bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Obstructive Sleep Apnea in Children with Cerebral Palsy
Authors: Munson Patrick D. , Dunham Andrew , Bower Charles M. , Richter Gresham T. , Hartzell Larry D. , Guillory Ryan 
Published: September 2011

Objective1) Determine the efficacy of combined surgical techniques for improving obstructive sleep apnea (OSA) in pediatric patients with cerebral palsy (CP). 2) Evaluate the addition of tongue base suspension for children with CP that have moderate to severe OSA.MethodSeven‐year retrospective chart review of 14 children with CP undergoing surgical management of OSA, including adenotonsillectomy (T&A) and uvulopalatopharyngoplasty (UPPP), with or without tongue base suspension (TBS). Response to treatment was determined by its impact on PSG parameters: apnea/hypopnea index (AHI) and arousal index (AI).ResultsChildren with CP who received TBS had a mean preoperative AHI of 27.2 compared with an AHI of 6.8 in the group that underwent only T&A and UPPP (non‐TBS). AHI decreased by a mean of 16.5 (TBS) vs 5.0 (non‐TBS); (P value. 03 vs 04). AI also improved in both groups (33.1 to 20.7 and 11.0 to 5.8); (P value. 05 vs 10). Hospital length of stay was slightly longer for the TBS groups than the non‐TBS groups (mean 9.3 days and 6.6 days) but was not statistically significant (P =. 09). Average length of follow‐up was 52 months with no surgical complications.ConclusionCombined surgical therapy improves OSA in children with CP. Children with CP and moderate to severe OSA (AHI>15) may safely benefit from the addition of tongue base suspension to T&A and UPPP to maximize treatment.
Middle Ear Ventilation in Children with Primary Ciliary Dyskinesia
Authors: Wolter Nikolaus Ernst , Dell Sharon , James Adrian L. , Campisi Paolo 
Published: September 2011

Objective1) To review the otological presentation of children with primary ciliary dyskinesia (PCD) treated medically and surgically. 2) To compare the audiological outcomes and complications of surgical management to medical management in children with PCD.MethodA retrospective chart review was performed of all patients with PCD and OME presenting to a specialized clinic at a tertiary‐quaternary care hospital from 1991 to 2009. Patients were grouped into “medical management” and “ventilation tube (VT) insertion” groups to observe changes in hearing and postoperative complications.ResultsOf 32 patients with PCD and OME, 20 received VTs, and 12 were treated by medical management strategies. A median of one set of VTs (range, 1‐7) were inserted per patient. Audiometric pure tone averages improved from 28.1dB to 21.6 dB (P =. 036) following VTs, whereas patients managed medically had stable thresholds from 22.7dB to 23.6 dB (P =. 307). At least one episode of postoperative otorrhea occurred in 9 (40%) VT insertion patients during the study period, and four had multiple episodes. Otorrhea was well controlled with medical therapy with only one requiring tube removal.ConclusionOur data supports the use of VT insertion as an option for patients with PCD and OME with mild to moderate hearing loss. Patients should be counseled on the possibility of multiple insertions and the likelihood of postoperative otorrhea, although this was not a major problem in our study group.
Multimedia Approach to Adentonsillectomy Preoperative Counseling
Authors: Adams Mary Theresa , Chen Brian S. , Boseley Mark E. , Makowski Renee L. , Bevans Scott 
Published: September 2011

Objective1) Compare surgical risk retention in participants who received a handout or watched a video in addition to standard verbal preoperative counseling. 2) Determine if time from counseling to day of surgery affects risk retention.MethodWe performed a prospective randomized control study in March 2010 through February 2011 in participants who had children undergoing adenotonsillectomy. Those unable to perform pre‐ and postoperative testing were excluded. We compared the preoperative and postoperative test scores of those undergoing verbal counseling, counseling with handout, or counseling with video.ResultsA total of 27 participants were tasked to identify 9 risks of adenotonsillectomy. Preoperatively, participants identified an average of 6.5 (SD 1.08) in the counseling group, 7.1 (SD 1.9) in the counseling and handout group, and 6.77 (SD 1.5) in the counseling and video group; P =. 54. Postoperatively, participants identified an average of 5.3 (SD 1.4) in the counseling group, 6.5 (SD 2) in the counseling and handout group, and 5.3 (SD 2.1) in the counseling and video group; P =. 29. Time between preoperative counseling and day of surgery were inversely correlated with postoperative score, correlation coefficient ‐0.36; P =. 07.ConclusionParticipants were not able to identify all of the risks associated with adenotonsillectomy. There was no difference in identification of risks associated with adenotonsillectomy among different modalities of counseling. Participants retained more information when there were fewer days between preoperative counseling and day of surgery.
Multivariable Analysis of Risk Factors for Supraglottoplasty Failure
Authors: Day Kristie , Wolf Bethany , Discolo Christopher , White David R. , Meier Jeremy D. 
Published: September 2011

