bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Removal of Massive Sinonasal and Skull Base Osteoblastoma
Authors: Patel Amit , Liu James , Eloy Jean , Friedel Mark E. 
Published: September 2011

ObjectiveOsteoblastomas are uncommon bone neoplasms, accounting for 1% of all newly diagnosed primary bone tumors. Sinonasal and skull base osteoblastomas are exceedingly rare. We describe an endoscopic resection of a massive sinonasal/skullbase osteoblastoma, which was misdiagnosed as an ossifying fibroma. We discuss the histopathologic diagnosis of these sinonasal bony lesions.MethodCase report and current literature review.ResultsA 14‐year‐old female presented with progressive right‐sided proptosis and nasal obstruction. CT and MRI scanning demonstrated a massive sinonasal lesion with orbital and skull base involvement. An endoscopic biopsy performed by another otolaryngologist revealed a fibrous and highly vascular lesion. Histopathologic diagnosis was consistent with an ossifying fibroma. Endoscopic endonasal extended approach of this anterior skull base tumor was successfully performed with complete resection. Final histopathologic diagnosis revealed an osteoblastoma. The patient did well postoperatively without complication.ConclusionThis case aims to increase awareness of this infrequently encountered disease of the nasal cavity and paranasal sinuses and offers insight into the diagnosis and treatment of this rare entity.
Endoscopic Sinus Surgery: Complications and Experience
Authors: Ribeiro Ricardo B. , Ribeiro  , Sousa Cecília , Reis Cláudia , Ferreira João P. , Castro Sandra S. 
Published: September 2011

ObjectiveDetermine the incidence of complications in endoscopic sinus surgery (ESS) in a surgical center with 20 years of experience, and whether or not the surgeon’s experience can be a predisposing factor for them to happen.MethodThe clinical data of the patients submitted to EES between 2006 and 2009 was reviewed, and the perioperative and postoperative complications were evaluated, with a minimum follow‐up period of 3 months. For each surgery, the surgeon’s experience and surgery particularities were correlated with the presence of complications.ResultsIn the 677 surgeries, the incidence of complications was 7.39% (5.91% minor and 1.48% major). There was no correlation between surgery complications and the years of experience of the main surgeon. When comparing the complication rate between residents and specialists, there were no statistically significant differences between them. Extensive surgeries, revision surgeries, and the presence and grade of polyposis, were associated with a higher rate of complications.ConclusionWhen some rules are imposed, experience is not the key factor in what concerns the presence of complications during ESS. Patients who are submitted to surgery by residents are not at greater risk of complications than those operated on by specialists.
Endoscopic Transnasal Dacryocystorhinostomy: Technique and Results
Authors: Silva Maria L. S. , Santos Fabio P. , Balieiro Fernando O. , Pacoto Gabriela R. , Pignatari Shirley S. N. , Stamm Aldo E. C. 
Published: September 2011

ObjectiveThe complete or partial obstruction of the lacrimal system is a disorder that manifests clinically by epiphora and/or recurrent dacryocystitis. The recommended treatment for obstructions below the common canaliculus is external or endoscopic transnasal dacryocystorhinostomy (ETDCR). This study aims to evaluate ETDCR as surgical treatment for patients with lower lacrimal system obstruction.MethodThis was a retrospective study, performed at the Complexo Hospitalar Edmundo Vasconcelos in the period from 2000 to 2009, with 20 patients showing low obstruction of the lacrimal system unilaterally or bilaterally, which were submitted to ETDCR with a total of 27 queries.ResultsA total of 27 procedures were performed in 20 patients (10 male and 10 female, mean age of 1.6 to 81 years). The most common complaint was epiphora, and the most frequent causes were idiopathic (59.2%), followed by congenital (29.6%), iatrogenic (4.5%), and trauma after radiotherapy (3.7%). Two patients had a new blockage in the postoperative period, and only 3 patients remained with Crowcroft probe for a period of 3 months postoperatively. The success rate of ETDCR in our series was 92.5%.ConclusionETDCR proved to be a safe technique as a surgical option to treat lower lacrimal system obstruction, with some advantages compared to the external technique, and it can still be accomplished without the use of a stent.
Epistaxis: Is Routine Hemoglobin Recheck Required after Admission?
Authors: Mahalingappa Yogesh , Rashid Mamun 
Published: September 2011

