bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Airway in the Adult Population of São Paulo, Brazil
Authors: Stefanini Renato , Haddad Fernanda , Bittencourt Lia , Mattos Soares Maria C. , Santos‐Silva Rogerio , Tufik Sergio , Gregorio Luis‐Carlos 
Published: September 2011

Objective1) Study the prevalence of otolaryngologic symptoms and findings of physical examination of upper airway of a representative sample of the adult population of São Paulo, Brazil. 2) Correlate subjective symptoms with physical findings.MethodA total of 1101 randomly selected volunteers representing the adult population of São Paulo according to gender, age, and socioeconomic class were included in this study. The sampling process was probabilistic, consisting of 3 stages. Otolaryngologic examination included investigation of nasal complaints, physical examination of the upper airway, and facial inspection.ResultsA total of 993 volunteers (53.9% women) underwent otolaryngologic examination, with a mean age of 41.8 ± 0.89 years. The most prevalent symptoms were rhinitis (44.9%), snoring (42.8%), mouth breathing (39.3%), and nasal obstruction (33.3%). On physical examination, the most common findings were web palate (62.9%), septum deviation (56.9%), and inferior turbinate hypertrophy (37.7%). Significant correlations between symptoms and physical examination variables were nasal obstruction with septum deviation, inferior turbinate hypertrophy, high‐arched palate, and class II dental occlusion; symptoms of rhinitis with inferior turbinate hypertrophy; and snoring with deviated septum obstruction, Mallampati III and IV, increased neck circumference, and age ≥ 50 years.ConclusionThe prevalence of otolaryngologic symptoms and changes in physical examination of the upper airway are high in the adult population of São Paulo, Brazil. There is a significant association between snoring and nasal obstruction with objective signs of physical examination of upper airway and inspection of the facial skeleton.
Acoustic Features of Voice in Patients with Snoring
Authors: Guastini Luca , Crippa Barbara , Mora Francesco , Salzano Francesco‐Antonio , Mora Renzo , Santomauro Valentina 
Published: September 2011

ObjectiveDetermine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice.MethodGroup A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too.ResultsCompared with control group, in group A: the acoustic parameters presented a statistically significantly higher value (P <. 05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of group B).ConclusionThe study indicates that snoring affects voice production by changing its acoustic parameters. A voice analysis program MDVP can be used for snoring sound analysis as a noninvasive procedure for examination of sleep‐related breathing disorders.
Coblation Channeling for the Tongue
Authors: Zhang Qingfeng , Qin Wenfei , Liu Delong 
Published: September 2011

ObjectiveInvestigate the efficacy of coblation‐channeling for the tongue (CCT) in treatment of tongue hypertrophy in OSAHS.MethodCCT was performed on 30 patients with OSAHS with tongue Friedman III or IV. Tongues were channeled perpendicularly to tongue base with laterally to tongue body from 10mm before FC and 25 mm from apex using Coblator II Wand Reflex55.ResultsMRI was done at 12 month follow‐up and showed the retrolingual airway space had widened significantly without severe complications. Tongue base were decreased from Friedman III or IV to I or II.ConclusionThe results showed that CCT was a safe, minimally invasive, effective and repeatable option for hypertrophy tongue, although long term observations need to be done.
Implant‐Related Outcomes following Hypoglossal Nerve Implant for OSA
Authors: Woodson B. Tucker , Netzer Aviram , Lin Hosheng , Maurer Joachim T. , Hohenhorst Winfried , Van de Heyning Paul 
Published: September 2011

