bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Factors Associated with Revision Surgery in Allergic Fungal Sinusitis
Authors: Wang Eric W. , Crosby Brittany , Carroll William R. , Schlosser Rodney J. , Nguyen Shaun A. 
Published: September 2011

Objective1) Examine the efficacy of FESS combined with aggressive postoperative medical management in the treatment of allergic fungal sinusitis (AFS). 2) Determine prognostic factors associated with disease recurrence and the need for subsequent revision surgery in a population of AFS patients.MethodA retrospective case control study examined demographic and disease‐related characteristics and adjuvant therapies in patients undergoing combined surgical and medical treatment of AFS in a single tertiary academic center. Exclusion criteria included follow‐up of less than 6 months. The dependent variable was revision surgery. Average follow‐up was 29.4 months.ResultsEighty consecutive AFS patients from 2002 to 2009 were identified and 62 patients did not require revision surgery (78%).ConclusionAFS can be effectively controlled with multimodality therapy. Compliance with postoperative medical therapy and topical steroid use are prognostic factors associated with treatment success, decreasing the rate of revision surgery to 13%. African‐American race and prior surgeries are prognostic factors associated with revision surgery, suggesting more aggressive disease.
The ADVANCE II Study: A Prospective, Randomized, Multi‐center Study to Assess the Safety and Efficacy of a Bioabsorbable Steroid‐Eluting Sinus Implant
Authors: Marple Bradley F. , Gould Andrew R. , Han Joseph , Jampel Henry , Smith Timothy L. , Mugglin Andrew S. 
Published: September 2011

ObjectiveEndoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) may be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent intervention. To address this issue, we investigated the safety and effectiveness of controlled delivery of mometasone furoate to the sinus mucosa via bioabsorbable implants deployed at the time of ESS.MethodA prospective, multicenter, randomized, double‐blind trial was performed on 105 patients with CRS under‐going ESS, comparing the effect of drug‐eluting to non‐drug‐eluting stents. Postoperative interventions, polyposis, and adhesions were assessed postoperatively. Efficacy was determined through independent analysis of randomized video‐endoscopies by 3 blinded sinus surgeons. Safety assessments included ocular exams.ResultsImplants were successfully deployed in all 210 sinuses. Compared with control sinuses, the drug‐eluting stent provided a 29% relative reduction in postoperative interventions (P =. 0280), a 52% (P =. 0053) decrease in lysis of adhesions, and a 29% (P =. 0881) decrease in oral steroid prescriptions. The relative reduction in frank polyposis was 45% (P =. 0023). Similar reductions were observed in real‐time grading performed by the clinical investigators. No clinically significant changes from baseline in intraocular pressure or cataracts were observed.ConclusionContinual postoperative application of topical corticosteroids applied via drug‐eluting stent deployed at surgery was studied to assess its impact upon ESS outcomes. This study strongly suggests that steroid‐eluting implants are effective at improving surgical outcomes by reducing the need for postoperative interventions, with negligible ocular safety risk.
All‐Cause Mortality and Obstructive Sleep Apnea Revisited
Authors: Rich Jeremy , Raviv Ayelette , Raviv Nataly , Brietzke Scott 
Published: September 2011

