bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fine Needle Biopsy: Comparison of Aspiration versus Nonaspiration Techniques in Head and Neck Tumors
Authors: Ashimori Naoki , Hashimoto Ayako , Suzuki Takahiro 
Published: August 2013

Objectives:Fine needle aspiration (FNA) has been adopted as a simple and cost‐effective method for cytological studies of head and neck tumors. Recently the fine needle nonaspiration (FNNA) is reported to provide good specimens. In this study, we compare the efficacy of the two techniques.Methods:During a 3‐year period, 297 cytological examinations were conducted in patients with head and neck tumor. Sites of biopsy studied included thyroid tumor (n=200), lymph node (n=75), and salivary tumor (n=22). Fine needle biopsies were performed in each lesion with 23‐gauge needles, and results were analyzed by a single pathologist.Results:Overall, specimens from 21 patients (7.1%) of 297 were inadequate with both techniques together. Forty‐three (14.5%) were insufficient specimens with FNA alone and 33 (11%) with FNNA alone. Insufficient specimens were obtained at 30 (15%) and 21 (10.5%) of 200 thyroid tumors and 2 (9.1%) and 1 (4.5%) of 22 salivary tumors with and without aspiration, respectively. The inadequacy rates were the same (14.6%) in the lymph nodes with each technique. The causes of insufficient specimens were blood contamination with FNA and the absence of cellular material with FNNA. No statistically significant difference was noted in the diagnostic yield between the two techniques.Conclusions:We concluded that FNNA is equal to FNA in the cytological studies in head and neck tumors. Double sampling may reduce inadequacy rates to low levels and be useful as a routine policy.
Preoperative Evaluation of Round Window Niche Visualization in Cochlear Implantation by Means of Computed Tomography
Authors: Kashio Akinori , Sakamoto Takashi , Karino Shotaro , Kakigi Akinobu , Iwasaki Shinichi , Yamasoba Tatsuya 
Published: August 2013

Objectives:Evaluate round window niche (RWN) visibility during cochlear implant (CI) surgery and to predict RWN visibility using high resolution computed tomography (HRCT).Methods:Sixty‐five ears from 19 adults and 46 children who received CI were enrolled. All patients were examined with HRCT and their surgical video was recorded. In the axial slice showing RWN, a line was drawn along the posterior wall of the external auditory canal (line A). Another line (line B) parallel to line A was drawn to get contact with the vertical segment of the facial nerve. Relationship between the band between lines A and B and the position of the RWN was classified into 3 types: RWN was 1) fully, 2) partially, or 3) not included in the band. The visibility of the RWN during CI was classified as A) fully, B) partially, or C) not visible.Results:From the surgical video review, 27 cases were classified as A), 21 as B), and 17 as C). All the 15 cases classified as 3) based upon CT findings were classified as C). Out of 19 cases classified as 2), 17 were classified as B) and 2 as C). Out of 31 cases classified as 2), 27 were classified as A) and 4 as B).Conclusions:The visibility of the RWN during surgery exhibited high correlation with preoperative predictions from HRCT findings. This method is useful to preoperatively predict the difficulty of exposing the RWN in CI surgery.
Results of Hearing Gain according to Ossicular Prosthesis Materials
Authors: Choi Young‐Seok 
Published: August 2013

Objectives:Compare the functional results and extrusion rates according to the type of ossciular prosthesis materials in POR and TOR cases.Methods:A retrospective analysis was performed. Sixty‐two patients were involved in POR cases and 70 patients were involved in TOR cases. In POR cases, Plastipore was used in 21 cases, hydroxy‐apatite in 20 cases, and titanium in 20 cases. In TOR cases, Plastipore was used in 20 cases, hydroxy‐apatite in 25 cases and titanium in 25 cases. We reviewed postoperative air‐bone gap (ABG; less than 20dB and more than 20dB) and extrusion rate for more than 1 year follow‐up period.Results:In POR cases, extrusion rates (ER) were 14.3%, 15.0%, 5.0% in plastipore, HA, and titanium prothesis, respectively. ABG less than 20dB were 71.4%, 80.0%, 85% in platipore, HA, and titanium, respectively. In TOR cases, ER were 30.0%, 20.0%, 8.0% in plastipore, HA, and titanium prothesis. ABG less than 20dB were 25.0%, 28.0%, 32.0% in plastipore, HA, and titanium prothesis, respectively.Conclusions:There were no differences in hearing gain results and extrusion rates between Plastipore, HA, and titanium prosthesis in POR and TOR cases statistically. But clinically, better hearing gain and low‐rate of extrusion were found in titanium prosthesis and this material is recommended in cases of ossicular surgery.
The Functional Comorbidity Index Is Useful to Predict Quality of Life
Authors: Weaver Edward M. , Levine Corinna G. 
Published: August 2013

