bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upregulation of Genes for Innate Immune Signaling and Apoptosis after Surgery for Chronic Rhinosinusitis: Evidence of a Mucosal Immune Dysfunction in CRS?
Authors: Hubin Gregory , Divoy Celine , Desrosiers Martin Y. , Filali‐Mouhim Ali , Mfuna‐Endam Leandra 
Published: September 2011

ObjectiveEndoscopic sinus surgery (ESS) for chronic rhinosinusitis is a frequently performed surgical procedure. However, the mechanism by which it improves disease is unknown. We wished to determine patterns of changes in gene expression associated with resolution of disease following ESS in order to identify mechanisms implicated in resolution of disease.MethodTwelve patients undergoing ESS for CRS were recruited. An epithelial sample from the frontal sinus was collected using a cytology brush at time of surgery and repeated 3 months after surgery. Microarray analysis of gene expression was performed using the Illumina Human HT‐12 Beachip v3.ResultsBoth single gene expression analysis (using Limma package from Bioconductor software.) and gene set analysis (using Ingenuity Pathway Analysis software) were used to identify implicated genes and pathways (or networks), respectively. All patients resolved CRS with surgery. A total of 4707 genes or transcripts showed significant differential expression changes (pFDR). Healing was associated with increased expression of cytokines and transcription factors in the IL1B signaling pathway (IL8 (FC: 8.56; P =. 00027) IL1B (FC: 4.21; P =. 0008) NFkBIZ (FC: 2.27; P =. 0008), innate immune signaling (IRAKs‐1, ‐2, and ‐3, CD14, MD2, MyD88), and apoptosis (CASP3, BAK, BID).ConclusionResolution of CRS after ESS is characterized by marked upregulation of the IL‐1B and innate immune signaling pathways and increased expression of pro‐apoptosis genes. This supports the concept that microbial detection and clearance are impaired in CRS, and that strategies increasing immune activation may represent novel therapeutic opportunities.
Validation of a Low‐Cost Sinus Surgery Task Trainer
Authors: Steehler Matthew K. , Na Hana , Pfisterer Michael , Hesham Hosai N. , Malekzadeh Sonya 
Published: September 2011

ObjectiveAssess the face, content, and construct validities of a low‐cost sinus surgery task trainer in acquisition of skills for endoscopic sinus surgery.MethodParticipants performed nasal endoscopy and 5 specific tasks using this model. Face and content validities were assessed based on the attendings’ responses to a questionnaire evaluating the task trainer. Construct validity was determined by comparing novice to expert performance using a checklist and global rating scale.ResultsA total of 77 subjects, including attending otolaryngologists, otolaryngology residents at various levels of training, and medical students, participated in the study. On the questionnaire, 80% of evaluators rated the trainer as realistic and agreed that this model correlates with the essential skills needed for endoscopic sinus surgery; 90% felt this model provided adequate training and would increase resident competency, and 90% were interested in using the model to train residents. On the task trainer, experienced otolaryngologists and senior residents scored significantly higher than junior residents and medical students using the objective measures of global rating scale and checklist.ConclusionOur study demonstrates face, content, and construct validity of the low cost sinus surgery task trainer. This model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents.
One Hundred Consecutive Patients Undergoing Drug Induced Sleep Endoscopy (DISE): Results and Evaluation
Authors: Ravesloot Madeline , De Vries Nico 
Published: September 2011

ObjectiveDocument the results of 100 consecutive DISE and investigate associations between PSG and DISE findings.MethodBetween June and August 2010, 100 consecutive patients, eligible for sleep surgery or MRA underwent a PSG and DISE. DISE findings were reported using the VOTE classification system; site, degree of airway narrowing, and configuration of obstruction were reported. Associations were analyzed between PSG results, patient characteristics and DISE findings.Results82% suffered from OSA, 52% from positional OSA. 75% were found to have a multi‐level obstruction, which was associated with a higher AHI value, as was a complete collapse and a tongue base collapse. A tongue base collapse or epiglottal collapse was associated with positional OSA. And lastly, a complete concentric collapse was associated with an increased BMI.ConclusionPSG is mandatory in the diagnostic work‐up of OSA; DISE a valid addition. The results of this small scale study help us understand the pathogenesis of OSA and the various associations between PSG outcomes and DISE results, as well as assisting the sleep surgeon to tailor surgery for the patient.
Analysis of the Correlation between Sleep Hygiene and Clinical Symptoms in Obstructive Sleep Apnea Patients
Authors: Lee Joonseok , Lee Kunhee , Shin Seungyoup , Kim Sungwan , Jung Su Young 
Published: September 2011

