional rank order methods.Methods:Applicants completed pressure equalization tube (PET) insertion on a simulator following an instructional presentation. A published global rating scale (GRS) was completed by the resident proctor and time to completion was recorded. Applicants were informed that scores were not used in final rank order list. After the interview an online survey was sent to the applicants.Results:Forty‐eight applicants completed PET simulation. Survey response rate was 81% (39/48). Inclusion of a simulation exercise during interviewing positively changed the opinion of 21% (8/38) of the applicants, with 1 negative response. The majority of respondents (88%) had no negative response to inclusion of simulation if GRS scores are not included in ranking process. If GRS results are used for ranking, respondents felt it was more fair if the task was non‐novel versus novel (54% vs 23%). The inclusion of GRS results in ranking engendered negative opinions of the program (28% non‐novel task, 46% novel task). Mean GRS score for applicants was 16 ± 0.98. Time to completion and GRS score were correlated (P <. 01), but neither GRS score (P =. 91) nor time to completion (P =. 31) were correlated to rank order.Conclusions:Simulated task performance may provide complementary information to that of traditional interviews. Inclusion in ranking may negatively affect resident perception of the program, notably if the task is novel.
Early versus Delayed Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: Impact on Health Care Utilization
Authors: Benninger Michael S. , Holy Chantal E. , Sindwani Raj , Hopkins Claire 
Published: September 2014

Objectives:Using a patient cohort with chronic rhinosinusitis (CRS) refractory to medical management, evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization.Methods:The MarketScan CCAE database was queried. Patients with ESS in 2010 and complete medical history from 2004 to 2012 were identified. Diagnoses of CRS or polyposis prior to 2005 as well as ESS prior to 2010 were exclusion criteria. Patients were characterized by time interval of first CRS diagnosis to ESS and grouped as follows: (1) <1 year (N = 888); (2) 1‐2 years (N = 267); (3) 2‐3 years (N = 300); (4) 3‐4 years (N = 414); and (5) 4‐5 years (N = 649). Outpatient visits/procedures and prescriptions associated with CRS were analyzed for all groups at the following time points: year immediately preoperative, year 1 postoperative, and year 2 postoperative.Results:Patients in all groups showed significant decline in health care utilization following surgery. Groups 1 and 2 had significantly fewer health care needs pre‐ and postoperatively compared to Group 5. Specifically, Group 1 had an average of 3.45 visits (95% confidence interval [CI]: 3.31‐3.58) and 2.92 filled prescriptions (95% CI: 2.71‐3.14) preoperatively versus Group 5 (visits: 4.57 (95% CI: 4.37‐4.78); prescriptions: 4.69 (95% CI: 4.33‐5.05)). At year 2 postoperative, Group 1 had 0.92 visits (95% CI: 0.74‐1.10) and 0.82 prescriptions (95% CI: 0.67‐0.96) versus Group 5, with 1.78 visits (95% CI: 1.45‐2.11) and 2.06 prescriptions (95% CI: 1.73‐2.39).Conclusions:Patients treated surgically early in the diagnosis of CRS have lower health care needs than patients treated after many years of failed medical management.
The Effect of Surgical Approach on Outcomes following Pituitary Tumor Resection
Authors: Goyal Parul , Villwock Jennifer A. , Villwock Mark R. , Deshaies Eric 
Published: September 2014