ObjectiveEpistaxis is one of the most common reasons for hospital presentation. To our knowledge there is no prior study that addresses the need for routine hemoglobin recheck prior to discharge. This study assesses the hemoglobin change for patients admitted as inpatients in a ENT department at a busy UK hospital.MethodWe retrospectively analyzed records of all adult hospital admissions in a 6‐month period between January and June 2009. We included patients with whom at least 2 Hb values were available for comparison.ResultsA total of 42 patients fulfilled the inclusion criteria. Twenty patients were female, 22 male. The age range varied between 65 and 90 years. On average, we measured a Hb drop of 10.22 g/l.ConclusionEpistaxis clearly has the potential to affect hemoglobin levels, particularly when severe. Although initial Hb measurement is relevant to assess hemodynamic stability, our data suggest that there is no need for a routine recheck if not clinically indicated. Further prospective research in this area is recommended.
Evaluation of Clinical Features of Antrochoanal Polyps
Authors: Yamada Yuko , Asaka Daiya , Okushi Tetsushi , Moriyama Hiroshi , Otori Nobuyoshi , Nakayama Tsuguhisa , Matsuwaki Yoshinori 
Published: September 2011

ObjectiveAntrochoanal polyps (ACPs) are benign polypoid lesions that arise from the maxillary sinus and extend into the choana. Current knowledge regarding the prevalence and clinical features of ACPs in Japan is very limited. Here, we performed a prospective study to evaluate the prevalence and clinical features of ACPs.MethodBetween April 2007 and March 2008, 728 patients undergoing endoscopic endonasal sinus surgery were prospectively enrolled in this study at the Department of Otorhinolaryngology, Jikei University School of Medicine.ResultsFifteen (2.1%) of those patients were diagnosed as having ACP(s). The symptom scores for nasal obstruction, rhinorrhea, and postnasal drip were each significantly reduced postoperatively. The distribution of the ACPs’ origin in the maxillary sinus was as follows: floor of the maxillary sinus to the posterior wall (40%), floor of the maxillary sinus (26.7%), and floor of the maxillary sinus to the internal wall (20%). The recurrence rate following endoscopic endonasal sinus surgery was 13.3%.ConclusionEndoscopic endonasal sinus surgery for ACPs was most effective when the origin of the polyp in the maxillary sinus was carefully determined and excised as completely as possible, followed by appropriate postoperative treatment.
Evaluation of Estrogenic Receptors in the Nasal Mucosa of Women Taking Oral Contraceptives
Authors: Millas Ieda , Liquidato Bianca , Barros Mirna Duarte 
Published: September 2011

ObjectiveEvaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.MethodTwo groups of 32 women with regular menstrual cycles who had undergone nasal surgery were selected. One group of women was taking oral contraceptives, and the other wasn’t. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta estrogen receptors.ResultsThe use of oral contraceptives induced a decrease of beta‐receptor in lamina propria cells. On the other locations there was no 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.
Evaluation of Peak Nasal Inspiratory Flow as an Objective Method of Measuring Nasal Airflow
Authors: Teixeira Rodrigo Ubiratan Franco , Zappelini Carlos Eduardo Monteiro , Costa Everardo Andrade , Alves Fábio 
Published: September 2011

ObjectiveEvaluate the Peak Nasal Inspiratory Flow as a method of measuring nasal patency and compare the values between healthy and obstructive nasal symptoms of allergic rhinitis.MethodA cohort with contemporary cross‐sectional study, nonrandomized in a sample of 78 subjects.ResultsIn simple linear regression, the PNIF shows significant results for nasal obstruction, rhinorrhea, itching, sneezing, and watery eyes (P <. 0001). There was also a correlation between the presence of nasal septal deviation and PNIF (P =. 561). We found a positive correlation between PNIF and the Visual Analogue Scale ‐ VAS for nasal obstruction (P <. 001). Finally, in a multiple linear regression model, statistical significance was found between the values found in PNIF with allergic rhinitis and age (P =. 005 and P =. 023 respectively).ConclusionThe PNIF proved to be a reliable method for detecting changes in nasal patency by both inflammatory and obstructive causes, with an acceptable level of statistical significance, simple, easy to handle, inexpensive, and reproducible.
Experiences of Sublingual Immunotherapy in Allergic Rhinitis
Authors: Lee Heung‐Man , Choi Hyuk , Park Il‐Ho , Kim Yong‐Dae 
Published: September 2011