ObjectiveObstructive Sleep Apnea Syndrome (OSAS) is a pervasive problem that affects millions worldwide. OSAS is strongly linked to hypertension, coronary artery disease, and stroke. However, its association with mortality is not clearly quantified. A large database of patients who underwent sleep testing was explored for associations with all‐cause mortality.MethodOver 77,000 patients who underwent a validated, portable sleep study (SNAP Test, SNAP Diagnostics Inc, USA) were matched to the Social Security Death File to establish mortality. Measures of OSAS severity and other major confounding factors were correlated to all‐cause mortality using survival analysis with multivariate Cox proportional hazards regression.ResultsAs expected, increasing age (adjusted HR = 1.08095%CI = 1.074‐1.086 P <. 0001), BMI (HR = 1.042 95%CI = 1.033‐1.051 P <. 0001), and male sex (HR = 1.378 95%CI = 1.190‐1.595 P <. 001) were associated with increased all‐cause mortality. Epworth sleepiness score was also associated with mortality (HR = 1.015 95%CI = 1.005‐1.025, P =. 002). Apnea Hypopnea Index (AHI) was NOT associated with mortality after adjustment for age (HR = 1.001 95%CI = 0.998‐1.004, P =. 416). However within 10‐year age subgroups, desaturation index (41‐50 year olds, adjusted HR = 1.217 95%CI = 1.014‐1.461, P =. 035), Apnea Index (21‐30 year olds, HR = 1.632 95% CI = 1.053‐2.532 P =. 028), and AHI (31‐40 year olds, HR = 1.222 95% CI = 1.010‐1.478 P =. 039) were significantly associated with all‐cause mortality in younger patients. In older patients (over 50 years), age, sex, and BMI were dominantly associated with mortality.ConclusionIncreasing OSAS severity as measured by a validated home sleep test and quantified by AHI, Apnea index, and pulse oximetry desaturation index, is independently associated with a modestly increased all‐cause mortality in younger patients (less than age 50 years) after adjustment for major confounding factors.
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea Treatment
Authors: Kezirian Eric J. , Kezirian  , Palme Carsten , Goding George , Campbell Matthew , Hee Geoffrey , Park Steven Y. , Huntley Tod C. 
Published: September 2011

ObjectiveReduced upper airway muscle activity during sleep contributes to obstructive sleep apnea (OSA) pathogenesis. A novel therapy (HGNS, Apnex Medical, Inc) is designed to address this issue by stimulating the hypoglossal nerve synchronous with respiration during sleep. This study evaluated the safety and effectiveness of HGNS for OSA treatment.MethodFrom 2009‐2010, 32 subjects with moderate to severe OSA underwent implantation of the HGNS system. Subjects had objective assessment using laboratory polysomnography (PSG) and subjective symptom assessment using validated questionnaires. Preliminary analyses are presented. The primary outcome variable was the change in apnea hypopnea index (AHI).ResultsHGNS was used on a median of 97% of nights, with a mean use of 5.1 ± 1.7 hours per night. Thirty‐one/32 subjects had PSGs at the 3‐ and/or 6‐month interim time points. Treatment with HGNS therapy resulted insignificant improvement in AHI (45.4 ± 17.5 to 23.2 ± 18.50; P <. 05). Symptoms also improved (all P <. 05): Epworth Sleepiness Scale (12.0 ± 4.6 to 8.3 ± 3.9), Functional Outcomes of Sleep Questionnaire (14.2 ± 2.0 to 16.6 ± 2.3), and Pittsburgh Sleep Quality Index (10.5 ± 3.0 to 8.4 ± 4.1). There was no change in body mass index.ConclusionHGNS therapy was associated with a significant decrease in AHI and improvement in symptoms, and compliance was high. Based on the results of this feasibility trial, the HGNS System will be evaluated in a randomized pivotal trial.
Quantifying Osteotome Sharpness: Comparing the Major Manufacturers
Authors: Ransom Evan R. , Becker Daniel , Bloom Jason D. , Antunes Marcelo B. 
Published: September 2011

Objective1) Develop a method for quantification of osteotome sharpness in a rhinoplasty model, using artificial bone; 2) demonstrate changes in osteotome sharpness over multiple uses; and, 3) compare sharpness of osteotomes from different manufacturers at baseline and after multiple uses.MethodOsteotomes were passed through synthetic bone blocks. Sharpness was measured using the Instron Universal Tester (force required to cut #2 Prolene suture) at baseline and after 1, 4, 7, and 10 osteotomies. Changes in sharpness over time were assessed using within‐sample t tests. Comparison of manufacturers was performed with multiway ANOVA.ResultsA novel, prospective surgical model was developed. Osteotomes from 5 manufacturers were tested (Nextedge, Black & Black, Storz, Miltex, and Biomet). Baseline measurements showed that the Storz osteotome was sharpest (1.74 lbs, P <. 001), followed by Miltex and Biomet (2.50 lbs, 2.68 lbs), and Nextedge and Black & Black (3.48 lbs, 3.40 lbs). All osteotomes except Nextedge (P =. 098) demonstrated a significant decrease in sharpness over time (P =. 02 to P <. 001), though relative changes and absolute sharpness varied widely between instruments. ANOVA showed the Storz osteotome was significantly sharper across all uses and timepoints (P <. 001). The greatest decrease in sharpness over time was seen with Black & Black (‐1.28 lbs).ConclusionOtolaryngologists use osteotomes in cosmetic and functional rhinoplasty. Millimeter‐level accuracy in these procedures is essential to maximize outcome and minimize complications. Multiple similar‐appearing instruments are available, but their relative efficacy is infrequently tested. We have demonstrated that, at least in the case of osteotomes, not all instruments are created equally.
Polysomnographic Evaluation of Drug Induced Sleep Endoscopy (DISE)
Authors: Valera Fabiana , Braga Adriano , Küpper Daniel , Rabelo Fabio , Sander Heidi H. , Fernandes Regina 
Published: September 2011

