bluuebunny/crossref_metadata_2025_split huggingface dataset:
Binary versus 5‐Point Likert Scale in Assessing Otolaryngology Trainees in Endoscopic Sinus Surgery
Authors: Awad Zaid , Taghi Ali S. , Sethukumar Priya , Ziprin Paul , Darzi Ara , Tolley Neil S. 
Published: September 2014

Objectives:(1) Examine the discriminant validity of 2 validated assessment tools in endoscopic sinus surgery (ESS) training. (2) Compare the binary versus the 5‐point Likert‐scale tools in ESS assessment.Methods:A cross‐sectional study was conducted from February‐August 2013. All otolaryngology trainees in the North‐London training program were assessed while performing ESS on sheep heads, which previously showed face and content validity. Performance was rated by 2 blinded assessors using 2 validated tools: The Inter‐Collegiate‐Surgical‐Curriculum‐Project tool, which utilizes a binary system and is used throughout the UK surgical training system, and the John Hopkins 5‐Point Likert scale ESS tool. The tools’ construct validities were tested by comparing performance of experts and novices. The tools were also tested by correlating task‐specific and global skills ratings with overall performance level.Results:The binary tool showed higher inter‐rater reliability than the Likert scale, both in task‐specific (Kappa: 0.89 versus 0.62) and global skills (Kappa: 0.79 versus 0.68) rating. Both tools discriminated between different levels of expertise in global and task‐specific skills (Kruskal‐Wallis: P <. 001 for all). But pairwise comparison showed that Likert scale tool was a better discriminator between novices and trainees, globally (P =. 016 versus P <. 271) and task‐specifically (P =. 049 versus P =. 449). Likert scale tool also correlated better with overall performance globally (r = 0.903 versus 0.741) and task‐specifically (r = 0.833 versus 0.802).Conclusions:While the binary assessment tool may show higher inter‐rater reliability and is easier to complete, the Likert scale, when each level is well defined, showed good agreement and better construct validity, which can be useful when monitoring progress in training.
Chlorogenic Acid: A Potential Activator of Dysfunctional Mucus Transport in Chronic Rhinosinusits
Authors: Illing Elisa A. , Dean Nichole , Dunlap Quinn , Skinner Daniel , Zhang Shaoyan , Woodworth Bradford A. 
Published: September 2014

Objectives:Salubrious effects of the green coffee bean are purportedly secondary to high concentrations of chlorogenic acid (CA). CA has a molecular structure similar to bioflavanoid polyphenols known to activate transepithelial Cl‐ transport in sinonasal epithelia. In contrast to bioflavonoids, chlorogenic acid is freely soluble in water. The objectives of this study are to evaluate the Cl‐ secretory capability of CA and potential as a therapeutic activator of mucus clearance in sinus disease.Methods:CA was tested on primary murine nasal septal epithelial (MNSE) [CFTR+/+ and transgenic CFTR‐/‐] and human sinonasal epithelial(HSNE) [CFTR+/+ and F508del/F508del] cultures under pharmacologic conditions in Ussing chambers to evaluate effects on transepithelial Cl‐ transport. Changes in airway surface liquid depth and CFTR mRNA transcription were also measured.Results:CA stimulated transepithelial Cl‐ secretion [(change in short‐circuit current(^†ISC)] in MNSE (13.11 ± 0.9 vs 0.1 ± 0.1, P <. 05) and HSNE (34.3 ± 0.9 vs 0.0 ± 0.1, P <. 05). The drug had a slow onset with peak effect at 15 minutes after application. Administration of the CFTR blocker INH‐172 significantly reduced ISC (MNSE −16.4 ± 1.0 vs −9 ± 0.9 and HSNE (−44.6 ± 1.0 vs 34.1 ± 0.3, P <. 05), indicating effects of the drug are likely mediated through CFTR. CA‐mediated Cl‐ secretion was absent in CFTR‐/‐ MNSE and F508del/F508del HSNE, confirming CFTR dependency. A modest increase in ASL depth was noted with 1 hour incubation (9.4 vs 8.3 µm). The compound did not alter CFTR mRNA levels when analyzed by quantitative reverse transcription polymerase chain reaction.Conclusions:CA is a water‐soluble agent that promotes CFTR‐mediated Cl‐ transport in sinonasal epithelium. Further in vivo evaluation as a therapeutic activator of mucus clearance is planned.
Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis
Authors: Kingdom Todd T. , Gitomer Sarah A. , Sillau Stefan H. , Katial Rohit K. , Ramakrishnan Vijay R. 
Published: September 2014

