bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Pediatric Obstructive Sleep Apnea beyond Tonsillectomy and Adenoidectomy
Authors: Friedman Michael , Maley Alex , Taylor David , Kelley Kanwar , Pearson‐Chauhan Kristine , Hoehne Colleen 
Published: September 2011

Objective1) Compare the efficacy of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone in the treatment of pediatric OSAHS. 2) Compare the morbidity of adenotonsillectomy with pharyngoplasty vs adenotonsillectomy alone.MethodRandomized single‐blind controlled study of 60 pediatric patients treated between January 2009 to January 2010 at a tertiary care center. Patients were randomized into 2 groups: adenotonsillectomy alone (group I) and adenotonsillectomy with pharyngoplasty (group II). Endpoints included: pre‐ and postsurgical AHI, number of cures, pain levels, and change in OSA‐18.ResultsSixty patients were enrolled and 52 patients completed the study (group I n = 27, group II n = 25). The mean age, BMI, and baseline AHI did not differ significantly between the two groups. The change in AHI from pre‐ to postsurgery was not found to be significant between the 2 groups (P =. 337). No significant differences were found in the number of cures (P =. 709). There was no significant difference between groups for OSA‐18 score (P =. 478). Pain outcomes measured on postoperative days 1 to 7 using VAS did not reveal a significant difference in pain levels.ConclusionWith short‐term follow‐up, the addition of pillar closure to traditional adenotonsillectomy did not significantly improve sleep parameters as measured by polysomnogram or in quality of life as measured using the OSA‐18. It is unknown if pharyngoplasty will have long‐term benefits in preventing progression of OSA.
Viral Profile in Chronic Adenotonsillar Diseases
Authors: Anselmo‐Lima Wilma T. , Arruda Eurico , Paula Flavia , Tamashiro Edwin , Proenca‐Modena Jose Luis , Valera Fabiana C. P. , Buzatto Guilherme P. 
Published: September 2011

ObjectiveAlthough there is a known role of virus in acute upper respiratory infections, few studies have explored the relationship between chronic diseases of Waldeyer’s ring and viral infections. This study aimed to analyze the presence of the main respiratory viruses in patients with chronic adenotonsillar diseases.MethodNasal lavage and peripheral blood from 60 children with chronic adenotonsillitis or adenotonsillar hypertrophy were analyzed by RT‐PCR for bocavirus, adenovirus, rhinovirus 1 and 2, enterovirus, respiratory syncytial virus, parainfluenza virus type 1 and 3, influenza virus A and B, and human coronavirus.ResultsVirus infection was found in 66% of nasal lavage samples (40/60). The most prevalent virus was adenovirus (33.3%), followed by rhinovirus (30%), bocavirus (10%), enterovirus (8.3%), respiratory syncitial virus (5%), and influenza virus (5%). Parainfluenza virus and coronavirus were not detected in any sample. Co‐infection was present in 24% of patients (14/60), especially adenovirus (9/14) and bocavirus (8/14). In peripheral blood, none of the patients had virus genome detected.ConclusionThe high prevalence of local genomic viruses in chronic adenotonsillar diseases may reflect a tissue persistence or virus latency, and may be an important etiology that could trigger inflammatory mechanisms involved in chronic diseases of the Waldeyer’s ring.
A Blinded Randomized Controlled Trial on the Efficacy of Postsurgical Debridement of Sinus Cavities on Wound Healing following Endoscopic Sinus Surgery
Authors: Naidoo Yuresh , Wen David , Pow Vincent , Wormald Peter J. 
Published: September 2011

ObjectiveAscertain whether early debridement, with its related costs and patient discomfort, limits adhesion formation as evaluated by a blinded observer, via video‐endoscopy at 3 months post‐surgery.MethodA blinded RCT of patients undergoing primary bilateral sinus surgery at a tertiary referral hospital. One side of the nose was randomized to receive debridement postoperatively. The sinus cavities were videotaped at 3 months, and 2 surgeons blindly evaluated each side.ResultsNo significant difference in the 2 sides was found in terms of adhesion and patency rates.ConclusionRegular and frequent debridement following sinus surgery might not be as crucial as previously thought to prevent adhesion formation and improve wound healing. However, removal of crusting does seem to improve patients perception of malodor and nasal obstruction in the immediate postoperative period.
Antimicrobial Activity of SinuSurf
Authors: Adappa Nithin D. , Kofonow Jennifer 
Published: September 2011

