bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Performance in Endoscopic Rhinology Procedures
Authors: Awad Zaid , Touska Philip , Arora Asit , Tolley Neil S. , Darzi Ara 
Published: February 2015

ObjectiveInvestigate the best predictor of performance of otolaryngology trainees in a rhinology skills lab.MethodCross‐sectional study carried out in February 2012 where 15 trainees from the London otolaryngology training program (year 3‐5) were asked to complete 9 operative tasks on a sheep head model and were assessed by 5 experts on task‐specific and global performance using a previously validated tool. We tested 7 factors as predictors of performance including time (months) in surgical training, time in otolaryngology training and time in rhinology sub‐speciality training, practical rhinology courses attended, total rhinology procedures, procedures as main operating surgeon, and precourse operative global scores from video recordings.ResultsThe task‐specific and global scores correlated well (Pearson 0.66). Six out of the 7 factors did not show correlation with performance at the skills lab (time in surgery, time in otolaryngology, time in rhinology, number of courses, total procedures, and procedures performed, Pearson: 0.19, 0.12, 0.3, 0.11, 0.28, and 0.13, respectively). The only measure that correlated well is precourse performance scored blindly and independently using the same tool based on video recordings of trainees operative procedures (Pearson: 0.62)ConclusionPredicting surgical performance is a multi‐factorial complex process. The assessment process including the tool and assessors have been validated further by showing consistency in scoring the same trainee twice, before and during the course as well as good correlation between task‐specific and global assessment. Previously acquired skills have the highest predictive value.
Regional Patterns of Nasal Decongestion
Authors: Cetto Raul , Rennie Catherine E. , Bates Alister J. , Schroter Robert C. , Doorly Denis J. , Tolley Neil S. 
Published: February 2015

ObjectiveWe present a study investigating the effect of a decongestant on the nasal mucosa, showing results in terms of the change in erectile tissue volume (ETV) in normal subjects using high resolution 3T‐MRI scanning.MethodSeven volunteers with no nasal complaints (SNOT‐22) or obvious rhinoscopic abnormalities were studied. Each subject underwent 2 MRI scans producing a series of 120 contiguous 1.2 mm sections pre‐ and postdecongestion. Patients were decongested with xylometazoline‐HCL, remaining immobilized following the first scan. The scans were segmented using ITK‐Snap and analyzed using MATLAB.ResultsSubject age ranged from 21‐38 years (mean = 28). The SNOT‐22 scores ranged from 1‐10 (mean = 4.8). Decongestion had the greatest effect in 3 sites: the inferior turbinates, middle turbinates, and septum. The greatest change in ETV was observed in the inferior turbinates (P <.005), reducing by up to 1/3 at the posterior aspect of the inferior turbinate following decongestion. Changes were also seen in ETV of the middle turbinate and septal mucosa to a lesser extent.ConclusionThe effect of decongestion on ETV has been investigated here in far greater detail than previously studied, and at higher spatial resolution. 3T‐MRI was found to be an excellent modality for mapping changes in nasal mucosa. Our results demonstrate the significant effect of decongestion on ETV of the inferior turbinates.
Submucosal Resection of the Middle Turbinate
Authors: French Christopher , Goyal Parul 
Published: February 2015

Objective1) Describe a new technique to improve access to the middle meatus in select endoscopic sinus surgery (ESS) cases. 2) Describe the indications and outcomes of this technique. 3) Compare outcomes of this technique to those of conventional middle turbinate resection.MethodRetrospective chart review, January 2007 to January 2012. Eleven subjects underwent submucosal resection of the middle turbinate during routine ESS. The indication was middle turbinate bony hypertrophy that prevented adequate middle meatal access. The technique involves elevating submucosal flaps along medial and lateral aspects of the middle turbinate. The prominent bone is then resected.ResultsSubmucosal resection of the middle turbinate improved surgical access in all cases (11 patients, 13 turbinates). Follow‐up duration ranged from 1‐41 months (mean 10.4 months). Adequate middle meatal access was obtained intraoperatively in all cases. Postoperatively, the middle meatus remained patent in all patients. None of the patients experienced any complications.ConclusionThis study describes a safe and effective technique for improving middle meatal access in ESS. Complications of conventional middle turbinate resection were not seen in our study. This technique allows for preservation of the majority of middle turbinate structure and function, avoiding risks associated with total or partial full‐thickness resection.
The Practicioner’s View: Sinus Surgery with Image Guidance
Authors: Breinlich Thomas W. 
Published: February 2015

