bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Series with Endoscopic Findings of a Novel Nasal Irrigation Protocol for Refractory Chronic Rhinosinusitis
Authors: Mehra Saral , Chandler Michael , Prasad Mukesh 
Published: September 2011

ObjectivePresent an innovative treatment protocol for refractory chronic rhinosinusitis (CRS) in order for practitioners to 1) learn of a new topical treatment regimen, 2) be able to apply this protocol to their own patients, and 3) understand the proposed mechanism of its action.MethodCase series of 20 patients with refractory CRS treated with a novel topical sinus regimen that included diluted baby shampoo between June 2009 and June 2010 with analysis of patient, disease, and treatment characteristics. Treatment endpoints include subjective improvement of nasal symptoms and objective improvements on nasal endoscopy.ResultsOur novel treatment protocol involves gentamicin 20 mg per 240 mL (8 ounces), Johnson’s Baby Shampoo 1 drop per 240 mL, and pulmicort respules 1 mg per 240 mL. Patients are advised to use 120 mL via a 240 mL squeeze bottle. We then remove the gentamicin, pulmicort, or both, and track patient progress based on symptomatic improvement and improvements seen on nasal endoscopy. All patients had positive response using this treatment protocol after failed medical and surgical management with a variety of other topical and systemic therapies. Two notable cases are presented with endonasal photos to illustrate the positive response achieved using this treatment protocol.ConclusionThis novel sinus irrigation treatment protocol is effective in the treatment of CRS as documented by subjective improvements in nasal symptoms as well as significant improvement in nasal endoscopic findings. This protocol is well tolerated by patients and should be considered by otolaryngologists and allergists treating refractory CRS.
CFTR Modulation by the Tobacco Smoke Toxin Acrolein
Authors: Alexander Nathan S. , Skinner Daniel , Sorscher Eric , Zhang Shaoyan , Woodworth Bradford A. 
Published: September 2011

ObjectiveTobacco‐smoke exposure inhibits transepithelial Cl‐secretion—a major determinant of airway surface liquid hydration and mucociliary clearance (MCC). The objective of the current study was to evaluate the effects of acrolein exposure (a tobacco smoke toxin) on Cl‐transport through the major apical anion channel CFTR in sinonasal epithelium.MethodPrimary murine nasal septal (MNSE, wild type, and transgenic CFTR‐/‐) and human sinonasal epithelial (HSNE) cultures were exposed to acrolein in Ussing chambers, and effects on Cl‐secretion were investigated using pharmacologic manipulation. Cellular cAMP signaling and cytotoxicity were also investigated.ResultsAcrolein‐stimulated Cl‐secretion (ΔISC ‐ change in short‐circuit current in µA/cm2) at low concentrations (100 µM, 15.8 ± 2.2 vs 2.4 ± 0.8 (control); p‐transport at 300 µM (13.3 ± 1.2 vs 19.9 ± 1.0; p‐secretion was solely reliant upon the presence of CFTR (confirmed in transgenic CFTR ‐/‐ MNSE), but independent of cAMP signaling. Inhibition at higher concentrations was not secondary to cellular cytotoxicity, indicating direct effects on the CFTR.ConclusionDecreased MCC is a major contributing feature to chronic rhinosinusitis. The present study demonstrated that acrolein has complex but direct interactions with CFTR. Robust inhibition of Cl‐transport at higher concentrations indicates the potential contribution of this toxin to decreased MCC in individuals with chronic tobacco smoke exposure.
Chronic Facial Pain and Blood Serotonin: A Pilot Study
Authors: Agius Adrian M. , Muscsat Richard , Jones Nick 
Published: September 2011

ObjectiveTo study whole blood serotonin levels in patients with chronic mid‐facial segmental pain and to compare with normal matched controls. Peripheral blood serotonin is stored almost exclusively in platelets, which reflect intra‐neuronal serotonin. In chronic facial pain, low intraneuronal serotonin may cause dysfunction of descending serotonergic inhibition of nociceptive pathways.MethodThirty patients with chronic tension‐type facial pain according to International Headache Society criteria and 30 matched controls were studied. Patients were symptomatic for at least 3 months, had normal nasoendoscopy, and had normal CT sinuses/brain. Other causes of pain, such as facial migraine, trigeminal neuralgia, or TMJ dysfunction, were excluded.ResultsPatients with chronic facial pain tended to have normal peripheral blood serotonin levels. There was no significant difference in serotonin levels between patients and controls.ConclusionThis study does not provide evidence of serotonergic dysfunction in chronic tension‐type facial pain. Dysfunction of other inhibitory descending pathways, such as noradrenergic pathways, may play a significant role in the development of chronic tension‐type facial pain.
Correlation of Clinical History and Physical Examination to Positive CT Findings for Nonpolypoid Paranasal Sinus Disease
Authors: Rassouli Alipasha , Al Rasheed Abdulaziz , Tewfik Marc A. 
Published: September 2011