ObjectiveSublingual immunotherapy (SLIT) is currently used worldwide as an allergic rhinitis management tool. The purpose of this study was to investigate the efficacy and safety of SLIT for Asian patients with allergic rhinitis to house dust mites.MethodNinety‐eight patients who had allergic rhinitis for dermatophagoides were included and started to receive SLIT. Symptom scores and quality of life were evaluated before and until 1 year by questionnaires. Medication score was assessed monthly by a diary medication card. Adverse effects and compliance were also investigated.ResultsAll nasal and non‐nasal symptoms and quality of life were significantly improved after treatment except itchy palate (P <. 05). Total medication score was decreased after treatment significantly (P <. 05). Some minor adverse effects was reported, however there was no systemic reaction. The drop‐out rate was 19%.ConclusionSLIT for Korean patients with allergic rhinitis to house dust mites is an efficient and safe treatment tool.
Expression of Matrix Metalloproteinase‐2 and ‐9 in Recurrent Nasal Polyposis
Authors: Wang Ling‐Feng , Chien Chen‐Yu , Tai Chih‐Feng 
Published: September 2011

ObjectiveMatrix metalloproteinase (MMP) is involved in the upper airway remodeling process. We hypothesized that MMP had an additive effect to the formation of recurrent nasal polyp. We also investigated the association of MMP’s functional promoter polymorphism and its labeling index in different tissues.MethodThirty‐two patients with recurrent nasal polyps and 30 patients without recurrence of nasal polyp (non‐recurrent) after surgery were collected. Inferior turbinate mucosa obtained from 31 patients without chronic rhinosinusitis were used as controls. Two promoter functional single nucleotide polymorphisms were selected. Tissue samples were frozen for immunohistohemistry.ResultsThe expression of MMP‐9 was significantly enhanced in gland, but not in surface epithelium, for recurrent nasal polyp (P =. 016) and non‐recurrent nasal polyp (P =. 005) compared with the control. MMP‐2 positivity was significantly increased in surface epithelium, but not in gland, for recurrent nasal polyp (P =. 004), and a trend toward significance for non‐recurrent nasal polyp compared to the control. However, there was no statistically significant difference of MMP‐9 and ‐2 expressions between recurrent nasal polyp and non‐recurrent nasal polyp. The genetic polymorphism of MMP‐2 and ‐9 functional promoters was not associated with the intensity of immunohistochemical labeling index.ConclusionThese results suggested up‐regulation of MMP‐9 in gland and MMP‐2 in surface epithelium were characteristic of both recurrent nasal polyp and non‐recurrent nasal polyp. The pathogenesis of recurrent nasal polyps may involve a mechanism other than MMP.
Extramedullary Hematopoiesis of the Maxilla in Beta‐Thalassemia
Authors: Dorton Leighanne Hoskins , Mims James W. 
Published: September 2011