ObjectiveObstructive sleep apnea (OSA) is a common disorder associated with multiple abnormal health outcomes. Failure of surgical treatment may be secondary to obstruction at the level of the tongue. To assess the non‐disease related outcomes of an implantable hypoglossal nerve (CN XII) stimulating system (Inspire, Inspire Medical, Minneapolis, Minnesota).MethodMulticenter academic prospective trial of a unilateral hypoglossal nerve implant system (stimulation lead, sense lead and pulse generator). Implant procedure, technical details of stimulation titration, directed functional examinations, tongue EMG studies, and complications were reviewed from 31 implanted subjects.ResultsFollow up averaged 424 days. Serious adverse events included delayed infection with explantation (n = 1), insufficient stimulation with explantation (n = 1), explantation per patient request (n = 1), and acute infection/inflammation (n = 1). Minor local pain/stiffness (n = 7), transient odynophagia (n = 4), stitch abscess (n = 1), local swelling (n = 1), fever (n = 1) were observed. Stimulation thresholds for sensation, morphologic change, and sub‐discomfort (1.6 ± 0.6, 2.1 ± 0.7, 2.6 ± 0.8 respectively) did not change at 2, 4 and 6 months post‐implant). At over 1 year follow‐up, no abnormal findings in speech, swallowing, tongue morphology, or hypoglossal nerve function were observed.ConclusionPlacement of a CN XII implant system is technically feasible. Serious adverse outcomes occurred in 6% (delayed infection, inadequate stimulation requiring explantation). At over one year, placement of a CN XII implant for treatment of OSA demonstrates stable stimulation thresholds and is functionally well tolerated.
Modified Hyoid Suspension in the Treatment of Obstructive Sleep Apnea
Authors: Piccin Ottavio , Marra Francesca , Sorrenti Giovanni , Scaramuzzino Giuseppe , Gobbi Ricardo 
Published: September 2011

ObjectiveUsing the Hormann technique of hyoid suspension in sleep apnea surgery, a steel wire is placed through the thyroid cartilage and slung around the hyoid bone. However, we experienced thyroid cartilage fracture by steel wire traction. A modification is presented to avoid thyroid cartilage fracture.MethodTwenty‐two patients affected by OSAS underwent Hormann hyoid suspension. In 2 patients of the series, the steel wire caused a fracture of the thyroid cartilage. The technique was therefore modified in 20 subsequent patients. The wire is threaded through an adaptation titanium miniplate placed on the surface of the thyroid cartilage.ResultsAHI decreased from 40 to 11.7. Sixteen patients met the criteria for a successful outcome. There was no change in BMI postoperatively. No complications related to this modification were noted.ConclusionThe Hormann hyoid suspension is a procedure that advances the hyoid bone in order to expand the airway and its effectiveness has been proven previously. The modified hyoid suspension presented here promises similar results without the risk of serious complications as thyroid cartilage fracture.
Morbidity of Combined Lateral Pharyngoplasty and Midline Glossectomy for Obstructive Sleep Apnea
Authors: Vivero Richard J. , Ruiz Jose W. , Cofnas Paul 
Published: September 2011

Objective1) Describe the technique of lateral pharyngoplasty and midline glossectomy. 2) Evaluate the morbidity of multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy for management of obstructive sleep apnea (OSA).MethodRetrospective chart review of adult patients with polysomnographic evidence of OSA treated at a tertiary care referral center with multilevel sleep surgery involving lateral pharyngoplasty and midline glossectomy between 2009 and 2010. Outcome measures included estimated blood loss, length of hospital stay, and complications during the perioperative and postoperative period.ResultsThirty‐three patients were identified that met inclusion criteria. Estimated blood loss at time of surgery was 144 milliliters. The average hospital stay was 1.4 days with 1.03 days in an intensive care setting. Sixty‐one percent of patients required postoperative oxygen and 9.1% required postoperative continuous positive airway pressure therapy. The perioperative complication rate was 3% (1/33). There were 21% (7/33)minor and 0% (0/33) major complications in the immediate postoperative period.ConclusionLateral pharyngoplasty and midline glossectomy are safe procedures that present a minimal risk to the patient. Postoperative complications are marked predominantly by treatable complaints, including odynophagia and minor infections requiring antibiotic therapy.
Nasal Obstruction in Patients with Obstructive Sleep Apnea Syndrome
Authors: De Oliveira Barros Thiago , Melo Tavares Lima Marco Antonio , Mendez Raquel , Caiaffa Rosana , Tomita Shiro 
Published: September 2011

Objective1) Evaluate the prevalence of the symptom of nasal obstruction in patients with obstructive sleep apnea syndrome. 2) Identify which polysomnographic variables were most altered by nasal obstruction.MethodA transversal study was performed through the analysis of overnight polysomnography in association with the Epworth’s Sleepiness Scale, nasal symptoms and clinical assessment of sleep. In this study, 80 patients were evaluated between March and July of 2010, both male and female, with snoring and apnea complaints.ResultsNo statistically significant differences between the groups regarding age, gender, body mass index and neck circumference were observed. We found that patients with nasal obstruction were more likely to have a severe obstructive sleep apnea (apnea/hypopnea index >30 per hour of sleep) with an increase of 35.71% in comparison with those without nasal obstruction (P =. 028), as well as an increase in hypopnea index(P =. 026)and latency for REM stage (P =. 020). There was no correlation between excessive daytime sleepiness complaints and the symptom of nasal obstruction.ConclusionPatients with a nasal obstruction complaint are more likely to present a severe obstructive sleep apnea, hypopnea events and a higher latency of paradoxal sleep stage.
Cytology as an Oral Lesion Surgical Biopsy Timing Instrument
Authors: Seltzer Paul , Gold Daniel R. , Loewenstein Ronald K. , Carroll Deborah J. 
Published: September 2011