Objectives:The goals of pituitary tumor resection include normalizing endocrine function, relieving mass effect, and minimizing risk of recurrence. This study sought to determine the effect of surgical approach “transsphenoidal or transfrontal” on outcomes.Methods:Retrospective review of the 2008‐2011 Nationwide Inpatient Sample for patients undergoing pituitary lesion resection. Hospital and patient demographics and outcomes were compared between transfrontal and transsphenoidal surgical approaches.Results:A total of 8543 admissions for resection of pituitary lesions met our inclusion criteria. Most (>90%) were treated transsphenoidally. The transfrontal approach was most frequent in the young (<35 years) and in the South. Transfrontal resection led to significant increases in mortality and complications including central diabetes insipidus, iatrogenic panhypopituitarism, and intracerebral hemorrhage. Multivariate analysis found transsphenoidal resection reduced hospital costs and length of stay by over 50%; low‐volume hospitals increased cost and length of stay. There was an increased rate of transfrontal approaches at low‐volume centers.Conclusions:Multiple factors influence outcomes of pituitary tumor resection. Case specifics, including tumor location and size, influence approach and lead to a selection bias that cannot be controlled for in the present study. The prevalence of transfrontal resections at low‐volume centers may indicate that surgeon familiarity rather than contraindication to transsphenoidal surgery serves as the basis for surgical planning.
The Effect of Vibrissae on Subjective and Objective Measures of Nasal Obstruction
Authors: Stoddard David G. , Pallanch John F. , Hamilton Grant S. 
Published: September 2014

Objectives:(1) Recognize the impact of nasal vibrissae on subjective and objective measures of nasal obstruction. (2) Apply presented data to make informed recommendations to patients regarding vibrissae reduction as an adjunct or alternative to other treatments for nasal obstruction.Methods:In this prospective study, 30 healthy participants without nasal symptoms were assessed for baseline vibrissae concentration and treated with a topical decongestant. Subjects were then asked to subjectively assess nasal breathing using the NOSE instrument prior to undergoing rhinomanometry. Nasal vibrissae were then trimmed, and participants repeated the subjective and objective assessments. Pre‐ and post‐intervention outcomes including NOSE values, airflow, and resistance were compared using statistical analysis.Results:Statistically significant improvement was noted in subjects’ NOSE assessment of nasal obstruction (80% average improvement, P <. 001) and 2 of 4 questionnaire outcomes (P =. 016,. 083, P =. 031, and P =. 25). Statistically significant improvements occurred in objective measurement of inspiratory: flow (P =. 009); effective total resistance (P =. 003); and average vertex (maximum) resistance (P =. 029). Patients with moderate or severe vibrissae at baseline were noted to have more improvement in subjective and objective obstruction assessments than patients rated mild.Conclusions:In these 30 subjects, strong statistically significant improvement occurred in both subjective and objective assessments of nasal obstruction, particularly in patients with more dense vibrissae. These data suggest consideration of reduction of vibrissae density in patients complaining of nasal obstruction. Furthermore, the role of nasal vibrissae should be considered in any study examining the impact of medical or surgical interventions on nasal obstruction.
Endoscopic Anterior Skull Base Resection: University of Miami Experience
Authors: Hachem Ralph Abi , Sargi Zoukaa B. , Rivera Andrew M. , Wood John W. , Grobman Ariel B. , Casiano Roy R. 
Published: September 2014

Objectives:To report: (1) Oncological safety of endoscopic technique using disease free survival and a Kaplan Maier analysis for malignant tumors and recurrence rate for benign tumors; (2) Type of reconstruction of large anterior skull base defects and rate of postoperative cerebrospinal fluid leak; (3) Postoperative major (cranial and orbital) and minor complications.Methods:Retrospective chart review identifying patients undergoing endoscopic anterior skull base resection for malignant and benign tumors at a tertiary care medical center between September 1997 and June 2013.Results:Preliminary analysis shows that 34 patients underwent transnasal endoscopic resection for malignant disease and 2 patients for benign disease. The median follow‐up was 30 months. Olfactory neuroblastoma was the most common pathology. There were 3 major and 5 minor complications. Three patients recurred locally resulting in a local control rate of 90.9%. The overall mortality rate was 18%, and the disease specific mortality was 3%. Reconstruction of the skull base defect was done using acellular dermis as a sole graft with a success rate of 97% and a cerebrospinal fluid leak in 1 case.Conclusions:Endoscopic anterior skull base resection for benign or malignant disease is a safe and valid alternative compared to standard approaches. It is gaining more popularity, and with increasing surgical expertise, the indications of this procedure are expanding.
Endoscopic Balloon Dacryocystorhinostomy
Authors: McLaughlin Kevin E. 
Published: September 2014

