bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achievement of competency in endoscopic sinus surgery of otolaryngology residents
Authors: Laeeq Kulsoom , Lin Sandra Y. , Varela David A. Diaz Voss , Lane Andrew P. , Reh Douglas , Bhatti Nasir I. 
Published: October 2013

Objectives/HypothesisThe goal of our study is to identify the number of Endoscopic Sinus Surgery (ESS) cases required to obtain competency in ESS, using a previously validated assessment tool.Study DesignProspective observational study.MethodsSeventeen residents from Johns Hopkins Otolaryngology–Head & Neck Surgery residency program were evaluated as they performed endoscopic sinus surgery in the operating room. Global and checklist parts of the ESS instrument were used for assessment purposes. Items on the tool were grouped into three different milestones for analysis of data (Milestone 1 = Maxillary Antrostomy + Anterior Ethmoidectomy, Milestone 2 = Posterior Ethmoidectomy + Sphenoidostomy, Milestone 3 = Frontal Sinusotomy). Residents were deemed competent if they achieved a minimum score of 3 on a 5‐point Likert scale on each step of the surgery.ResultsA total of 73 evaluations were completed for 17 residents (Postgraduate Level 2–5) by eight evaluators between 2009 and 2011. A 60% probability of achieving competency in performance of all milestones of ESS is obtained with performing 42 ESS procedures and the probability is increased to a 100% with performance of 55 endoscopic sinus surgery procedures. On average it took residents 23 cases to become competent in performance of maxillary antrostomy and anterior ethmoidectomy.ConclusionsOur results suggest that it requires 42 ESS procedures to attain a 60% probability of competency in ESS. These results have implications for otolaryngology residency programs when developing curriculum and benchmarks for the training residents. Laryngoscope, 123:2932–2934, 2013
Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma
Authors: Fink Daniel S. , Achkar Jihad , Franco Ramon A. , Song Phillip C. 
Published: October 2013

Objectives/HypothesisThis study evaluated the efficacy of botulinum toxin type A injected into the interarytenoid muscle to treat recalcitrant vocal process granulomas.Study DesignRetrospective clinical review at a tertiary care center.MethodsEight patients with vocal process granulomas refractory to a variety of prior treatments including surgical resection, proton pump inhibitor therapy, and voice therapy underwent percutaneous injection of botulinum toxin type A into the interarytenoid muscle, performed in an office setting. Doses ranged from 5 U to 25 U in one to two injections.ResultsOne patient demonstrated no improvement, two patients demonstrated partial resolution, and five patients demonstrated complete resolution of their granulomas. Four patients noted transient breathiness. There were no other side effects. All patients tolerated the injections without difficulty.ConclusionBotulinum toxin injection into the interarytenoid muscle appears to be a safe and effective modality for treating recalcitrant vocal process granuloma. Laryngoscope, 123:3084–3087, 2013
Pharyngotracheal fistula closure using the internal mammary artery perforator island flap
Authors: Mirghani Haïtham , Leymarie Nicolas , Amen Furrat , Qassemyar Quentin , Leclère Franck Marie , Kolb Frederic 
Published: October 2013

Objectives/HypothesisSalvage laryngectomy following organ preservation therapy is a frequent condition that exposes patients to pharyngocutaneous and pharyngotracheal fistulas. Definitive treatment frequently requires well vascularized tissue harvested from the chest. To limit tracheostoma obstruction, a thin and pliable flap is preferable. The internal mammary artery perforator (IMAP) island flap fulfills these criteria, but it is not well known and is not commonly used by head and neck surgeons. In this article, based on our experience, we describe our surgical technique and the strengths and weaknesses of this flap.Study DesignRetrospective cohort study and systematic review of the literature.MethodsAn IMAP flap was performed on 12 patients to repair postoperative fistulas, located in the lower neck close to the tracheal stoma or involving the posterior tracheal wall, from March 2009 to December 2012. The medical records of each of patient were retrospectively analyzed.ResultsA breach of the pleura occurred in one patient. It was diagnosed and treated perioperatively. One patient had a total flap necrosis and required a reoperation. The postoperative course was uneventful in 11 patients (92%). All donor sites were closed primarily without any wound‐healing problems.ConclusionsThe IMAP flap is reliable. Its advantages make it a convenient flap to repair peritracheostomal defects and fistulas. The harvesting technique is not very demanding but requires training.Level of Evidence4. Laryngoscope, 124:1106–1111, 2014
Resource analysis of tonsillectomy in children
Authors: Shah Udayan K. , Theroux Zachary , Shah Gopi B. , Parkes William J. , Schuck Christine 
Published: October 2013