ObjectiveFor patients with certain risk factors and suspicious oral cavity lesions not meeting criteria for immediate surgical biopsy, we evaluated the use of a brush biopsy cytology as a screening tool to assist in choosing between treatment options of immediate surgical biopsy and patient observation.MethodOral mucosal brush biopsy cytology was performed on patients with risk factors and mildly suspicious lesions in the oral cavity. Specimens obtained were reviewed for presence of abnormal or dysplastic cells. Data were collected from 2008 to 2011. We correlated the results with the follow‐up treatment decisions.ResultsDuring the study period, 52 patients had brush biopsies. Pathology results in 21% (P < 0.01) of cases showed presence of abnormal or dysplastic cells and an immediate follow‐up surgical biopsy was performed. In 71% of cases, results did not reveal abnormal cells, and patients were put under observation. In 7% of cases results indicated a fungal infection, and patients were treated.ConclusionWhere brush biopsy cytology revealed presence of abnormal or dysplastic cells, an immediate follow‐up scalpel biopsy was recommended. Brush biopsy cytology from suspicious lesions provides information to aid in determining the treatment pathway for suspicious oral mucosal lesions not meeting criteria for an immediate surgical biopsy.
Reliable Calculation of the Efficacy of Nonsurgical and Surgical Treatment of Obstructive Sleep Apnea
Authors: Ravesloot Madeline , De Vries Nico 
Published: September 2011

ObjectiveThe effectiveness of CPAP compliance criteria can be questioned, just as the effectiveness of surgical success criteria has often been questioned. The aim of the study was to measure the effectiveness of compliant CPAP use.MethodUsing mathematical function formulas, the effect on the AHI of various treatment modalities and their respective compliance and success criteria were calculated.ResultsThe more severe the AHI, the more percentage of total sleep time (TST) CPAP must be used to significantly reduce the AHI. Patients with moderate OSA reduce the AHI by 33.3% to 48.3% when using CPAP 4 h/ night (AHI 0‐5, respectively). The required nightly percentage use rises as one reduces the AHI target to smaller than 5. CPAP must be used 66.67% to 83.33% per night to reduce the AHI below 5 (AHI of 0 while using CPAP).ConclusionUsing a mean AHI in CPAP therapy is more realistic than using arbitrary compliance rates, which, in fact, hide insufficient reductions in AHI.
Turbinate Size and Sleep‐Related Breathing Disorders: Is There a Correlation?
Authors: Forest Veronique‐Isabelle , Benedetti Andrea , Lavigne Francois 
Published: September 2011

ObjectiveThe tail of the turbinates is a site of nasal obstruction that may be associated with sleep related breathing disorder (SBD). We describe a technique, the trans‐oral nasopharyngoscopy (TON), to evaluate turbinate size and determine if an association exists between turbinate size and the various parameters measured in SBD.MethodThirty‐six patients with SBD completed an Epworth Sleepiness Scale (ESS) and a Quebec Sleep Questionnaire (QSQ). They underwent a nasal examination, allergy skin tests, full night polysomnography, and TON. Turbinate size was divided into two groups: I) turbinate obstructing 1/2.ResultsSixteen patients were grade I and 20 patients were grade II. Turbinate size at the choana did not show any statistical significant association with nasal congestion, allergies, ESS and QSQ scores. Among the PSG parameters analyzed, no association was found with the apnea‐hypopnea index (AHI), but the size of the turbinate showed a positive correlation with respiratory event related arousals (RERA; P =. 03). Total sleep time spent snoring showed a weak association with turbinate size.ConclusionTON is a simple technique allowing the evaluation of the size of the turbinates. Turbinate size was associated with RERA and total sleep time spent snoring, but not with AHI.
Upper Airway Surgery for the Treatment of Obstructive Sleep Apnea: Surgical Outcomes and the Effect on CPAP
Authors: Cowan Douglas H. , Romaker Ann , Larsen Christopher G. , Spake R. Vanneman , Sykes Kevin J. 
Published: September 2011