ObjectiveBy doing a survey on obstructive sleep apnea patients, this study tried to analyze the relationship between the various subjects relating to sleep hygiene and clinical symptoms.MethodA total of 197 patients completed the survey. The survey was composed of 4 categories; daytime symptoms, nighttime symptoms, the Epworth Sleepiness Scale, and sleep hygiene. The daytime and nighttime symptoms were graded by the 10 point Visual Analogue Scale, and sleep hygiene by the 3 Point scale, the higher points indicating severity.ResultsThe result of figuring out the correlation between the 9 categories of sleep hygiene and the 3 categories of the symptoms, showed that in cases of inappropriate temperature and humidity, the 3 symptom categories were more severe (nighttime symptoms r = 0.565, daytime symptoms r = 0.379, ESS r = 0.318). Drinking before sleep (nighttime symptoms r = 0.647, daytime symptoms r = 0.455, ESS r = 0.297) and emotional excitement or arousal (nighttime symptoms r = 0.542, daytime symptoms r = 0.392, ESS r = 0.336) caused higher severity results in each symptom category.ConclusionIf patients who complain of sleep apnea symptoms were to control the factors in sleep hygiene mentioned above, it could be possible to hope for an improvement in daytime symptoms as well as increase in sleep quantity and satisfaction.
Hypoglossal Nerve Stimulation and Airway Changes under Fluoroscopy
Authors: Goding George , Tesfayesus Wondimeneh , Kezirian Eric J. 
Published: September 2011

ObjectiveCharacterize the changes in tongue base position, the anteroposterior dimension of the retropalatal and retrolingual airway spaces, and the hyoid bone during hypoglossal nerve stimulation in OSA subjects under general anesthesia.MethodTwenty‐four subjects underwent implantation of the Apnex Medical Hypoglossal Nerve Stimulation (HGNS) system, with cross‐table fluoroscopy imaging during hypoglossal nerve stimulation under general anesthesia. Standardized measurements determined changes in tongue base position, the retrolingual and retropalatal airways, and the hyoid bone. Airway changes were compared with subject’s C3 vertebral width.ResultsDuring hypoglossal nerve stimulation, all subjects demonstrated anterior displacement of the tongue base. The resulting anteroposterior retrolingual airway opening was at least one‐third the width of the C3 vertebral body in all subjects, with a mean ratio of 0.61 ± 0.15. Opening of the retropalatal airway with stimulation occurred in 74% (14/19) of subjects; in 5 cases the fluoroscopy videos did not permit adequate visualization of the retropalatal region. There was a wide variation in the change of hyoid bone position during stimulation.ConclusionHypoglossal nerve stimulation created anterior tongue base displacement and an increase in the anteroposterior retrolingual airway dimensions in all subjects. Opening of the retropalatal airway occurred in the majority of subjects. Further study is warranted to evaluate 3‐dimensional airway changes and the mechanisms of action, especially for the retropalatal airway.
Influence of Intranasal Corticosteroids on Sleep Parameters and Airway Inflammation
Authors: Lavigne François , Petrof Basil J. , Dubé Normand , Lavigne Philippe , Hamid Qutayba , Benedetti Andrea 
Published: September 2011