Objectives/HypothesisTo analyze variables that affect time and cost parameters of pediatric adenotonsillectomy.Study DesignLongitudinal 7‐month retrospective review of sequential tonsil and adenoid surgery at a university pediatric tertiary care hospital.MethodsAll children aged 2 to 12 years who underwent adenotonsillectomy from May 2008 to October 2008 had charts and billing records analyzed for variations in charges and times of adenotonsillectomy according to patient age, body mass index for age (BMIFA), American Society of Anesthesiologists (ASA) status, surgical indication, technology used, and teaching status of case. A total of 214 children had records reviewed.ResultsStatistically significant variations were observed for all measured parameters except for indications for surgery. Children 3 years and younger had shorter procedures (P = .005) and total operating room times (P = .037). Charges for supplies were lower for ASA 1 patients than for ASA 2 patients (P = .010). Obese children with elevated BMIFA required longer procedures (P = .039) and more expensive surgery (P = .003). Procedure times were shorter for Coblation (ArthroCare, Austin, TX) compared with electrocautery (P = .27) and for microdebrider compared with electrocautery (P < .001). Charges for Coblation were substantially higher (P < .001). Teaching cases took longer (P < .001).ConclusionsCharges and times for adenotonsillectomy surgery varied by patient age, BMIFA, ASA status, tonsillectomy technique, and teaching case status. Clinically salient differences were noted for ASA status, BMIFA, and surgical technique. This method of cost analysis provides useful information for resource management in tonsillectomy.Level of Evidence2c. Laryngoscope, 124:1223–1228, 2014
The relationship of the natural sphenoid ostium to the skull base
Authors: Halawi Akaber M. , Simon Patrick E. , Lidder Alcina K. , Chandra Rakesh K. 
Published: October 2013

Objectives/HypothesisVarious intranasal landmarks have been described to aid in the localization of the natural sphenoid sinus ostium. The objectives of this study are to identify the ostium location relative to the skull base and assess the relationships between the location of the ostium and sphenoid disease or pneumatization pattern.DesignDescriptive study.MethodsConsecutive Xoran Mini‐CAT (Ann Arbor, MI) scans of patients with no history of sinus surgery (n = 202) were evaluated. The natural sphenoid ostium was identified in axial, coronal, and sagittal planes. Distances from the planum to the ostium and from the planum to the sinus floor were calculated. Lund‐Mackay score and pneumatization pattern were recorded for each sphenoid sinus.ResultsThe mean distance from planum to ostium was 11.2 ± 2.6 mm (range 4.4–19.2). On average, this encompassed 45.5% ± 10% of the total sphenoid height. ANOVA with posthoc Tukey analysis revealed that the ostium was closer to the planum in sinuses with sellar (P = 0.05) or presellar (P = 0.02) pneumatization, compared to those with postsellar pneumatization. There was no significant relationship between the ostium location and degree of sinus disease. There was a significant difference in the pneumatization pattern between males and females (P = .04). More males had postsellar pneumatization than expected, and more females had sellar pneumatization than expected.ConclusionsThe natural ostium of the sphenoid sinus is located at approximately the midpoint of the sphenoid face. Nevertheless, significant variability can be observed based on the pneumatization pattern. Surgeons should recognize that the ostium may be closer to the skull base when the sinus is less pneumatized.Level of Evidence4. Laryngoscope, 125:75–79, 2015
Round window closure affects cochlear responses to suprathreshold stimuli
Authors: Cai Qunfeng , Whitcomb Carolyn , Eggleston Jessica , Sun Wei , Salvi Richard , Hu Bo Hua 
Published: October 2013