Objective1) Learn about the cost (time necessary to get an image guidance system ready to use), and 2) understand the benefits of using image guidance for routine cases of microscopic‐endoscopic sinus surgery as an attending physician.MethodA prospective case series of 24 consecutive patients undergoing FESS with image guidance from April to December 2011 was conducted. The technical and patient related setup time was measured, and minor and major complications were recorded. The benefit of a safer or more complete surgery was estimated by the surgeon.ResultsAmong the 24 patients were 3 tumor cases (12.5%) and 21 cases of chronic sinusitis (87.5%). Six patients were revision cases (25%). The technical setup time shows a mean value of 245 seconds (minimum 170, maximum 330 seconds). The patient related setup time shows a mean of 192 seconds (minimum 25, maximum 595 seconds). The total mean value of the time necessary is 437 seconds. There were no minor or major complications. The advantages as estimated by the surgeon are a more complete or safer surgery (16.6%) and the educational value for the surgeon and staff.ConclusionIn this study the cost of time (mean value 7 minutes and 17 seconds) in 24 consecutive routine cases of FESS is highlighted against the benefits of a more complete or safer surgery and the educational value for the surgeon and staff.
Video‐Assisted ALT Harvesting, Technique Validation, and Results
Authors: Moreno Mauricio A. , Suen James Y. 
Published: February 2015

ObjectiveWe have previously described a novel video‐assisted technique (VAT) for the identification of cutaneous perforators of the anterolateral thigh (ALT) free flap. We sought to validate the technique by comparing its findings with standard open thigh exploration in a series of consecutive patients.MethodRetrospective review of a prospectively collected database; 23 consecutive cases operated at a tertiary academic institution between September 2010 and October 2011. In all these cases a standard open exploration of the thigh—considered the gold standard—was performed immediately after the endoscopic exploration. Data retrieved included surgical findings, demographics, and outcomes.ResultsThere were 16 males and 7 females with a mean age of 55 (23‐83). The most common defect location was cutaneous n = 7 (30.4%) and oral cavity in n = 6 (26.1%). Average operative time for VAT was 25.4 minutes (9‐47). On standard exploration there were 53 total perforators identified; 49 of these were successfully identified endoscopically. Findings were discordant in 4 cases (17.4%), with the endoscopic technique missing 1 perforator in all of 4 of them. The sensitivity of VAT was 92.4% (CI, 80.9‐97.5) with a correlation coefficient of 0.91 with open exploration. All flaps survived, and there were no complications associated with the technique.ConclusionVideo‐assisted exploration has a high sensitivity for identification of cutaneous perforators of the thigh. There is a high correlation between findings with this technique and a standard open approach. This minimally invasive technique could help minimize donor site morbidity in patients undergoing reconstruction with an ALT free flap.
Transnasal Endoscopic Approach to Sino‐orbital Lesions
Authors: Damaty Ahmed Hesham El , Badran Hatem 
Published: February 2015

ObjectiveTo present Cairo University experience in approaching sino‐orbital lesions endoscopically.MethodFifty‐one patients with sino‐orbital and medially placed orbital lesions admitted and operated endoscopically by a combined ENT and ophthalmology team were included in this study. Their preoperative and postoperative signs, symptoms, outcomes, and radiologic data as well as their operative details were collected and analyzed.ResultsAmong those 51 patients the majority of cases were inflammatory (26 patients) followed by neoplasms (16 patients) mainly of sinuses extending to the orbit followed by thyroid orbitopathy (7 patients) and finally 2 traumatic cases. The final outcome was favorable as a whole, zero mortality, 1 unilateral loss of vision, and good control of pathology with only 11.8% recurrence rate (6 patients); 4 of them required reintervention. The mean follow‐up period was 12 months.ConclusionThe transnasal endoscopic surgical technique for orbital and sino‐orbital lesions is a minimally invasive alternative to traditional invasive approaches for selected patients and can achieve favorable outcome with very low morbidity. More practice and time are required to increase our skills and experience to master this approach.
Acoustic Pharyngometry: A Substitute for Drug‐Induced Sleep Endoscopy?
Authors: Friedman Michael , Samuelson Christian G. , Hamilton Craig S. 
Published: February 2015