Objectives:Comorbidity indexes adjust for comorbidity confounding on a specific outcome, but no index is designed specifically for a quality of life (QOL) outcome. The Functional Comorbidity Index was previously designed to predict physical function‐related QOL. The goals of this study: 1) Assess the Functional Comorbidity Index as a predictor of general QOL in sleep apnea patients (measured by SF‐36 component scores); 2) Compare the ability to predict general QOL between the Functional Comorbidity Index and the widely used Charlson Comorbidity Index.Methods:Between 2004‐2007 669 adults with sleep apnea were prospectively enrolled and data collected for the QOL outcome variables and the comorbidity indexes as independent variables. A random sample of 250 was analyzed with Spearman correlations between each index and QOL measures. Multivariate linear regression models calculated the ability to predict QOL (adjusted R2) adjusted for demographics and sleep apnea severity. Bootstrapping generated variances in the regression coefficients to test statistically for a clinically important (10%) difference between indexes.Results:Correlations of the Functional and Charlson Comorbidity Indexes with the mental component of QOL were ‐0.38 (P < 0.0001) and ‐0.07 (P = 0.2946), respectively. The Functional Comorbidity Index was clinically and statistically superior to the Charlson Comorbidity Index for predicting the mental component of QOL (adjusted R2 0.23 and 0.13, respectively, P < 0.001). Similar results were found for predicting the physical component of QOL.Conclusions:The Functional Comorbidity Index is useful to predict QOL and is a more robust predictor of QOL than the Charlson Comorbidity Index in sleep apnea patients.
Value of Hearing Handicap Elderly‐Screening in Predicting Hearing Impairment
Authors: Ho Eu Chin 
Published: August 2013

Objectives:Evaluate the usefulness of the Screening Version of the Hearing Handicap Inventory for the Elderly (HHIE‐S) questionnaire in screening for hearing impairment in the general population.Methods:We recruited subjects at a health awareness event organized by the ENT Department of a tertiary hospital. Members of the public were invited to fill in the HHIE‐S questionnaire and to undergo a four‐frequency pure tone audiogram (PTA), of which 37 subjects aged 25 to 82 years completed both.Results:Conventionally, moderate or high scores on the HHIE‐S questionnaire are considered strongly suspicious of a hearing impairment. If hearing impairment is defined as four‐frequency average (0.5kHz, 1kHz, 2kHz & 4 kHz) PTA > 26dB in the better hearing ear, the sensitivity of the HHIE‐S questionnaire in screening for hearing impairment is 80%, but its specificity is low at 18%. The positive predictive value is 40% and the negative predictive value 57%. However, if hearing impairment is defined as four‐frequency average PTA > 41dB, the sensitivity of the HHIE‐S questionnaire in screening for hearing impairment is increased to 100% though its specificity remains low at 20%. The positive predictive value of the screening questionnaire is greatly reduced to 6%, though the negative predictive value rises to 100%.Conclusions:For general population screening, the HHIE‐S is too inaccurate to screen for slight and mild hearing loss, but it can be used to screen for moderate to severe hearing loss. However, all patients with moderate and high scores need a formal audiogram to confirm the hearing levels.
Analysis of Hearing Screening Test Findings of 11,575 Newborns in Turkey
Authors: Ulusoy Seçkin , Uğraş Hilmi , Cingi Cemal , Yılmaz Huseyin B. 
Published: August 2013