Objectives/HypothesisThe round window acts as a vent for releasing inner ear pressure and facilitating basilar membrane vibration. Loss of this venting function affects cochlear function, which leads to hearing impairment. In an effort to identify functional changes that might be used in clinical diagnosis of round window atresia, the current investigation was designed to examine how the cochlea responds to suprathreshold stimuli following round window closure.Study DesignProspective, controlled, animal study.MethodsA rat model of round window occlusion (RWO) was established. With this model, the thresholds of auditory brainstem responses (ABR) and the input/output (IO) functions of distortion product otoacoustic emissions (DPOAEs) and acoustic startle responses were examined.ResultsRound window closure caused a mild shift in the thresholds of the auditory brainstem response (13.5 ± 9.1 dB). It also reduced the amplitudes of the distortion product otoacoustic emissions and the slope of the input/output functions. This peripheral change was accompanied by a significant reduction in the amplitude, but not the threshold, of the acoustic startle reflex, a motor response to suprathreshold sounds.ConclusionsIn addition to causing mild increase in the threshold of the auditory brainstem response, round window occlusion reduced the slopes of both distortion product otoacoustic emissions and startle reflex input/output functions. These changes differ from those observed for typical conductive or sensory hearing loss, and could be present in patients with round window atresia. However, future clinical observations in patients are needed to confirm these findings.Level of EvidenceN/A. Laryngoscope, 123:E116–E121, 2013
Longer length baha™ abutments decrease wound complications and revision surgery
Authors: Allis Terah J. , Owen Benjamin D. , Chen Baojiang , Jones Dwight T. , Moore Gary F. 
Published: October 2013

Objectives/HypothesisTo study the complication rates of skin overgrowth, infection, and the need for revision surgery in longer length Baha™ abutments.Study DesignProspective observational cohort study compared with a retrospective historical control.MethodsAfter the University of Nebraska Medical Center (UNMC) Institutional Review Board approval was obtained, data was collected from a prospective 8.5‐mm abutment study group of 21 subjects with informed consent from October 2011 through October 2012, and was compared to a retrospective 5.5‐mm abutment historical cohort of 23 patients who had undergone Baha™ by the same surgeon from May 2010 to October 2011. Patient demographics, body mass index (BMI), smoking status, and wound complications (skin overgrowth, infection, the need for revision surgery) were statistically investigated and compared between the groups.ResultsForty‐four patients were studied. The groups were similar in smoking status, diabetes, and a female preponderance. The 8.5‐mm abutment group was older (P = 0.012). The average BMI for both groups was classified as overweight and nearly obese (BMI 28.8). Rates of infection, skin overgrowth, and the need for revision surgery related to wound complications were significantly decreased in the longer 8.5‐mm abutment group (P = 0.020, P = 0.012, P = 0.007, respectively). BMI did not correlate with decreased infection, skin overgrowth, and the need for revision surgery based on abutment length as hypothesized (P = 0.214, P = 0.206, P = 0.408).ConclusionsThe 8.5‐mm abutment lends to decreased complications postoperatively, including infection, skin overgrowth, and the need for revision surgery.Level of Evidence3b. Laryngoscope, 124:989–992, 2014
Differences in perception of hearing handicap between cochlear implant users and their spouses
Authors: Mistry Dipan , Ryan Jillian , Maessen Heather , Bance Manohar 
Published: October 2013

Objectives/HypothesisTo examine the relationship between patient and proxy ratings of health‐related quality of life (HRQL) in patients with cochlear implants.Study DesignProspective survey.MethodsEighty‐two adult cochlear implant recipients and their spouses/partners were asked to complete the Nijmegen Cochlear Implant Questionnaire (NCIQ) and the Hearing Participation Scale (HPS) that were mailed to them.ResultsFor the NCIQ, there were 38 useable responses from recipients and 31 useable responses from the partners. There were 27 paired and useable questionnaires (i.e., from both the recipient and his/her partner). For the HPS, there were 42 useable responses from recipients and 36 useable responses from the partners. Of these, there were 35 paired questionnaires. There was good agreement between partners and patients with both the HPS (r = 0.62) and the NCIQ (r = 0.80). There was a significant statistical difference in the scoring of the Basic Sound Perception subscale between the two groups (P = .039), with spouses under‐rating performance in this subscale.ConclusionsFor patients with cochlear implants, patients' partners corroborate patients' self‐reported HRQL. In cases in which patients have sensory impairment, there may be an additional role for proxy ratings of HRQL to give a more complete assessment of functional limitations.Level of Evidence4. Laryngoscope, 124:1199–1203, 2014
Excised larynx evaluation of wedge‐shaped adjustable balloon implant for minimally invasive type I thyroplasty
Authors: Hoffman Matthew R. , Devine Erin E. , McCulloch Timothy M. , Jiang Jack J. 
Published: October 2013

