bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intranasal Steroids for Adenoidal Nasal Obstruction
Authors: Chadha Neil K , Zhang Linjie , Mendoza‐Sassi Raul , Cesar Juraci 
Published: August 2008

Objective1) To systematically review the evidence for intranasal steroids in the treatment of nasal obstruction caused by adenoidal hypertrophy, in children. 2) To determine the risk of adverse events of treatment.MethodsWe performed a systematic review and metaanalysis following a specified protocol. Databases searched (May 2007) included Cochrane CENTRAL, MEDLINE, EM‐BASE, CINAHL, AMED, LILACS, KoreaMed, IndMED, SIGLE, Cambridge Scientific Abstracts, mRCT, National Research Register, ISRCTN, and ISI Web of Science.Results56 studies were identified, with 4 randomized controlled trials (RCTs) meeting the inclusion criteria. Trial 1: an 8‐week crossover RCT demonstrating 4‐weeks beclomethasone (336 mcg/day) showed a 45% reduction in symptom scores (p<0.01). Trial 2: a 4‐week crossover RCT demonstrating a reduction in nasal obstruction index by 50% in patients treated with beclomethasone (400 micrograms/day) for 2 weeks (p<0.0001). Trial 3: a 40‐day parallel RCT which showed that 77.7% of patients treated with mometasone (100 micrograms/day) demonstrated an improvement in nasal obstruction symptoMS Trial 4: an 8‐week parallel RCT demonstrated no significant improvement in nasal obstruction symptoms after 8‐weeks treatment with beclomethasone (200 micrograms/day). Low statistical power and low dose of beclomethasone may have contributed to this negative result.ConclusionsCurrent evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with adenoidal hypertrophy, and this improvement was associated with a reduction of adenoid size. Given the safety and tolerability of intranasal corticosteroids, it seems reasonable to recommend the use of these drugs as an effective treatment for children with adenoidal hypertrophy when adenoidectomy is not urgently required.
Lingual Tonsillectomy for Persistent Pediatric Sleep Apnea
Authors: Lin Aaron C , Koltai Peter J 
Published: August 2008

Objective1) To describe our experience with a technique of lingual tonsillectomy using coblation with endoscopic visualization. 2) To document its utility for treating children with persistent sleep apnea after adenotonsillectomy who on sleep endoscopy have enlarged lingual tonsils and tongue base obstruction.MethodsRetrospective cohort study in a tertiary pediatric medical center. Between 2005 and 2007, 20 patients (ages 3 ‐18), who had a previous adenotonsillectomy (T&A) for obstructive sleep apnea (OSA), were diagnosed with persistent OSA by polysomnography (PSG). These children had both in‐office unsedated fiberoptic laryngoscopy and dynamic anesthesia‐assisted sleep fiberoptic laryngoscopy, both of which demonstrated lingual tonsillar hypertrophy contributing to tongue base obstruction of the hypopharynx. With a visually confirmed site of lesion, these children underwent endoscopic lingual tonsillectomy for treatment. Pre‐ and post‐operative PSG data were paired and analyzed statistically.ResultsStatistically significant reductions in respiratory distress index (RDI) were observed when pre‐ and post‐operative data were compared (mean 14.9 vs. 7.8, median 12.6 vs. 3.3). There were similar reductions in the number of apneas and hypopneas. The mean and median low O2 saturations did not change significantly.ConclusionsEndoscopic lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea after T&A. Anesthesia‐assisted sleep endoscopy is key to diagnosing the obstructive contribution of the enlarged lingual tonsils. The combination of endoscopic access with the near bloodless technique for ablation of the lingual tonsils provides a consistently reproducible method of treating children with this uncommon problem.
Microdebrider‐Assisted Supraglottoplasty for Laryngomalacia
Authors: Groblewski Jan Casimir , Shah Rahul K , Zalzal George H 
Published: August 2008

