bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can CT Scans Predict Need for Septoplasty in Sinus Surgery?
Authors: Walden Ashley , Choudhury Natasha , Parvizi Nassim , Marais Joe 
Published: February 2015

Objective1) Ascertain whether CT findings correlate with surgical need for access septoplasty during endoscopic sinus surgery. Evaluated due to risk of litigation from patients not consented for septoplasty who require it, despite having a “straight septum” on CT. 2) Establish whether site of septal deviation affects the requirement for septoplasty.MethodWe retrospectively studied 129 endoscopic sinus surgery procedures. The preoperative CT report was recorded. Blinded to the report, 2 independent observers commented on evidence and site of septal deviation and predicted the need for access septoplasty. The operative notes were used to record the surgical outcome.ResultsSeptal deviation was reported by radiologists in 57 of the 129 patients (44%). Both observers agreed on septal deviation being present in 85 patients (66%). Thirteen of 87 patients who were predicted not to need access septoplasty underwent the procedure (15%). A confidence interval (CI) of 95% gives a range of 9%‐24% for patients undergoing access septoplasty who were predicted not to. Eight of 72 patients who had no septal deviation reported on CT underwent access septoplasty (11%). A CI of 95% gives a range of 5%‐21%. The most common site of septal deviation requiring septoplasty was antero‐medial (33%).ConclusionCT scans cannot always be used to reliably predict the need for access septoplasty. Preoperative clinical examination is the gold standard for assessment. Therefore, patient consent should include that for septoplasty to decrease the chance of litigation should complications of septoplasty occur.
Clinical Relevance of IL‐17 during SLIT on AR to HDM
Authors: An Soo‐Youn , Wee Jee Hye , Kim Dong Kyu , Han Doo Hee , Lee Chul Hee , Min Yang‐Gi , Rhee Chae‐Seo 
Published: February 2015

ObjectiveTo investigate the clinical relevance of serum IL‐17 levels in AR patients treated with sublingual immunotherapy (SLIT) to identify the function of TH17 cells and IL‐17 in AR.MethodThe patients with AR to HDM starting to receive SLIT in Seoul National University Hospital between June 2008 and August 2010 were enrolled. We detected serum IL‐17 levels via ELISA before and 1 and 2 years after starting SLIT. Symptom diaries, rescue medication use, and other immunological parameters were analyzed.ResultsLonger onset of symptoms and moderate to severe symptoms were significantly related to higher serum IL‐17 levels before starting SLIT. HDM‐specific IgE significantly increased between the baseline and the first year of SLIT, while HDM‐specific IgG4 had no significant change. There was a significant positive correlation between serum ECP and IL‐17 levels during SLIT. The changes of serum IL‐17 and total IgE levels for 1 year had an inverse relationship with the effectiveness of SLIT. Changed serum IL‐17 levels at the first year was the most significant factor in relation to the effectiveness of SLIT by multivariate analysis.ConclusionSerum IL‐17 levels in AR correlated with duration from symptom onset, symptom severity, and serum ECP levels. Changes of serum IL‐17 levels during SLIT are expected to be a prognostic factor to predict the effectiveness of SLIT. Thus, IL‐17 and TH17 cells might have an important role in AR pathogenesis.
Cost Analysis of Approaches to the Anterior Skull Base
Authors: Kroeker Andrew , Raza Syed N. , Kahn Adam , Marentette Lawrence J. , McKean Erin M. 
Published: February 2015

ObjectiveTo ascertain 1) the cost‐effectiveness and 2) short‐term outcomes of endoscopic endonasal cribriform resection in comparison to open/subcranial approaches.MethodRetrospective cohort study reviewing consecutive patients (2008‐2011) undergoing primary surgical treatment for cribriform malignancies via endoscopic or open/subcranial approaches. All patients were reviewed to ensure feasibility of endoscopic approach. Outcomes based on complications and length of stay were reviewed, and cost to society was analyzed using QALYs. Sensitivity analyses were performed.ResultsEight patients were treated for cribriform malignancies, 4 with an endoscopic endonasal approach, and 4 with an open surgical approach. The mean length of hospitalization following the first surgery did not differ significantly between the 2 groups (5.25 days endoscopic vs 5.5 days open; P =. 92). Differences were seen in blood loss and length of surgery, but neither were statistically significant (blood loss: 275 mL endoscopic vs 1200 mL open; P =. 27; and length of surgery: 314 min endoscopic vs 394.5 min open; P =. 33). Costs of each surgical intervention and associated follow‐up and specialized care appear equivocal.ConclusionEconomic evaluations are the mainstay for determining cost effectiveness of an intervention, and this is the first such evaluation for endoscopic skull base surgery for anterior cribriform tumors. Though differences between the 2 approaches seem equivocal, this is likely due to the few patients who have received this intervention.
DuraSeal™ in Endoscopic Repair of Cerebrospinal Fluid Leak
Authors: Yelverton Joshua C. , Vyas Priyam K. , DiNardo Laurence J. 
Published: February 2015