Objective1) Elucidate the efficacy of upperairway surgery for the treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). 2) Observe the change in polysomnography, continuous positive airway pressure (CPAP) therapy, and sleepiness following upper airway surgical intervention. 3) Objectively measure CPAP compliance using smart card CPAP devices.MethodSurgical and clinical records were reviewed on patients (N =51) who underwent upper airway surgery for the treatment of moderate‐severe OSAHS from January 2008 to June 2010 at an urban tertiary‐care center. Outcome measurements recorded pre and postoperatively include BMI, Epworth sleepiness score, CPAP settings and compliance, and polysomnography.ResultsData was collected and is currently undergoing analysis in a collaborative effort between the otolaryngology and pulmonology departments at our tertiary care center. A unique requirement for this study is the use of smart card CPAP devices on all patients allowing an objective measure of CPAP compliance. All patients underwent traditional uvulopalatopharyngoplasty (UPPP), lateral pharyngoplasty or expansion sphincter pharyngoplasty. Additionally, patients underwent turbinate reduction (N = 29), septoplasty (N = 20) and base of tongue reduction (N = 16). Initial analysis indicates a significant improvement in polysomnographic data and CPAP compliance. There does not appear to be problems associated with air‐leak postoperatively.ConclusionMucosa‐sparing pharyngoplasty and multilevel upper airway surgery are effective treatment options for moderate‐severe OSAHS. These surgical interventions can significantly reduce CPAP pressure settings and improve CPAP compliance. All patients undergoing CPAP therapy should be required to use smart card devices in order to objectively measure compliance.
Does the Duration of Ofloxacin Otic Drops Matter in Immediate Post‐tube Otorrhea?
Authors: Chen Timothy , Cheng Leah , Chen Sharon , Cheng David 
Published: September 2011

ObjectiveUnderstand whether the duration of Ofloxacin Otic drops would make a difference in the incidence of immediate postmyringotomy tube otorrhea.MethodChart review for myringotomy tube surgery from July 2005 to December 2010 was done. The ears were examined 1 week after myringotomy surgery for otorrhea.ResultsThere were 854 ears with no drops used, 182 ears with Ofloxacin Otic drops used once at time of tube insertion, and 303 ears with Ofloxacin Otic drops used twice a day for 5 days postsurgery. Of the ears without any drops used, 51 ears (6.0%) had immediate postmyringotomy tube otorrhea; of the ears with Ofloxacin once, 9 ears (4.9%) had immediate postmyringotomy otorrhea; and of the ears with Ofloxacin for 5 days, 8 ears (2.6%) had immediate postmyringotomy otorrhea. The chi square test showed significant difference between Ofloxacin Otic drops for 5 days and no drops (P value =. 02).ConclusionThe results seem to indicate that Ofloxacin Otic drops decreased the incidence of postmyringotomy tube otorrhea with single dose administration, with a more significant difference in the 5 day course of Ofloxacin Otic drops.
Juvenile Nasopharyngeal Angiofibroma Sites of Extension
Authors: Khalifa Mohamed Adel , Gamea Ahmed M. 
Published: September 2011

ObjectiveJuvenile nasopharyngeal angiofibroma is a historically benign, yet locally aggressive vascular tumor that affects exclusively adolescent boys. Its etiology is still considered one of the dangerous head and neck tumors. Early diagnosis is now available by the use of endoscopes and advanced imagining.MethodThis retrospective study included 18 patients operated upon in the ENT Department of Tanta University Hospital through the period from 2002 to 2009. Those patients were diagnosed radiologically by CT scan, MRI, and endonasal endoscopic biopsy.ResultsTwo cases were confined to the lateral nasal wall extending into the nasopharynx, 9 cases extended to the sphenoid sinus superiorly and to the pterygopalatine fossa laterally, 4 cases extended laterally to the infratemporal fossa, and 1 case extended intracranially to the middle cranial fossa. The rare sites of extension were one case occupying the right ethmoid sinus completely (this mass eroded the fovea to the anterior cranial fossa) and another case of a recurrent mass extending into the right parapharyngeal space through the sinus of morgagni.ConclusionThe rare sites of extension of juvenile nasopharyngeal angiofibroma included the anterior cranial fossa through the fovea ethmoidalis. It may also spread through the sinus of morgagni to the parapharyngeal space.
Nasal Apocrine Hydrocistoma
Authors: Costa Viviane , Viana Fernanda M. L. , Barnewitz Joao P. , Doria Thais , Riberiro Thais K. , Ribeiro Ulisses J. 
Published: September 2011

