bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypoxia Increases Epithelial Permeability in Human Nasal Epithelia
Authors: Chung Hyo Jin , Min Hyun Jin , Kim Da Hee , Kim Chang‐Hoon 
Published: September 2014

Objectives:The nasal mucosa is the first site that encounters pathogens and forms continuous barriers to various stimuli. Here, we studied the effect of hypoxia on barrier function in normal human nasal epithelial (NHNE) cells. The expression levels of various junction complex proteins were assessed in hypoxia‐stimulated NHNE cells and human nasal mucosal tissues.Methods:We performed real‐time polymerase chain reaction analysis, western blotting, and immunofluorescence assays to examine differences in the mRNA and protein expression of ZO‐1 and E‐cadherin in NHNE cells. Moreover, we evaluated the transepithelial resistance (TER) of NHNE cells after hypoxic stimuli to check for changes in permeability. The expression of ZO‐1 and E‐cadherin was measured in human nasal mucosa samples by western blotting.Results:Hypoxia time‐dependently decreased the expression of ZO‐1 and E‐cadherin at the gene and protein levels. We also found that hypoxia decreased the TER of NHNE cells, which indicated increased permeability. Human nasal mucosa samples, which are supposed to be hypoxic, showed significantly decreased levels of ZO‐1 and E‐cadherin expression compared to control.Conclusions:Our results demonstrate that hypoxic condition in the nasal cavity, which can occur because of natural ostium obstruction, alters the expression of junction complex molecules and increases epithelial permeability in human nasal epithelia. This suggests that hypoxia is a major pathogenic mechanism of rhinosinusitis through its effect of deteriorating barrier function.
Increased Intracranial Pressure in Spontaneous CSF Leak Patients Is Not Associated with Papilledema
Authors: Aaron Geoffrey , Vaphiades Michael , Riley Kristen , Doyle Jennifer , Woodworth Bradford A. 
Published: September 2014

Objectives:Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks.Methods:Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1‐year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure was measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema.Results:Sixteen patients (avg. age 52 years) were evaluated. Obesity was present in 94% of individuals (avg. BMI 43.5; range, 27‐65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.7 cmH20 (P <. 001). IIH controls (avg. age 33 years, avg. BMI 36.7, 22‐52) exhibited average ICP (36 ± 10.5) identical to post‐clamp measurements in the spontaneous CSF leak cohort.Conclusions:Subjects with spontaneous CSF leaks had post‐clamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.
Long‐term Low‐Dose Doxycycline for Difficult‐to‐Treat Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago , Soter Ana C. , Pezato Rogerio , Pinna Fabio , Bachert Claus , Van Zele Thibaut , Voegels Richard L. 
Published: September 2014

Objectives:Assess the clinical outcome of long‐term low‐dose oral doxycycline in difficult‐to‐treat chronic rhinosinusitis with polyps.Methods:We conducted an open label prospective study in a university‐based tertiary care center from 2013 to 2014 with 60 patients with difficult‐to‐treat chronic rhinosinusitis with nasal polyps uncontrolled after 6 or more months of endoscopic sinus surgery. They were divided into 2 groups: 28 patients received nasal steroids plus doxycycline (200 mg on the first day, followed by 100 mg once daily) for 12 weeks while 32 patients received only nasal steroids. The main outcome measure was a meaningful improvement in SNOT‐20 (>0.80). Other outcome measures were the SNOT‐20, NOSE, and Lund‐Kennedy scores. The following parameters were also analyzed: asthma, rhinitis, DREA and blood testing before treatment for IgG, IgA, IgE, IgM, antineutrophil cytoplasmic antibodies, and blood eosinophil count.Results:There was a statistically significant association among meaningful improvement in SNOT‐20 and doxycycline treatment [50.0% (14/28) vs 9.4% (3/32), P =. 01]. The patients who received doxycycline also showed a statistically significant outcome in SNOT‐20 (P =. 002), NOSE (P =. 046), and Lund‐Kennedy (P =. 004). The group who presented a clinically significant improvement of SNOT‐20 also presented better outcomes on SNOT‐20 and NOSE scores (P =. 001),and almost statistically significant on Lund‐Kennedy (P =. 07). The presence of asthma (P =. 006), aspirin‐exacerbated respiratory disease (AERD; P =. 018), and raised serum IgE (P <. 035) were associated with a worse prognosis after treatment.Conclusions:These findings suggest that doxycycline may have a beneficial role in chronic rhinosinusits with polyps, particularly in patients without high levels of IgE, asthma, and AERD.
Medical Treatment of Traumatic Anosmia
Authors: Jiang Rong‐San 
Published: September 2014