Objective1) Review outcomes after supraglottoplasty forlaryngomalacia. 2) Identify risk factors for supraglottoplasty failure.MethodThis study is a retrospective case series evaluating patient outcomes after supraglottoplasty at an academic medical center between 2004 and 2010. Surgical failure was defined as need for postoperative revision surgery, tracheotomy tube, or gastrostomy tube. Multivariable logistic regression was performed to identify risk factors for failure.ResultsWe identified 95 children who underwent supraglottoplasty. After excluding patients within adequate follow‐up data, 74 patients were included. Based on chart review, 12 (16%) of those patients were defined as failures according to the criteria above.ConclusionOutcomes after supraglottoplasty were comparable to previous reports in the literature. History of prematurity should be considered a risk factor for surgical failure.
Outcome of Sinus Balloon Catheter Dilation in Adenoidectomy Failures
Authors: Ramadan Hassan H. , Hester Samuel T. , Terrell Andrew M. , Bueller Hope A. 
Published: September 2011

ObjectiveAdenoidectomy is the first line of surgical management for children with chronic rhinosinusitis (CRS). This procedure is successful in only 50% of patients. The goal of this study is to assess surgical outcomes in children undergoing sinus balloon catheter dilation who have failed previous adenoidectomy.MethodThis is a prospective review of children who had surgery for CRS between January 2006 and February 2010. Children included had persistent symptoms after adenoidectomy as documented by SN‐5 score and positive CT score. The main outcome measure was the SN‐5 score at 1‐year postprocedure.ResultsTwenty six children met inclusion criteria. The age range was 4 to 12 years with average age of 8 years (SD, 2.5). The average CT score, as graded by the Lund‐Mackay, was 7.3 (SD, 2.9). The minimum preoperative SN‐5 score was 3.0, with an average of 4.6 (SD, 0.9). The average time of postoperative follow‐up is 13 months (SD, 3.0). The average SN‐5 score at 1 year was 3.0 (SD, 1.2). This was a significant change from preoperative scores (P. 5 on the postoperative SN‐5, score was achieved in 22 children, equaling a success rate of 85%.ConclusionSinus balloon catheter dilation has previously been shown to be safe and effective in children. This current study demonstrates that balloon dilation is effective in children who have failed previous adenoidectomy. Balloon catheter dilation may be considered prior to proceeding to functional endoscopic sinus surgery in children with CRS.
Pediatric Enuresis, Sleep Apnea, and Adenotonsillectomy
Authors: Jeyakumar Anita , Armbrecht Eric S. , Rahman Syed I. , Mitchell Ron B. 
Published: September 2011

ObjectiveTo evaluate the prevalence of nocturnal enuresis in children diagnosed with sleep disordered breathing and the effect of adenotonsillectomy on enuresis.MethodA systematic analysis of the literature was performed from 1980 to 2010 on patients who had documented sleep disordered breathing, along with data collection on enuresis. Data were noted if the patient underwent adenotonsillectomy (T&A) with follow‐up documentation on enuresis.ResultsA total of 14 studies (1998‐2010) were reviewed. The total number of subjects was 21,744 to 51.77% were male. The age range was 18 months — 19 years. The prevalence of SDB was 16.3% (3,550 subjects), and 31% (or 1,113 subjects) had preoperative enuresis. We analyzed 7 studies with post‐tonsillectomy follow‐up. Mean sample size was 194, median follow‐up was 6 months, and age range was 2 to 18 years. The preoperative and postoperative prevalence of enuresis were 32% (408/1,274 enrolled subjects) and 16%, respectively, based on the available sample of 587 subjects.ConclusionSleep‐disordered breathing in children has a higher prevalence of nocturnal enuresis as compared with the general population. Adenotonsillectomy has a favorable therapeutic effect on enuresis in children with SDB. There is a need for further prospective trials.
Infections after Gracilis Free Flap Reconstruction
Authors: Lee Linda N. , Henstrom Douglas , Cheney Mack , Durand Marlene , Hadlock Tessa 
Published: September 2011