Objectives:(1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predict disease severity in CRSwNP.Methods:Patients with CRSwNP treated at an academic hospital specializing in respiratory and allergic disease from 2008 to 2010 were included in this study. Clinical information was collected retrospectively. Sinus computed tomography (CT) scans were scored by a single author according to the Lund‐Mackay (LM‐CT) system, and surgical specimens were evaluated by a single author for degree of tissue eosinophilia. Statistical analysis was performed with t test, chi‐squared test, Fisher's exact test, and multiple regression models.Results:Seventy CRSwNP patients were included. They had a mean LM‐CT score of 16.7, 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. There was no significant correlation between tissue and serum eosinophil counts (P =. 97). There was a significant positive correlation between CT score and peripheral eosinophil level (P <. 05). Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms (P =. 91), or Lund‐Mackay scores (P =. 25), nor did it correlate with presence of asthma, but it may be elevated in aspirin‐sensitive patients (P =. 09). Patients with mild asthma had significantly more tissue eosinophils when compared to patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics.Conclusions:Higher serum eosinophil levels may indicate worse mucosal disease as measured on CT scan, but neither serum nor tissue eosinophilia predicted disease severity in our population CRSwNP patients.
Combined Rhinosurgical and Neurosurgical Management of Intradural Angiofibromas
Authors: Naraghi Mohsen , Saberi Hooshang , Boroojerdi Masoud 
Published: September 2014

Objectives:Although intracranial extension of angiofibromas is not uncommon, intradural penetration is rare. Management of such rare tumors is a challenging issue in skull base surgery, necessitating tumor removal via combined approaches in most cases. In this paper we present our experience for management of extensive intradural angiofibromas.Methods:Six cases were male patients, 5 between 15 and 19 years old, presenting with nasal obstruction and epistaxis and proptosis. One of them was an aggressive recurrent tumor in a 32‐year‐old patient. They were scheduled for combined approaches with assistance of image‐guided endoscopic surgery.Results:Six cases underwent combined transnasal, tramaxillary, and craniotomy approaches with assistance of image‐guided endoscopic surgery. Craniotomy preceded rhinologic approach in 3. CSF leak and skull base defect was repaired by temporalis muscle flap and pericranial flap in 4 and fascia lata in 2. One postoperative leak was repaired with fascia lata transcranially. Otherwise the course was uneventful in all cases.Conclusions:The intradural intracranial extensions of angiofibroma require meticulous approach in terms of surgery because of their greater risk for complications during the dissection. Carotid rupture and brain damage are 2 catastrophic complications which should be kept in mind. In cases with extensive intradural involvement of the middle cranial fossa by angiofibroma, craniotomy with intradural approach could help to decrease complications.
Correlation between Nasal Nitric Oxide and Quality‐of‐Life Improvements after Sinus Surgery
Authors: Fu Chia‐Hsiang , Lee Ta‐Jen , Huang Chi‐Che , Hang Po‐Hung 
Published: September 2014