Objectives:Study the effects of zinc and steroid in the treatment of traumatic anosmia.Methods:Patients with a clear history of complete loss of smell after head injury were collected from January 2010 to May 2013. All patients received phenyl ethyl alcohol threshold test, and those whose thresholds were –1 were included in this study. They were randomly divided into 4 groups. Patients in group 1 were treated with zinc sulfate (15mg tid) for a month and high dose prednisolone (1 mg/kg per day) with tapering for 2 weeks. Those in group 2 only took zinc, and those in group 3 only took prednisolone. Patients in group 4 did not take any medicine. All patients were followed up by phenyl ethyl alcohol threshold test to find whether their olfactory function improved and had magnetic resonance imaging to measure the volume of olfactory bulbs.Results:There were 145 patients completing the study. Thirty‐nine belonged to group 1, 34 to group 2, 35 to group 3, and 37 to group 4. Olfactory function improved in 11 patients (28.2%) who took prednisolone and zinc, in 9 (25.7%) who took zinc, in 4 (11.8%) who took prednisolone, and in 1 (2.7%) who did not take any medicine. The olfactory improvement rates of groups 1 and 2 are significantly higher than that of group 4. The volume of olfactory bulbs is not significantly different between those with and without improved olfactory function.Conclusions:Our results show that zinc has good effect in treating traumatic anosmia.
Olfactory Improvement and Decline in Patients with Posttraumatic Olfactory Dysfunction
Authors: Kuo Chin‐Lung , Fan La‐Yuan , Shiao An‐Suey , Shu Chih‐Hung 
Published: September 2014

Objectives:Identify the prognosis for patients with post‐traumatic olfactory dysfunction.Methods:From 2007 to 2013, patients with posttraumatic olfactory dysfunction were enrolled. The threshold, discrimination, and identification (TDI) score of Sniffin’ Sticks test was ≤15 for anosmia, ≥30 for normosmia, and between these values for hyposmia. Olfactory improvement/decline was defined as an increase/decrease in TDI score ≥ 6 points. The cumulative incidence rates of olfactory improvement and decline were calculated using the Kaplan‐Meier method. Variables with a potential impact on olfactory changes were entered into Cox regression analysis. The correlation between the TDI scores of the first and last visit was evaluated.Results:We included 80 patients with an average 9.4‐month follow‐up period (range, 1‐52 months). The 12‐month cumulative rates of olfactory improvement and decline were 8.4% and 11.8%, respectively. Anosmia, hyposmia, and normosmia were noted in 71.2%, 27.5%, and 1.2% of the patients at the first visit and 72.5%, 23.8%, and 3.8% at the last visit (Fisher's exact, P =. 583). Multivariate analysis revealed no associations between clinical predictors and olfactory changes (all P >. 05). A positive correlation between the TDI scores of first and last visit (Spearman test, Rho = 0.532, P <. 001) confirmed the absence of significant changes in olfaction.Conclusions:Posttraumatic olfactory dysfunction was associated with a lower risk of decline in olfaction and a lower likelihood of improvement. Although most patients maintained a stable disease status, anosmia in the majority of patients may reflect a poor prognosis in olfactory recovery for patients with head trauma.
Characterization of Contemporary Otolaryngology‐Specific Emergency Room Care at the Massachusetts Eye and Ear Infirmary
Authors: Sethi Rosh K. V. , Kozin Elliot D. , Remenschneider Aaron K. , Lee Daniel J. , Gray Stacey T. , Shrime Mark G. , Gliklich Richard E. 
Published: September 2014