Objective1) Determine the antimicrobial potential of a novel topical sinonasal surfactant, SinuSurf. 2) Evaluate whether the addition of SinuSurf™ with mupirocin or gentamicin creates an additive/synergistic effect on recalcitrant chronic rhinosinusitis (CRS) pathogens such as methicillin‐resistant Staphylococcus aureus (MRSA) and Pseudomonas aurginosa (PA).MethodMRSA and PA01 cultures were grown in 96‐well plates containing 10‐fold serial dilutions of mupirocin (1x = 150ug/ml) or gentamicin(1x = 80ug/ml), diluted in normal saline with or without the addition of SinuSurf. Colony forming units (CFUs) were determined 20 hours later.ResultsIn the absence of antibiotics, SinuSurf evinced a 6 log reduction in CFUs for PA and 3 log reduction for MRSA. At the clinically used concentrations of respective antibiotics (80 ug/ml gentamicin, 150 ug/ml mupiricin) no growth was evident. In combination with SinuSurf, mupirocin at 1:10 dilution demonstrates complete eradication not seen with mupiricin alone. Similarly, SinuSurf in conjunction with gentamicin at 1:100 dilution demonstrates no growth while gentamicin alone at that dilution yielded growth. Furthermore, addition of SinuSurf resulted in a 5 log reduction in CFUs at a 1:100 dilution of mupirocin and 1:1000 dilution of gentamicin.ConclusionBacterial biofilms have recently been demonstrated in the sinonasal cavities of CRS patients and implicated in recalcitrant disease. Bacteria in the biofilm state require 100X to 1000X concentrations of antibiotics for effective therapy. Our data demonstrate the addition of SinuSurf increases the effective in vitro concentration of antibiotics significantly.
Characterization of Bacterial Community Diversity in Chronic Rhinosinusitis Infections Using Novel Culture‐Independent Techniques
Authors: Salib Rami , Stressman Franziska A. , Bruce Kenneth , Chan Samuel , Harries Philip G. , Howarth Peter , Rogers Geraint B. 
Published: September 2011

ObjectiveChronic rhinosinusitis (CRS) is a common condition involving a microbial component. Only a small fraction of the total range of bacterial species present in CRS is detected through conventional culture‐dependent techniques. We aimed to characterize the bacterial diversity in CRS samples using the novel molecular technique TRFLP.MethodThrough 16S ribosomal RNA (rRNA) gene clone sequencing and Terminal Restriction Fragment Length Polymorphism (TRFLP) analysis, the bacteria present in 70 clinical samples from 43 CRS patients undergoing endoscopic sinus surgery were characterized.ResultsBacterial TRFLP profiles were generated for 70 from 73 samples, and a total of 48 separate bands were detected. Species belonging to 34 genera were identified as present by clone sequence analysis. Of the species detected, those within the genera Pseudomonas, Citrobacter, Haemophilus, Propionibacterium, Staphylococcus, and Streptococcus were found to be numerically dominant, with Pseudomonas aeruginosa being the most frequently detected species.ConclusionThis study has validated the use of the culture‐independent molecular technique TRFLP in sinonasal samples. Preliminary characterization of the microbial diversity in CRS suggests a complex range of common and novel bacterial species within the upper airway in CRS, providing further evidence for the polymicrobial etiology of this disease.
Chitosan Packing for Epistaxis in Coagulopathy Set‐up
Authors: Shikani Alan H. , Al‐Qudah Mohannad A. , Kourelis Konstantinos G. 
Published: September 2011

ObjectiveThe management of refractory epistaxis in the context of coagulation disorders can be challenging for the physician and agonizing for the patient. This study investigates the efficacy of chitosan, a hemostatic polysaccharide that forms a coherent seal when it comes in contact with red blood cells, on these difficult‐to‐treat cases.MethodThe study population comprised 35 patients with bleeding diathesis (warfarin administration in 10 cases, antiplatelets in 18, both anticoagulants in 6, thrombocytopenia in 1) and persistent epistaxis despite aggressive tamponade. Treatment consisted of outpatient placement of a light packing with chitosan dressing supported by a polyvinyl acetal sponge for 48 hours.ResultsImmediate control of epistaxis was successfully achieved on an outpatient basis in 32 patients (91%) within a mean time of 3.5 minutes. Three patients (9%) continued to bleed despite the chitosan pack and required further treatment (two had repacking and one had electro‐coagulation of the spheno‐palatine artery). Upon packing removal, mild self‐limited sero‐sanguinous oozing was noted in 17 cases (48%). On the 1‐week follow‐up, no rebleeding was reported.ConclusionChitosan‐based nasal packing is an effective outpatient method for the management of refractory epistaxis in the setting of coagulopathy due to its unique hemostatic properties, which are independent of clotting factors and/or platelets.
Do Nasal Muscles Really Work during Nasal Breathing?
Authors: Bettega Silvio , Bettega Marcelo 
Published: September 2011