ObjectiveInvestigate the incidence, bacteriology, and clinical outcomes of surgical site infection (SSI) after gracilis transfer for facial reanimation, with a focus on determining the optimal perioperative antibiotics in these clean‐contaminated cases.MethodA retrospective chart review was performed for facial paralysis patients who underwent gracilis free flap reconstruction from 2003 to 2010. Microbiology, medication allergies, type and duration of perioperative prophylactic antibiotics, surgery length, and ASA status were reviewed. Functional smile outcomes were compared between those who developed infections and those who were infection‐free.ResultsSince 2003, 110 patients have undergone 116 gracilis free flap operations for facial reanimation, with 6 SSIs. All of the infections occurred in patients receiving clindamycin, levofloxacin, and/or cefazolin perioperative antibiotics. None of the patients who received ampicillin/sulbactam developed a SSI. Surgical site cultures from infected patients grew alpha‐hemolytic streptococci, Haemophilus parainfluenzae, Fusobacterium, coagulase‐negative staphylococci, and Neisseria. Notably, there were no methicillin‐resistant Staphylococcus aureus (MRSA) infections. In the patients with SSIs, the mean oral commissure excursion improved by 7.49 ± 3.83 mm, which was not significantly different from noninfected patients with subjective excellent outcomes of 11.4 ± 7.1 mm.ConclusionIn gracilis flap infections, the organisms identified were consistent with oral flora. Infections occurred in patients receiving prophylactic clindamycin, levaquin, and/or cefazolin, but not in those receiving prophylactic ampicillin/sulbactam. Infections were not associated with decreased functional outcome. These data may have implications for the optimal choice of prophylactic antibiotics.
Ventilation Tube Insertions for Pediatric Otitis Media with Effusion: With Adenoidectomy or Not
Authors: Wang Mao‐Che 
Published: September 2011

ObjectivePerforming adenoidectomy or not in conjunction with ventilation tube insertion (VTI) to treat pediatric otitis media with effusion (OME) has been debated for decades. This study used population‐based data to determine the recurrence rate of persistent OME with adenoidectomy or not in conjunction with VTI.MethodThis study included all children less than 12 years old who underwent VTI in the year 2003 by using the NHI databank in Taiwan. We compare the recurrence rate and time to recurrence of persistent OME in children who received adenoidectomy in conjunction with VTI and VTI alone in a 3‐year follow‐up.ResultsFrom 2736 cases evaluated, the children having both adenoidectomy and VTI had a lower recurrence rate of OME than those who had VTI alone (P <. 0001). The children under the age of 8 years having both adenoidectomy and VTI had a statistically significant lower recurrence rate of OME than those who had VTI alone (P =. 0384 for age 0‐3years, P =. 0286 for age 4‐7years). There is no difference in OME recurrence with adenoidectomy or not in the age group 8 to 11 years (P =. 1539). There is no difference in time to recurrence in all age groups.ConclusionCombined adenoidectomy and VTI for pediatric OME can reduce OME recurrence of tube re‐insertion rate than that of VTI alone, especially in children under 8 years old. The time to recurrence seemed to be lengthened in the combined adenoidectomy and VTI group, but without statistical significance.
Vitamin D3 Deficiency in Children with Chronic Rhinosinusitis with Nasal Polyps
Authors: Mulligan Jennifer Konopa , Sansoni E. Ritter , White David R. , Wang Eric W. , Schlosser Rodney J. 
Published: September 2011