Objectives:(1) Characterize contemporary utilization patterns of a stand‐alone otolaryngology emergency room (ER). (2) Assess the range of otolaryngologic complaints. (3) Determine characteristics of patients that require inpatient admission. (4) Provide a practical discussion about the utility of a specialized ER in otolaryngologic care.Methods:Retrospective review of demographic and diagnostic data for all patients with an otolaryngologic complaint evaluated at our institutions ER from January 2011 through September 2013. Descriptive analysis was performed to characterize utilization and diagnostic patterns. Multivariable regression modeling was used to identify predictors of inpatient admission. Geocoding analysis was performed to characterize the ER catchment area.Results:A total of 12,234 patient visits were evaluated. Mean patient age was 44.7 years with equal sex distribution. The majority of visits occurred during daytime hours (75%) with peak volume occurring mid‐day. Auditory and vestibular problems constituted the most frequent presenting complaints (50.0%). The majority of patients were discharged home (92.3%). Significant predictors of inpatient admission were pediatric designation (odds ratio [OR] 1.9, P <. 0001), male sex (OR 1.3, P <. 0001), arrival overnight (OR 3.3, P <. 0001), postoperative complaint (OR 7.3, P <. 0001), and laryngeal complaint (OR 2.4, P <. 0001). Median distance traveled was 9.6 miles. Patients traveled farther for evaluation of hearing loss (11 miles) and less far for common diagnoses including impacted cerumen (7.1 miles; P <. 0001).Conclusions:This study provides a contemporary analysis of patterns of specialized otolaryngology ER care in the United States. This study has broad implications for otolaryngology care and resource utilization in the emergency care setting.
Prosthetics for Nasoseptal Perforation Repair: A Systematic Review
Authors: Taylor Robert J. , Kern Eugene B. , Sherris David A. 
Published: September 2014

Objectives:Prosthetics—including buttons and other obturators serve as an option for nasoseptal perforation repair in patients who have active systemic disease, are poor surgical candidates, or wish to avoid surgery. By systematically reviewing the literature on prosthetics for nasoseptal perforation repair, the objective of the present study is to critically appraise previous studies, provide evidence‐based guidelines for nasoseptal prosthetic use, and identify areas for further investigation.Methods:The Cochrane Controlled Trials Register, EMBASE, PubMed, and Web of Science were queried for relevant articles published from 1965 to 2013. Articles were selected for inclusion if they presented primary data for human nasoseptal perforation treatment utilizing prosthetic materials. The reference lists of included articles were searched for additional studies. Each included article's level of evidence was identified and grades of recommendation were assigned.Results:The search yielded 4756 abstracts for review, with 23 case series and 5 case reports meeting inclusion criteria. A total of 706 cases of prosthetic nasoseptal perforation repair were identified, with a case series median n = 20. All articles provided level 4 evidence, with an overall conclusion grade of C for improvement in nasoseptal perforation symptoms, prosthetic in situ rate, and complication rate.Conclusions:The literature provides considerable level 4 evidence for the efficacy and safety of prosthetics for nasoseptal perforation repair with success rates of 33% to 100% and minimal complications: only 1 fungal infection and 9 unspecified infections in 706 cases. The disease‐ and prosthetic‐specific factors influencing symptom improvement and prosthetic tolerance require additional study for further elucidation.
Role of IL‐5 and IL‐8 in the Pathogenesis of Nasal Polyps
Authors: Rosato Chiara , Pagliuca Giulio , Martellucci Salvatore , De Vincentiis Marco , Di Cristofano Claudio , Cerbelli Bruna , Gallo Andrea 
Published: September 2014