ObjectiveDescribe a case report of an apocrine hydrocistoma of unusual presentation site (nasal) and a literature review. Its pathogeny seems to be a result of the sudoriferous conduct obstruction just above the glandular wound, due to trauma or an inflammatory process.MethodFemale, 43 years‐old, complaining of a swelling over the right side of the nose, associated to pain and nasal obstruction over 1 year. The examination showed facial asymmetry with an elevated right nasal wing and bulging of nasal floor. We performed cyst resection.ResultsThis case shows a nasal apocrine hydrocistoma that differs from its usual eyelid location. The patient’s clinical and physical history, as well CT scan images, guided us to cyst resection with an intraoral access. The anatomopathology study proved to be an apocrine hydrocistoma. The literature review points this case report as a differential diagnosis for diseases in this area, such as inflammatory periapical lesions, nasal boils, nasopalatine duct cysts, dermoid cysts, and nasolabial cysts.ConclusionApocrine hydrocistomas are sudoriferous gland benign tumors in the face. Most people present themselves with a well‐delimitated swelling, local pain, and partial or complete nasal obstruction. CT is the ideal examination for its evaluation, with anatomopathology to confirm the diagnosis. Cyst resection is a choice treatment.
Nasopharyngeal Carcinoma Presenting as Deep Neck Abscess
Authors: Soon Sue Rene , Yuen Heng‐Wai 
Published: September 2011

ObjectiveNasopharyngeal carcinoma (NPC) is endemic in South East Asia and is the fifth most common cancer in Singapore. The most common presenting symptom is cervical nodal metastasis. There have been only 2 reports of NPC presenting as deep neck abscesses. We present our experience with 4 patients.MethodRetrospective review of the archives of patients admitted for deep neck abscesses from 2 tertiary hospitals from November 2006 to September 2010 revealed 4 patients with a nasopharynx primary.ResultsThe 4 patients consist of 3 males and 1 female with a mean age of 50 years (range, 32‐63 years). All patients presented with fever and a painful fluctuant neck mass. Incision and drainage was performed in 2 patients who did not improve symptomatically from intravenous antibiotics. Computer tomography (CT) showed deep neck abscess in all patients and a nasopharyngeal primary only in 2 patients. Repeat physical examination showed nasopharyngeal mucosa irregularity in these patients and biopsy performed showed undifferentiated NPC. Three patients were stage 4 NPC while 1 patient was stage 2.ConclusionThe nasopharynx should be carefully examined in patients presenting with deep neck abscess even with normal CT findings, especially in countries where NPC is endemic. Deep neck abscess may be the initial presentation of NPC.
Prevalence of Low Titers of Pneumococcal Antibodies
Authors: Beltran Constanza , Aranis Carolina A. , Talesnik Eduardo , Garcia Raimundo 
Published: September 2011

Objective1) Determine the prevalence of low titers of pneumococcal antibodies (PAB) in patients with recurrent infections. 2) Assess whether there is a difference in PAB titers between patients unimmunized and patients vaccinated against pneumococcus.MethodCross‐sectional study between September 2006 and May 2008 in patients with recurrent infections. PAB levels against 10 serotypes were measured in all patients, and it was established if they had been vaccinated against pneumococcus. We compared the frequency of PAB low titers between both groups using the chi‐square test.ResultsA total of 257 patients were included in the study, aged between 0 and 68 years (median: 5 years) and with 54% being male. Sixty‐one patients (24%) were vaccinated against pneumococcus. The prevalence of low titers of PAB (more than 50% of the serotypes with levels lower than 1.3 ug/mL) was 43% overall, with 8.2% and 53.6% in vaccinated and unvaccinated patients, respectively (P <. 0001).ConclusionLow levels of specific antibodies to pneumococcus is a common condition in patients with recurrent infections. It appears that the pneumococcal vaccine plays an important role in reducing the prevalence of this condition, but prospective studies are needed to prove it and show the clinical usefulness of the vaccine.