Objectives:Analyze the correlation between preoperative nasal nitric oxide (nNO) level, its postoperative change, and symptom scores in patients with chronic rhinosinusitis (CRS).Methods:We collected pre‐ and postoperative 3 and 6 months nNO level for patients who received bilateral endoscopic sinus surgery. They were classified according to existence of nasal polyps (NPs) and allergy test. Subjective symptoms were provided as Sino‐Nasal Outcome Test‐22 (SNOT‐22) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Associated medical parameters were analyzed.Results:Fifty‐four patients completed the follow‐up, including 16 CRS without NPs (CRSsNPs) and 38 CRS with NPs (CRSwNPs). Allergic patients had higher preoperative nNO level (P =. 042), but existence of NPs didn't make any difference. The nNO level correlated well with computed tomography score (P =. 001), endoscopy score (P <. 001), and current smoking (P =. 038). Baseline nNO correlated with postoperative 3‐month improvement in nose blowing (P =. 029) and nasal discharge (P =. 007) in CRSwNPs. In nonallergic patients, higher baseline nNO had better improvement in olfaction (P =. 039) and nasal discharge (P =. 035). Postoperative 3 month nNO change had significant correlation with improvement of olfaction only in CRSwNPs (P =. 036). The nNO change in postoperative 6 month had no correlation with any individual symptom score change in either group.Conclusions:Baseline nNO was significantly correlated to some of the symptom improvements in CRSwNPs and nonallergic group within 3 months postoperatively. Postoperative 3 month nNO change related to olfaction improvement in CRSwNPs group; however, no significant correlation could be detected in the 6‐month period after surgery.
Correlation between Rhinomanometry and NOSE Scale and Measurement of Therapeutic Success in Nasal Obstruction
Authors: Sánchez Hugo Lara , Álvarez Nuño Candelas , Sañudo Elisa Gil‐Carcedo , Iscar Agustín Mayo , Valdezate Luis Ángel Vallejo , María Luis 
Published: September 2014

Objectives:Active anterior rhinomanometry (AAR) and the Nasal Obstruction Symptom Evaluation (NOSE) scale are instruments for measuring nasal obstruction (NO). The study aimed to measure therapeutic success in the patients with NO by AAR and NOSE scale and establish the correlation between AAR and NOSE scale and between NOSE scale and visual analogue scale (VAS).Methods:Cohort study of patients with NO, on whom we performed an AAR, the NOSE scale, and the VAS at baseline and after medical treatment (topical nasal steroid) or surgery (septoplasty, turbinoplasty, or septoplasty and turbinoplasty). The nasal flows obtained by the AAR and the score of both subjective scales (NOSE and VAS) were compared and analyzed.Results:A total of 102 patients were included in the study. Surgical treatment resulted in statistically significant differences with AAR and the subjective scales (P =. 0001). In patients with medical treatment there was an increase in the AAR nasal flow but without statistical significance (P =. 1363). The correlation between the AAR, the NOSE scale, and VAS was measured, removing the effect of the intervention, finding only a strong correlation between the NOSE scale and VAS (r =. 83327).Conclusions:There is a higher treatment success in patients treated surgically. There is no significant correlation between AAR and NOSE scale and VAS. This is considered because the AAR and subjective scales are complementary and they measure different aspects of NO. Therefore, the AAR and the NOSE scale are helpful instruments to be used together for the diagnosis of NO and to measure objective therapeutic success and the feeling of satisfaction by the patient.
Cytologic and Functional Alterations of Nasal Mucosa in Smokers: Temporary or Permanent Damage?
Authors: Pagliuca Giulio , Rosato Chiara , Martellucci Salvatore , De Vincentiis Marco , Fusconi Massimo , De Virgilio Armando , Gallo Andrea 
Published: September 2014

Objectives:(1) Quantify the changes in the number of ciliated cells, ciliary beat frequency, and mucociliary transport of the nasal mucosa in smokers. (2) Evaluate if these cytologic and functional changes in smokers are permanent or reversible after smoking cessation.Methods:Ninety healthy volunteers recruited from the staff of A. Fiorini Hospital, Sapienza University of Rome, were enrolled in this study from September 2013 to January 2014. Volunteers were divided into 3 groups (smokers, nonsmokers, and ex‐smokers) composed of 30 subjects each. Cytological features of nasal mucosa and effectiveness of nasal mucociliary clearance were studied focusing on 4 parameters: 1) ratio between the number of ciliated cells and mucous‐secreting cells analyzed through microscopic observation of nasal scraping specimens; 2) in vitro evaluation of ciliary motility; 3) survival time of the ciliated cells analyzed by phase‐contrast microscopy; 4) nasal mucociliary clearance assessed by saccharin transit time test.Results:All parameters are significantly reduced in the group of smokers compared to the nonsmokers (P <. 05). However, there are no statistically significant differences between the nonsmoker and ex‐smoker groups (P >. 05).Conclusions:Cigarette smoking causes cytological modifications of nasal mucosa that influence the effectiveness of mucociliary clearance. Our study, although preliminary and conducted on a limited number of cases, suggests that these changes are not permanent and that nasal mucosa of ex‐smokers would recover normal cytologic and functional features.
Endoscopic Approach to Greater Palatine Artery to Control Recurrent Anterior Epistaxis
Authors: Butrymowicz Anna , Pinheiro‐Neto Carlos , Weisstuch Adam , Agarwal Jay 
Published: September 2014