ObjectiveUpper airway collapse measured using supine acoustic pharyngometry at respiratory residual volume (RV) has previously been correlated with obstructive sleep apnea‐hypopnea syndrome (OSAHS) severity. We aim to assess the agreement between sites of maximal upper airway obstruction measured by supine acoustic pharyngometry and drug‐induced sleep‐endoscopy (DISE) in snoring/OSAHS patients.MethodIn this case series, 50 consecutive patients with known snoring/OSAHS underwent in‐office supine acoustic pharyngometry and DISE. Pharyngometric measurements at respiratory tidal volume were compared against the standard normal curve to establish airway landmarks. Sites of minimal cross‐sectional‐area at respiratory RV were compared with sites of maximal obstruction identified through DISE.ResultsFifty patients (68% male, 32% female, age 47.3 ± 13.7, mean AHI 37.0 ± 26.8) were evaluated. All endoscopic assessments were performed by a single investigator (M.F.). Regions of maximal upper airway collapse per DISE were classified as retropalatal, mixed retropalatal and retroglossal, retroglossal, mixed retroglossal and retroepiglottic, or retroepiglottic. Graphical and numerical pharyngometric data were assessed by 3 investigators with complete agreement regarding regional collapse. Agreement between sites of maximal upper airway obstruction per DISE and regions of minimal cross‐sectional‐area per supine pharyngometry was 89.2% (95% CI 74.5, 95.9; P <. 001).ConclusionAcoustic pharyngometry is a completely non‐invasive mode of assessment through which numerical and graphical data regarding regional upper airway collapse can be rapidly obtained. Findings demonstrate a high level of agreement with those of DISE in the pretreatment/preoperative evaluation of patients with known snoring and/or OSAHS.
Ambulatory Visits and Comorbidity in Obstructive Sleep Apnea
Authors: Bhattacharyya Neil , Kepnes Lynn J. 
Published: February 2015

Objective1) Understand the epidemiology of obstructive sleep apnea (OSA) ambulatory office visits in the US. 2) Quantify and learn about the prevalence of comorbid illnesses that are likely to occur in the setting of OSA.MethodFrom the 2008‐2009 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, adult cases with a diagnosis of OSA were extracted. The epidemiology of OSA was determined. The prevalence of comorbid priority illnesses (obesity, asthma, cerebrovascular disease, depression, hypertension, and ischemic heart disease) was also determined.ResultsThere were an estimated 8.1 ± 2.4 million office visits with a diagnosis of OSA (60 ± 3.2% male; mean age, 56.4 ± 0.9 years). There were 389 ± 49 thousand visits to otolaryngologists for OSA. Comorbid illnesses were: obesity (23.8 ± 5.2%), asthma (14.3 ± 3.0%), cerebrovascular disease (2.5 ± 1.5%), depression (23.2 ± 2.6%), hypertension 53.8 ± 3.9%), and ischemic heart disease (10.3 ± 3.0%). Adjusting for age, sex, ethnicity, obesity and race, statistically significant increased odds for the presence of obesity (3.6, P <. 001), asthma (2.7, P <. 001), depression (2.5, P <. 001), and hypertension (2.0, P <. 001) with obstructive sleep apnea were noted. Increased odds for cerebrovascular disease and ischemic heart disease were not identified (P >. 083).ConclusionOSA is a common diagnosis in ambulatory and otolaryngologic care. It is associated with a significantly increased prevalence of several key priority healthcare conditions in the United States. Healthcare providers should be aware of these associations understanding the potentially broad impact of OSA on general health.
Extra‐Esophageal Reflux (EER) and Sleep Disorders
Authors: Laohasiriwong Supawan , Woodson B. Tucker , Johnston Nikki 
Published: February 2015

ObjectiveGERD is associated with sleep disorders, but how other reflux related disorders affect sleep is unknown. This study’s goal is to evaluate the interaction of extra‐esophageal reflux (EER) using subjective and objective (salivary pepsin) measures and sleep disorders including insomnia, hypersomnia, and sleep disordered breathing (SDB).MethodA prospective cohort of sleep and non‐sleep adult patients were evaluated for insomnia, hypersomnia, SDB, sleep quality of life, nasal symptoms, and EER using validated questionnaires (PSQI, ESS, STOP BANG, FOSQ10 RSI, NOSE). Simultaneous pharyngeal saliva samples obtained in clinic underwent Western blot immunoassay for pepsin.ResultsPrevalence of pepsin (+) and elevated Reflux Symptom Index (RSI) in 70 adult subjects (54 assay complete) was 26% and 46.3%, respectively. Significant heartburn symptoms were reported in 14.8%. Pepsin (+) was not associated with any measure of sleep or non‐sleep outcomes (P >. 05). In contrast, a significant correlation (P <. 001) was observed between RSI and insomnia (r = 0.47), sleep QOL (r = 0.45), and nasal symptoms (0.54) but not SDB (r = 0.03, ns). Nasal symptoms were strongly correlated with sleep disorders (r = 0.54, P <. 001).ConclusionDespite a low prevalence of GER in this population, a strong association between measures of EER and multiple measures of sleep quality as well as nasal obstruction was observed. Findings support that patient symptoms related to EER are associated with sleep disorders and sleep quality independent of GER.
Friedman and Mallampati Tongue Positions and Obstructive Sleep Apnea Severity
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G. 
Published: February 2015