Objective1) Present a rare case of diffuse craniofacial compensatory marrow expansion in a patient with β‐thalassemia resulting in near‐complete obliteration of bilateral maxillary sinuses and partial nasal obstruction. 2) Learn about compensatory extramedullary hematopoeisis in patients with beta‐thalassemia and its effects on the maxillae and paranasal sinuses.MethodA 41‐year‐old female with β‐thalassemia presented to the otolaryngology clinic for recurrent epistaxis. The patient was interviewed and examined, and the medical record and radiographic images were reviewed. The patient was observed for 6 months. Literature review of similar cases was performed.ResultsNasal endoscopy revealed an apparent mass within the right nasal cavity. CT of the sinuses showed diffuse marrow expansion resulting in complete obliteration of the right maxillary sinus, a small residual left maxillary sinus, partial nasal obstruction, and septal deviation. The radiologist described the appearance as consistent with extramedullary hematopoeisis. Despite the extensive bone remodeling, the patient’s remaining sinuses appeared clear, and she was minimally symptomatic. The appearance was stable as compared to imaging obtained 5 years earlier during an unrelated diagnostic workup. We elected to conservatively manage her epistaxis and follow her for worsening symptoms or clinical exam findings.Conclusionβ‐thalassemia causes characteristic changes of the maxilla that should be recognized on CT. The expansion of hematopoietic tissue may contribute to nasal or sinus symptoms. If asymptomatic, these abnormalities can safely be observed. The cornerstone of treatment for β‐thalassemia patients is frequent blood transfusions to suppress additional hematopoiesis.
Ideal Duration of Nasal Packing after Septoplasty
Authors: Cekin Engin Ibrahim , Pinar Dogan P. , Gungor Atila , Erkul Evern , Cincik Hakan 
Published: September 2011

ObjectiveSeptoplasty is a corrective surgical procedure for nasal septal deviation, and nasal packing is usually applied after septoplasty to avoid some complications. The objective of this study was to evaluate the complications and subjective discomfort of 24‐hour nasal packing compared to that of 48‐hour nasal packing in patients undergoing septoplasty.MethodA total of 149 patients were divided into two groups according to time of nasal packing removal. Nasal packings were removed 24 (group 1) and 48 (group 2) hours after septoplasty. Patients with complications were recorded, and verbal analog pain scores (VAS) of all patients were calculated after surgical procedure.ResultsPostoperative hemorrhage rates were 17.5% in the first group and 6.6% in the second group. Hemorrhages in the first group were mostly reactionary, and only two of them required repacking. None of the patients in the second group required repacking. There was no statistically significant difference between the two groups depending on hemorrhage. First day mean VAS scores were similar in both groups. Second day mean VAS score of the second group was higher compared to first day VAS scores of both groups.ConclusionAccording to our study, routine use of 48‐hour nasal packing after septoplasty is not necessary. We observed that prolonged nasal packing increases the postoperative pain significantly and has no significant beneficial effect on postoperative complications except in patients with hypertension.
Immune Dysfunction in Chronic Rhinosinusitis
Authors: Chang C. W. David , Goodwin Jason C. W. 
Published: September 2011

Objective1) Determine the prevalence of immunoglobulin abnormalities in patients with chronic rhinosinusitis. 2) Compare our results with similar studies for validity. 3) Draw conclusions on when to order these specific tests. 4) Alert providers on the prevalence and workup of immune deficiencies.MethodRetrospective study of all patients with CRS of a single provider, from 2008 to 2010, with attention given to those with refractory CRS on whom immunoglobulin laboratories were ordered. Measured variables were total patients, number of immune laboratories ordered, and results of those tests.ResultsAt our institution, 334 patients were seen by a single provider with the diagnosis of CRS. Of these patients, immunoglobulin levels (IgG, IgG subclasses, IgM, IgA, and/or IgE) were ordered on 37 patients. Deficiencies of at least one immunoglobulin class were found on 20 patients (54 percent of patients tested). This demonstrates a 5.9% prevalence of immunoglobulin deficiency in our chronic sinusitis patient population. The most common deficiency noted on this study was an IgG subclass deficiency. Two patients demonstrated common variable immunoglobulinemia.ConclusionDespite aggressive medical and surgical therapy, CRS can be a persistent disease. Immunoglobulin deficiency is common in this subset of refractory patients. The clinician should be aware of this likelihood and order appropriate studies. Proper recognition can allow the clinician to tailor their management of these patients.
Life Threatening Epistaxis in Hereditary Hemorrhagic Telangiectasia: Surgical and Medical Management
Authors: Fatakia Adil A. , Kahn Marc J. , Fazekas‐May Mary A. , Friedlander Paul L. 
Published: September 2011