ObjectiveDISE is increasingly being used to localize the obstructive site in OSAS patients. The objective of this study is to determine if propofol changes sleep parameters in polysomnography.MethodThirty subjects (6 controls/24 with OSAS) underwent 2 diurnal polysomnographies, with/without the use of propofol, controlled by target‐controlled infusion pump (Diprifusor). The examinations were compared regarding the presence of snoring, AHI, oxygen desaturation, and sleep architecture. Endoscopies with the patients sleeping and awake were also compared.ResultsThe use of propofol did not induce snoring in the control subjects, whereas 100% of the OSAS patients snored. Propofol increased N3 sleep and abolished totally REM sleep (P2 did not differ significantly between the 2 examinations (P >. 05). The minimum SaO2 were significantly reduced during propofol sedation.ConclusionPropofol changed the sleep architecture, but not the main respiratory parameters in OSAS. DISE was shown to be safe and more reliable to determine the sites of obstruction, supporting the view that this examinations is promising for the management of this disease.
Soft Palate Radiofrequency for Snoring: One vs Multiple Steps
Authors: Blumen Marc B. , Oker Nathalie , Chabolle Frederic , Buchet Isabelle , Vezina Jean‐Philippe 
Published: September 2011

ObjectiveEvaluate the need for multiple sessions of soft palate radiofrequency (RF) to treat snoring.MethodRetrospective study of patients with simple snoring or mild sleep apnea treated with RF. Efficacy on snoring and RF tolerance were compared in 3 protocols consisting of 1 or 2 RF sessions combined with an uvulectomy, performed during the first or second RF session or alone during a third session.ResultsA total of 97 patients were included. Mean age, body mass index (BMI), and apnea hypopnea index (AHI) respectively were 53.2 ± 10.1 years, 25 ± 3.9 Kg/m2 and 10.8 ± 9.1. The 2 groups were comparable in terms of age, BMI, AHI and preoperative snoring score on the visual analog scale. Postoperative snoring score was comparable among the 3 groups (P =. 77). Tolerance was poorer when uvulectomy was performed. It was more painful when it was performed during the first session compared with the second session or third session.ConclusionSoft palate radiofrequency can be effective in one session but induces greater pain.
The Impact of Uvulopalatopharyngoplasty on Metabolic Syndrome in Patients with Obstructive Sleep Apnea
Authors: Kanotra Sohit P. , Krespi Yosef P. 
Published: September 2011

ObjectiveObstructive sleep apnea (OSA) has been associated with metabolic syndrome (MS) and its various components. However, the impact of successful treatment of OSA on MS is still unclear. This study analyzes the prevalence of metabolic syndrome and its various components in patients with OSA and evaluates the impact of uvulopalatopharyngoplasty (UPPP) on MS.MethodA 3‐year retrospective chart review of patients referred to an otolaryngology department for sleep disordered breathing. A total of 134 patients met the inclusion criterion. The diagnosis of MS was established according to National Cholesterol Education Program Adult Treatment Panel III.ResultsAccording to the AHI, the patients were divided into OSA (mean AHI = 64) and controls (mean AHI = 4.46). The incidence of MS was significantly higher in patients with OSA (72.5%) v/s controls (39.5%). The components of MS which showed significance were fasting glucose (P =. 002) and blood pressure (P <. 032). The prevalence of MS before and 6 months after UPPP was 71.0% and 60.87% which was not statistically significant. The only component of MS showing significant improvement was blood pressure. (P <. 001).ConclusionThere is a high incidence of metabolic syndrome in patients with OSAS. Although UPPP improved respiratory parameters, it did not have a significant effect on the prevalence of MS. The only component which showed a significant improvement was blood pressure.
Strength of Titanium Intramedullary Implants vs Traditional Miniplate Fixation of Mandibular Condyle Fractures
Authors: Frake Paul C. , Wagner Mark J. , Joshi Arjun S. , Howell Rebecca J. 
Published: September 2011