Objectives:(1) Evaluate the histopathological and immunohistochemical characteristics of different types of nasal polyps. (2) Quantify the expression of IL‐5 and IL‐8 in 2 different histotypes of nasal polyps in order to evaluate the role of these cytokines in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP).Methods:This retrospective study was conducted on 44 specimens collected from nasal cavities of 44 patients with nasal polyposis who underwent functional endoscopic sinus surgery at the ENT University Unit of the A. Fiorini Hospital, Sapienza University of Rome, from January 2009 to January 2011. The specimens were analyzed at the histopathology unit of the university and divided into 2 groups according to their dominant histological features: Group A (polypoid mucosa and eosinophilia, 34 subjects) and Group B (polypoid mucosa associated with glandular hyperplasia, 10 subjects). Expression of IL‐5 and IL‐8 were analyzed on the specimens using immunohistochemical techniques. The same tests were run on nasal mucosa specimens drawn from 10 patients without sinusitis (control group).Results:IL‐5 expression was significantly more expressed in Group A than in Group B (P <. 05). Both IL‐5 and IL‐8 expressions were significantly more expressed in Groups A and B compared to the control group (P <. 05). No significant difference was found in the expression of IL‐8 between the 2 groups.Conclusions:The outcomes of this preliminary study suggest that IL‐8 may play a role in the pathogenesis of both histological subtypes of nasal polyps, whereas IL‐5 predominates in the eosinophilic subtype.
SNOT‐22 in a Control Population
Authors: Erskine Sally , Philpott Carl M. 
Published: September 2014

Objectives:This analysis uses data from the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim of CRES is to determine factors which influence the onset and severity of chronic rhinosinusitis (CRS). Sino‐Nasal Outcome Test (SNOT‐22) is a widely used score for nasal symptoms in many ENT clinics internationally, although there are few data characterizing SNOT‐22 scores for a normal population. The aim of this analysis is to establish a dataset of normal values for SNOT‐22 in a British population.Methods:Study‐specific questionnaires including demographic and socioeconomic factors and past medical history as well as SNOT‐22 and SF‐36 were distributed to patients with CRS attending ENT clinics and to a control population across several centers in the United Kingdom. This analysis considered just the control population. Controls had no self‐reported nasal problems in the past, no chronic conditions undergoing active treatment, and no hospital admissions in the preceding 12 months.Results:A total of 1529 participants were recruited; 57 with AFRS (allergic fungal rhinosinusitis), 659 CRSwNP (with nasal polyps), 577 CRSsNP (without nasal polyps), and 236 controls. Age range was 18 to 98 years. Two hundred thirteen controls included sufficient information to calculate SNOT‐22 score. Score range was 0 to 85; median 9, mean 13.4.Conclusions:SNOT‐22 is an important tool for measuring the impact of nasal symptoms and evaluating effectiveness of treatments. Data for a large population without nasal problems will be invaluable in both clinical and academic settings. Further analysis will characterize SNOT scores for different types of CRS and subgroup analysis of different elements of SNOT‐22.
Spontaneous Cerebrospinal Fluid Rhinorrhea: Correlation with Body Weight and Radiological Data
Authors: Karkas Alexandre , Attye Arnaud , Righini Christian A. , Schmerber Sebastien , Quatre Raphaelle 
Published: September 2014

Objectives:Search for correlations between spontaneous cerebrospinal fluid rhinorrhea (SCSFR) and overweight/obesity and imaging data.Methods:Retrospective study of patients with SCSFR operated in a tertiary center (1993‐2013). A 2‐sided test was used for statistics.Results:There were 17 patients with SCSFR: 9 females/8 males; mean age 45 years (range, 3‐84 years). Abnormalities on computed tomography (CT) were: bone defect (12), sinus opacity (11). Abnormalities on magnetic resonance imaging (MRI): continuity with meninges (7), meningocele (6), empty sella (6), dilation of optic nerve sheath (6), pneumocephalus (1). Patients underwent endoscopic closure of osteo‐meningeal defect with fat. Primary success rate was 13 out of 17 (76.5%). Regarding body mass index (BMI), 12 patients out of 17 (70.6%) were overweight (BMI ≥25) versus 32% in the French general population (P =. 001). Among patients with SCSFR and overweight, 3 out of 12 (25%) were obese (BMI ≥30) versus 15% in overweight individuals (P =. 483). Increased pneumatization of sinuses was observed in 15 out of 17 (88%) versus 35% in the general population (P =. 00009). Empty sella was found in 6 out of 17 (35.3%) versus 5.5% in the general population (P =. 0002). Dilation of optic nerve sheath was observed in 6 out of 17 (35.3%) versus 10% in the general population (P =. 0047).Conclusions:We found statistically significant correlations between SCSFR and overweight individuals, increased pneumatization of sinuses, empty sella, and dilation of optic nerve sheath, but not with obesity. This could be due to the small number of patients in this study and a weak statistical power for obesity. The 2‐sided test is ideal for small samples of patients, but a greater number is needed in the future to confirm these preliminary results.
Ablation‐Assisted Uvulapalatopharyngoplasty Technique for OSAS Treatment: A 5‐Year Follow‐up Study
Authors: Xiao Mang 
Published: September 2014

