bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study of the PEAK PlasmaBlade TnA in Adult Tonsillectomy Compared to Traditional Electrosurgery
Authors: Vose Joshua G. , Atmodjo Dominique , Weeks Brian H. 
Published: September 2011

ObjectiveRecently, the use of low temperature pulsed radiofrequency (RF) energy has emerged as a method for efficient tissue dissection with minimal thermal damage. When used for tonsillectomy, anecdotal reports have cited improved recovery compared with traditional electrosurgery (ie, Bovie). We evaluated this technology in adults undergoing subcapsular tonsillectomy.MethodTwenty adults were prospectively enrolled in this pilot study. Subjects were randomized to tonsillectomy with the PlasmaBlade (PB) or traditional electrosurgery (ES). Intra‐operative time and blood loss were recorded; postoperatively, subjects blindly reported visual analog scale painscores, narcotic consumption, diet volume, and activity level using a validated form.ResultsThe population age (34.7 ± 18.7 years, P =. 75) and BMI (24.7 ± 3.9 kg/m2, P =. 44) were equivalent. Operative time was also equivalent for both technologies (7:36 ± 1:58 min, P =. 99) with PB subjects demonstrating a 69% reduction in IBL (1.6 ± 1.8 vs 5.3 ± 7.9mL, P =. 02) compared with ES. Postoperatively, PB subjects demonstrated a 40% (2.5 ± 1.2 vs 4.1 ± 0.7 Tylenol‐Codeine/d, P =. 002) reduction in narcotic consumption over the 10‐day monitoring period. Modest improvements in activity level (6%; P =. 83), diet volume (20%, P =. 32), and VAS pain score (12%, P =. 41) were also reported. However, these were not statistically significant.ConclusionThe use of this new low‐thermal damage electrosurgical technology for adult tonsillectomy appears to offer several advantages over traditional electrosurgery, notably in reducing narcotic consumption in the postoperative period. Larger population‐based studies should be conducted to further examine these endpoints.
Automated Tube Deployment: Success Demonstrated in OR
Authors: Syms Charles A. , Gould Andrew R. , Zeiders Jacob W. , Faw Kenneth D. 
Published: September 2011

ObjectiveInvestigate the safety and efficacy of a novel automated tympanostomy tube delivery system for the creation of a myringotomy and the placement of a tympanostomy tube for patients presenting with chronic otitis media with effusion and/or recurrent acute otitis media.MethodA prospective, multicenter, single arm clinical study enrolled 53 subjects. Tube placement was performed in an operative setting using the Acclarent Tympanostomy Tube Delivery System (TTDS). Patients underwent physical examination and audiometry preoperatively and at one week postoperatively.ResultsA total of 53 subjects (47 subjects 5 years of age and younger) were enrolled in the study at 4 United States centers. From these subjects, 101 ears were enrolled and 5 were excluded because of study criteria related to condition of the tympanic membrane. There were no serious device‐related adverse events. The primary efficacy endpoint, successful tube deployment across the tympanic membrane, was achieved: 95 of 101 (94%) attempted deployments in the cohort were successful. Tube retention was also evaluated as a secondary endpoint, and 94 of 95 (99%) tubes placed with the device were retained at follow‐up.ConclusionThe Acclarent TTDS is a safe and effective device for placement of tympanostomy tubes in patients with chronic otitis media with effusion and recurrent acute otitis media. Given the device’s safety, efficacy, and speed of tube delivery, further investigation of its in‐office application under local anesthesia is warranted.
Characteristics of Dysphagia after Cerebellopontine Angle Surgery
Authors: Starmer Heather M. , Hillel Alexander T , Francis Howard W. , Akst Lee M. , Best Simon R. , Chien Wade W. , Agrawal Yuri 
Published: September 2011