ObjectiveVitamin D3 (VD3) is a steroid hormone that acts on the immune system similar to oral steroids. In asthmatics VD3 deficiency contributes to increased Th2 skewing and steroid use. We examined if children with allergic fungal rhinosinusitis (AFRS) or chronic rhinosinusitis with nasal polyposis (CRSwNP) were VD3 deficient.MethodPlasma levels of 25‐hydroxyvitamin D3 were measured by ELISA in children (<21 years old) with AFRS (n = 9), CRSwNP (n = 4), CRS without nasal polyposis (CRSsNP) (n = 10), and controls undergoing surgery for adenotonsillar hypertrophy (n = 10). Levels were confirmed for patients being examined in clinic in CRSwNP (n = 4) and AFRS (n = 15).ResultsThere was no difference in mean plasma 25‐OH VD3 between control and CRSsNP at time of surgery, 36.2 and 36.3 ng/ml respectively. Mean CRSwNP levels were 22.1 ng/ml and AFRS 17.7 ng/ml, both well below the minimum recommended level of 32 ng/ml and significantly lower than control and CRSsNP levels (p3 levels clinically confirmed that children with CRSwNP and AFRS were deficient (26 and 16.9 ng/ml, respectively). Presence of asthma did not appear to be associated with lower VD3, compared with nonasthmatic disease‐matched children. VD3 deficiencies were independent of race and gender.ConclusionChildren with AFRS and CRSwNP were VD3 deficient and had levels significantly lower than the recommended level 32/ng mL. These results were confirmed clinically by mass spectrometry. Supplementation of VD3 deficient children may improve symptoms and reduce steroid use.
3D Reconstructions for Point‐of‐Care Computed Tomography
Authors: McClurg Stanley W. , Das Subinoy , Welling D. Bradley 
Published: September 2011

ObjectiveDemonstrate improvements in diagnostic accuracy and efficiencies in health care delivery afforded by the use of 3‐dimensional reconstructions of point‐of‐care computed tomography (CT) in the office of the otolaryngologist.MethodThe Morita Accuitomo 3D CT scanner was used to obtain point‐of‐care CT images of the sinuses and temporal bones of patients at The Ohio State University Department of Otolaryngology in September of 2010. The advantages and limitations of 3D reconstructions in these cases were documented, and 3D videos were created.ResultsOne hundred consecutive cases utilizing 3D CT scans were analyzed for areas of potential improved diagnostic accuracy. Reconstructions increased overall scan time by 35 seconds, on average. Representative cases of typical benefits and disadvantages seen in patients with sinus and ear disease were tabulated. Atypical cases where 3D CT provided unforeseen advantages, including patients with septal perforations and displaced ossicular prostheses, were also identified and analyzed. Three illustrative cases were selected for the creation of 3D videos.Conclusion3D reconstructions of point‐of‐care CT scans provide enhanced diagnostic accuracy and efficiency of health care delivery, with minimal additional time costs for several patients in this investigation. These findings support the further prospective study of the cost efficiency and potential for improved patient outcomes with this novel technology.
Allergen‐Specific Cytokine Production by Human Nasal Polyps
Authors: Singh Narinder , Faith Alexander , Hawrylowicz Catherine , Roberts David N. , Corrigan Christopher J. 
Published: September 2011

ObjectiveStudy the ex vivo allergen‐specific cytokine responses of cells derived from human nasal polyps. We hypothesized that nasal‐polyp derived human respiratory cells from atopic individuals would respond with reduced IL10 compared with cells from nonatopics.MethodThirty‐one nonsmoking adults with nasal polyposis requiring surgery were recruited. Atopic status was determined by skin prick tests. Polyps were harvested during routine surgery. After digestion with collagenase, cell suspensions were incubated with positive and negative allergen (cat, grass, or HDM) for 6 days. Cytokine detection was by cytometric bead array.ResultsIL‐10 was induced in nasal polyp cell suspensions derived from both atopics and nonatopics with the addition of allergen in a dose‐response fashion.ConclusionOur results indicate that IL‐10 producing T cells regulate Th2 cytokine production in nasal‐polyp derived human airway cells.
Interpolation Flaps for Nasal Reconstruction
Authors: Paddack Angela Cogburn , Spencer Horace , Frank Robert , Vural Emre A. , Key J. Michael 
Published: September 2011