Objectives:Determine the long‐term outcome of patients suffering from obstructive sleep apnea syndrome (OSAS) treated by ablation‐assisted uvulapalatopharyngoplasty.Methods:Seventy‐five subjects were included between 2005 and 2007. All patients suffered from moderate or severe OSAS. They were treated by radiofrequency volumetric tissue reduction (RFVTR) of the palatopharyngeal abnormal tissues (including tonsillar RFVTR or tonsillectomy), the advance of palatopharyngeal arch after the dissection of palatopharyngeal vault, and the inferior one‐third of the palatine velum interspace. Polysomno‐graphy (PSG), snoring (assessed on a 10cm visual analog scale [VAS]), marital status, and presence of cardiovascular risk factors or pathologies were evaluated by postal questionnaire.Results:Mean follow‐up time was 5.3 ± 1.3 years. Mean snoring intensity decreased significantly in the immediate postoperative period (8.1 ± 2.9 to 3.5 ± 2.2 cm on VAS). Over the longer term, however, we observed a slight increase in snoring intensity (3.7 ± 2.9 cm) (P >. 05). PSG monitoring, RDN (344 ± 38), apnea‐hypopnea index (AHI; 59 ± 10), obstructive sleep apnea time (OSAT) (35 ± 13)s, longest obstructive apnea time (LOSAT) (87 ± 26)s, and the mean arterial pressure (145 ± 14) mm Hg in OSAS decreased significantly in the immediate postoperative period (P <. 01). Over the longer term, however, we observed a slight increase in PSG monitoring result (P >. 05) but still better than before surgery (P <. 01). Hypertension and diabetes were diagnosed during follow‐up in 12.1% and 6.6% of the subjects, respectively. A minority of patients failed to undergo repeat polysomnography.Conclusions:Ablation‐assisted uvulapalatopharyngoplasty is highly effective in the treatment of OSAS. Expected scar formation, enlarged nasopharyngeal and oropharyngeal cavity, reduction of the uvula and lateral pharyngeal bands may contribute to these good success rates.
Drug‐Induced Sleep Endoscopy Informs Management of Obstructive Sleep Apnea after Incomplete Mandibular Advancement Device Response
Authors: Kent David T. , Soose Ryan J. 
Published: September 2014

Objectives:(1) Understand that half of obstructive sleep apnea (OSA) patients failing positive airway pressure (PAP) attempt mandibular advancement device (MAD) therapy but still suffer from residual disease. (2) Describe how drug‐induced sleep endoscopy (DISE) evaluates anatomical patterns of obstruction under conditions that mimic sleep and aids management in patients with incomplete response to MAD.Methods:A review of 35 consecutive adult OSA patients, with continuous positive airway pressure intolerance and incomplete response to MAD therapy (apnea‐hypopnea index [AHI] >15 or AHI >5 with persistent subjective symptoms), who underwent DISE with and without the MAD between 12/2010 and 8/2013. Data collected included demographics, body mass index (BMI), Epworth Sleepiness Score (ESS), polysomnography data, and management decisions after DISE. Each DISE video was retrospectively scored using the VOTE classification system by the same blinded reviewer (R.J.S.).Results:All patients had multilevel airway obstruction during baseline DISE. 32 (91.4%) obstructed in the velopharynx despite MAD use. 26 (74.3%) patients were recommended to undergo targeted surgery based on DISE findings with 21 (60%) completing it. Nineteen (54.3%) underwent additional medical therapy such as MAD or PAP adjustment. Twelve (34.3%) were treated with surgical and medical therapy. Subjective and objective outcomes were significantly improved in 15 patients with outcome data currently available (mean AHI 39.3 to 10.7, P <. 01; ESS 11.2 to 6.25, P <. 01).Conclusions:In patients with incomplete response to MAD therapy, DISE with and without the MAD provides informs management decisions regarding additional medical or surgical options to augment the effectiveness of the MAD.