bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Sinus Surgery on Bodily Pain: A Metaanalysis
Authors: Chester Alexander C , Sindwani Raj , Smith Timothy L , Bhattacharyya Neil 
Published: August 2008

ObjectiveTo determine by systematic review and metaanalysis if (1) bodily pain as measured by the 36‐Item Short Form Health Survey (SF‐36) is consistently increased in patient populations with chronic rhinosinusitis (CRS); and (2) if SF‐36 bodily pain scores significantly and consistently improve following endoscopic sinus surgery (ESS).MethodsStudies published in any language reporting SF‐36 results before and after ESS were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional Web‐based sources (from 1980 to January 2008); by examining bibliographies of retrieved articles; and by contacting investigators in the field. Two authors independently evaluated studies for inclusion.ResultsAfter excluding 1 study reporting results as medians rather than as means, the remaining 10 observational ESS studies (909 patients) reported preoperative SF‐36 bodily pain scores 0.95 SDs below the general population mean (more bodily pain) in average weighted by sample size. Using a repeated‐measures design, all studies noted an improvement in SF‐36 bodily pain domain scores following surgery, with a moderate‐sized combined effect of 0.54 (95% confidence interval [CI], 040–0.69) and moderate heterogeneity (I2 = 50%). This pooled effect corresponds to a clinically and statistically significant mean improvement of 11.7 (95% CI, 7.1–16.3) units in the SF‐36 bodily pain domain.ConclusionsBodily pain is consistently increased in patient populations with CRS. Using within‐subject comparisons, a clinically and statistically significant improvement in bodily pain is noted after ESS, an improvement similar in size to that previously described for fatigue and other CRS symptoms.
Effects of Endoscopic Sinus Surgery and Device on Irrigation
Authors: Goddard John C , Harvey Richard J , Wise Sarah K , Schlosser Rodney J 
Published: August 2008

Objective1) Assess the effect of endoscopic sinus surgery (ESS) on the distribution of topical solutions to the para‐nasal sinuses. 2) Understand differences in topical solution distribution to the para‐nasal sinuses using various delivery devices.MethodsTen cadaver sinus systems were irrigated with radio‐opaque contrast prior to any surgery, after ESS, and following modified medial maxillectomy. Delivery of contrast was via pressurized spray, neti pot and squeeze bottle techniques for each surgical state. CT scans were performed before and after each irrigation using a portable CT machine. Blinded assessments were made for distribution of contrast within the sinuses. A semi‐quantitative grading scale was used to assess contrast distribution to each of 5 sinus regions (maxillary, anterior ethmoid, posterior ethmoid, sphenoid and frontal).ResultsTotal sinus distribution of contrast was significantly greater post‐ESS as compared to the un‐operated state (p<0.001). Sphenoid and frontal sinus distribution was most affected by surgery. Delivery device influenced contrast distribution, with neti pot and squeeze bottle techniques providing greater distribution than pressurized spray (p<0.001). Frontal sinus penetration was greater post‐ESS (p=0.017) and neti pot delivery was the most effective frontal delivery device (p<0.001).ConclusionsESS greatly enhances the delivery of nasal solutions, regardless of delivery device. Limited distribution to the sinuses exists without concomitant ESS, especially for sprays. Squeeze bottle/neti pot use, post‐ESS, offers a greatly enhanced ability to deliver solutions to the para‐nasal sinuses.
Evolution with Inverted Papilloma: Analysis of 200 Cases
Authors: Patel Zara , Lawson William 
Published: August 2008