ObjectiveDetermine the role of nasal muscle function in healthy patients and patients with nasal septum deviation who underwent surgical treatment.MethodForty‐five patients were divided into 2 groups: Group A (n = 16), with no septum deviation and no nasal obstruction; Group B (n = 29), with both. Electromyographic (EMG) activities of nasal muscles were evaluated. Group A was the control, and Group B underwent surgery. Patients were evaluated before and after surgery.ResultsNo abnormal finding was found in any of the nasal muscles of the control group. There was less EMG activity during normal breathing compared with forced breathing in both groups. In group B, there was a decrease in EMG activity 30 days after surgery (33.17% on normal breathing and 49.04% on forced breathing) as well as 90 days after surgery (27.21% on normal breathing and 36.14% on forced breathing).ConclusionThe decrease in electromyographic activities of nasal muscles after removal of an obstructive factor as septum deviation, correlates with the hypothesis that nasal muscles are important during nasal breathing.
Intraoral Approach to Chin Augmentation
Authors: Aynehchi Behrad B. , Parhiscar Afshin , Burstein David H. 
Published: September 2011

ObjectiveSilicone augmentation mentoplasty is a common procedure with consistent results in properly selected patients. While many plastic surgeons employ external approachs, the intraoral method affords acceptable aesthetic outcomes while avoiding an external scar. To date, a series of this magnitude involving the intraoral route has yet to be reported.MethodA total of 125 patients underwent chin augmentation with silicone implants between 2004 and 2010. Among these implants, 105 were placed transorally. 85 patients were followed for at least one year. Demographic information, indications, patient satisfaction questionnaire results, and complications were recorded.ResultsAll implants yielded satisfactory results with no displacement, infection, tissue reaction, lower lip incompetence, or mental nerve injury. In addition, no intraoral contamination of implants occured. Two cases of superficial mucosal irritation at suture sites were observed and resolved without consequence. Symmetry, projection, and overall balance of facial components were excellent as well. Although all patients were satisfied with the functional and aesthetic results, 20% stated they would like further augmentation. Patients were extremely satisfied with the lack of an external scar.ConclusionSilicone augmentation mentoplasty is a relatively simple, reliable, and aesthetically pleasing procedure associated with minimal morbidity. Based on our series, with the avoidance of excessively large implants, the intraoral technique is recommended for its lack of complications and circumvention of an external scar.
Effects of Anatomy and Particle Size on Nasal Sprays
Authors: Frank Dennis , Pawar Sachin , Rhee John S. , Kimbell Julia S. 
Published: September 2011

ObjectiveCompare spray penetration past the nasal valve (NV) predicted for particle sizes at varying spray speeds using a computational fluid dynamics (CFD) model of the human nasal cavity with septal deviation on the left side and inferior turbinate hypertrophy on the right.MethodSimulations using Fluent (ANSYS, Inc, Lebanon, New Hampshire) were carried out for 10 µm, 20 µm, 50 µm, or particle sizes following a Rosin Rammler Particle Size Distribution (RRPSD) ranging from 10‐110µm. Spray speed was 1 m/s, 3 m/s, or 10 m/s; steady state inspiratory airflow rate was 15.7 L/min.ResultsSimulations predicted at least 2 times higher NV penetration on the right side (hypertrophic turbinate) than the left (septal deviation) for most particle sizes and spray speeds. Simulated penetration of 10 µm particles at 1 m/s was 100% with none escaping via the nasopharynx. At 3 and 10 m/s, more simulated 10µm particles escaped the nose than other sizes. Maximum penetration of RRPSD, 20µm, and 50µm particles was predicted to be 15%, 35%, and 12% on the left side, and 52%, 58%, and 56% on the right, respectively, occurring at 1m/s for RRPSD and 50 µm, and 3 m/s for 20 µm.ConclusionIn the presence of a septal deviation, sprays containing 10 µm particles may have better penetration past the NV. Additionally, increasing spray speed (above 3m/s) appears to limit spray penetration, suggesting that patients should be discouraged from spraying medications forcefully, as this could limit penetration of the drug.
Evolution of the Draf III Procedure: Mucosal Grafting Technique
Authors: Conger Bryant T. , Riley Kristen , Woodworth Bradford A. 
Published: September 2011