Objectives:(1) Describe the anatomy of the incisive foramen. (2) Describe the endoscopic approach to the greater palatine artery. (3) Recognize the importance of the greater palatine artery as a cause of recurrent anterior epistaxis.Methods:Cadaveric and radiographic study of the incisive foramen; illustrative case series. Seventy computed tomography (CT) scans were reviewed, and measurements were made of the incisive foramina's distance to the anterior nasal spine and subnasale. An endoscopic approach to the incisive foramen was completed in 20 cadavers, and measurements of the distance from the anterior nasal spine to the incisive foramen were documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery.Results:Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Cadaveric measurements preliminarily correspond to radiographic measurements.Conclusions:Endoscopic cauterization of the greater palatine artery is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Preoperative evaluation of a CT scan can help aid a surgeon in determining the relative contribution of the greater palatine artery to the anterior septal blood supply, and guide surgical approach to control recurrent anterior epistaxis. Our case series corroborates the above.
Case Series and Systematic Review of IgG4‐Related Diseases in the Head and Neck
Authors: Mulholland Graeme B. , Jeffery Caroline C. , El‐Hakim Hamdy , Cote David 
Published: September 2014

Objectives:Immunoglobulin G4‐related disease (IgG4‐RD) is a poorly understood chronic inflammatory disorder affecting the middle aged and elderly that can present to the otolaryngologist. We aim to summarize the current literature by performing a systematic review as well as describe our institutional experience with 8 patients.Methods:Our search used Pubmed, Ovid, and Scopus using the keywords IgG4 related disease, head and neck, orbit, salivary glands, sialadenitis, Kuttner, angiocentric eosinophilic fibrosis, submandibular, lacrimal, thyroid, dacryoadenitis, nasal, sinus, paranasal, and Mikulicz's. Original research and review articles published in English from 1964 to 2013 whose major topic was IgG4‐RD affecting the head and neck were included. Data regarding the various presentations and management of IgG4‐RD were summarized. Additionally, we present our own experience with a series of 8 patients diagnosed with this condition.Results:One hundred twenty‐four articles met our inclusion criteria. IgG4‐RD most often presents as a mass lesion in the head and neck region. Common diagnostic features include: (1) elevated serum IgG4 level, (2) marked infiltration of exocrine glands by IgG4‐positive plasma cells with fibrosis, and (3) marked improvement with corticosteroid therapy. Early diagnosis and involvement of rheumatology is important in management.Conclusions:IgG4‐RD is a challenging nonsurgical disease that has multiple manifestations in the head and neck. It must be distinguished from various mimics including malignancy, systemic diseases, and infectious. Otolaryngologists should be aware of this condition and its management.
Exclusive Endoscopic Resection of Juvenile Nasopharyngeal Angiofibroma: A Systematic Review of the Literature
Authors: Khoueir Nadim P. , Nicolas Nicolas , Rohayem Ziad , Haddad Amine , Abou Hamad Walid M. 
Published: September 2014

Objectives:Systematically review the exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma in the literature in order to define the clinical features in terms of staging and the treatment outcomes in terms of bleeding, recurrence, residual tumor, and complications.Methods:Literature was searched by 2 reviewers in online databases including PubMed and Embase with the following inclusion criteria: English or French language and exclusive endoscopic treatment of juvenile nasopharyngeal angiofibroma. Reference sections of identified studies were examined for additional articles. We were only able to perform a meta‐analysis on the categorical outcomes using DerSimonian and Laird random effects models.Results:Ninety‐two studies were included with a majority of retrospective studies (54/92; 58.6%). No randomized controlled trials were found. A total of 821 patients were identified. The Radowski classification was the most commonly used (29/92; 31.15%). The mean operative blood loss was 564.21 mL (Min = 20 mL; Max = 1482 mL). It was 414.6 mL (Min = 20 mL; Max = 1000 mL) and 774.2 mL (Min = 228 mL; Max = 1482 mL) respectively in the group with and without embolization. No conclusion could be taken because it was not stratified by tumor stage and because of the absence of randomized controlled trials. The random effect estimate of recurrence was 10% (95% confidence interval, 0.083‐0.117). It was 9.3% (95% confidence interval, 0.072‐0.115) for complications and 7.7% (95% confidence interval, 0.054‐0.101) for residual tumor.Conclusions:Endoscopic treatment is an evolving modality. It is considered today as the treatment of choice. A new classification system based on the endoscopic approach should be proposed in future studies.
Fungal Sinusitis: Fact or Fiction?
Authors: Katzer Cara M. , Bhalla Vidur , Horvat Rebecca T. , Tawfik Ossama W. , Beahm D. David , Robinson Ann B. , Hoover Larry A. 
Published: September 2014