Objective1) Review use of DuraSeal (Confluent Surgical, Waltham, MA) as sealant in the primary repair of spontaneous cerebrospinal fluid (CSF) leaks and in secondary repair following transspehnoidal pituitary surgery for persistent leak. 2) Compare success and postoperative course of DuraSeal to fibrin glues in our patients and in the literature.MethodA database of endoscopic cerebrospinal fluid leak repairs was created by retrospective review of the operative log from 1999 to 2012 at a tertiary care hospital. Operative reports and postoperative hospital records were collected and analyzed for type of repair and CSF leak recurrence.ResultsNine cases were identified in which DuraSeal was used as a dural sealant during endoscopic CSF leak repair for spontaneous leak or in secondary repair of CSF leaks following previous transsphenoidal pituitary surgery. There was no recurrence of CSF leak in any patients in which DuraSeal was used in the repair. The average follow‐up was 21 months (range 1 to 53 months). There were no complications from the use of DuraSeal. A similar group of 7 patients in whom fibrin glue was used noted 1 repair failure (14.3%) with a 32‐month average follow‐up.ConclusionThe use of DuraSeal to strengthen CSF leak repair and form a watertight seal was successful in 100% of reported cases and had no adverse events related to its use. This report of 9 patients would be the largest to date where DuraSeal was used in this manner.
Effects of Sinus Surgery on Sinusitis Evaluated by SNOT20
Authors: Tan Guolin , Ma Yanhong 
Published: February 2015

ObjectiveTo explore the therapeutic effects of endoscopic sinus surgery on symptoms and quality of life of patients with chronic rhinosinusitis and nasal polyps (CRSP).MethodA survey of symptoms and quality of life was conducted using Sino‐Nasal Outcome Test‐20 (SNOT‐20) questionnaire in 76 patients before and after endoscopic sinus surgery. The overall effect of endoscopic sinus surgery on CRSP was subjectively self‐evaluated by patients.ResultsAfter 6 months follow‐up, the total SNOT‐20 score of patients was significantly decreased from the baseline (P <. 001). The most important 5 items were found to be “thick nasal discharge,” “need to blow nose,” “dizziness,” “frontal pain,” and “lack of a good sleep.” The other items, related to sleep and emotion, were also significantly improved. By patients’ self‐evaluation, the ration of “much improved,” “improved,” and “not‐improved” were, respectively, 56.3%, 33.3%, and 10.4%.ConclusionEndoscopic sinus surgery demonstrated positive effects on symptoms and quality of life of CRSP.
Endoscopic Management of Frontal Sinus Fractures
Authors: Chaaban Mohamad R. , Conger Bryant T. , Woodworth Bradford A. 
Published: February 2015

ObjectiveConventional treatment of frontal sinus posterior table fractures has included osteoplastic flap or cranialization procedures despite considerable advances in endoscopic technique and experience. The objective of the current study was to evaluate outcomes of frontal sinus fractures involving the posterior table managed using endoscopic approaches.MethodRetrospective evaluation of patients with posterior table fractures was performed at the University of Alabama at Birmingham from January 2008 through December 2011. Data were collected regarding demographics, etiology, technique, operative site, length involving the posterior table, size of the skull base defect, complications, and clinical follow upResultsEleven patients (age 39 ± 5 years) with posterior table fractures were treated using endoscopic techniques from 2008‐2011. Mean follow‐up time was 44 ± 15 weeks (range 2‐164). Patients were primarily managed using Draf IIb frontal sinusotomies with 1 individual requiring a concomitant trephine. A Draf III procedure was performed in 1 patient. Average fracture defect (length vs width) was 13.5 3.6 mm and the average length involving the posterior table was 9.6 mm (1‐30 mm). Skull base defects were covered with a septal flap and/or Surgisus tissue grafts. One patient referred after failed cranialization was endoscopically obliterated. Although 1 individual required a revision frontal sinusotomy, all sinuses remain patent on last follow‐up.ConclusionManagement of frontal sinus posterior table fractures using minimally invasive endoscopic techniques provides excellent outcomes in selected cases. Posterior table fractures of up to 30 mm in length were adequately managed in this series and indicate this approach should become an active part of the treatment algorithm.
Endoscopic Removal of Fungus Balls in Maxillary Sinuses
Authors: Lo Wu Chia , Liao Li‐Jen , Cheng Po‐Wen 
Published: February 2015