ObjectiveThe Draf III procedure is an advanced surgical option for frontal sinus disease refractory to endoscopic frontal sinustomy and also delineates the anterior limit of skull base tumors during endoscopic resection. Our objective was to evaluate outcomes of a novel strategy utilizing mucosal grafts to decrease postoperative closure.MethodPatients with frontal sinus pathology requiring a Draf III procedure were prospectively enrolled in the study. Demographics, reason for the procedure, percent graft viability, and complications were recorded. The primary outcome measure was anterior‐posterior (AP) diameter at 3 months.ResultsMucosal grafting technique was performed during 19 Draf III procedures from August 2008 to November 2010. Seventeen patients (average age 54 years) were available for endoscopic measurement at 3 months with an average postoperative follow‐up of 13.5 months (4‐24). Reasons for the procedure included tumor (n = 9), frontal ostium stenosis (n = 7), and trauma (n = 1). Fourteen patients (83%) had complete mucosal graft viability. Average intraoperative AP diameter was 12.3 mm. All patients maintained a patent combined frontal sinus ostium for the duration of follow‐up with an average diameter of 10.9 mm at 3 months and no closure >25% of intraoperative size.ConclusionCicatricial stenosis and osteoneogenesis are common following the Draf III procedure in up to 50% of individuals. The present study demonstrated that the mucosal grafting technique decreases Draf III stenosis when compared with historical series and should be considered a routine strategy for preventing postoperative closure.
Intracranial Abscess from Acute Sinusitis without Craniotomy
Authors: Crozier Emily E. , Brenski Amy C. , McClay John E. 
Published: September 2011

ObjectiveTo evaluate the success of treatment of intracranial abscess occurring from acute sinus disease without utilizing craniotomy.MethodRetrospective chart review based at a tertiarty care children’s medical center. Children were evaluated from 1995 to 2010 with intracranial abscess formation from acute sinusitis. The main outcome measures were treatment modalities for acute intracranial and sinus disease.ResultsTwenty‐five children were evaluated from 1995 to 2010 with acute sinusitis resulting in brain abscesses. Over the first 10 years, 15 were treated successfully with an intracranial procedure and sinus surgery. Over the past 5 years, 10 cases of intracranial abscess were encountered, with 5 out of 10 treated successfully without the need for craniotomy. 4 out of 5 had small epidural abscesses treated with endoscopic sinus surgery and intravenous antibiotic, and 1 out of 5 had a small epidural and subdural abscess treated with medical therapy alone.ConclusionMedical management of intracranial abscess along with medical or surgical treatment of acute sinusitis may be a viable option for certain children with small epidural abscesses caused by acute sinusitis.
Management of Refractory Nasal Polyposis in Samter’s Triad
Authors: Shikani Alan H. , Basaraba Randall , Kourelis Konstantinos G. , Leid Jeff G. 
Published: September 2011

ObjectiveRhinosinusitis and polyposis in Samter triad is difficult to treat, commonly recurring despite sinus surgery, antibiotics, and/or nasal steroids. Systemic steroids are limited by side effects. The present study assesses the efficacy of a gel placed into the sinuses, releasing steroids and antibiotics, along with topical nebulization of the same medications.MethodTen Samter patients with recurrent rhinosinusitis after sinus surgery received weekly intra‐sinus placement of a hydroxycellulose gel‐releasing mometasone and antibiotics, along with endoscopic sinus debridement, for 6 weeks. Outcome was evaluated by Lund‐Kennedy (LK) endoscopic and symptom scales immediately, 3 weeks, 6 weeks, and 10 weeks after the beginning of the protocol.ResultsBoth LK symptoms and endoscopic scores showed a progressive and statistically significant decline throughout the course of therapy, reaching at the end of treatment 56% (P =. 003) and 59% (P =. 004) improvement of pretreatment values, respectively. At 1 month posttreatment, mild relapse was noted.ConclusionA topical membrane therapy regimen consisting of gel‐releasing corticosteroids and antibiotics, along with topically nebulized corticosteroids and antibiotics, regular saline hydrotherapy, and sinus debridement, improves symptoms and endoscopic findings in recurrent Samter sinonasal polyposis.
Novel Irradiated Axial Rotational Flap Model in the Rodent
Authors: Luginbuhl Adam , Pribitkin Edmund A. , Curry Joseph , HeffelfingerModest Ryan , Modest Mara C. 
Published: September 2011