Objectives/HypothesisTo describe the method of inserting a wedge‐shaped adjustable balloon implant (wABI) via a minithyrotomy for medialization thyroplasty and evaluate its effect on a range of phonatory parameters using the excised larynx bench apparatus.Study DesignRepeated measures with each larynx serving as its own control.MethodsA prototype wABI was deployed in six excised canine larynges of various sizes through a minithyrotomy and then filled with saline. Mucosal wave, aerodynamic, and acoustic parameters were measured for three conditions: normal, vocal fold paralysis, and paralysis with the wABI.ResultsPhonation threshold pressure (P < .001), flow (P < .001), and power (P = .002) were significantly lower for wABI compared to paralysis trials; values did not differ significantly from normal trials. Percent jitter (P = .002) and percent shimmer (P = .007) were also significantly decreased compared to the paralysis condition, and values were not significantly different compared to normal. The mucosal wave was preserved after insertion of the wABI.ConclusionsEffective vocal fold medialization with preservation of the mucosal wave was observed with the wABI in this preliminary excised larynx experiment. The wABI offers the potential for a minimally invasive insertion in addition to postoperative adjustability. Further studies in living animals and humans are warranted to evaluate clinical utility.Level of EvidenceNA. Laryngoscope, 124:942–949, 2014
Subglottic stenosis: A ten‐year review of treatment outcomes
Authors: Hseu Anne F. , Benninger Michael S. , Haffey Timothy M. , Lorenz Robert 
Published: October 2013

Objectives/HypothesisTo evaluate the endoscopic surgical management of adult subglottic stenosis and describe treatment outcomes.Study DesignRetrospective review.MethodsTen‐year review of adult patients with subglottic stenosis.ResultsNinety‐two adults (23 male, 69 female) with subglottic stenosis underwent 247 endoscopic dilations between 2001 and 2010. The mean age was 48 years at time of first surgery. Etiology was GPA (granulomatosis with polyangiitis, formerly Wegener's granulomatosis) (45%), intubation (25%), or idiopathic (33%). Forty‐one patients (45%) underwent a single procedure; 51 patients (55%) required multiple surgeries. The average interval for patients requiring a subsequent procedure was 13.7 months. Variations in surgical technique did not show differences in time to next procedure, and the use of mitomycin‐C did not result in longer intervals between procedures. No significant complications were encountered after dilation.ConclusionsSubglottic stenosis remains a treatment challenge. Although patients are often symptomatically improved after endoscopic dilation, recurrence rates remain high.Level of Evidence4. Laryngoscope, 124:736–741, 2014
Antisomnogenic cytokines, quality of life, and chronic rhinosinusitis: A pilot study
Authors: Alt Jeremiah A. , Sautter Nathan B. , Mace Jess C. , Detwiller Kara Y. , Smith Timothy L. 
Published: October 2013

Objectives/HypothesisSleep disturbance, reduced quality of life (QOL), and other components of “sickness behavior” in patients with chronic rhinosinusitis (CRS) are poorly understood. These complex changes in central behavior are due to the effects of immune mediators acting in the brain. We hypothesized that immune mediators that have been associated with CRS are also associated with sickness behavior, somnifacient complaints, and CRS disease‐specific QOL.Study DesignPilot study.MethodsTwenty patients with CRS were prospectively enrolled and completed the Pittsburgh Sleep Quality Index (PSQI), disease‐specific QOL, and olfactory instruments. Ethmoid mucosa was obtained and reverse transcription‐polymerase chain reaction was performed for the cytokines interleukin (IL)−4, −13, and transforming growth factor‐β (TGF‐β). Average change in crossover threshold was calculated, and differences in gene expression were correlated with sleep quality, CRS‐specific QOL, and disease severity.ResultsPatients with CRS reported overall poor sleep quality and poor CRS‐specific QOL with significant correlations between them. Increased expression of TGF‐β (r = −0.443; P = .050) and IL‐4 (r = −0.548; P = .012) correlated with sleep dysfunction, whereas IL‐13 expression was linearly associated with worse sleep quality (PSQI scores r = −0.417; P = .075). IL‐4 and TGF‐β expression was not associated with CRS disease severity or QOL, whereas significantly higher levels of IL‐13 expression correlated with worse CRS disease severity and QOL.ConclusionsPatients with CRS exhibited behavioral changes commonly referred to as sickness behavior, which include poor sleep quality and reduced QOL. The upregulation of IL‐4 and TGF‐β may contribute to inflammatory brain‐mediated effects on sleep quality, whereas IL‐13 may be a pleiotropic signaling molecule influencing sleep, QOL, and CRS disease severity.Level of Evidence2b. Laryngoscope, 124:E107–E114, 2014
A reporter assay for the next generation of biomaterials: Porous‐wall hollow glass microspheres
Authors: Cunningham Aaron , Faircloth Hunter , Jones Matthew , Johnson Christopher , Coleman Tiffany , Wicks George , Postma Gregory , Weinberger Paul 
Published: October 2013