ObjectiveWe aimed to compare between a newly developed instrument, powered saline irrigation system, and the traditional technique in the complete removal of fungus balls in maxillary sinuses during functional endoscopic sinus surgery.MethodBetween July 2009 and July 2011, unilateral maxillary sinus fungus balls were removed with the traditional method in 17 patients and with the assistance of powered saline irrigation in 12 patients. The duration, complication and recurrence by these 2 procedures were compared.ResultsThe fungus balls could be efficiently cleared in all (100%) maxillary sinuses. However, the mean duration for the traditional method group was 397 ± 42 seconds, significantly longer than 155 ± 29 seconds for the powered saline irrigation group (P <. 001). In the traditional method group, 4 patients (24%) developed focal maxillary mucosal detachment during the procedure and 1 patient (6%) developed chronic bacterial maxillary sinusitis later, requiring a secondary endoscopic sinus surgery. Neither operative complication nor disease recurrence occurred during the follow‐up period in the powered saline group.ConclusionOur series confirms the efficacy of functional endoscopic sinus surgery in the treatment of maxillary fungus balls. The assistance of powered saline irrigation provides more timesaving procedures and less postoperative complications.
Endoscopic Treatment of Olfactory Neuroblastomas
Authors: Hermann Diego R. , Balsalobre Leonardo , Abreu Cassiana B. , Balieiro Fernando O. , Stamm Aldo E. C. 
Published: February 2015

ObjectiveTo illustrate an transnasal approach (endoscopic assisted transnasal‐craniectomy) used for olfactory neuroblatoma treatment and to advocate this method of management followed by radiation therapy for selected cases, based on the Stamm‐Kennedy (SK) stage system.MethodA retrospective chart review was performed with 16 patients harboring olfactory neuroblastomas. Patients were categorized secondary to SK staging system. Twelve patients underwent the endoscopic assisted transnasal craniectomy (EATNC) approach, and 4 were submitted to hybrid approach (cranio‐endoscopic) between 2000 and 2011 at a tertiary referral center.ResultsSeven SK‐IVa, 5 SK‐II, 2 SK‐IVb, 1 SK‐I, and 1 SK‐V patients, aged 10 to 67 years (9 females and 7 males), were identified. In 10 cases the tumor was bilateral, and in six cases the tumor was unilateral. Twelve patients were submitted to EATNC, 4 patients were submitted to hybrid approach (cranio‐endoscopic), and 1 was submitted to endonasal approach without craniectomy. Gross total resection was achieved in 12, and near total was achieved in 4 patients. Twelve patients were submitted to radiotherapy (75%). Four cases needed posterior surgery. Fourteen patients were disease free 5 to 72 months postresection, and 2 patients were lost during follow‐up. Only 4 patients preserved olfactory function (unilateral cases treated without radiotherapy).ConclusionThe EATNC is a promising approach for olfactory neuroblastoma treatment, even for those tumors with intradural extension. Most patients require radiation therapy, and in these cases there is no olfaction preservation.
FESS Malpractice Risk Factors Identified Using Case‐Controls
Authors: Sewell Ryan K. , Roberson David W. , Zappia John J. , Troxel David , Shah Rahul K. 
Published: February 2015