ObjectiveTo describe our series in the surgical treatment of laryngomalacia using a microdebrider.MethodsA retrospective review of patients undergoing supraglottoplasty for laryngomalacia at a tertiary children's hospital between October 2004 and February 2008 was performed. Patients with complex co‐morbidities and those undergoing alternative methods for supraglottoplasty were excluded. Patient charts and operative reports were reviewed to assess demographic characteristics, co‐morbidities, procedural times, hospitalizations, intra‐operative and post‐operative complications, and post‐operative outcome. Main outcome measures included complications, pain, resolution of stridor, presence of aspiration, and need for revision surgery.Results27 patients underwent microdebrider‐assisted supraglottoplasty. Mean age at diagnosis was 109 days; mean age at time of the procedure was 187 days. 18 Eighteen patients (67%) had gastro‐esophageal reflux at the time the laryngomalacia was diagnosed. Average operative time was 35.7 minutes (std. dev. 12.9, range 11–65 minutes). No intra‐operative complications or device problems were noted. Only 2 patients remained intubated at the conclusion of the procedure; no patient required tracheotomy or revision supraglottoplasty. One patient had post‐operative aspiration, which later resolved. One patient was readmitted for stridor one month following her procedure. There was no pain from the procedure, as all patients immediately resumed a diet. All patients had eventual resolution of stridor.ConclusionsThis is the largest series of patients that underwent microdebrider‐assisted supraglottoplasty for laryngomalacia. This procedure is safe, without pain, and effective in patients with laryngomalacia. Microdebrider‐ assisted supraglottoplasty is the method of choice for supraglottoplasty in our institution.
Molecular Resonance vs. Coblation Tonsillectomy in Children
Authors: D'Eredita Riccardo 
Published: August 2008

ObjectiveTo compare molecular resonance (MRT) with coblation (CAT) devices for pediatric tonsillectomy.MethodsProspective, 2‐group, randomized trial in a tertiary care pediatric institution. 89 children for whom tonsillectomy was indicated were randomly assigned to receive MRT (n=45) or CAT (n=44). Main outcome measures included intraoperative time, blood loss, postoperative pain, and weight loss. Histopathologic examination was performed on all excised tonsils. Patients, parents, and pathologist were blinded to surgical modality.ResultsHistopathologic evaluation revealed significantly reduced thermal injury with MRT than with CAT (43 microns vs. 126 respectively, p<0.001), and was statistically associated with reduced muscular, blood vessels, and nerve fibers damage. No intraoperative blood loss was observed in patients following MRT. Statistically significant reduced pain scores were related to the MRT (p<0.002). In addition, the MRT method showed a quick return to normal diet with even weight gain during the 10‐day postoperative period. One child in the CAT group experienced delayed bleeding and required read‐mission.ConclusionsMolecular resonance for pediatric tonsillectomy resulted in significantly reduced histopathologic thermal injury, and lower pain scores as compared to coblation. Further studies are advised to support these data.
Resistant Pneumococci Causing Otitis and Sinusitis Failures
Authors: Poole Michael D 
Published: August 2008

ObjectiveDescribe cases of non‐responsive otitis media and rhinosinusitis due to highly resistant strains of Streptococcus pneumoniae.MethodsResistant strains of Streptococcus pneumonia were isolated from cases of non‐responsive pediatric otitis media or rhinosinusitis, from September 2005 to September 2008, from a single pediatric otolaryngology practice. Children had failed therapy with “high dose” amoxicillin‐clavulanate and/or ceftriaxone injections.Results54 cases of apparent failed therapy were detected. The strain(s) demonstrated in vitro high level resistance to penicillin, amoxicillin‐clavulanate, oral cepahalosporins, trimethoprim‐sulfamethoxazole, macrolides, and clindamycin; and were intermediately or fully resistant to ceftriaxone. Serotyping of representative isolated demonstrated these to be 19A pneumococcal isolates. These cases were often in unusually young infants, and often were from a single prolonged episode of acute otitis medi, including 2 cases of mastoiditis with subperiostial abscess. Most of the cases were identified by office‐based diagnostic tympanocentesis and were rarely isolated from children undergoing tympanstomy tube placement. All cases resolved after therapy with levofloxacin pediatric suspension (25 mg/ml, 20 mg'kg/day divided BID.ConclusionsThis is the largest series of otitis and sinusitis cases due to these highly resistant organisms; and these cases suggest that resistant pneumoccocci are likely causing a significant number of treatment failures in the U.S. They are not detected unless nasal or middle ear cultures are taken from treatment failures. Treatment with fluoroquinolones is effective, but raises issues concerning the role of this class of anitbiotics in children.
Safety and Efficacy of Balloon Sinus Dilation in Children
Authors: Ramadan Hassan H , McLaughlin Kevin E , Josephson Gary D , Rimell Frank L , Bent John P 
Published: August 2008