Objectives/HypothesisThe primary objective was to design a reporter assay to measure molecular release kinetics from a new porous‐wall hollow glass microsphere biomaterial with great potential in regenerative medicine and drug delivery. Second, future avenues for research will be discussed specifically in regard to potential clinical uses in laryngology.Study DesignBasic science data report.MethodsWe developed an assay using fluorescent nanocrystals or quantum dots (Qdot 605) as a reporter. A Nuance FX multispectral imaging system was used to detect fluorescence in aqueous phase. Spectral output of known concentrations of aqueous Qdot 605 was measured by the Nuance system to create a standard curve.ResultsThese data were plotted and fit to a curve. Qdot 605 emission demonstrates excellent correlation with concentration in a log‐log relationship [R2 = 0.99649, median error = 9.9%], indicating that the Qdot 605 assay is reliable and should be explored regarding its ability to evaluate the drug‐eluting properties of this material.ConclusionsWe have derived a method to measure Qdot concentration using fluorescent microscopy, which will facilitate future research on this exciting new biomaterial. This material has great potential for use in head and neck surgery. Specific avenues within laryngology to be investigated include laryngeal and tracheal reconstruction, vocal fold healing, and nerve regeneration. Furthermore, we believe this is the first documented use of the Nuance system to determine aqueous molecular concentrations.Level of EvidenceNA Laryngoscope, 124:1392–1397, 2014
Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy
Authors: Bergeron Jennifer L. , Chhetri Dinesh K. 
Published: October 2013

Objectives/HypothesisTo describe indications, management, and outcomes of endoscopic CO2 laser cricopharyngeal myotomy (CPM).Study DesignCase series with chart review.MethodsAll patients treated with endoscopic CO2 laser CPM over a 6‐year period were identified. A retrospective chart review was performed for surgical indication, history and physical examinations, and swallow evaluations. Swallowing outcomes were assessed using the Functional Outcome Swallowing Scale (FOSS); findings were compared across groups.ResultsEighty‐seven patients underwent endoscopic CO2 laser CPM during the study period for cricopharyngeal dysfunction. Indications included Zenker's diverticulum (ZD) (39), DiGeorge syndrome (two), stroke (five), nerve injury (two), radiation for head and neck cancer (15), idiopathic (16), hyperfunctional tracheoesophageal speech (five) and dysphagia from cricopharyngeus stricture after laryngectomy (three). Mean, median, and mode time to feeding postoperatively were 1.4, 1, and 0 days respectively. Mean, median, and mode hospital stays were 1.8, 1, and 1 day respectively. Overall, FOSS scores improved from 2.6 to 1.6 (P < .001). Improvement was greatest for patients with ZD (2.4 to 1.0) and cricopharyngeal dysfunction from nerve injury (3.3 to 1.8) and least for those with prior radiation (3.9 to 3.2). All patients undergoing CPM for poor tracheoesophageal speech regained speech postoperatively. No patients developed mediastinitis, abscess, or fistula.ConclusionsEndoscopic CO2 laser CPM is a safe treatment for cricopharyngeal dysfunction of various causes, though swallowing outcomes may vary depending on the surgical indication. Early feeding postoperatively after CPM is safe and facilitates early hospital discharge.Level of Evidence4. Laryngoscope, 124:950–954, 2014