ObjectiveComplications related to functional endoscopic sinus surgery are well documented. These complications will, in some instances, lead to claims of medical malpractice. This study seeks to preoperatively identify both patient and procedural characteristics which are more likely to result in adverse events. This may then allow them to develop risk management strategies as they pertain to functional endoscopic sinus surgery.MethodCase control study of The Doctors Company closed claims involving functional endoscopic sinus surgery between 2005‐2009. These were then compared with a control group of 196 survey responses sent by The Doctors Company in 2011 to insured otolaryngologists.ResultsA total of 17 claims were closed from 2005‐2009. There was no significant age difference in the claims group and controls. Age greater than 60 inferred a 2.8‐fold increase in risk of a closed claim (P =. 09). The lack of polyps was associated with an increased risk of a claim (P =. 04). All claims involved surgery that included at least an ethmoidectomy. The use of powered instrumentation was not statistically significant. Revision surgery was associated with a 13‐fold increase in risk of a claim (P =. 05).ConclusionThe present article illustrates the utility of a case control method to identify scenarios that are more likely to result in malpractice claims. Identification of risk factors preoperatively has the potential to help avoid complications and, thus, lawsuits. This methodology may be useful when examining other surgical procedures as well.
Flexural Modulus in Tissue‐Engineered Human Septal Cartilage
Authors: Kushnaryov Anton , Wong Van , Reuther Marsha S. , Briggs Kris , Sah Robert L. , Masuda Koichi , Watson Deborah 
Published: February 2015

Objective1) Determine the flexural modulus (intrinsic flexibility) of tissue‐engineered human septal neocartilage constructs using 3 point bending mechanical testing. 2) Compare the flexibility of native human septal cartilage to human tissue‐engineered septal cartilage constructs using 3‐point bending mechanical testing.MethodStrips of tissue‐engineered human septal neocartilage and native septal cartilage were subjected to 3‐point bending using a testing apparatus with axial load cell and actuator. Uniform stress was applied while displacement and strain were recorded. The flexural rigidity or bending modulus was calculated for each sample.ResultsAfter 10 weeks in culture, the flexural modulus of tissue‐engineered human septal neocartilage constructs was 0.462 N/mm2 versus 3.28 N/mm2 for native tissue (P =. 002). No samples fractured or demonstrated plastic deformation.ConclusionTissue‐engineered septal neocartilage was 7.1‐fold more flexible than native septal cartilage. This study demonstrates that flexural moduli of tissue engineered septal cartilage can be determined after 10 weeks in culture, providing a useful measure of construct properties relative to native tissue.
Improving the Detection of Fungi in CRS Histopathology
Authors: Guo Canting , Ghadersohi Saied , Kephart Gail , Sherris David A. , Kita Hirohito , Laine Roger , Ponikau Jens U. 
Published: February 2015

ObjectiveTo investigate the improvement in histologic detection of fungi with Gomori methenamine silver (GMS) stain by trypsin predigestion in the mucus of chronic rhinosinusitis patients (CRS).MethodProspective, single group, descriptive analysis conducted in multiple institutions. Thirty‐four sinus specimens from 12 CRS surgical patients were stained with hematoxylin and eosin, GMS stain, GMS stain with trypsin digestion, and immunofluorescence for chitinase and anti‐Alternaria. Patients received skin testing, IgE serology, and radioallergosorbent tests for 23 fungal IgE antibodies.ResultsThe conventional GMS stain detected fungi only in 9/34 (27%) of the specimens. Predigesting the specimen with trypsin dramatically improved the visualization of fungi; 31 out of 34 specimens (91%) stained positive for fungi. The Chitinase immunofluorescence visualized fungi in 32/34 (94%), and anti‐Alternaria was visualized in 33/34 specimens (97%). Only 8/12 (75%) patients had detectable allergies.ConclusionThis report describes a modification of the conventional GMS stain that significantly improves the visualization of fungi on histology and explains the lack of detection in previous studies. These novel, more sensitive histologic methods reveal fungi within mucin in allergic and also non‐allergic CRS patients.
Macrophage Quantification in Chronic Rhinosinusitis
Authors: Banks Caroline A. , Mulligan Jennifer K. , Wang Eric W. , Casey Sarah E. , Mulligan Ryan M. , Schlosser Rodney J. 
Published: February 2015

ObjectiveMacrophages are major producers of inflammatory cytokines; however, their role in chronic rhinosinusitis (CRS) has not been clearly defined. The aim of this study was to quantify monocytes and macrophages in sinonasal tissue of patients with various subtypes of CRS.MethodHuman sinonasal tissue was taken from patients with CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP), and allergic fungal rhinosinusitis (AFRS). Control tissue was taken from patients without evidence of inflammatory sinus disease. Samples were immunhisotychemically stained for macrophage/monocyte markers Mac387, CD68, and PM‐2K.ResultsAFRS patients had approximately 4 times as many Mac387 and CD68 staining cells as CRSsNP and control patients (P <. 05). CRSwNP patients had approximately 2.5 times as many Mac387 cells and 3 times as many CD68 cells as CRSsNP and control patients (P <. 05). There were trends toward increased numbers of cells staining positively for PM‐2K in tissue samples of AFRS and CRSwNP, and increased staining of CD68 and PM‐2K in atopic CRWwNP patients; however, this did not reach statistical significance.ConclusionMacrophages are increased in CSRwNP and AFRS patients and may contribute to the immunopathology of CRS.
Microdebrider versus Conventional Partial Turbinectomy
Authors: Damaty Ahmed Hesham El , Badran Hatem 
Published: February 2015