ObjectiveDescribe swallowing disorders encountered after Cerebellopontine Angle (CPA) surgery as well as to explore variables associated with increased incidence of postoperative dysphagia.MethodRetrospective chart review of 181 consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Presence and characteristics of dysphagia were determined by speech pathologist reports. Clinical variables were extracted from the electronic medical record.ResultsPostoperative dysphagia was identified in 57 out of 181 patients (31%). Oral, oropharyngeal, and pharyngeal deficits accounted for 49%, 37%, and 12% of dysphagic symptoms respectively. Facial nerve weakness in the immediate postoperative period was noted in 91% of dysphagic subjects (mean House‐Brackmann score of 4) compared with 43% of those without dysphagia (mean House‐Brackman score of 2). Diet alterations were required for 65% of dysphagic individuals, and an additional 9% required tube‐feeding. Common findings during Videofluoroscopic Swallowing Studies (VFSS) were pharyngeal residue, reduced pharyngeal constriction, and anterior bolus loss. Abnormal Penetration‐Aspiration Scores (≥3) were found in 59% of those undergoing VFSS.ConclusionOral and pharyngeal swallowing deficits are commonly encountered after CPA surgery. Consultation with a speech‐language pathologist appears most critical for any individuals demonstrating postoperative cranial nerve dysfunction, particularly for those with evidence of facial nerve weakness. Early consultation may help to manage short‐ and long‐term functional difficulties.
Cost Analysis of Postthyroidectomy Hypocalcemia
Authors: Young Jadrien 
Published: September 2011

ObjectiveOne of the more common complications following total thyroidectomy is postoperative hypocalcemia. Numerous protocols have been developed over the years for management including perioperative parathyroid hormone (POPTH) levels and obtaining ionized calcium levels postoperatively with supplementation based on the values. Our goal was to perform a cost analysis of POPTH.MethodWe examined the postoperative hypocalcemia using ICD‐9 codes for thyroid nodules and examined those that underwent total thyroidectomy. We excluded revision surgeries and pathology of cancer. The postoperative PTH values, initial ionized calcium, and number of calcium draws were obtained. The patients were then stratified based on initial PTH value.ResultsFor initial PTH For initial PTH 21‐50, the initial ionized calcium was 3.99 ± 0.38 and the number of laboratory draws was 3.8 ± 3.3. For initial PTH >50, the initial ionized calcium was 4.27 ± 0.37 and the number of laboratory draws was 2.5 ± 1.7. There was no significant difference in the initial ionized calcium between those that had an initial PTH drawn and those that did not.ConclusionFor total thyroidectomies (benign goiter), there was no difference in the initial ionized calcium for PTH90 (P =. 29). This suggests that PTH is not an adequate predictor of postoperative calcium level. Also there is a significant cost burden with obtaining the PTH level where tremendous savings could be achieved.
Estrogen Receptors in Nasal Mucosa
Authors: Millas Ieda , Liquidato Bianca M. , Correa Carla Sant`Anna , Buck Hudson S. , Dolci Jose‐Eduardo L. , Barros Mirna Duarte , Paes Roberto Antonio Pinto 
Published: September 2011

ObjectiveEvaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.MethodThere were selected 2 groups of 32 women, with regular menstrual cycles, who had undergone nasal surgery. One group of women was taking oral contraceptives and the other was not. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta estrogen receptors.ResultsA decrease of beta‐receptor in lamina propria cells with the use of oral contraceptives was observed. On the other locations there was not any statistically significant difference. In both groups there was a predominance of beta‐receptor presence.ConclusionWomen taking contraceptive pills had a decrease of beta‐receptor in lamina propria cells.
Half‐time SPECT Acquisition with Resolution Recovery for 99mTc‐sestaMIBI SPECT/CT Imaging in the Assessment of Primary Hyperparathyroidism
Authors: Bar Ronen , Frenkel Alex , Netzer Aviram , Golz Avishay , Israel Ora , Keidar Zohar 
Published: September 2011

Objective99mTc‐sestaMIBI SPECT/CT has a proven value for diagnosis and localization of parathyroid adenoma (PTA). Present study compared diagnostic accuracy and image quality of half‐time SPECT to standard full‐time SPECT.MethodA total of 90 patients performed 99mTc‐sestaMIBI scintigraphy. “H”‐mode, 360 degrees SPECT was performed 45 minutes after injection using standard and half‐time protocols. The SPECTs were reviewed randomly. Results were graded as negative, probable, and positive. SPECT image quality was graded as poor, good and excellent. PTA detection and image quality were compared.ResultsA total of 85 studies demonstrated cervical 99mTc‐sestaMIBI foci and 5 were ectopic. A total of 73 studies (81%) showed congruent PTA detection scoring. In 17 studies a difference of one level in the probability for PTA was found. One of the ectopic foci was demonstrated on standard full‐time SPECT only. Image quality was graded as good or excellent in all studies. 64 studies (71.1%) showed the same image quality on full‐ and half‐time SPECT acquisition including 39 graded good, and 25 graded excellent. No significant difference in image quality was found between SPECT techniques.ConclusionSignificant reduction in acquisition time of 99mTc‐sestaMIBI SPECT can be successfully implemented into SPECT/CT for a total study time of 9 min. Diagnosis and precise preoperative localization is obtained without compromising clinically significant information.
Hedgehog Pathway in HNSCC: A Target in Future Therapies?
Authors: Mozet Christian , Dehghani Faramarz , Wichmann Gunnar , Dimitrova Kamelia , Stöhr Matthäus , Dietz Andreas 
Published: September 2011