ObjectiveDetermine whether the type (paramedian forehead [PMFF] vs nasolabial [NLF]) or the defect thickness (full vs partial) play a role in take rates of interpolation flaps in nasal reconstruction.MethodA retrospective chart review was performed on patients who underwent nasal reconstruction with 2‐stage paramedian forehead or nasolabial flaps between 2002 and present. Defect characteristics recorded were thickness, size, location; flap type used for repair, utilization of cartilage grafts; and comorbidities, including diabetes, peripheral vascular or coronary artery disease, and smoking habits.ResultsA total of 107 total patients; 82 (76%) reconstructed using 2‐stage paramedian forehead flap; 25 (24%) using a 2‐stage nasolabial flap (NLF). A total of 47 PMFF and 12 NLF were used for full thickness defects. Overall failure rate was 5%, both partial and complete. Five PMFF failed (7%), 3 full thickness. One NLF failed (4%), also full thickness. Any use of cartilage in reconstruction did not affect failure rates. Both flaps with complete failure were used more distally, while partial failure flaps for more proximal defects. No comorbities were noted to have a significant effect on failure rates, 5 out of 6 failures were in smokers.ConclusionThis study provides outcome data when interpolation flap reconstruction, with or without cartilage grafts, is offered. Overall success rates for nasal reconstruction using interpolation flaps in this study were 94%. Thickness of defect and type of flap did not affect outcome, while positive smoking status did significantly affect failure rate.
Assessment of Predictive Factors for Biofilms Presence in Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago F. P. , Gebrim Eloisa Marie , De Rezende Pinna Fabio , del Melo Padua Francini Grecco , Saldiva Paulo , Voegels Richard L. 
Published: September 2011

ObjectiveEvaluate predictive factors for the presence of biofilms during sinus surgery for chronic sinusitis with nasal polyps (CRSwP).MethodProspective study conducted in a tertiary care center in 2008 to 2009. Patients underwent sinus surgery for CRSwP, and mucosal samples were harvested for scanning electron microscopic. Preoperative data were recorded. Data were considered nonparametric. Mann‐Whitney test and Spearman rank correlation were used.ResultsBiofilms were present in 66.6 % (22/33) of the CRSwNP patients. Both groups had similar age median [Interquartile Range] = 45.0 [15.0] (38‐56) vs 46.5 [27.0] (22‐78) and the same sex distribution (male:female ratio = 1.75). Patients with biofilms had worst Lund‐Kennedy score (6.0[3.0] (3‐10) vs 8.0[3.0] (3‐11), U = 69.5, P =. 44). Although patients with biofilms had worst NOSE and Lund‐Mackay scores and best SNOT‐20 and SNOT‐20(5+) scores, those were not statistically different between groups. There was a strong correlation between preoperative NOSE and SNOT‐20 scores in both groups.ConclusionThis study showed that biofilms were present in most patients with CRSwNP. Despite the fact that NOSE and Lund‐Mackay scores were worse in patients with biofilms, only Lund‐Kennedy scores shown a significant predictive value to find biofilms intraoperatively.
Atypical Mycobacterium Detection in Refractory Chronic Rhinosinusitis
Authors: Solyar Alla , Lee Annie S. , Lanza Donald C. 
Published: September 2011

ObjectiveAtypical mycobacterium (AM) involvement in refractory chronic rhinosinusitis (CRS) is sought by some surgeons with customary acid‐fast bacilli cultures (AFBC) in the operating room (OR). We evaluate our experience with AM in CRS by describing: 1) associated risk factors, 2) species identified, and 3) frequency of positive cultures in clinic vs OR.MethodAFBC taken between 2005 and 2010 were identified from microbiology laboratory databases. Charts were reviewed for gender, age, medical history, risk factors for AM, pathogen types, and treatments with statistical comparison using PearsonX2. Benefit of “targeted AFBC” for cases with high clinical suspicion was compared with “customary AFBC” in OR.ResultsThirty‐one patients were identified with AM, of which 10 had one or more risk factors for AM, including foreign body (n = 4), non‐HIV immune dysfunction (n = 4), and previous chemo‐radiation (n = 4). Six different AM species were identified: most frequently M abscessus (50%), followed by M avium‐intracellulare complex (20%) and M chelonae (17%). “Targeted AFBC” from outpatient setting were positive in 10 out of 190 (5.3%), whereas 10 out of 393 (2.5%) of “customary AFBC” in OR were positive (P =. 09). Macrolide therapy was employed in 16 out of 31 (52%) patients with AM‐associated CRS but was not prescribed in patients with positive “customary AFBC” alone.ConclusionAM‐associated CRS is an uncommon condition that can occur in the absence of foreign body or overtly altered innate/adaptive immunity. Management with macrolide therapy, as well as the potential relationships between existence of AM in tap water, AM biofilms, and frequent nasal irrigations, warrant further investigation in refractory CRS.