Objective1) To assess the association between tongue position, classified by both Mallampati (MP) and Friedman Tongue Position (FTP) scales, and severity of sleep apnea (OSA) as determined by the apnea‐hypopnea index (AHI). 2) To determine which of these assessment methods is most closely correlated with OSA severity.MethodPubMed, MEDLINE, and Cochrane Trial Registry through December 2011 were searched, combined with review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the association of tongue position and OSA severity were performed. Outcomes are reported as correlations.ResultsTen studies met inclusion criteria and had data suitable for pooling (2515 patients). Overall, increasing tongue position (categorical variable) was significantly associated with increasing OSA severity (continuous variable of AHI) with a correlation of. 351 (95% CI. 094,. 564; P =. 008). Sensitivity analysis revealed correlations of. 184 (95%CI. 052,. 310; P =. 006) and. 388 (95% CI. 049,. 646; P =. 026) for MP and FTP, respectively. Analysis of publication bias revealed a nonsignificant Egger’s regression intercept; however, 4 imputed values to the right of the mean were found using Duval and Tweedie’s trim and fill method. Adding these values yielded an overall correlation of. 498 (95% CI. 474,. 521).ConclusionBoth the MP and FTP assessment techniques are significantly correlated with OSA severity. Publication bias does not affect or skew our results. The strength of the correlation between AHI and tongue position is greater for FTP than for MP, though the 95% confidence intervals for their respective correlation coefficients overlap.
Mandibular Advancement for Obstructive Sleep Apnea: Relating Outcomes to Anatomy
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G. 
Published: February 2015

ObjectivePrevious studies assessing the correlation between airway anatomic factors and success with oral appliance (OA) therapy in the treatment of obstructive sleep apnea (OSA) have failed to reach consensus. We aim to assess the role of regional upper airway obstruction measured by acoustic pharyngometry as a determinant of OA success.MethodIn this outpatient case‐series, data from OSA patients (100% CPAP‐failures) fitted with a custom OA between 07/2011‐01/2012 were reviewed. Regional maximal upper airway collapse was determined on acoustic pharyngometry and classified as retropalatal (RP), retroglossal (RG), or retroepiglottic (RE). Apnea‐hypopnea index (AHI) improvement on titration‐polysomnography was assessed against regional collapse.ResultsSeventy‐five patients (74.7% male, age 49.0 ± 13.6, BMI 29.4 ± 5.2, mean AHI 30.6 ± 20.0) were assessed and their data grouped on the basis of region of maximal collapse on pharyngometry at respiratory residual volume (RP = 29, RG = 28, RE = 18). Overall AHI reduction at OA‐titration was –20.2 (95% CI –23.6, –16.8; P <. 001) with no significant difference in AHI reduction between groups. There was no significant difference in the rate of response to treatment when defined as >50% AHI reduction plus AHI <20 (RP = 69%, RG = 75%, RE = 83%; P =. 545), or rate of cure defined as AHI <5 (RP = 52%, RG = 43%, RE = 72%; P =. 146). Correlation of minimum cross‐sectional‐area and response trended toward significance (r =. 202; –.026,. 410; P <. 1).ConclusionSuccess with oral appliance therapy is not predicted by identification of the region of maximal upper airway collapse as measured by acoustic pharyngometry. OA therapy achieves reasonable objective response and cure rates in patients with primary retropalatal, retroglossal, or retroepiglottic obstruction at the time of initial titration‐polysomnography.
OSA Diagnosis by Peripheral Arterial Tonometry
Authors: Friedman Michael , Samuelson Christian G. , Hamilton Craig S. 
Published: February 2015