ObjectiveFatigue is associated with obstructive sleep apnea (OSA). Increased inflammation in the pharyngeal tissues of OSA patients may further exacerbate the disease. This study evaluates the effects of intranasal corticosteroid (INCS) treatment on sleep parameters and airway inflammation in AR vs non‐AR OSA patients.MethodAllergic rhinitis (34), non‐AR (21) received mometasone. Before and after treatment, patients underwent polysomnography, MWT, Epworth assessment, and tissue biopsies from the turbinate, nasopharynx, uvula. The biopsies were processed for EG2, CD4, CD8, macrophages and neutrophils.ResultsThere were no differences in age, sex, BMI, or apnea‐hypopnea index (mean AHI = 28.4 vs 27.7/h) at baseline. After treatment, AR group showed significant improvements in: 1) supine AHI (55.85 vs 39.7/h), 2) oxygen saturation nadir (86.42 vs 88.8%), and 3) Epworth scores. This improvement was associated with reduction of eosinophils (P <. 0001), and to lesser extend CD4 positive cells (P <. 05) in the tissue obtained from the 3 sites, CD68 decreased at the uvula. Allergic subjects had a higher nasal symptoms score before treatment, not statistically significant, nor was there evidence that change over time differed by allergy status.ConclusionThis study confirmed the implication of inflammation in sleep apnea and showed that controlling inflammation in the upper airways is very useful in improving clinical symptoms associated with this disease.
OSAS and Bariatric Surgery: Incidence of OSAS in the Bariatric Surgery Population
Authors: Ravesloot Madeline , De Vries Nico 
Published: September 2011

ObjectiveObesity is a significant risk factor for OSA. The benefits of bariatric surgery (BS) are increasingly reported, but concern about the safety is also heightened. With the aim to prevent OSA related complications of BS, we were interested to see which percentage of patients undergoing BS in our clinic have OSA.MethodThe prospective, multidisciplinary, single‐center, observational study enrolled 289 consecutive patients eligible for BS from June 2009 until June 2010. Irrespective of history or clinical findings, all patients on the waiting list for BS visited our ENT out‐patient clinic and underwent a full night polysomnography, unless performed previously.ResultsA total of 69.9% fulfilled the criteria for OSA (mean BMI: 44.2 ± SD 6.4). A total of 40.4% of the patients met the criteria for severe OSA. A mere 13.3% of the patients were aware with OSA before being placed on the waiting list for BS. Increased neck circumference, BMI, or ESS were found to be insufficient predictors of OSA presence on linear stepwise regression and ROC curve.ConclusionIn this large patient series, 69.9% of patients undergoing BS meet the criteria for OSA. Increased neck circumference, BMI, or ESS are insufficient predictors of OSA presence. Polysomnography is an essential component of the preoperative workup of patients undergoing BS. When OSA is found, specific perioperative measures are indicated.
PASS Palatal Ablation and Suspension Suture Technique: A Novel, Minimally Invasive UPPP Technique for Sleep Apnea
Authors: Melder Patrick C. 
Published: September 2011

Objective1) Develop a minimally invasive surgical technique to treat the palatal component of OSA. 2) Ccombine a proven ablation technology to create palatal stiffening with a novel suspension technique to relieve palatal obstruction. 3) Perform a pilot trial to determine feasibility.MethodThe PASS technique was used to treat the palatal component of obstruction for OSA. Palatal ablation was performed. Four permanent, submucosal, periosteal based sutures were placed from the hard palate to the palatopharyngeus muscle and free edge of the soft palate (bilateral). Gentle tension resulted in advancement of the palate.ResultsTwenty patients were studied. Each patient had a preoperative/postoperative PSG. The PASS technique was used for the palatal component to treat mild apnea or as a part of multilevel surgery for moderate to severe OSA. The PASS technique proved to be a consistently reliable method to advance, suspend, and stiffen the palate without mucosal/muscular (palatal) disruption to correct the palatal component of OSA. The average palatal advancement noted bilaterally at the palatal arches was 7.5 mm. Postoperatively, the mucosal sparing technique resulted in no complications of velopharyngeal insufficiency. Isolated PASS procedures for mild apnea resulted in a 70% reduction in RDI.ConclusionThe PASS technique was proven as a functionally and anatomically superior nondestructive treatment for palatal obstruction. The PASS technique resulted in no complications of VPI. The limitations of the study are the limited number of patients and lack of a control arm with the gold standard UPPP.
Quantification of Retropalatal Region in Sleep Apnea
Authors: Tanyeri Hasan M. , Serin Gediz M. , Polat Senol 
Published: September 2011