ObjectiveChronic rhinosinusitis affects a significant portion of the population and is one of the most common reasons for otolaryngology visits. Computed tomography (CT) has become the main modality of investigation. Given the significant paucity in evidence, associated radiation exposure, and economic burden, clinical guidelines regarding CT investigation are needed.MethodProspective investigation correlating presenting symptoms and positive CT outcomes that affected subsequent management in 80 consecutive patients without nasal polyps. A questionnaire of paranasal sinus disease symptoms was completed prior to imaging, and findings from rigid nasendoscopy were recorded. CT sinuses were subsequently graded using the Lund‐Mackay scoring system.ResultsThe symptom most closely correlated was facial pressure, and the symptom least correlated was postnasal drip. Positive predictive values of each of the symptoms assessed as well as physical findings will be detailed.ConclusionClinical guidelines can play an important role in directing the radiologic investigation for paranasal sinus disease, decreasing radiation exposure, and economic burden on healthcare.
Effect of Berberine on Nasal Polyp‐derived Fibroblast
Authors: Park Il‐Ho , Choi Hyuk , Lee Heung‐Man , Kim Yong‐Dae 
Published: September 2011

ObjectiveBerberine is a compound isolated from medicinal herbs such as coptidis rhizoma. Berberine has been reported with diverse pharmacological effects. Nasal polyps are a common chronic inflammatory disease of nasal mucosa. In this study, we investigated the effect of berberine on myofibroblast differentiation in nasal polyp‐derived fibroblast (NPDF).MethodNPDFs were prepared with and without berberine before TGF‐beta1 treatment. The mRNA expressions of alpha‐SMA was determined by RT‐PCR. The expression of alpha‐SMA protein and Phosphorylation of Smad2/3, ERK, p38, JNK, c‐fos was determined by western blotting and or immunocytochemistry. The amount of total collagen production was analyzed by SirCol assay.ResultsWe observed that berberine inhibited the expression of alpha‐SMA and total soluble collagen in a dose dependent manner. The TGF‐β1‐induced expression of pERK, p38, and AP‐1 were decreased by berberine.ConclusionBerberine abrogates TGF‐beta1‐induced myofibroblast differentiation by inhibition of Akt, MAPK phosphorylation, and AP‐1 activation. These findings offer a mechanism for the antifibrotic effects of berberine and a therapeutic point in the treatment for nasal polyps.
Effects of Total Intravenous Anesthesia vs Inhalational Anesthesia in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Randomized Controlled Study
Authors: Gomez‐Rivera Fernando , Cattano Davide , Ramaswamy Uma , Citardi Martin , Fakhri Samer , Luong Amber , Man Li‐Xing 
Published: September 2011

ObjectiveCompare anesthesia with sevoflurane/remifentanyl (SR) to total intravenous anesthesia with propofol/remifentanyl (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in the following parameters: 1) effects on blood flow to the mucosa; 2) amount of blood loss; and 3) surgical field visualization score (SFS).MethodA total of 23 adults undergoing endoscopic sinus surgery for chronic rhinosinusitis within a 6‐month period were randomized to receive SR or PR. The SFS was based on the Boezaart scale. Sinonasal mucosa blood flow was measured by optical rhinometry (OR). Blood loss was recovered with the Neptune Waste Management System.ResultsThe groups were evenly distributed, with similar clinical characteristics and Lund‐Mackay score. Median blood loss was 105 cc in the PR group and 180 cc in the SR group (P =. 15). The length of surgery was 134 minutes in the PR group and 177 minutes in the SR group (P =. 19). The average SFS was 1.6 in the PR group and 2.0 in the SR group (P =. 22). OR showed a decrease in blood flow to ‐0.1 OR units from the beginning of surgery in the PR group compared with ‐0.4 OR units in the SR group (P =. 02).ConclusionOur preliminary results suggest that PR appears to be associated clinically to a decreased blood loss, improved surgical field visualization, and decreased operative time in endoscopic sinus surgery. We showed however that blood flow to the nasal cavity appears to be increased with TIVA.
Endoscopic DCR in Children
Authors: de Souza Chris , Nisar Jayesh 
Published: September 2011