ObjectiveDemonstrate the expression of components of the Hedgehog signaling pathway (Hh) in HNSCC. A subsequent over‐stimulation of this pathway is described in several types of malignancies and is associated with poor prognosis. Hh inhibition with antagonists like Cyclopamin (Cyc) may reveal a potential therapeutic relevance.MethodiParaffin‐embedded sections of 10 HNSCC were incubated with Alexa 568‐labeled antibodies specific for Hh proteins. Further, we tested the effects of Cyc on the growth of KB cells and on HNSCC cells ex vivo in FLAVINO‐bioassays alone and in combination with chemotherapeutic agents. Immunofluorescent colonies of epithelial cells were counted.ResultsEpithelial cells in HNSCC expressed components of the Hh‐pathway (PTCH‐1, PTCH‐2, SMO, GLI, andSHH) preferentially at the invading tumor margins. The intensity and distribution of the staining was heterogeneous but significant. Peritumoral stroma cells stained partly positive, too. Cyc alone suppressed mitosis and proliferation of KB cells and suppressed the formation of cytokeratin‐positive (CK+) colonies of HNSCC ex vivo in a concentration dependent manner. Further, Cyc enhanced the inhibitory effects of Cisplatin (Cis) and Docetaxel (DTX) on colony formation of CK+ cells in the KB cell line and in HNSCC ex vivo.ConclusionOur results underline a potential relevance of Hh in HNSCC. Additional targeting of Hh components may support established therapy regimens in HNSCC‐treatment in the future and, therefore, represents a promising aim for drug discovery.
How Good Is Google? The Quality of Otolaryngology Information on the Internet
Authors: Pusz Max Daniel , Brietzke Scott E. 
Published: September 2011

ObjectiveDespite any cautionary warnings from medical providers, searching internet websites is likely to be a patient’s (or parent’s) first step in obtaining timely information on the treatment of common otolaryngology problems. The quality of the information a patient (parent) may encounter using a Google search for typical otolaryngology ailments was critically examined.MethodA Google keyword search was performed for 10 common otolaryngology problems including ear infection, hearing loss, tonsillitis, etc. The top 10 search results for each were critically examined using the 16 item (1‐5 scale) standardized DISCERN instrument. The DISCERN instrument was developed to assess the quality of patient treatment choice literature.ResultsA total of 100 websites were assessed. Nineteen (19%) were primarily advertisements for products and were excluded from DISCERN scoring. Searches for more typically chronic otolaryngic problems (eg, tinnitus, sleep apnea) resulted in more biased, advertisement results than typically acute problems (eg, ear infection, sinus infection, P =. 03). The search for “sleep apnea treatment” produced the highest scoring results (mean overall DISCERN score, 3.49; range, 1.81‐4.56), and the search for “hoarseness treatment” produced the lowest scores (mean, 2.49; range, 1.56‐3.56). Results from major comprehensive websites (WebMD, EMedicinehealth.com, Wikipedia, etc) scored higher than other websites (Mean DISCERN score, 3.46; vs 2.48; P <. 001).ConclusionThere is marked variability in the quality of website information for the treatment of common otolaryngologic problems. Searches on more chronic problems resulted in a higher proportion of biased advertisement websites. Larger, comprehensive websites generally provided better information but were less than perfect in presenting complete information on treatment options.
Inservice Exam Predicts Written Board Passage
Authors: Puscas Liana 
Published: September 2011