Objectives:Review the newborn hearing screening test data performed at Corlu State Hospital, Turkey, during the last 3 years.Methods:A total of 11575 newborns that were either born in this hospital or referred from other healthcare centers between September 2009 and September 2012 were included. TEOAE (Transient Evoked Otoacoustic Emissions) test and AABR (Automated Auditory Brainstem Response) were used as screening tests. After the newborn failed the initial TEOAE test, the test was repeated after 15 days. If the same result was obtained at the second test, the newborns were referred for ear, nose, and throat (ENT) examination. TEOAE and AABR screening tests were performed as the third stage evaluation.Results:Out of 11575 newborns, 593 (5.12%) had failed the test and were referred for ENT examination and further evaluation. Out of these 593 neonates, 474 (79.93%) passed the second step test at the referral center. 106 (17.87%) did not show up again, so we did not get any information about them. Unfortunately, bilateral and unilateral sensory neural hearing impairment was detected in 12 and 3 babies, respectively. Seven of these babies had risk factors such as family history of hearing loss and consanguineous marriages.Conclusions:Newborn hearing screening and early diagnosis are an problems in our field. The final hearing impairment ratio of our study was parallel to general statistics, but our false positive ratio seemed to be higher than that of other centers. It is important to do all tests at the same center concomitantly in order to decrease the false negative ratio.
Antibiotics and Ibuprofen Do Not Affect Post‐tonsillectomy Bleeding Risk
Authors: Bannos Cassandra , Kirby Alexann , Leslie Jessica , Lee Gi Soo , Roberson David W. 
Published: August 2013

Objectives:Determine if the use of ibuprofen or perioperative ampicillin affect post‐tonsillectomy bleeding risk. Investigate other potential risk factors for post‐tonsillectomy bleeding. As recommended by the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) tonsillectomy practice guideline, several members of an academic department stopped using perioperative ampicillin and also began using ibuprofen postoperatively. This quality improvement project was designed to determine whether these actions altered bleeding risk.Methods:Case control comparison methodology. A case was defined as any patient who returned to the operating room for cauterization. A control was defined as any patient who did not have known post‐operative bleeding. Four randomly selected patients (2 cases and 2 controls) were identified in each month from November 2010 to August 2012 (n = 88).Results:Ibuprofen (odds ratio [OR] = 1.13, P = 0.8), perioperative ampicillin (OR = 0.91, P = 0.9), and postoperative amoxicillin (OR = 1.0, P = 1.0) had no effect on bleeding risk. Several trends were identified: Use of a microdebrider (vs. cautery) was associated with decreased bleeding risk (OR 0.21, P = 0.04). Neurologic/psychosocial comorbidity was associated with increased bleeding risk (OR 2.93, P = 0.06). Positive pre‐operative bleeding risk assessment questionnaire was associated with increased bleeding risk (OR 1.76, P = 0.24).Conclusions:The use of ibuprofen and omission of perioperative ampicillin had no effect on the bleeding rate. The role of tonsillectomy technique, neurological/psychosocial comorbidity, and positive bleeding risk questionnaire are being examined prospectively.
Auditory Brainstem Response and Distortion‐Product Otoacoustic Emission Studies in Neonates at High‐Risk for Hearing Loss
Authors: Cohen David S. , Rudd Tracy , Nation Javan J. , Shah Priyanka , Shah Shivani , Cortez Josef , Coticchia James M. 
Published: August 2013

Objectives:1) Recognize that preterm infants less than 1300g have a well‐described and markedly increased incidence of hearing loss, possibly attributed to reversible early middle ear pathology. 2) Analyze if distortion product oto‐acoustic emissions (DPOAE) and/or auditory brainstem response (ABR) could be useful adjuncts when used in addition to tympanometry and otoendoscopy in evaluation of neonatal hearing and middle ear.Methods:Institutional review board approved prospective study at a tertiary care center neonatal intensive care unit with subjects undergoing ABR, DPAOE, tympanometry, and otoendoscopy studies within 72 hours of birth and in scheduled increments until discharge. From January 2010 to date, 77 neonates have been examined.Results:Our results confirmed that DPOAE could be a reliable and repetitive study from 24 weeks of gestational age and onward. When comparing traditional tympanometry to DPOAE, 85.7% of examinations with type B or C tympanometry also had an abnormal DPOAE result. Conversely, 62.5% of patients with type A tympanometry had a normal DPOAE result. Furthermore, in patients with a clinical diagnosis of AOM or OME, 66.7% percent had an abnormal DPAOE result. Regarding ABR threshold studies, there were several limitations with data acquisition due to incubator interference and background noise; thus, the potential of ABR in this population remains to be determined.Conclusions:This study suggests that DPOAE can be used as a reliable hearing evaluation in the neonatal population. Additionally, it may serve as a useful adjunct and insight into evaluating neonatal middle ear pathology, especially when combined with tympanometry and otoendoscopy.
Creating an Algorithm for Preoperative Cardiac Assessment of Adenotonsillectomy Patients with Obstructive Sleep Apnea
Authors: Huang Jane Z. , Hede Sannya V. , McHugh Catherine , Brock Linda , Larrier Deidre R. 
Published: August 2013

