bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Smoking on Short‐Term Quality of Life Outcomes in Sinus Surgery
Authors: Das Subinoy , Becker Adam M. , Perakis Helen , Prosser J Drew , Kountakis Stilianos E. 
Published: February 2009

AbstractObjective: The purpose of this study was to prospectively compare the short‐term benefit of endoscopic sinus surgery for smokers and nonsmokers using a disease specific, clinically validated, quality of life outcomes measure, the Sinonasal Outcomes Test‐20 (SNOT‐20).Study Design: Prospective clinical trial.Methods: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative SNOT‐20 scores and comprehensive demographic data were obtained. All patients underwent endoscopic sinus surgery under the supervision of the senior author. Preoperative SNOT‐20 scores were compared to short‐term postoperative SNOT‐20 scores.Results: Short‐term postoperative results were available for 221 patients for comparison. Preoperative SNOT‐20 scores in 49 smokers (mean: 27.8) and 172 nonsmokers (mean: 26.2) were statistically similar. Both smokers and nonsmokers achieved a highly significant reduction in SNOT‐20 scores at short‐term follow‐up evaluations. (P < .0005) Smokers achieved a greater reduction in SNOT‐20 scores (mean difference: 22.1) at short‐term follow‐up compared to nonsmokers (mean difference: 16.1). This result was statistically significant (P < .044).Conclusions: This study confirms that smokers and nonsmokers achieve a highly significant short‐term benefit from endoscopic sinus surgery using a clinically‐validated symptom severity scale in a prospective study. Interestingly, smokers achieved a greater short‐term benefit than nonsmokers did. This study calls into question the notion that current smokers are poorer candidates for endoscopic sinus surgery. Further prospective studies to confirm these results and provide long‐term analysis should be performed.
Technique, Utility, and Safety of Awake Tracheoplasty Using Combined Laser and Balloon Dilation
Authors: Andrews Brian T. , Graham Scott M. , Ross Alan F. , Barnhart William H. , Ferguson J Scott , McLennan Geoffrey 
Published: February 2009

AbstractObjectives: Laryngotracheostenosis (LTS) is a condition in which the airway is narrowed between the vocal cords and the carina. We seek to examine whether flexible bronchoscopy with neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser incision and balloon dilation tracheoplasty is a practical choice in the management of patients with subglottic or tracheal stenosis.Methods: A retrospective chart review was performed at a tertiary care hospital. All subjects with laryngotracheostenosis treated between January 1, 2000, and April 2005 who underwent endoscopic Nd:YAG laser incision and balloon dilation tracheoplasty performed using topical anesthesia and intravenous sedation were included.Results: A total of 18 patients comprised the study and 36 procedures were performed without complication. Only one procedure was required by eight subjects, while five subjects required two procedures, three subjects had three procedures, one subject had four procedures, and one subject had five procedures until an adequate stable airway was obtained. The average follow‐up was 22 months (range 3–55 months). The average body mass index (BMI) was 32.0 kg/m2 (range = 20.8–42.2 kg/m2) and 11 of the 18 subjects (61.1%) were categorized as obese or morbidly obese by BMI criteria.Conclusion: Combined Nd:YAG laser incision and balloon dilation in an awake, spontaneously breathing patient is a safe and effective management tool in the treatment of laryngotracheostenosis. This technique may be particularly beneficial in patients who are at increased risk for general anesthesia such as those with morbid obesity or who have had a history of airway problems during anesthesia.
Endoscopic and Quality‐of‐Life Outcomes After Revision Endoscopic Sinus Surgery
Authors: Litvack Jamie R. , Griest Susan , James Kenneth E. , Smith Timothy L. 
Published: February 2009

AbstractObjectives: First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality‐of‐life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co‐morbidities influence the relationship between revision surgery status and outcomes of ESS.Study Design: Prospective observational study with an internal comparison group.Methods: Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease‐specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's χ2 and multiple logistic regression models.Results: Mean preoperative Lund‐Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status.Conclusions: Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non‐polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.
Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic Center
Authors: Jacob Abraham , Robinson Lawrence L. , Bortman Jared S. , Yu Lianbo , Dodson Edward E. , Welling D Bradley 
Published: February 2009

AbstractObjective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS).Study Design: Retrospective.Methods: Chart review.Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy‐one of 74 patients (95%) patients with IVN tumors achieved a House‐Brackmann (HB) grade I–III, while 35 of 35 patients (100%) with SVN tumors retained HB I–III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1‐cm tumors, and 4 of 20 patients (20%) with 1‐ to 1.5‐cm tumors. For all cases with documented facial nerve function, HB I–III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures.Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow‐up.
Migration of Cymetra After Vocal Fold Injection for Laryngeal Paralysis
Authors: Bock Jonathan M. , Lee John H. , Robinson Robert A. , Hoffman Henry T. 
Published: February 2009