ObjectiveDetermine if there is any association between the Resident Otolaryngology Training Examination (OTE) score and the pass rate on the American Board of Otolaryngology (ABOto) Written Qualifying Examination.MethodData from the 2005 to 2009 OTE and the 2007 to 2010 ABOto Written Examination were available for comparison. Odds ratio, chi‐squared test of independence, and logistic regression were used to determine the relationship between OTE score and passage of the written ABOto examination.ResultsThe proportion of Board examination failures for those whose OTE score was in the bottom 10th percentile is 25%. Proportion of Board examination failures for those whose OTE score was above the 10th percentile is 7.29% (P = <. 0001). Odds ratio analysis revealed that every 10 point increase in percentile corresponds to an estimated 50% increase in odds of passing the examination on the first attempt (OR = 1.54, SE = 0.08; CI = 1.39, 1.71). Logistic modeling showed no significant association for year of exam or cohort of residents.ConclusionThere is a significant association between a lower score on the OTE and increased failure rate on the first attempt at the ABOto Written Qualifying Examination.
Nationwide Multicenter Study on Posttonsillectomy Bleeding
Authors: Sarny Stephanie , Ossimitz Guenther , Habermann Walter , Stammberger Heinz 
Published: September 2011

Objective1) Assess risk factors for the frequency of postoperative hemorrhage. 2) Apply a new classification of postoperative hemorrhage using a clear definition and 7 grades depending on severity. 3) Assess multiple bleeding episodes after tonsil surgery.MethodThe study is based on a complete census of tonsillectomies (TE), tonsillotomies (TO), and adenoidectomies (AE) within 9 months in Austria. Postoperative hemorrhage was defined as every bleeding episode after extubation and classified in grades A1, A2, B1, B2, C, D, and E according to severity and the treatment needed.ResultsIncluded were 9,405 patients: 48.5% TE with or without (±) AE, 37.1% AE, and 14.0% TO ± AE. Postoperative hemorrhage was far more frequent for TE than for TO or AE (P <. 001). A return to theater was necessary for 4.6% after TE. Adults had a significantly higher risk of postoperative bleeding than children for all types of surgeries (P <. 05). Males had a significantly higher risk of postoperative bleeding episodes (P <. 05). The “hot” operation techniques (bipolar diathermy or Coblation) showed a significantly increased risk of hemorrhage (P <. 05). The evidence of a light bleeding episode increased the risk of a severe bleeding episode (P <. 05).ConclusionAssessing all grades of postoperative hemorrhage offers a far more precise picture about postoperative bleeding. Risk factors for postoperative hemorrhage have been the type of surgery, age, and operation technique.
Surgical Patient Tracking with the Karl Storz OR‐Ticket
Authors: Fischer Milos , Dressler Christian , Dietz Andreas , Strauss Gero 
Published: September 2011

ObjectivePatient safety of surgical patients depends on correct identification and tracking in the operating theater. Additionally, surgical resources, presented patient data from the electronic patient chart, and surgical documentation are highly variable depending on the surgical procedure.MethodWe compared the surgical workflow of ENT‐surgical patients equipped with a QR‐code based OR‐Ticket. The ticket provided relevant electronic patient data: name, surname, date of birth, surgical procedure, operative site and side. The time for pre‐ and postoperative patient tracking and surgical documentation was investigated for 50 exemplary procedures.ResultsThe time for the generation of the OR‐ticket could be neglected because it was directly printed from the electronic patient documentation system. There were no technical problems with the readout from the OR‐ticket. All patients were identified correctly. The time for patient identification was reduced compared with standard procedure. The time for documentation purposes was reduced compared with standard documentation.ConclusionThe OR‐ticket provides the possibility to improve patient safety and ergonomics in the operating theater. Further technical development may provide automatic presentation of relevant patient data in the surgical cockpit and concentrate surgical resources depending on the identified patient and procedure, especially in operating theaters with a high patient turnover.
Postoperative Medication Errors in Otolaryngology
Authors: Gonzalez Danny S. , Antonelli Patrick J. , Winterstein Almut 
Published: September 2011