Objectives:Create guidelines in preoperative cardiac workup for obese pediatric patients with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (T&A). Specific objectives include: 1) Correlate body mass index (BMI) with postoperative complications. 2) Correlate BMI with cardiac pathology on preoperative and/or postoperative studies. 3) Determine if severity of OSA based on polysomnography (PSG) testing can predict postoperative complications.Methods:We conducted a retrospective chart review of over 110 pediatric patients with a BMI ≥ 25 kg/m2 who underwent T&A for OSA at a tertiary care children's hospital from January 2006 to December 2011, excluding syndromic features or pre‐existing cardiopulmonary disorders. Postoperative complications were analyzed in conjunction with BMI and severity of OSA based on polysomnography.Results:Preliminary analyses of cardiopulmonary pathology revealed 6 patients with right ventricular hypertrophy or dilation, 18 with tricuspid regurgitation, and 1 with reactive airway disease. There were no severe postoperative complications. Thirty‐four patients underwent a polysomnogram with a mean apnea‐hypopnea index (AHI) of 37.1 and a mean oxygen nadir of 80.5%. Increasing BMI was significantly correlated with higher AHI (P = 0.01, r = 0.5) but did not predict postoperative complications (P = 0.91). Preoperative oxygen nadir on PSG more closely predicted cardiac pathology, though results did not approach significance (P = 0.15).Conclusions:No adverse cardiopulmonary events were experienced by obese pediatric patients undergoing T&A, and hence, current data suggest that preoperative cardiac evaluation for obese children solely for the purpose of undergoing T&A is not routinely warranted.
Developing a Standard of Care for Pediatric Tracheostomy Decannulation
Authors: Maslan Jonathan , Kirse Daniel J. , Moustafa Farah , Whigham Amy S. 
Published: August 2013

Objectives:1) Recognize which diagnostic modalities are helpful to facilitate safe decannulation. 2) Provide data‐driven conclusions about pediatric tracheostomy management, given the recent American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) Consensus Statement on Tracheostomy Management (January 2013), which was based on expert opinion alone. 3) Define a pediatric tracheostomy decannulation protocol that can be extended to a large subset of patients.Methods:Study type: 10‐year retrospective review of one surgeon's pediatric tracheotomy decannulation methods. Inclusion criteria: Patients less than 18 years old. Setting: Tertiary care pediatric hospital. Outcome measurements: Airway endoscopy findings, sleep study results, capping trial tolerance, successful decannulation, and tracheocutaneous fistula repair and management.Results:167 patients underwent tracheotomy during this period, and 52 were decannulated. Of these, 22 had suprastomal granulation tissue removed and 4 patients had tonsillectomies, adenoidectomies, epiglottopexies, and/or supraglottoplasties prior to decannulation. Seventeen patients had subglottic stenosis; 9 underwent laryngotracheal reconstruction. Twenty‐five patients developed tracheocutaneous fistulas; 24 patients elected repair with 100% success rate.Conclusions:Decannulation of the pediatric patient requires a starkly different approach compared to the adult population, as many require surgical intervention prior to decannulation, and a much higher percentage of pediatric patients will keep a tracheocutaneous fistula. Our decannulation protocol includes daytime capping, rigid airway endoscopy to detect anatomic airway abnormalities, flexible endoscopy during simulated sleep to detect dynamic airway problems, and capped sleep studies. We also describe our novel trapdoor stomal flap technique, which has a 100% success rate for closure of tracheocutaneous fistulas.
Diagnostic Injection Laryngoplasty Predicts Success of Type I Laryngeal Cleft Repair: Results of Pilot Study
Authors: Skinner Margaret L. , Mavrothalassitis Orestes , Ishman Stacey L. , Au Yeung Karla J. , Collaco J. Michael , Lefton‐Greif Maureen 
Published: August 2013