ObjectiveFiberoptic nasopharyngolaryngoscopy (FNPL) allows us to visualize the obstructive sleep apnea (OSA) related airway passages. However, objective data presenting evidence of OSA through this perspective is lacking. The aim of this study was to quantify the surface area of the retropalatal region in normal and OSA patients utilizing FNLP images.MethodFifty‐two OSA patients in group 1 and 68 patients with no complaints of OSA in group 2 were retrospectively evaluated. Retropalatal region photos were captured at the base of uvula through endoscopic images. Retropalatal surface area (RPSA) was measured using AutoCad. Results were analyzed using unpaired t test.ResultsThe RPSA measurements in group 1 were between 20 and 143 [mean (sd) 64.13 (27.4)]. The RPSA measurements in group 2 were between 51 and 202 [mean (sd) 121.9 (32.4)]. The mean difference was 57.761. RPSA values of group 2 were significantly higher than group 1.ConclusionThe RPSA is significantly higher in OSA group 2, implicating prediction of OSA. Therefore, RPSA can be used as a sign of OSA during FNLP.
Reduction of CRP after CPAP Treatment of OSA: A Systematic Review and Meta‐Analysis of the Literature
Authors: Friedman Michael , Kelley Kanwar , Fischer Michelle , Lin Hsin‐Ching , Wang Pa‐chun 
Published: September 2011

Objective1) Determine the effect of continuous positive airway pressure (CPAP) on C‐reactive protein (CRP) levels in patients with obstructive sleep apnea (OSA). 2) Demonstrate the effect of CPAP on general health status using CRP as a marker for cardiovascular health.MethodA computerized search was conducted using PubMed, Ovid, and the Cochrane database. A systematic review was preformed to identify studies that included CRP levels in adult patients (age >18 years) with OSA pre‐ and post‐CPAP treatment.ResultsInitial search results identified 136 articles of which 64 articles then underwent second‐stage review. Ten studies met the inclusion criteria and a meta‐analysis was performed to determine the overall change in CRP levels. Meta‐analysis included 325 subjects (mean sample size of 32.5 patients) with mean BMI of 33.12. The mean CRP level in patients with OSA decreased from 0.43 ± 0.39 mg/dL to 0.35 ± 0.346 mg/dL following CPAP treatment (p = 0.002).ConclusionIn patients with OSA, CRP levels significantly decrease after CPAP therapy. Therefore, using CRP as a marker systemic inflammation, CPAP reduction of CRP levels may benefit patients’ cardiovascular health in addition to controlling OSA symptoms.
Robotic Glossectomy for the Treatment of Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Friedman Michael , Kelley Kanwar , Taylor David , Maley Alex , Pearson‐Chauhan Kristine 
Published: September 2011

Objective1) Present the safety, morbidity, and efficacy of robotic midline glossectomy (RG) for the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) in the first series of patients undergoing this procedure without tracheotomy. 2) Compare the efficacy of robotic midline glossectomy (RG) vs coblation and radiofrequency base‐of‐tongue (RFBOT) MG.MethodRetrospective review of patients treated between January 2009 and December 2010 at a tertiary care center. Efficacy and morbidity of 40 RG patients was compared with a matched cohort of 40 patients who underwent traditional MG. Outcome variables included: postoperative pain, narcotic use, postoperative reduction of AHI, disposable costs, and complications.ResultsTwenty patients with severe disease treated with ZPP+RG were compared with 20 patients with ZPP + Coblation. The mean AHI of patients undergoing RG decreased from 55.1 (SD 28.7) preoperative to 25.9 (SD 9.9) postoperative which was significantly greater than the AHI reduction for (P <. 05). Twenty patients with moderate disease treated with palatal stiffening + RG were compared with 20 patients with RFBOT + palatal stiffening. Pain outcomes measured on postoperative days 0‐5 using the Faces Visual Analogue Scale (VAS) resulted in no statistical difference between RG and coblation whereas RG vs RFBOT showed higher pain levels for RG.ConclusionThis is the first recorded series of robotic MG performed without the need for tracheotomy. Results demonstrated an excellent safety profile with no significant complications. Although morbidity vs standard hypopharyngeal treatments is significant, robotic glossectomy allows for more aggressive tissue removal vs coblation and RFBOT thereby significantly improving efficacy.
Thermoplastic Mandibular Advancement Devices for the Treatment of OSAHS
Authors: Friedman Michael , Maley Alex , Taylor David , Kelley Kanwar , Pearson‐Chauhan Kristine 
Published: September 2011