ObjectiveThe epidemiology of medication errors (MEs) in ambulatory and inpatient care is well understood, but little is known about ambulatory surgery. This study aims to quantify the incidence and nature of MEs after ambulatory otolaryngologic surgery.MethodAmbulatory surgery patients were assessed for 1) pre‐surgical home medications, 2) clinical history, 3) written prescriptions, 4) discharge instructions, and 5) medication use reported by patients within 48 hours of discharge. Potential MEs were reviewed by an expert panel to determine validity, contributing factors, and potential preventative measures.ResultsFrom 100 surgeries, 12 postoperative MEs were identified. All were without clinical sequelae, in part due to investigator involvement. Contributing factors included providers (2), patients (5), and the healthcare system (5). Causes for MEs included failure to verify patient information (eg, allergies), failure to accurately reconcile medications, and misunderstanding of instructions by the patients. Discharge instructions and medication reconciliation protocols appeared insufficient for optimal postoperative care and resulted in many after‐hours calls for clarification.ConclusionMEs are common following ambulatory otolaryngologic surgery even though regimens are simple and limited to few medications. Key targets for quality improvement include fragmentation in information flow and physician‐patient communication.
Risks and Benefits of DVT/PE Prophylaxis in Otolaryngology
Authors: Shuman Andrew G. , Jackson Christopher , Hu Hsou Mei , Bahl Vinita , Bradford Carol R. 
Published: September 2011

ObjectiveThe consequences of perioperative venous thromboembolism (VTE) can be devastating. This study is designed to 1) correlate the incidence of VTE with perioperative risk assessment, 2) determine whether VTE prophylaxis effectively decreases the risk of perioperative VTE, and 3) assess if VTE prophylaxis increases bleeding complications in otolaryngology.MethodA retrospective case‐control study was conducted at a tertiary care medical center among adults presenting for otolaryngologic surgery from 2003 to 2010 (n = 3498). Patients treated before the implementation of guideline‐based VTE prophylaxis protocols were compared to patients treated after implementation. Primary outcome variables were Caprini risk level, perioperative VTE, and bleeding complications.ResultsThe odds of a VTE increased 1.435 times with each level increase in the Caprini VTE risk level (P =. 048). The VTE rate after implementation of prophylactic protocols was significantly lower than prior to implementation (OR 0.286, P =. 005). However, the type of VTE prophylaxis had no significant effect on the likelihood of developing a VTE. The likelihood of a bleeding complication was not significantly different before and after implementation. The odds of a bleeding complication increased for patients receiving twice daily enoxaparin (OR 4.546, P =. 032) or a treatment (rather than prophylactic) dose of anticoagulant (OR 3.546, P <. 001).ConclusionPerioperative VTE risk stratification based on Caprini risk assessment in otolaryngology is effective. The odds of VTE decreased after the implementation of guideline‐directed VTE prophylaxis. Although perioperative bleeding complications did not increase after the implementation of VTE prophylaxis protocols, therapeutic anticoagulation is associated with a higher incidence of bleeding complications.
The Outcomes of 4 Different Techniques of Tonsillectomy
Authors: Civelek Senol , Sayin Ibrahim , Caglayan Volkan , Emre Ismet E. , Turgut Suat 
Published: September 2011

ObjectiveCompare 4 different techniques of tonsillectomy reagarding operative time, intra‐operative blood loss, and pain scores.MethodA total of 160 patients were randomly assigned to the cold dissection tonsillectomy (CDT), bipolar elecrocautery tonsillectomy (BPT), Harmonic Scalpel tonsillectomy (HST), and Thermal Welding tonsillectomy (TWT) groups. Patients underwent tonsillectomy where intraoperative blood loss and time were evaluated. Patients where then followed for pain analysis.ResultsOperative time varied from 6 to 31 minutes, and mean operative time was 13.76 ± 5.28 minutes. Operative time in the HST group was significantly shorter than in the CDT and TWT groups (p = 0.001). Highest intraoperative bleeding was observed in the CDT group (68.6 ± 35.3 ml) and was significantly higher than in the HST (9.4 ± 3.1ml) and BPT groups (13.4 ± 3.8 ml) (P =. 001, resp P =. 022). Pain scores in the HST group were much lower than in the CDT and BPT groups (P =. 022, resp P =. 001). Pain scores between other groups did not show any statistically significant difference (P >. 05).ConclusionThe 4 techniques compared all show different attributes useful during surgery, but considering long learning curves and high prices we believe that cold dissection tonsillectomy still has the upper hand.