ObjectiveTo assess the correlation between respiratory sleep indices as measured by portable sleep testing using peripheral arterial tonometry (PAT) and respiratory sleep indices as measured by formal polysomnography (PSG). Thereby assess the validity of PAT devices as diagnostic tools for obstructive sleep apnea in the adult population.MethodPubMed, MEDLINE, Cochrane Trial Registry (through 12/2011), and relevant article bibliographies were searched. Articles were assessed by 3 reviewers. Systematic review and meta‐analysis of studies assessing correlation of respiratory sleep indices between PAT devices and PSG in adults (>18 years) was conducted. Included studies provided an r value for correlation.ResultsEleven studies met inclusion criteria and had data suitable for pooling (775 patients). Of these, 10 studies were “blinded” in that PAT and PSG were conducted simultaneously in either the home or laboratory setting. One study contained 2 trial phases for the same patient group (n = 21), 1 laboratory and 1 home‐based, which were analyzed separately. Overall correlation of respiratory sleep indices was high (r =. 867,. 836‐.892, P <. 001). Studies comparing respiratory disturbance index (RDI) had a combined r =. 854 (.823‐.880, P <. 001), and those comparing apnea‐hypopnea index (AHI) had a combined r =. 890 (.833‐.929, P <. 001). Analysis of publication bias revealed a nonsignificant Egger’s regression intercept.ConclusionRespiratory indices calculated using PAT‐based portable devices correlate well with those calculated from the scoring of formal PSG. The strength of this correlation is supported by the “blinded” nature of the majority of the included studies. This technology represents a viable alternative to PSG for confirmation of clinically suspected sleep apnea.
Reflux Disease and Proton Pump Inhibitor Therapy: Impact upon Sleep Disturbance
Authors: Regenbogen Elliot , Helkin Alex , Georgopoulos Rachel , Vasu Tajender , Shroyer A. Laurie W. 
Published: February 2015

ObjectiveTo perform a systematic literature review that evaluates the impact of proton pump inhibitor treatment of gastroesophageal reflux disease upon sleep disturbance‐related outcomes.MethodPubMed, Web of Science, and Cochrane databases were searched from 1989 to present, identifying all radomized placebo‐controlled clinical trials where both proton pump inhibitor use and outcome measures of sleep disturbance were reported for esophageal refludisease patients. Using pre‐established systematic review protocol 4 co‐authors independently reviewed all articles.ResultsThe original search idetified 20 articles; 9 were not directly relevant, and 3 were not placebo controlled. Sample sizes varied from 15 to 642; mean age was 47.4 ± 4.56; mean body mass index was 29.4 ± 2.90; the proportion of women varied widely across studies. Esopmeprazole was studied most frequently. Over 50% of publications permitted rescue antacids. Two studies reported polysomnography outcomes, without statistically significant improvement. All studies reported nonpolysomnography outcomes; 7 identified statistically significant improvements demonstrating drug treatment superiority over placebo.ConclusionThe existing evidence supports the use of proton pump inhibitor as a treatment for esophageal reflux disease to improve quality of life sleep disturbance‐related outcomes. While variability in treatments and outcomes prevented direct comparisons, this conclusion appears robust for 7 of 8 studies, including the highest 3 quality studies.
Radiofrequency Volume Reduction of Tongue Base: A 12‐Year Experience
Authors: Kao Yi H. 
Published: February 2015

Objective1) To report on the evolution and success rate of radiofrequency volume reduction of the tongue base over a 12‐year period. 2) Introduce a novel method for deploying the RFVR probes to the tongue base without pulling the tongue forward. 3) Show reduced complication rates by avoiding nerves and vessels. 4) Show increased success rate with increased number of lesions per treatment session. 5) Demonstrate the possibility of treating the genioglossus and geniohyoid muscles to shorten these muscles and retract the tongue anteriorly.MethodIn an IRB‐approved prospective study at a community hospital, over 400 patients with obstructive sleep apnea over a 12 year period were selected for RFVR of the tongue base when there is evidence of hypopharyngeal involvement. Treatment evolved from single pronged to a double pronged probe with the rapid lesion mode and from to 2 lesions to 14 lesions. RFVR is usually performed in conjunction as part of multilevel treatment. Polysomnography prior to and 3 months after treatment were analyzed. Complications were recorded. Success is defined as RDI less than 20 and a greater than 50% reduction from preoperative levels.ResultsSuccess rates increased from 58% to 68% while the number of sessions of treatment decreased from 4 to 1 as the number of lesions increased from 2 to 14. There were no major complications.ConclusionRFVR of tongue base has evolved over a 12‐year period to become a more efficacious and integral part of multilevel treatment for OSA.