Objectives:Participants should be able to: (1) Recognize chronic fungal sinusitis based on clinical examination and radiologic imaging; (2) Analyze the implications of nasal flora contents in suspected chronic fungal sinusitis patients; and (3) Implement surgical and medical treatment of chronic fungal sinusitis.Methods:A retrospective review of the senior author's patients from 1990 to 2014 was completed in which 50 immunocompetent patients thought to have evidence of fungal sinusitis were identified by the following criteria: Classic “high density” material seen on computed tomography (CT), fungal mycelium seen at surgery/fungal smears, and “Fig Newton” material visualized endoscopically in sinuses. Endoscopic surgery was performed on patients with emphasis to widely open sinuses and trim turbinates, allowing postoperative access to affected areas. Intraoperatively, material from sinus cavities was sent for microbiological and pathological analysis. Postoperatively, patients used saline irrigations to remove debris and potent topical steroids to reduce mucosal reactivity and edema. Antifungal agents were not employed. Regular debridements were carried out in the clinic until healing was complete.Results:Fungus was present in 29% of cultures/smears, while staphylococcus, pseudomonas, and other organisms were present in 44%. Nasal sinus mucosa returned to normal appearance in the majority of patients with topical treatment. Some patients with a strong allergy history had persistence of hypertrophic mucosa. A pulsed course of oral prednisone generally resolved this.Conclusions:Wide surgical drainage of affected sinus areas in combination with saline/acetic acid irrigations and topical steroids were successful in nearly all patients without the use of antifungal agents.
Health‐Related Quality of Life and Its Contributory Factors in Allergic Rhinitis Patients in Nigeria
Authors: Adebola Stephen O. , Abidoye Babatunde , Ologe Foluwasayo E. , Adebola Oyebola E. , Oyejola Benjamin A. 
Published: September 2014

Objectives:(1) Determine the health‐related quality of life (HRQoL) in allergic patients. (2) Identify contributory factors to patient well‐being.Methods:Cross‐sectional study by multistage sampling from October, 2013, to January, 2014. Kwara state has 16 local government areas with 3 senatorial districts, total land mass of 36,825 km2 with population of 2,591,555. Subjects: 132 consenting adults; 66 had allergic rhinitis (AR) using Score for Allergic Rhinitis (SFAR) instrument, and 66 were age‐ and sex‐matched controls. (χ2 = 0, df = 1, P = 1 and χ2 2 = 1.24, df =2, P =. 54, respectively). Information on HRQoL was obtained using the 14‐parameter mini Rhinoconjuctivitis Quality of Life questionnaire (mRQOL). Socio‐demographic variables possibly contributory to patient's well‐being were obtained. Analysis of variance and T test were used to compare means.Results:The overall Total Symptom Score (TSS) was 3.37 ± 0.9, while male and female allergic patients and control TSS were 3.61 ± 1.0; 3.16 ± 0.8, and 0.98 ± 0.2; 0.95 ± 0.2, respectively. Effects of sex, marital status, senatorial districts, residential area, and duration of symptoms had significant impact on quality of life. The highest correlation between the components of the mRQOL questionnaire existed between eye problems and other symptoms (P =. 703).Conclusions:AR had appreciable impact on HRQoL of the participants. Sex, marital status, senatorial districts, residential area, and duration of symptoms were major identifiable contributory factors to patient well‐being. We recommend prompt diagnosis and management as appropriate.