ObjectiveTest the strength of internal fixation of mandibular condyle fractures repaired with titanium miniplates vs titanium intramedullary implants.MethodCondylar osteotomies were created in 40 urethane hemimandible models and 24 human cadaveric specimens. Half of the samples in each group were repaired with traditional miniplates and the other half were repaired with intramedullary titanium pins. Anteroposterior and mediolateral loads were applied and the displacement across the fracture site was calculated.ResultsWhen subjected to physiologic and supraphysiologic loads, titanium intramedullary implants provided more resistance to bone fragment displacement than traditional miniplates. This was true for both the urethane model and the cadaveric mandible experimental groups. Mechanical failures in the miniplate groups were due to plate bending and/or screw extrusion. However, a 1.65 mm diameter titanium intramedullary pin did not mechanically fail in any of the cases. Intramedullary implantation failures were due to secondary fracture of the adjacent cortical bone under high forces or rotation of the smooth pin implant.ConclusionMechanical failures which were encountered under physiologic forces with miniplate fixation were not seen with titanium intramedullary implants. These intramedullary implants provide stronger and more durable fixation of mandibular condyle fractures than traditional miniplates in both urethane and cadaveric laboratory models.
The SNaP Wound Care System for Head and Neck Wound Closure
Authors: Stucken Chaz L. , Reino Anthony J. 
Published: September 2011

ObjectiveVacuum‐assisted closure of head and neck wounds has been previously described. Negative pressure wound therapy, although efficacious, has practical limitations in the outpatient setting. The purpose of this study is to describe a novel method of treating complex head and neck wounds using an ultraportable mechanical vacuum wound care system.MethodA cohort study at 2 tertiary care centers. All head and neck patients with complex, low to moderately exudative wounds were treated by the senior author using the SNaP Wound Care System. Patient comorbidities, wound etiology, site, length of treatment, outcomes, and ancillary procedures were recorded.ResultsA variety of wounds was treated with this system and included mucocutaneous fistulas, a tracheocutaneous fistula, soft tissue defects of the head and neck, and tendon exposure of a radial forearm free flap donor site. Outpatient SNaP therapy was utilized in five patients with 6 small‐ to medium‐sized wounds. This system was successful in obtaining wound closure in all patients. These patients were able to complete routine activities of daily living, participate in public social settings, and tolerate therapy without adverse events. One patient required an adjunctive procedure of split thickness skin grafting.ConclusionThis study demonstrates a novel use of the first FDA‐approved ultraportable, mechanical negative pressure device in the treatment of several complex head and neck wounds. The device has utility in the outpatient setting for adjunctive closure of wounds with minimal disturbance to patients’ activities of daily living and lifestyle.
Classification of Posttonsillectomy Hemorrhage
Authors: Sarny Stephanie , Ossimitz Guenther , Habermann Walter , Stammberger Heinz 
Published: September 2011

ObjectiveApply a new classification of postoperative hemorrhage using a clear definition and seven grades (A1, A2, B1, B2, C, D, and E) depending on severity and based on the intensity of treatment needed. Postoperative hemorrhage was defined as every bleeding after extubation.MethodGrade A: anamnestic recorded blood‐tinged sputum; A1 dry wound, no coagulum; A2 coagulum, dry wound after removal. Grade B: bleeding actively under examination; B1 noninvasive treatment; B2 treatment in local anaesthesia. Grade C: hemorrhage needing treatment in general anesthesia. Grade D: dramatic hemorrhage requiring blood transfusion. Grade E: fatal hemorrhage.ResultsOf the 4594 patients undergoing tonsillectomy within 9 months evaluation period, 818 bleeding episodes had been recorded (17.8%). A1 bleeding episodes were recorded for 146 patients, A2 for 274 patients, B1 for 104 patients, B2 for 65 patients, C for 221 patients, and D for 8 patients. No fatal hemorrhage occurred. Surgical treatment was necessary in 4.6% of all patients. About half of all bleeding episodes have been anamnestic recorded. For patients with multiple bleeding episodes, light bleedings (grade A1 to B2) increased the risk for severe bleedings of grade C or D (P <. 05).ConclusionPostoperative hemorrhage is strongly related to the definition of bleeding episodes. A new classification could have been approved for the first time in a large study population.
Epidemiology and Burden of Recurrent Acute Rhinosinusitis
Authors: Bhattacharyya Neil , Grebner Jeff , Martinson Noel G. 
Published: September 2011