Objectives:A pilot study to determine the effectiveness of injection laryngoplasty (IL) as a predictor for success of subsequent endoscopic laryngeal cleft repair (ELCR). Study Design: Case series with chart review. Setting: Tertiary care academic hospital.Methods:Retrospective analysis of children with type I laryngeal clefts who underwent IL and/or ELCR from September 2009 to January 2013.Results:Thirty‐six patients underwent IL with or without subsequent ELCR, and 11 underwent ELCR alone. Of those who underwent isolated ELCR, 8/11 (72.7%) had complete resolution of presenting symptoms. Of those who underwent IL, 29/36 (81%) had adequate follow‐up and 21/29 (72.4%) experienced compete resolution of presenting symptoms, similar to those undergoing ELCR (P = 0.679). Fourteen with complete response and 1 with partial response to IL underwent subsequent ELCR with adequate follow‐up. In all cases, response to ELCR was predicted by response to IL; 14 experienced complete resolution and 1 had partial resolution of presenting symptoms. While the rate of full resolution of symptoms following ELCR was better in the children undergoing previous successful diagnostic IL, it did not reach statistical significance (P = 0.072) due to the limited sample size.Conclusions:Diagnostic IL is an effective indicator for successful ELCR. This suggests that IL may be a useful diagnostic method to determine the degree of pathology presented by a type I laryngeal cleft in symptomatic patients and to predict the degree of success of subsequent ELCR. Future studies employing a larger sample size are recommended to confirm this relationship.
Evolving Indications for Tonsillectomy
Authors: Patel Hetal , Carr Michele M. , Straight Chelsey 
Published: August 2013

Objectives:Determine if there is a change in the trend of indication for tonsillectomy in a pediatric population over the last 9 years. Recurrent tonsillitis and obstructive sleep apnea are the two most common indications for tonsillectomy. Recurrent tonsillitis was the most common indication for tonsillectomy from the 1950s to 1980s. With the advent and effectiveness of antibiotic therapy for treatment of tonsillitis, however, recurrent tonsillitis has become a less prevalent indication.Methods:A retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 at a tertiary care children's hospital was performed. Patients were categorized by indication with the following group classifications: 1) Obstructive sleep apnea/sleep disordered breathing (OSA/SDB), 2) Recurrent tonsillitis and SDB/OSA, and 3) Recurrent tonsillitis alone. The data were analyzed using SPSS software.Results:A total of 2367 patients undergoing tonsillectomy were identified, 52% male, with mean age of 6.4 years. The frequency of OSA as an indication for tonsillectomy increased from 37% in 2003 to an average of 71% over the last 3 years. In 2003, 33% of children underwent tonsillectomy for recurrent tonsillitis alone. This dropped to a low of 10.5% in subsequent years. In the last half of 2011 and throughout 2012, the incidence increased to about 19%. Children with OSA and sore throats together as an indication for surgery has run about 12% over the last 5 years.Conclusions:Recurrent tonsillitis dropped in frequency around 2005, but more recently there has been a trend toward an increase in its frequency.
The Fetal Larynx and Pharynx: Structure and Development Described by 2D and 3D Ultrasound Examination
Authors: Shaul Chanan , Liberty Gad , Sichel Jean‐Yves 
Published: August 2013

Objectives:Define the structure and function of the fetal pharynx and larynx. We describe for the first time the various components of these anatomical sites by 3D multiplanar and render modes during the late 1st and 2nd trimesters. Understanding these structures’ normal anatomy and function may contribute to our evaluation of pathologies.Methods:Gravidae with singleton fetuses were enrolled. Transabdominal 3DUS scan of the fetal neck was acquired. The pharynx width and height, upper, middle, and lower larynx width, and larynx height were measured. We developed a new approach based on 5 spatial planes: posterior and anterior coronal planes and high, mid, and low axial planes. Multiplanar reconstruction (MPR) in post‐processing allowed adjustment of the volume to obtain the coronal plane of the area. Color Doppler was used to show fluid motion in the target area. 2DUS was also applied.Results:582 fetuses were examined during the late 1st and 2nd trimester of pregnancy. Components identified were the sphenoid bone, pterygoid processes, constrictor muscles, piriform sinus, uvula, epiglottis, aryepiglottic folds, arytenoid, cricoid, and thyroid cartilages, and the vocal cords. We defined the bilateral mode of movements of the constrictor muscles, aryepiglottic folds, and vocal folds, and bidirectional fluid jet flows through the larynx.Conclusions:The fetal larynx and pharynx can be visualized and measured with 3DUS in the late 1st and 2nd trimester. Knowledge of normal anatomy and biometry may prove useful in the evaluation of anatomic or functional pathologies involving the fetal upper respiratory tract.