ObjectiveProvide a comprehensive review of the pathophysiology, clinical presentation, surgical treatment, and advanced medical treatment of hereditary hemorrhagic telangiectasia.MethodCase study of a patient with hereditary hemorrhagic telangiectasia detailing the clinical presentation and treatment algorithm of the disease. Comprehensive literature review detailing the pathophysiology and clinical presentation, with special attention to the surgical and advanced medical management of the disease.ResultsA comprehensive review of hereditary hemorrhagic telangiectasia with special attention to the most up to date surgical and medical treatment regimens and algorithms.ConclusionHereditary hemorrhagic telangiectasia creates a backdrop for life threatening epistaxis. While surgery remains the mainstay of treatment for refractory epistaxis in the setting of HHT, medical management plays a vital role in the prevention and treatment of this disease entity.
Management for Nonmalignant Primary Tumors of the Nasal Cavity
Authors: Hashimoto Shigehisa , Takahashi Sugata T. 
Published: September 2011

ObjectiveAssess the treatment strategy for nonmalignant primary tumors of the nasal cavity.MethodThe subjects were 41 patients who underwent surgery for nonmalignant tumors of the nasal cavity during the 3 years. An endoscopic examination, contrast‐enhanced computed tomography (CT), and magnetic resonance imaging (MRI) were performed preoperatively, and all of the patients were treated surgically.ResultsThe diagnosis was papilloma in 21 cases, hemangioma in 15 cases, juvenile angiofibroma in 3 cases, and leiomyoma in 2 cases. For patients diagnosed with papilloma by endoscopy and CT, additional MRI was performed to identify the tumor base. Computer‐aided surgery was used, and the tumor was endoscopically resected. Because blood flow was sufficient in cases of hemangiomas or angiofibromas, preoperative embolization was performed in 2 cases. Although external incision was anticipated in some cases, endoscopic resection of tumors was possible in all cases, and none of the patients required transfusions.ConclusionIt was possible to make the differential diagnosis between papilloma and hemangioma/angiofibroma on the basis of the preoperative endoscopic and CT findings. Safe and reliable resection was possible by combined use of MRI and computer‐aided surgery for the papillomas, and use of embolization for the hemangiomas and angiofibromas.
Meta‐analysis of Endoscopic vs Sublabial Pituitary Surgery
Authors: DeKlotz Timothy , Aulisi Edward , Makambi Kepher , Lu Wenxin , Chia Stanley , Deeb Ziad 
Published: September 2011

ObjectiveDetermine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.MethodA Medline search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta‐analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.ResultsA total of 21 endoscopic studies (n = 2335) and 17 sublabial studies (n = 2565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs 65%, P <. 0001), as well as lower rates of cerebral spinal fluid leak (5% vs 7%, P <. 01), septal perforation (0% vs 4%), and postoperative epistaxis (1% vs 4%, P <. 0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the 2 techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay (P =. 01) and length of operation were shorter for endoscopic surgery compared to sublabial surgery.ConclusionThe sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta‐analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.
MRSA Central Skull Base Osteomyelitis and Occipital Condylar CSF Leak
Authors: Friedel Mark Erik , Liu James K. , Eloy Jean , Tomovic Senja 
Published: September 2011

ObjectiveCommunity acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA) is emerging as an important pathogen in paranasal sinus disease. However, CA‐MRSA has been a rarely reported source of central skull base osteomyelitis or a subsequent occipital condylar cerebrospinal fluid leak in an otherwise immunocompetent patient.MethodCase report and current literature review.ResultsWe report on an unusual case of a previously healthy and immunocompetent adult who developed meningitis, central skull base osteomyelitis, and occipital condylar cerebrospinal fluid rhinorrhea from CA‐MRSA sphenoid sinusitis requiring endoscopic surgical repair.ConclusionThe increasing prevalence of CA‐MRSA, in conjunction with its potential for intracranial complications, challenges the otolaryngologist to remain vigilant about detecting its possible manifestations. This case clearly demonstrates the expanding spectrum of severe infections caused by CA‐MRSA, which requires prompt diagnosis and appropriate medical and/or surgical management.