Objectives:(1) Describe new endoscopic balloon technique for dacryocystorhinostomy. (2) Review preliminary outcomes of endoscopic balloon DCR.Methods:This study has 2 parts. The first entails a cadaver study looking at feasibility of applying balloon dilation technology to nasolacrimal duct obstruction. Five cadavers (10 sides) were used to confirm the technique. All 10 nasolacrimal ducts were successfully cannulated and dilated with a 5 × 16 mm balloon via a 70° guide. The second part of the study details our preliminary experience using this technique in patients referred to a tertiary rhinology clinic for nasolacrimal duct obstruction.Results:A total of 5 patients have enrolled in our prospective study. All patients were successfully cannulated. Follow‐up ranges from 1 to 6 months. Resolution or decrease of preoperative epiphora has been noted in all 5 patients.Conclusions:Transnasal endoscopic balloon dilation of the nasolacrimal duct system may be a possible therapeutic option for the treatment of nasolacrimal duct obstruction. Furthermore, this may be a particularly attractive option for patients who are not candidates for a general anesthetic or cannot be taken off of anticoagulant medication. Further study is warranted.
Endoscopic Endonasal Removal of Advanced Sinonasal Inverted Papilloma
Authors: Hinohira Yasuyuki , Kyo Yoshiyuki , Watanabe So 
Published: September 2014

Objectives:(1) Demonstrate our endonasal procedure to totally remove advanced sinonasal inverted papilloma (SIP). (2) Show the successful outcome in the long‐term follow‐up study.Methods:A retrospective study. Forty‐six sides of the 45 patients with SIP were operated on for the last 13 years. Nineteen of the 45 patients showing advanced stage (III:17 and IV:2 in Krouse's staging) were enrolled in this study. They consisted of 11 men and 8 women, and the age ranged from 28 to 92 years old. Endoscopic endonasal sinus surgery with aid of supplementary techniques described below was performed in all patients.Results:Extranasal methods were not required in this study. Transinferior turbinate approach to the anterior part of the maxillary sinus was applied to 5 of the 11 patients where SIP originated from the maxillary sinus. Endonasal medial maxillectomy was added to 2 of the 5 patients because of the inferior turbinate invasion. Draf type IIb or III procedure was applied to 4 of the 5 patients in whom the frontal sinus was involved. In 2 patients who showed the sphenoid sinus invasion, transseptal approach was used. During the 15 to 122 months follow‐up period, recurrence was seen in 2 patients in whom simple ESS procedure had been performed in the maxillary sinus.Conclusions:Our endonasal removal procedure for advanced SIP is acceptable, and may be alternative to extranasal methods, although longer follow‐up study is required.
The Endoscopic Modified Lothrop: Lessons Learned during a 17‐Year Experience
Authors: Leavitt Kathryn A. , Rasband‐Lindquist Allison N. , Robinson Ann B. , Beahm D. David , Hoover Larry A. 
Published: September 2014

Objectives:Participants should be able to: (1) Recognize factors contributing to failure; (2) Describe techniques required for a safe/successful surgery; (3) Implement postsurgical medical treatment enhancing long term outcome.Methods:Results with the endoscopic Modified‐Lothrop were reviewed. Although the success rate is good for revision sinus surgery (90%), factors contributing to failure such as allergy, mucosal reactivity, and scar formation were investigated. The senior author's series of 104 endoscopic modified Lothrops completed between January 1997 and October 2013 were reviewed for patency of the frontal floor drainage, mucosal condition, and symptomatology. The Lothrop procedure was first reported in 1914 using an external incision. Draft in 1991, Close in 1994, and Gross in 1995 described the endoscopic modified Lothrop. All patients selected for this procedure had failed medical treatment of nasal saline and antiseptic irrigations, topical steroids, and appropriate antibiotics. Nearly all of these patients had also failed standard endoscopic sinus procedures at least once.Results:Image guidance has improved the precision and safety of this operation. Three of the first 5 procedures performed without image guidance failed. Of the succeeding 99 procedures performed with image guidance, 96% were successful in maintaining open frontal drainage and resolving most symptoms with a prolonged follow‐up (mean 42 months).Conclusions:The endoscopic modified Lothrop is a technically difficult procedure. When performed under the supervision of an experienced endoscopic surgeon with image guidance and modern endoscopic irrigated curved drills, it can be performed safely and effectively when standard endoscopic procedures fail.
Endoscopic Resection of Anterolateral Maxillary Sinus Inverted Papillomas
Authors: Dean Nichole , Illing Elisa A. , Woodworth Bradford A. 
Published: September 2014