Objective1) Learn about the epidemiology of recurrent acute rhinosinusitis (RARS). 2) Understand healthcare costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis.MethodMedical claims data (2003‐2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis [ARS] claims each with a filled oral antibiotic prescription in a 12‐month period) were extracted. Diagnostic procedures, surgery rates, and medical costs were determined.ResultsA total of 4,588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. Similarly, 0.2%, 2.0%, and 4.1% underwent endoscopic sinus surgery at these same intervals. Average total healthcare costs related to RARS averaged $1207/patient‐year. Antibiotic and nasal prescription costs averaged $210 and $452, and an average of 3.8 antibiotics were filled per patient‐year with RARS.ConclusionRARS may affect approximately 1 in 3000 adults. Despite significant health care costs over $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.
Office‐Based Laser Surgery of the Larynx: A Cost Analysis
Authors: Halum Stacey L. , Kuo Connie 
Published: September 2011

ObjectiveWhile office based laser surgery (OBLS) for benign laryngeal disease is cost‐effective for the patient, the financial impact on the office offering the service has not been characterized. We hypothesize that OBLS offers a savings to the patient which is not widely realized because the technology poses a financial liability.MethodA 2‐part cost analysis study was performed. First, cost and reimbursements for 50 patients undergoing OBLS was compared with 50 patients undergoing operative direct laryngoscopy with laser (DLL). Second, detailed financial comparison was done on a self‐paired series of patients who had each undergone both OBLS and DLL.ResultsWhen compared with DLL, there was over $5,000.00 per case cost savings to the patient/third party payer for OBLS. Mean total reimbursement per DLL was $6,453.44, including hospital, anesthesiologist, and surgeon reimbursements of $5,150.00, $745.66, and $357.78, respectively. Based on a mean hospital DLL cost of $2,069.15, the hospital profited over $3000 per case. For OBLS in a nonfacility office setting, mean total reimbursement was $643.08 with mean procedure and laser fiber reimbursements of $596.52 and $46.56, respectively. Based on mean office expenses of $1,388.06 for equipment expenses and nursing staff, the office lost over $500 per OBLS case.ConclusionOBLS offers health care cost savings that are not widely realized because of the financial loss incurred by the office. An ideal reimbursement model is proposed that would cover the cost of OBLS, and could lead to nearly $400 million in health care costs savings annually.
Hardware Removal Rates for Mandibular Angle Fractures: Comparing the 8‐Hole Strut and Champy’s Plates
Authors: Moore Evan R. , Bayrak Sinehan , Vural Emre A. , Key J. Michael , Moody Marcus W. 
Published: September 2011

Objective1) Compare the rate of removal of Champy’s plates vs 8‐hole strut plates used for repair of mandible angle fracture. 2) Determine the reason for removal of these plates.MethodA retrospective chart review was conducted from 2006 to 2010 comparing the removal rate between Champy’s plates and 8‐hole strut plates for internal fixation of traumatic angle mandible fractures at a large adult tertiary care hospital. The reason for removal of each plate was then determined from the clinical record.ResultsA total of 104 patients with a total of 106 angle fractures met the inclusion criteria for this study. A total of 73 angle fractures were treated with the 8‐hole strut and 33 angle fractures were treated with Champy’s plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8‐hole strut plate group and 18.2% in the Champy’s group (P =. 133). Loose hardware was determined to be the cause of plate removal in 1 (2.7%) of the 8‐hole strut plate group compared with all 6 (18.2%) of the Champy’s group (P =. 005).ConclusionIn our experience, the 8‐hole strut plate has a lower rate of plate removal compared to the Champy’s plate in treating mandible angle fractures. The main reason for plate removal was loose hardware. The rate of removal for loose hardware was higher and statistically significant in the Champy’s group.