ObjectiveCompare the microdebrider assisted partial inferior turbinectomy with the conventional turbinectomy in patients with inferior turbinate hypertrophy.MethodSixty patients with nasal obstruction and bilateral hypertrophied inferior turbinates were included.The patients were randomly assigned to receive microdebrider partial turbinectomy (n = 30) or conventional surgical turbinectomy (n = 30). Main outcome measures: operative time, blood loss, subjective improvement of the patients symptoms, and postoperative complications.ResultsThe 2 groups were comparable in age and sex. The operative time and operative blood loss were less in the microdebrider group (P <. 001). Follow‐up visit after 3 months revealed improvement in 93.3% of the patients in the microdebrider group vs 96.7% in the surgical group (P >. 05). There was no difference in the incidence of postoperative complications between the 2 groups.ConclusionPartial turbinectomy with the microdebrider is as effective and safe as the conventional surgical turbinectomy with shorter operative time and minimal blood loss.
Non‐invasive Correction of Nasal Septum Deformities
Authors: Helidonis Emmanuel S. , Sobol Emil N. , Svistushkin Valery , Ovchinnikov Yuri , Shekhter Anatoly , Velegrakis George A. , Sviridov Alexander 
Published: February 2015

Objective1) To study laser septochondrocorrection (LSC) technology. 2) To characterize the medical equipment. 3) To present clinical data. The LSC uses the thermo‐mechanical effect of non‐destructive laser radiation for a bloodless and painless correction of septonasal deformities.MethodsThe equipment for non‐invasive reshaping of cartilage includes a fiber 1.56‐micrometer laser, special instrument and feedback control system. The LSC was performed on 1000 patients whose ages ranged between 12 and 68 years of age, including 934 patients in Russia and 64 patients in Greece.ResultsThe straightening of nasal septum and the improvement of breathing were obtained immediately after laser procedure in all patients. No age limitations, no complications, and no negative secondary effects were observed. Partial return to initial position of the nasal septum was observed in 20% of the patients 2 or 3 weeks after LSC. A 2‐year follow‐up did not show any posterior alterations in the position of the nasal septum. Only 5% of the patients who underwent LSC showed no improvement of nasal breathing. The positive results were obtained in 95% of the treated patients.ConclusionLSC is a new non‐invasive procedure with many advantages over the traditional traumatic surgical techniques applied to correct septonasal deformities. The high effectiveness and the safety of laser procedure are ensured by strictly meeting the appropriate correction conditions and by using a feedback control system.
Olfactory Bulb Volume for Prognosis in Olfactory Loss
Authors: Rombaux Philippe , Huart Caroline , Deggouj Naïma , Duprez Thierry 
Published: February 2015

ObjectiveThe olfactory bulb (OB) is essential for olfactory perception, and its volume is correlated to the olfactory function in normal and pathologic cases. We hypothesized that olfactory bulb volume could also be used as a new predictor of olfactory recovery.MethodA cohort of 60 patients suffering from PI (n = 28) and PT olfactory loss (n = 32) was studied. Assessment of olfactory function was performed using orthonasal and retronasal tests, at the time of the diagnosis and 15 months later. All patients were examined on a 3T‐MRI. The olfactory bulb volume was calculated.ResultsRecovery rate was 25% in patients with PT olfactory loss and 35.7% in patients with PI olfactory loss. There was a correlation between both the orthonasal and the retronasal score, and between olfactory testing and the total olfactory bulb volume, both at T1 and at T2. In addition, we observed a significant correlation between changes in olfactory functions and initial measures of the total OB volume, with larger volumes relating to higher improvement on olfactory. Finally, we found that none of the patients with a total OB volume of 40 mm or less exhibited recovery of olfactory function.ConclusionOlfactory bulb volume is a predictor of olfactory recovery in patients suffering from PI and PT olfactory loss.