ObjectiveEvaluation of results of endoscopic DCR in children.MethodA total of 39 children (aged 5‐14 years) had undergone first time endoscopic DCR. A total of 37 had undergone removal of the medial wall of the lacrimal sac. Two children with lacrimal sac fistula on the face had undergone stenting. Parameters of success: No epiphora, patency of neofistula, and no attacks of dacryocystitis.ResultsA total of 37 children who had undergone endoscopic DCR had large lacrimal sacs (LS) and had undergone removal of the medial wall of the LS. Of these, 34 experienced success. Three patients got blocked within 2 weeks and refused revision surgery. Two patients had undergone stenting, as they had fistulae on the face over the LS. Stents were removed for both after 2 months after the fistula healed. But both got blocked again and refused revision surgery.ConclusionEndoscopic DCR is a safe procedure in children and is associated with a high degree of success. Fistulae over the lacrimal sac would indicate that stenting is necessary and should not be removed if the sac is to be patent.
Endoscopic Hypophysectomy
Authors: Papaspyrou Spyros , Sakkas Damianos , Siggounas Evangelos , Stranjalis George 
Published: September 2011

ObjectiveEndoscopic endonasal hypophysectomy constitutes a challenge and an opportunity for the otolaryngologist. In the past 15 years, 246 hypophysectomies have been performed in cooperation with the neurosurgical department of our hospital.MethodFor the first 182 hypophysectomies a sublabial approach was performed with the use of a microscope. Subsequently, 22 hypophysectomies were performed with a combined approach (sublabial microscope‐endoscope assisted). Lastly, for the most recent 42 hypophysectomies, an endonasal endoscopic 4‐hands technique was applied.ResultsWith all 3 techniques, the success rate did not significantly differ. Complication rate (hemorrhage, cerebrospinal fluid leak) was significantly lower in the endoscopic technique. Hospital stay was also significantly lower in the endoscopic technique.ConclusionThe advantages of endoscopic approach are: less traumatic, faster, panoramic view, angle‐view with the use of different endoscopes, and possibility to explore the sella for residual tumor at the end of operation. Its disadvantages are the lack of three‐dimensional view and the need for an assistant to hold the endoscope.
Endoscopic Management of Meningiomas
Authors: Naidoo Yuresh , Padhye Vikram , Wormald Peter J. 
Published: September 2011

ObjectiveEvaluate the management of meningiomas surgically resected via an endoscopic transnasal approach by the South Australian Endoscopic Skull Base Unit in South Australia since 2004. The safety and efficacy of the procedure and areas for further refinement and improvement are analyzed.MethodRetrospective case series of 16 consecutive patients who underwent endoscopic transnasal resection of anterior skull base meningiomas in South Australia between 2004 and 2010.ResultsPreoperative symptoms, tumor size, tumor location, intraoperative time, intraoperative complications, defect closure techniques, postoperative complications, and length of hospital stay were assessed and compared. The results achieved by this unit are comparable with the published literature.ConclusionAnterior cranial fossa meningiomas can be safely removed endonasally and offer significant advantages over the traditional transcranial approach.
Endoscopic Surgery for Fronto‐Ethmoidal Mucoceles: A Fifteen Year Experience
Authors: Dhepnorrarat Rataphol Chris , Subramaniam Somasundaram , Sethi Dharambir Singh 
Published: September 2011