ObjectiveThe safety and feasibility of balloon catheters to dilate obstructed sinus ostia was established in adults in the CLEAR study. This minimally invasive approach to endoscopic sinus surgery is potentially advantageous for pediatric patients due to possible decrease in scarring, post‐operative pain, and need for operative debridement. This is a preliminary report on the safety and efficacy of using balloon sinuplasty instruments.MethodsA prospective, multi‐center, non‐randomized evaluation is currently underway in pediatric patients diagnosed with chronic rhinosinusitis. To date, 35 patients (58 maxillary, 9 sphenoid, and 3 frontal sinuses) have been enrolled at 5 sites. Safety was assessed by rate of adverse events. Effectiveness was assessed through measurement of patient sinus symptoms. Patients age 12 and older completed the Sino‐Nasal Outcome Test (SNOT 20). Parent/guardians completed the SN‐5 Questionnaire for patients under age 12.ResultsNo unanticipated adverse effects were noted in any patients. Patient symptoms improved on the SN‐5 from average scores of 4.7 at baseline (n=24) to 2.7 at 12 weeks post‐surgery (n=11)(p = 0.0001). Patient symptoms improved on the SNOT‐20 from 1.7 at baseline (n=10) to 0.9 at 12 weeks post‐surgery (n=5)(p = 0.33). Twelve week follow‐up data for the entire cohort is anticipated by June 2008 and the abstract will be updated accordingly.ConclusionsPreliminary results indicate that when patients are appropriately selected, sinus ostial dilation using balloon catheters in children has an excellent safety profile and may be an effective minimally invasive treatment option to relieve sinus ostial obstruction.
Tonsillectomy for Obstructive Sleep Apnea in Obese Children
Authors: Costa Dary J , Mitchell Ron B 
Published: August 2008

ObjectiveTo determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children.MethodsMeta‐analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data was analyzed using the random effects model. Statistical significance was P less than 0.05.ResultsData from four studies that included 110 children were analyzed. Mean sample size was 27.5 (range: 18 ‐ 33). Mean body mass index (BMI) z‐score was 2.81. The mean pre‐and postoperative apnea‐hypopnea index (AHI) was 29.0 (range 22.2 ‐ 34.3) and 9.9 (range 6.0 ‐ 12.2) respectively. The weighted mean difference between pre‐ and postoperative AHI was a significant reduction of 18.3 events per hour (95% CI 11.2–25.5). The mean pre‐ and postoperative oxygen saturation nadir was 78.9% (range 73.9 ‐81.1%) and 85.7% (83.6 ‐89.9%) respectively. The weighted mean difference was a significant increase in the oxygen saturation nadir of 6.3% (95% CI 3.9 to 8.7). Approximately 43% of children had a postoperative AHI less than 5, 21% of children had a postoperative AHI less than 2, and 11% of children had a postoperative AHI less than 1.ConclusionsT&A improves but does not resolve OSA in the majority of obese children. Up to 89% of obese children have persistent OSA after T&A. The efficacy and role of additional therapeutic options requires more study. The high incidence of obesity in children makes this a public health priority.
Ultrasound Characterization of Middle Ear Effusion
Authors: Seth Rahul , Discolo Christopher , Krakovitz Paul R 
Published: August 2008

ObjectiveTo further 1) enhance and assess the ability to detect and characterize middle ear effusion using A‐mode ultrasonography with miniature curved array transducers, and 2) identify bacterial presence in relation to effusion viscosity.MethodsA prospective unblinded comparison study was performed to determine ultrasound efficacy in detecting effusion characteristics. Ultrasonographic examination using an ultrasound probe was performed on 107 patients (197 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings from the tympanic membrane and middle ear space were recorded and analyzed for viscosity. Middle ear aspirate was sent for bacterial culture. Myringotomy was then performed.ResultsComputer‐based algorithms analyzed the waveforms and were able to detect the presence of thick, thin, and lack of fluid with a sensitivity and specificity of greater than 90%. Thin effusions had a significantly higher infection rate (64% versus 12%, p<0.01, Fisher's exact test) when cultured from ears of children not taking oral antibiotic therapy. Similar results were obtained from cultures taken of middle ear fluid in children taking antibiotics (69% versus 12%, p<0.002).ConclusionsThe specificity and sensitivity of ultrasound middle ear fluid detection is greater than 90%, exceeding the accuracy of tympanometry and other devices. Moreover, it can accurately predict the viscosity of an effusion, which can give insight into its likelihood of infection. Further technologies to promote ease of use will be needed.
Efficacy of Pre‐Operative MRSA Screening in Otolaryngology
Authors: Richer Sara L , Wenig Barry L 
Published: August 2008