ObjectiveCreate a local flap model in the rodent mimicking the rotational flaps used in head and neck reconstruction, secondarily to see if irradiation of this model will result in flap failure and necrosis.MethodA 3 × 8 cm flap was designed over the right side of the abdomen pedicled off of the inferior epigastric. Left side of the abdomen a 3 × 8 cm defect at 60 degrees from midline was created and the flap was inset. On POD #7 area of necrosis was analyzed.ResultsEight rats were irradiated with 40 gy in 4 divided doses over 8 days. Field of radiation was restricted to an 8 × 10 cm across the abdomen. One month elapsed for the irradiated group prior to surgery. The control group consisted of 5 rats without radiation. Seven rats in the radiation group completed the study. One rat was sacrificed because of self‐mutilation after surgery. Four out of 7 (57%) rats in the irradiated group had necrosis of the distal flap ranging from 1 to 6 cm from the distal edge. No necrosis was seen in the control group. Histology revealed collagen and vascular changes in the irradiated skin.ConclusionThe irradiated rat model of an axial rotational flap is consistent with what is seen in previously irradiated patients that develop skin necrosis after reconstruction with local rotational flaps.
Outcomes of a Novel Titanium Nasal Implant for Nasal Valve Dysfunction
Authors: Cunningham Aileen , Fayad George G. 
Published: September 2011

Objective1) Analyze an initial cohort of UK patients undergoing surgery for nasal valve dysfunction with a novel titanium nasal implant, the Breathe‐Implant à Wengen. 2) Assess surgical outcomes, operative complications, subjective symptom improvement, and patient satisfaction with this new procedure in order to improve current practice and inform future patients.MethodRetrospective case note evaluation collated demographic details, indications, examination findings, imaging reports, operative details, length of follow‐up, surgical outcomes, and complications. Patients were contacted by telephone to complete a postoperative symptom evaluation questionnaire consisting of 4 procedure specific questions and a modified Glasgow Benefit Inventory (GBI) consisting of 11 questions.ResultsTwenty‐three patients underwent the procedure since 2009. Seventeen patients had nasal obstruction as the primary indication for surgery. Mean follow‐up 3.6 months (range, 1‐9 months). One patient had persistent postoperative nasal obstruction requiring further surgery. A total of 18 patients completed the questionnaire. Patient evaluation of postoperative nasal obstruction was found to be mean score of 1.5 (scale of 0 = no obstruction and 10 = complete nasal obstruction). Cosmetic appearance following insertion of the implant was reported as worse in 8 patients. A total of 72% reported that they would undergo the procedure again, and 83% felt that the operation made their overall life better.ConclusionThis unit is the first in the UK to use this device for nasal valve dysfunction. Our preliminary outcome data has found low complication rates and high patient satisfaction with improved symptoms and quality of life. However, cosmetic outcomes are an important issue to discuss with all potential Breathe‐Implant patients.
Prevalence of Rhinovirus RNA in Patients with Chronic Rhinosinusitis
Authors: Valera Fabiana , Arruda Eurico , Paula Flavia , Tamashiro Edwin , Anselmo‐Lima Wilma T. , Proenca‐Modena Jose L. 
Published: September 2011

ObjectiveThe real impact of virus infection in the perpetuation of chronic rhinosinusitis (CRSsNP) and nasal polyps (CRSwNP) is still to be established. The purpose of this study was to evaluate the prevalence of rhinovirus RNA in nasal lavage from patients with CRSwNP and CRSsNP, without acute exacerbations.MethodNasal and sinusal (maxillary) lavages were collected from a total of 36 patients with CRSwNP and CRSsNP, during ESS procedure, from July 2008 to August 2010. The RNA of human rhinovirus was evaluated through RT‐qPCR using TaqMan primers specific to human rhinovirus sp.ResultsRhinovirus RNAs were found in 19 (51.35%) of the samples. Correlation between nasal and sinusal lavages was of 61%. There was no correlation between rhinovirus prevalence and seasonality. Rhinovirus was present in 6 out of 13 samples of CRSsNP (46%) and 12 out of 23 samples of CRSwNP (52%). Lund Mackay score ranged from 2 to 8 (mean 4.4) among CRSsNP patients and from 8 to 24 (mean 14) among CRSwNP patients. Mean Lund‐Mackay score was similar between patients with or without rhinovirus, both for CRSwNP (16.9 vs 17.3, respectively) and CRSsNP (5.4 vs 3.5, respectively).ConclusionThere is a very high prevalence of rhinovirus RNA in nasal lavages from patients with CRSsNP and CRSwNP.