Objective1) Report our experience with custom‐made and thermoplastic mandibular advancement devices (MADs). 2) Compare the cost, efficacy, and compliance of thermoplastic mandibular advancement devices vs custom made MADs.MethodRetrospective review of 287 consecutive adult outpatients treated between July 2009 and August 2010. Compliance was assessed using chart review and phone interviews after 1 and 6 months. Endpoints included: 1. Efficacy measured by post‐MAD AHI.ResultsThe percentage of patients achieving AHI reduction criteria for efficacy was 70.3% and 72.2% for thermoplastic vs custom‐made devices (P =. 204). Compliance more than 4 hours a night for 70% of nights within the first month after receiving MAD was 88.2% for thermoplastic vs 64.3% for custom‐made (P <. 001). At 6 months compliance was 47.4% for thermoplastic devices vs 61.1% for custom devices (P =. 01). The average cost for the thermoplastic devices was $150 vs $1450 for the custom‐made devices.ConclusionThermoplastic devices resulted in slightly better compliance rate compared with the custom‐made devices during the first month after prescription, but reversed at 6 months. Thermoplastic devices have the advantage of significantly lower cost, higher initial acceptance, and comparable efficacy, whereas custom‐made devices result in higher long‐term compliance.
Minimum Extremes in Otolaryngology Resident Surgical Case Numbers
Authors: Rosenberg Tara L. , Franzese Christine B. 
Published: September 2011

Objective1) Understand the significance between the mean and minimum case numbers for surgical procedures among otolaryngology residents nationwide. 2) Understand potential weaknesses of the ACGME resident case log system and possible errors contributing to inaccurate data. 3) Understand educational definitions of competency and proficiency.MethodRetrospective review of otolaryngology resident national data reports from ACGME resident case log system for three academic years (2007‐2010). Minimum, mean, and standard deviation about the mean for total number of cases and for specific surgical procedures were compared. Comparison of “tracked” vs “untracked” CPT codes was also performed.ResultsThe total number of cases for residents graduating from 2008 to 2010 remained fairly constant, ranging from a mean of 1701.5 ± 486 in 2008 to 1772.2 ± 517 in 2010. The minimum total number of cases also remained somewhat constant, ranging from 730 in 2009 to 811 in 2008, with these values falling approximately two standard deviations below the mean for most years. Comparison of case numbers for procedures such as parotidectomy, thyroidectomy, mastoidectomy, and endoscopic sinonasal surgeries, among others, yielded similar results. “Tracked” CPT codes tended to be fewer than “untracked” CPT codes for some surgical procedures.ConclusionLarge differences between the mean and minimum case numbers for resident surgical procedures exist. Establishing minimum case number requirements for otolaryngology residents should be considered. Closer critical examination of the ACGME resident case log system and resident documentation habits is needed to improve accuracy of reporting.
Trends in Facial Fracture Repairs, 1996 to 2006
Authors: Lee Linda N. , Bhattacharyya Neil 
Published: September 2011

Objective1) Learn how rates of operative facial fractures may have changed between 1996 and 2006. 2) Determine potential impact of such change on otolaryngology residency surgical key indicator cases.MethodThe National Hospital Discharge Survey (NHDS) and National Survey of Ambulatory Surgery (NSAS) 1996 and 2006 cases were reviewed, extracting all cases of nasal, malar/zygomatic, maxillary, and mandibular fracture reductions, in inpatient and outpatient settings, respectively. Procedure rates for each facial fracture were tabulated and compared between 1996 and 2006.ResultsOverall in 1996, there were an estimated 113,041 ± 3,740 operative facial fracture repairs performed. Among the 3 key indicator fracture repairs most relevant to otolaryngologists, there were 15,810 ± 2,143 open nasal fracture reductions, 9,360 ± 1,742 open zygomaticomaxillary (ZMC) fracture reductions, and 20,214 ± 2,585 open mandibular fracture repairs. Overall in 2006, there were 120,463 ± 7,554 total facial fracture procedures, with 11,613 ± 2,846 open nasal fracture reductions, 10,216 ± 2,881 open ZMC fracture reductions, and 17,965 ± 3,171 open mandibular repairs. Comparing cohorts, there was no significant change in number of open nasal, ZMC, or mandibular fractures repairs (P =. 24, P =. 58, P =. 80, respectively).ConclusionDespite perceptions, facial fracture procedure rates have remained largely stable over the past 10 years. These data have implications for otolaryngology training programs and could help guide resident education in facial trauma.