AbstractInjection laryngoplasty is a common operative technique used in the management of unilateral vocal fold paralysis. Cymetra is a micronized particulate injectable form of acellular human dermis that is commonly used for vocal cord medialization procedures. We report migration of an intracordal bolus of Cymetra into the medial wall of the pyriform sinus. Histopathology from endoscopic resection of the migrated Cymetra demonstrated a localized foreign body reaction with characteristic giant cells. Specific anatomic considerations through cadaveric laryngeal dissection are presented to demonstrate the likely pathway of intralaryngeal bolus migration.
Cochlear Implantation in Organ Transplantation
Authors: Patterson D Michael , Telischi Fred F. , Connell Sarah S. , Ulubil S Arif , Hodges Annelle V. , Eshraghi Adrien A. , Balkany Thomas J. 
Published: February 2009

AbstractObjectives/Hypothesis: Compared to immunocompetent patients, organ transplant recipients receiving immunosuppressant medications may experience higher rates of postoperative complications. This study was designed to retrospectively review the outcomes of cochlear implantation among organ transplant patients.Study Design: Retrospective case series.Methods: Five organ transplant patients received seven cochlear implantations at the University of Miami Ear Institute from January 1, 1992, until August 31, 2005. Inpatient and outpatient records were analyzed to identify healing problems, wound infections, and speech recognition after implantation.Results: There were no healing problems, wound infections, or other complications noted among cochlear implant recipients who had also received organ transplantation. Open‐set sentence discrimination as measured by the Hearing in Noise Test (HINT), City University of New York (CUNY) test, and/or Central Institute for the Deaf (CID) tests ranged from 46% to 89%. Open‐set word recognition as measured by the Consonant Nucleus Consonant (CNC) or the Northwestern University number 6 (NU‐6) test ranged from 26% to 64%.Conclusions: This series suggests that cochlear implantation can be safe and effective for solid organ transplant recipients on immunosuppressants, with discrimination performance within the expected ranges for cochlear implant patients.
High Incidence of Malignant Transformation of Laryngeal Papilloma in Taiwan
Authors: Lee Li‐Ang , Cheng Ann‐Joy , Fang Tuan‐Jen , Huang Chung‐Guei , Liao Chun‐Ta , Chang Joseph Tung‐Chieh , Li Hsueh‐Yu 
Published: February 2009

AbstractObjectives: Papillomas of the larynx include solitary laryngeal papilloma and recurrent respiratory papillomatosis. This study investigated the incidence of malignant transformation and assessed possible risk factors for laryngeal papillomas.Study Design: A prospective, longitudinal study.Methods: Twenty‐six consecutive laryngeal papilloma patients were prospectively studied for 5 or more years, and each patient was periodically examined at 3 to 6 month intervals. A detailed epidemiologic questionnaire was administered at the initial visit. After enrollment, tissue obtained during each laryngeal surgery was examined by polymerase chain reaction assay for human papilloma virus (HPV) and typing.Results: During 237 person‐years of follow‐up, six new, pathologically confirmed cases of laryngeal carcinoma were ascertained (incidence 2.5/100 person‐years), and all were associated with HPV‐6 or HPV‐11. Malignant transformation revealed no correlation with the following: age less than 3 years at diagnosis, sex, history of tobacco use, history of alcohol consumption, family history of laryngeal cancer, or type of laryngeal papilloma. Laryngeal papilloma without demonstrable HPV DNA was the only significant risk factor for malignant transformation (P < .05). The cumulative risk of malignant transformation in subjects without demonstrable HPV DNA was significantly higher than that in HPV‐positive patients (relative risk, 8.0; 95% confidence interval, 1.1–60.3; P = .05).Conclusions: A relatively high incidence of malignant transformation of laryngeal papilloma was noted in Taiwanese patients. Patients without demonstrable HPV DNA require more frequent follow‐up and may benefit from anti‐HPV vaccinations.
The Malleus‐Stapes Offset
Authors: Todd N Wendell 
Published: February 2009