Objective1) Understand the factors affecting outcomes in surgery for fronto‐ethmoidal mucocoeles (FEM). 2) Add to the senior author’s experience to the existing literature regarding the management of FEM.MethodA retrospective study of patients treated by the senior author from 1995 to 2010 was undertaken. A patient database was used to identify those who had endoscopic surgery for FEM. Patient notes and operative records were reviewed and assessed for variables that may affect outcome after surgery.ResultsA total of 40 patients underwent 44 endoscopic procedures for treatment of FEM. The mean age was 46.3 years, and mean follow‐up time was 74.9 months. Two patients (5%) had head trauma as an etiological factor. A total of 28 Draf IIa procedures, 13 Draf IIb, and 3 Draf III procedures were performed. Three patients had surgery combined with open approaches. Two patients had bilateral surgery, and 2 patients required revision surgery: one for restenosis after a Draf IIa procedure (1/28) and one for disease recurrence. Stenosis was found in a further 3 patients who had Draf IIb surgery (3/13).ConclusionThe current series represents one of the largest for the endoscopic management of FEM. Endoscopic approaches are suitable for all but the most lateral of mucocoeles. The most common complication, restenosis of the frontal recess, was more likely following Draf IIb procedures (23%) than Draf IIa (3.6%) procedures.
Endoscopic vs Transfacial Removal of Sinusal Adenocarcinoma
Authors: Vergez Sebastien , Decotte Anne , Lepage Benoit , De Bonnecaze Guillaume , Martin‐Dupont Nathalie , Serrano Elie 
Published: September 2011

ObjectiveCompare the overall survival, recurrence‐free survival, and complication rates between 2 comparable groups of patients operated by an endoscopic or a transfacial resection of a sinonasal adenocarcinoma.MethodA first group of 24 patients with a sinonasal adenocarcinoma recently operated endoscopically (« ENDO », 1999‐2009) is compared to another group of 24 patients operated anteriorly by a transfacial approach (lateral rhinotomy “LR” 1993‐2007). In this retrospective study, we included patients who would have had in 2010 an endoscopic resection.ResultsGroups were comparable in terms of age and sex (P =. 49) and tumoral stages with 13T1‐T2/11T3‐T4 in the group ENDO and 12T1‐T2/12T3‐T4 in the group LR (P =. 77). a total of 43 out of 48 patients have had a postoperative radiation therapy. The mean follow‐up was respectively of 27 and 82 months for the groups ENDO and LR. After 27 months, the overall survival curves were not significantly different. The recurrence‐free rates were equally similar in both groups (P =. 71). The median duration of hospitalization was significantly shorter in the ENDO group (4 vs 8 days, P <. 0001). The rate of early complications was strictly identical in both groups (3/24).ConclusionThe endoscopic approach is an effective treatment in selected cases of sinonasal adenocarcinomas. Early oncological outcome and morbidity are comparable to a transfacial approach. Hospitalization was significantly reduced and skin scars avoided. This procedure is less invasive but requires an optimal preoperative imaging protocol and an experienced surgical team.
Epinastine Hydrochloride for Pediatric Allergic Rhinitis
Authors: Hara Hirotaka , Sugahara Kazuma , Hashimoto Makoto , Yamashita Hiroshi 
Published: September 2011

Objective1) Prospectively evaluate the effectiveness of epinastine hydrochloride (EH) for pediatric outpatients with sleep‐disordered breathing (SDB) symptoms caused by allergic rhinitis (AR); 2) Assess the quality of life (QOL) of those children prior to and following treatment with oral EH.MethodPediatric AR outpatients (19; boys, 9; girls, 10; average age, 5.6 years [SD = 1. 4]) with SDB symptoms were recruited. They were all treated with oral EH for 4 weeks. Before and after the 4‐week treatment period, the otolaryngological findings and OSA‐18 scores were collected for each participant.ResultsEpinastine hydrochloride significantly improved the swelling of the inferior nasal turbinate mucosa and decreased the quantity of nasal discharge. The initial total mean OSA‐18 score was 58.5, whereas the total score reduced to 22.8 after oral epinastine hydrochloride treatment.ConclusionEpinastine hydrochloride therapy demonstrated positive clinical effects on both nasal findings and the QOL of pediatric outpatients with symptoms of SDB caused by allergic rhinitis. Epinastine hydrochloride therapy may improve nasal findings and QOL in pediatric outpatients with SDB symptoms.
FESS Does Not Improve Lung Function in Cystic Fibrosis
Authors: Sajan Javad A. , Kempainen Robert , Rimell Frank L. 
Published: September 2011