Objectives:Endoscopic medial maxillectomy (EMM) has become the surgical procedure of choice for resection of maxillary sinus inverted papillomas (IPs). Traditionally, IPs pedicled on the anterior and/or lateral walls of the maxillary sinus have required an adjuvant Caldwell‐Luc approach due to decreased visualization with transnasal endoscopy in these locations. The objective of the current study is to evaluate outcomes concerning the endoscopic surgical resection of anterolateral maxillary sinus IPs.Methods:A prospective review of patients presenting with maxillary sinus IPs pedicled on the anterior and/or lateral walls was performed. Demographics, pedicle location, operative technique, pathology, complications, recurrence, and postoperative follow‐up were evaluated.Results:Over 6 years, 35 patients (avg. age 56) underwent EMM for maxillary sinus IPs located on the anterolateral maxilla. Most patients (69%) were referred for recurrence after previous attempts at surgical resection. Adequate visualization was obtained following EMM in the majority of patients with use of a 70° endoscope and angled instrumentation. The addition of transseptal surgical access was critical to the removal of IPs in 16 patients. No Caldwell‐Luc approaches were required. Pathologic dysplasia was identified in 8 subjects, and 3 had carcinoma. There were no recurrences with a mean disease‐free interval of 27 months (6‐72 months).Conclusions:In the present study EMM provided excellent surgical access to anterolateral maxillary sinus IPs. The transseptal approach allowed enhanced visualization to this challenging location previously considered accessible only with external procedures.
Ethmoid Drug‐Eluting Catheter for Nasosinusal Polyposis: Results after a Randomized Controlled Trial
Authors: Plaza Guillermo , Espitia Elizabeth A. , Hernández‐García Estefanía , Eisenberg Gustavo , García‐Peces Victoria , Montojo Jose , Pascual Maria Urbasos 
Published: September 2014

Objectives:Assess the safety and efficacy of a drug‐eluting catheter to be inserted into the ethmoid sinuses during endoscopic sinus surgery to elute triamcinolone in patients with CRSwP (nasosinusal polyposis).Methods:Prospective, randomized, controlled, double‐blind, clinical trial using intrapatient control design. The study enrolled 40 patients with CRSwP undergoing endoscopic sinus surgery. In every case, after polypectomy was done to expose the ethmoid bulla, a drug‐eluting catheter to elute triamcinolone (0.3 mL) was randomly applied to one nasal fossa, whereas the other was treated by conventional total ethmoidectomy. Outcome measures were visual analogue scales, Rhinosinusitis Disability Index, endoscopy, and olfactometry assessment at baseline, 3, 6, and 12 months. Safety assessments included ocular examinations at baseline and 30 days. All CT imaging was done after more than 12 months of follow‐up.Results:After randomization was performed, unilateral devices were successfully placed in all patients and easily removed after 4 weeks. When comparing both nasal fossae in postoperative endoscopies at 6 and 12 months, the prevalence of edema, adhesions, and recurrent polyposis were statistically similar. Changes from baseline in patient‐reported outcomes were statistically relevant in both sides. No clinically important changes in intraocular pressure occurred. CT resolution of pathology was achieved in both sides, improving Lund‐Mackay scale, without significant differences.Conclusions:This trial provides clinical evidence on the safety and efficacy of a drug‐eluting catheter for use in patients with CRSwP. It achieves similar results compared to complete ethmoidectomy, without any major complications.