AbstractBackground: The malleus‐stapes offset create challenges during ossiculoplasty, specifically the positioning of an interposed incus or replacement prosthesis relative to the manubrium.Objectives: To depict the malleus‐stapes offset, its relationship to the orientation of the manubrium as viewed through the external ear canal relative to a horizontal plane, and mastoid pneumatization size.Study Design: Postmortem anatomic dissection of 41 bequeathed adult crania (82 temporal bones) without clinical otitis.Methods: The malleus‐stapes offset was analyzed both as a surgeon does intraoperatively and from above through the tegmen tympani. Mastoid sizes were determined radiographically.Results: From the surgeon's perspective, for the right ear, the “height” (manubrium to caput stapedis) ranged from 0 to 1.5 (mean, 0.5) mm; the “horizontal” offset ranged from 1.0 to 4.0 (mean, 2.2) mm. Differences in angular offset, as viewed transcanally versus trans‐tegmenally, averaged 8.5 degrees (range to 53 degrees). Both height and horizontal offset exhibited wide intersubject variability, quite weak bilateral symmetry, and no relationship with either manubrium orientation or mastoid size.Conclusion: Reliable determination of the malleus‐stapes offset is difficult. Because the error of visual offset assessment exceeds the generally accepted 45 degrees alignment allowance for an ossicular prosthesis, visualized ossiculoplasty alignment should be perfect. The ranges of manubrium‐stapes offset do not correlate with either manubrium orientation or the extent of mastoid pneumatization.
The Influence of Olfactory Loss on Dietary Behaviors
Authors: Aschenbrenner Katja , Hummel Cornelia , Teszmer Katja , Krone Franziska , Ishimaru Tadashi , Seo Han‐Seok , Hummel Thomas 
Published: February 2009

AbstractObjectives: To assess dietary behavior and possible changes in food selection in patients with smell loss.Patients and Methods: A total of 176 patients (114 women and 62 men) age 17 to 86 years were classified into three diagnostic groups (normosmia, n = 12; hyposmia, n = 75; functional anosmia, n = 89) according to their olfactory test scores obtained with “Sniffin' Sticks.” Group differences in food intake and dietary behaviors were investigated with a specifically designed questionnaire providing a dietary alterations score (DAS).Results: Numerous dietary changes were reported, e.g., 29% of all patients reported that they eat less since the onset of olfactory dysfunction, 39% use more spices with their food, 47% go out to eat at restaurants less frequently, 37% eat less sweets, and 48% drink less sweet beverages.Subjects with weight gain or weight loss scored higher on the DAS scale than subjects who did not report changes in weight. Similarly, DAS scale changes were more pronounced in subjects with a gradual onset of olfactory loss compared to subjects with a sudden loss of olfaction. Finally, a change of taste preferences toward savory and salty foods was observed across all patients enrolled in the present study.Conclusions: Patients with olfactory loss report alterations of dietary behaviors. Numerous factors appear to impact the results of olfactory loss in terms of changes in diet.
Responses to Trigeminal Irritants at Different Locations of the Human Nasal Mucosa
Authors: Scheibe Mandy , van Thriel Christoph , Hummel Thomas 
Published: February 2009

AbstractBackground: Previous work suggests differences in the distribution of human intranasal trigeminal receptors. The aim of this study was to investigate these topographic differences for different concentrations of different trigeminal irritants using an electrophysiologic measure of trigeminal activation, the negative mucosa potential (NMP).Materials and Methods: A total of 15 healthy volunteers participated. Presented by a computer‐controlled olfactometer CO2 (30% and 40% v/v), ethyl acetate (5.5% and 9.3% v/v) and acetic acid (205 and 40% v/v) were used for stimulation. NMP was recorded at the middle septum, the middle turbinate, and the floor of the nasal cavity.Results: Maximum amplitudes of the NMP were found at the middle septum and were lowest at the nasal floor. Response amplitudes were related to stimulus concentrations. There was no significant difference between responses to the three different stimuli in relation to three recording sites.Conclusions: In agreement with previous work, the present data suggest that there are topographic differences in the responsiveness of the mucosa to chemical irritants.
Resolving Feeding Difficulties With Early Airway Intervention in Pierre Robin Sequence
Authors: Lidsky Michael E. , Lander Timothy A. , Sidman James D. 
Published: February 2009

AbstractObjectives/Hypothesis: To observe rates of gastrostomy tube (g‐tube) placement in Pierre Robin Sequence (PRS) and to determine whether relieving airway obstruction solves feeding difficulties.Study Design: All PRS referrals to a multidisciplinary cleft team for children at a tertiary pediatric hospital from January 1988 to June 2006 were retrospectively reviewed.Methods: Patients were analyzed for occurrence of g‐tube placement, neurologic disorders, and airway intervention including tracheotomy and mandibular distraction osteogenesis.Results: Sixty‐seven PRS patients were divided into two categories: 51 (76.1%) isolated PRS (iPRS) and 16 (23.9%) with additional disorders and syndromes (sPRS). Patients were then placed into two subgroups: those who received early airway intervention and those who received late or no airway intervention. Of the 51 iPRS children, 12 (23.5%) received early airway intervention, none of whom required a g‐tube. There were 39 (76.5%) children who received late or no airway intervention, and 5 (12.8%) of these required g‐tube placement. Of the 16 sPRS children, 8 (50%) received early airway intervention, and 7 (87.5%) of these still required a g‐tube. Of the remaining 8 (50%) sPRS patients who received late or no airway intervention, 5 (62.5%) required a g‐tube.Conclusion: In children with iPRS, feeding difficulties can be resolved with early airway intervention. Delaying airway intervention may necessitate feeding assistance because all of the iPRS children who required a g‐tube fell into this category. The presence of additional disorders and syndromes further complicates treatment because most of the sPRS children required g‐tubes regardless of airway intervention.
Role of Local Immunoglobulin E Specific for Alternaria alternata in the Pathogenesis of Nasal Polyposis
Authors: Sabirov Albert , Hamilton Robert G. , Jacobs Joseph B. , Hillman Dean E. , Lebowitz Richard A. , Watts Joe D. 
Published: February 2009