ObjectiveFunctional endoscopic sinus surgery (FESS) provides symptomatic relief of sinus disease in patients with CF (cystic fibrosis), but it is unclear whether it has beneficial effects on lung disease in this population. This study assessed the effect of FESS on the respiratory status of adult CF patients.MethodWe performed a retrospective chart review at a tertiary medical center encompassing 32 adult CF patients who underwent 45 operative cases. Outcome measures were the effect of FESS on the rate of decline in lung function, intravenous antibiotic use, and hospitalization for pulmonary exacerbation.ResultsFESS was performed in 32 patients encompassing maxillary antrostomy, ethmoidectomy, frontal sinusotomy, sphenoidectomy, and polypectomy. The rate of decline in FEV1 and FVC were not significantly different in the 12 months before and after FESS. FESS did not reduce days hospitalized or days on intravenous antibiotics for a respiratory exacerbation in the pre‐ vs postoperative period. Limiting the analysis to the 30 surgeries that were performed in patients with concomitant respiratory symptoms did not significantly alter the results. Covariates of importance in CF, including CFTR genotype, gender, or microbiology, did not affect the study results.ConclusionFESS does not improve pulmonary status of adults with cystic fibrosis. These results suggest the routine use of FESS to address lung disease progression in CF patients may not be warranted.
Massive Flap Donor Sites and Vacuum‐Assisted Closure Devices
Authors: Skoner Judith Marie , Banks Caroline A. , Schmedes Gregg W. 
Published: September 2011

ObjectiveDetermine the effect of vacuum assisted closure (VAC) on massive scapular and latissimus dorsi free flap donor site morbidity, when used over a closed incision line under great tension.MethodPatients who underwent complex head and neck reconstruction with scapular fasciocutaneous/osteocutaneous and latissimus dorsi myocutaneous free flaps between the years of 2006 and 2010 at a tertiary academic referral center were identified and a retrospective chart review was performed.ResultsSeventy patients who underwent scapular or latissimus dorsi free flap reconstruction were identified. Those with and those without VAC over the closed incision line were identified. The method of application of the VAC dressing was performed by the same team at one institution. None of these patients required skin grafting, and only 1 patient had donor site breakdown secondarily requiring wound care and VAC replacement and 1 patient had an asymptomatic seroma; all others with VAC treatment over the closed incision line were without donor site complications.ConclusionVacuum‐assisted closure is a safe technique in the postoperative management of massive back free flap donor sites closed under great tension, and may eliminate the need for skin grafting. In our study, data suggests this approach decreases seroma formation and secondary wound breakdown.
Functional Endoscopic Sinus Surgery (FESS) Alone vs FESS and Balloon Sinuplasty: A Comparative Outcome Analysis in a Pediatric Population with Chronic Rhinosinusitis
Authors: Thottam Prasad John , Sirigiri Ranga R. , Madgy David N. , Haupert Michael S. , Saraiya Sonal , Belenky Walter M. , Dworkin James 
Published: September 2011

ObjectiveChronic rhinosinusitis (CRS) is a common disease afflicting children. For those affected, conventional FESS and balloon sinuplasty are surgical options for those refractory to medical management. Our objective was to evaluate whether the addition of balloon sinuplasty would improve the treatment outcome in children who undergo FESS for CRS.MethodA 2‐group, retrospective blinded chart review comparing 11 pediatric patients who underwent balloon sinuplasty to 15 undergoing FESS from 2007 to 2010 at the Detroit Medical Center. Preoperative CT scans as well as pre‐ and postoperative sinus symptoms and medications were compared. All group data were compared using 1‐tailed independent t tests.ResultsMean age at the time of procedure was 8.74 (SD = 4.2 years; range, 2‐19 years). Both groups had similar presurgical Lund‐Mackay CT CRS scores (FESS: mean = 9.33, SD = 4.7; Balloon: mean = 10.5, t = ‐.61, p =. 55). Analyses identified posttreatment differences in symptom reduction and needed intervention between the 2 groups. Postoperatively patients who underwent balloon sinuplasty reported fewer headaches (t = 2.51, P =. 01), less postnasal drip (t = 1.88, P =. 04), and reduced sinus congestion (t = 2.05, P =. 03). A comparison of the amount of topical steroidal/saline and antibiotic use identified a reduction in the amount of topicals used in children who received balloon treatment (t = 2.66, P =. 007) and a reduction of antibiotic use (t = 1.79, P =. 04).ConclusionBalloon sinuplasty directed at the frontal and maxillary sinuses resulted in better outcomes than those with traditional FESS techniques. Balloon sinuplasty patients had less sinus symptoms, required less antibiotics, and required less topical nasal steroids postoperatively. Preservation of the native anatomy in balloon sinuplasty may play a role in these findings.