ObjectiveTo examine the efficacy of pre‐operative Staphylococcus aureus screening by nasal swab on post‐operative Methicillin‐resistant Staphylococcus aureus (MRSA) infection rates in surgical patients undergoing varied otolaryngological procedures.MethodsRetrospective review of MRSA colonization and infection rates in surgical otolaryngology patients at a single institution. MRSA infection rates in unscreened patients undergoing procedures during a one‐year period were compared to infection rates in patients undergoing pre‐operative Staphylococcus aureus screening in an 11‐month time frame. Patients colonized with Staphylococcus aureus were treated with Mupirocin and Chlorhexidine prior to the procedure.ResultsRecords of 420 patients undergoing varied otolaryngological procedures were evaluated. In the 241 patients without pre‐operative screening, 9 patients had Staphylococcus aureus‐infected wounds. There were two (0.83%) post‐operative MRSA surgical site infections. Out of 179 patients followed after screening was initiated, 24 patients (13.4%) were colonized with Staphylococcus aureus and underwent preoperative treatment. There were no MRSA infections in the post‐operative period.ConclusionsEarly results demonstrate the potential benefit of pre‐operative Staphylococcus aureus screening in reducing the MRSA infection rate. Screening and treatment of MRSA colonized patients pre‐operatively reduces infectious complications and should be considered in otolaryngology surgical practice.
Post‐tonsillectomy Bleeding as a Stochastic Process
Authors: Blakley Brian W 
Published: August 2008

Objective1) Establish an acceptable post‐tonsillectomy bleeding rate from the literature, and 2)provide a literature‐based comparator for institutional bleed rates.MethodsA MEDLINE literature search entering the keyword “tonsillectomy” identified 4,610 papers for all available years. The abstracts were loaded into a database and searched to identify the incidence of bleeding if reported. The weighted mean, standard deviation and 95% confidence intervals were calculated for those papers. For papers that compared a new technique to a control technique, only the control group rate was used. The definitions of bleeding rate were those used by the original authors of the papers.Results63 papers reported post‐tonsillectomy bleeding rates. The mean (4.5%) plus 2 standard deviations (9.4%) suggests a maximum “expected” sustained bleeding rate of 13.9%. Even in this literature which should reflect optimum results, there were 3 reports of bleed rates in the 18–20% range.ConclusionsPost‐tonsillectomy bleeding rates of about 5% are typical. Rates above 14% justify monitoring, and sustained rates over 20% occur at times. Transient increases greater than 20% may occur.
Bacterial Flora of Normal Maxillary Sinuses in Adults
Authors: Abou Hamad Walid M , Matar Nayla E. , Elias Michelle , Hokayem Nabil , Nasr Marwan W. , Sarkis Dolla Karam , Haddad Amine C 
Published: August 2008