AbstractObjective/Hypothesis: The role of fungal pathogens in the etiology of nasal polyposis remains unclear. The aim of this study was to determine whether there was a correlation between the presence of Alternaria‐specific immunoglobulin (Ig)E antibodies, eosinophilic inflammation, and the development of nasal polyps.Study Design: Prospective study.Methods: Serum and nasal tissue homogenates from 21 patients with manifestations of chronic sinusitis with nasal polyps were compared with specimens from 13 chronic sinusitis patients without polyps and 8 healthy controls. The Phadia ImmunoCAP and enzyme‐linked immunosorbent assay were used to quantify levels of total IgE and Alternaria‐specific (IgE, IgG, and IgA) antibodies. Eosinophil cationic protein (ECP) and tryptase levels were measured in tissue homogenates, whereas the inflammatory response was evaluated using tissue eosinophil counts in tissue samples.Results: Serum analysis revealed no difference in the levels of total IgE and Alternaria‐specific IgE, IgG, and IgA antibodies between the study groups. In contrast, the levels of Alternaria‐specific IgE in tissue with polyps were significantly higher than in nonpolyp tissue. Increases in total tissue IgE paralleled increased levels of Alternaria‐specific IgG and IgA antibodies in chronic sinusitis with nasal polyps as compared with control groups. A positive correlation was found between Alternaria‐specific IgE and ECP in tissue. Increased mean levels of ECP corresponded to increased eosinophil counts in the group of patients with polyps.Conclusions: Alternaria‐specific IgE and eosinophilic inflammation in nasal tissue correlates with the incidence of nasal polyps irrespective of specific IgE antibodies in serum. Together, the correlation between the local immune responses and the eosinophilic inflammation in nasal polyps suggests a possible role of Alternaria in the pathogenesis of nasal polyposis.
Potential Structures That Could Be Confused With a Nonrecurrent Inferior Laryngeal Nerve: An Anatomic Study
Authors: Maranillo Eva , Vazquez Teresa , Quer Miquel , Niedenführ Marc Rodriguez , Leon Xavier , Viejo Fermin , Parkin Ian , Sanudo Jose R. 
Published: February 2009

AbstractObjectives: Study and detailed description of the large connections between the normally recurrent inferior laryngeal nerve (RILN) and the sympathetic trunk (ST) because these may be mistaken for a nonrecurrent inferior laryngeal nerve (NRILN).Study Design: Morphologic study of adult human necks.Methods: The necks of 144 human, adult, embalmed cadavers were examined (68 males, 76 females). They had been partially dissected by Cambridge preclinical medical students and then further dissected by the authors using magnification. The RILN, the ST, and their branches were identified and dissected. A total of 277 RILNs and STs (137 rights, 140 lefts) were observed.Results: A communicating branch (CB) with a similar diameter to the RILN occurred between the ST and the RILN in 48 of the 277 (17.3%) dissections, 24 from the 137 (17.5%) right dissections, and 24 from the 140 (17%) left dissections. In 12 cases, the CB was bilateral. The CB arose from the superior cervical sympathetic ganglion in 3 of the 48 (6.25%) cases, from the middle ganglion in 10 (21%) cases, from the stellate ganglion in 3 (6.25%) cases, and from the ST in 32 (66.6%) cases. One (0.36%) NRILN associated with a right retro‐esophageal subclavian artery (arteria lusoria) was found.Conclusions: 1) The CB between the RILN and the ST may have a diameter and course similar to an NRILN and may be confused with it. 2) The occurrence of the CB is greater than the occurrence referred to in previous studies. 3) The occurrence of the CB is similar by side and sex. 4) The CB may arise at different levels from the cervical ST and ganglia and end in the thyroid area. 5) Other neural elements may also be confused with an RILN, such as the cardiac nerves and the collateral branches from an NRILN to the trachea and esophagus.