Objective(1)To determine the bacterial flora and (2) to quantify the level of bacterial presence in healthy maxillary sinus cavities.MethodsSubjects included 25 consecutive patients undergoing Lefort I osteotomy for orthognathic surgery under general anesthesia between January 2007 and February 2008. All patients were preoperatively evaluated by a questionnaire and a complete physical examination including sinus endoscopy. Our exclusion criteria were: presence of sinonasal symptoms, asthma, antibiotic treatment in the past 3 months, treatment with local steroids, previous sinonasal surgery, traumatic surgery, and an abnormal sinus endoscopy. Washes were obtained from maxillary sinuses before surgery through an antral puncture. The sinus was irrigated with 1cc of sterile saline followed by aspiration with a syringe attached to the trocar. Basic sterility rules were rigorously applied. Specimens were transported to the laboratory in a sealed, airfree syringe. Time between collection of materials and inoculation of the specimen did not exceed 15 minutes. Specimens were inoculated for aerobic and anaerobic organisms.ResultsAfter applying the selection criteria, 14 patients (28 sinuses) remained. Eight (57.1%) were males with a mean age of 22.7 years. 82.14% of the specimens were sterile. Bacterial organisms were recovered in only 4 patients with 2 different coagulase negative staphylococci in the same patient: one in each sinus with 200UFC/ml in the left sinus and 10UFC/ml in the right sinus, 1 citrobacter fundii (70 UFC/ml) and 2 polymorphic floras.ConclusionsThis descriptive study demonstrates the large predominance of sterile maxillary sinus cavities in asymptomatic adults with endoscopically normal mucosa.
Balloon Sinuplasty: Fluoroscopic vs. Illumination Guided
Authors: Friedman Michael , Soans Rohit , Soans Roshan , Joseph Ninos J 
Published: August 2008

ObjectiveTo compare two balloon sinuplasty techniques, fluoroscopic guided and illumination guided, with regards to: 1) Sensitivity and specificity of identifying the sinus; 2) Accuracy of cannulating the natural sinus ostium; 3) Ease of technique and cost.MethodsOperative reports of 120 consecutive patients, equally representative of each technique, were analyzed to determine: 1) The success of sinus identification with the technique; 2) Evidence of endoscopic visual conformation of natural ostium dilation. The sensitivity and specificity of each technique in sinus identification was determined. The success of natural ostium cannulation was also determined. A cost analysis of each technique was performed with regards to equipment and time.ResultsA total of 330 sinuses were reviewed (fluoroscopy, n=171; illuminated guide wire, n=159). Fluoroscopy was 100% sensitive and 100% specific with regards to sinus identification; whereas the illuminated guide wire was 97.9 % sensitive and 85.7% specific. With respect to the cannulzation of the natural sinus ostium, the success rate of fluoroscopy and the illuminated guide wire was 85.9% and 87.5% respectively. These results demonstrated no significant difference between the two techniques. The elimination of fluoroscopy with the illuminated guide wire technique reduced overall cost and operative time significantly.Conclusions1) Balloon sinuplasty with illuminated guide wire is comparable to fluoroscopic guided with regards to sensitivity and specificity of sinus identification and successful cannulation of the natural sinus ostium. 2) Cost and operative time are reduced with the new technique.
Does Olfaction Improve After Endoscopic Sinus Surgery?
Authors: Litvack Jamie R. , Mace Jess Collin , Smith Timothy L 
Published: August 2008

ObjectiveNo large, prospective, multi‐institutional cohort studies have objectively examined the impact of surgery on olfaction with long‐term follow‐up. The aim of this study was to objectively examine the impact of endoscopic sinus surgery (ESS) on olfactory dysfunction (hyposmia) would benefit from ESS, whereas patients with severe olfactory dysfunction (anosmia) would not.MethodsIn this prospective, multi‐institutional cohort study, 111 patients presenting for ESS for treatment of CRS were examined pre‐operatively and at 6 and 12 months postoperatively. Demographic, co‐morbidity and Smell Identification Test (SIT) data were collected at each time point. Univariate and multivariate analyses were performed.ResultsThe prevalence of gender‐adjusted olfactory dysfunction prior to surgery was 67.5%: 50.4% of patients were hyposmic and 17.1% were anosmic. Surprisingly, hyposmic patients did not significantly improve after surgery (baseline, 6 month, 12 month mean SIT scores: 28.8, 30.0, 29.5). In contrast, patients with anosmia significantly improved after ESS (baseline, 6 month, 12 month mean SIT scores: 9.3, 21.3, 21.7; p=0.001); furthermore, improvement was sustained at 12‐month follow‐up (p=0.001). Multivariate linear regression analysis showed that baseline olfactory category and nasal polyposis were significantly associated with improvement in postoperative olfactory function (p=0.035, p=0.002), whereas age, gender, and disease‐severity as measured by CT and endoscopy scores were not.ConclusionsContrary to our hypothesis, patients with severe olfactory dysfunction significantly improved after ESS and sustained improvement over time, whereas patients with mild olfactory dysfunction did not.