ObjectiveOpen, endoscopic and endoscopic‐assisted surgical approaches to inverted papilloma (IP) have been described. 1) Assess the evolution of management within one institution with the largest case series and longest clinical follow‐up of IP to date in the literature. 2) Compare this management with what has been recently presented in publication.MethodsA retrospective review was performed of IP cases from 1973 to 2007, assessing gender, age, presenting symptoms, origin of lesion, staging, primary versus recurrence, radiographic findings, method of treatment, rate of recurrence, and associated malignancy. A comprehensive review of the literature was also performed.Results200 patients (average age, 57) underwent endoscopic or endoscopic‐assisted resection of IP. Mean follow‐up was 4.3 years (range 9 months −19 years). 80% of cases over the last decade had prior surgery before presentation. 63% were Krouse stage T3 and 25% were T4. Combined approaches were used for 57% of the most recent 40 cases, including Caldwell‐Luc, lateral rhinotomy, medial maxillectomy, trephine, or osteoplastic flap. Rate of recurrence was 13% (range 8 to 144 months), with multiple recurrences after 2 years. The rate of malignancy was 7%.ConclusionsIP can be safely addressed endoscopically when possible, with data from this study and the current literature suggesting this is feasible in 43–66% of cases. Variables affecting the decision to use adjuvant external approaches include significant scarring and anatomic distortion from previous surgery, high Krouse stage, and associated malignancy. Long‐term follow‐up is recommended. Emerging research on HPV will likely impact future management.
Experience with 1450 Endoscopic DCR and Four Methods
Authors: De Souza Christopher E 
Published: August 2008

Objective1) Comparing 4 methods when doing a DCR. 2) Determining superiority of stenting versus fistulization.MethodsRandomized uncontrolled study. 12 years (1994 to 2007), chronic dacryocytitis, 1195 patients studied, primary health care. 1. Resolution of Epiphora 2. Patency 3. Complete resolution of abcess Endoscopic DCR. 4 methods: simple incision, grommet insertion, stenting, and fistulization. 255 patients had their lacrimal sacs incised and drained, 300 had grommets inserted in their lacrimal in an attempt to achieve patency, 225 had lacrimal stents, and 415 had undergone fistulization.ResultsOf the 255 incisions and drainages, 65% were blocked after 2 months. Of the 300 who had grommets inserted, 68% were blocked after 2 months. Of the 225 who had lacrimal stents, all were patent but 10 (4%) had to be removed because of corneal opacities, and 1 (0.4%) had to be removed because of a foreign body granuloma at the punctum. Of the 415, 5 (1.2%) were blocked after 6 months and 1 (0.2%) patient had epiphora even though the sac was patent.Conclusions1) Fistulization and stenting are statistically more reliable in achieving resolution of epiphora, restoration of patency, and complete resolution of chronic dacryocystitis. 2) In our experience, we encountered corneal opacities following stenting and since the results with fistulization were comparable to stenting, we prefer to fistulize patients for chronic dacryocystitis as a safe and reliable method.
Flat Panel Cone Beam Computed Tomography of the Sinuses
Authors: Zoumalan Richard A , Yung Kathryn Shouyee , Wang Edwin , Lebowitz Richard A , Jacobs Joseph B 
Published: August 2008

ObjectiveFlat panel cone beam CT is a relatively new technology that improves upon traditional multidetector CT scanners by generating images with greater spatial resolution at lower radiation doses. 1) Learn whether flat panel cone beam CT evaluation is an effective imaging modality for the sinuses. 2) Learn which doses of radiation provide quality evaluation of the sinuses while exposing the patient to the least amount of radiation.MethodsIn 2007, a panel consisting of neuroradiologists and otolaryngologists blindly reviewed images from flat panel sinus CTs (Xoran MiniCAT) of 11 live human subjects, each irradiated at all 3 different techniques (denoted as: low dose mAs=9.27, medium dose mAs = 18.41, high dose mAs=36.7) and rated the image quality of a pre‐designated list of sinus anatomic structures. Techniques were compared in a pairwise manner using a Wilcoxon matched‐pairs signed ranks test.ResultsCompared to the low dose technique CT scan, the high dose CT scan technique had significantly better image quality (P=.0029) and image noise (P=.0049). Similarly, the medium dose CT scan technique had significantly better image quality (P=.0020) and image noise (P =. 0010) compared to the low dose technique. No difference in image quality and image noise existed between the medium and high dose techniques. No difference in visualization of 13 specific anatomic structures existed between any of the dose techniques.ConclusionsLower dose CT techniques achieved by flat panel cone beam CT may be an effective and safe alternative to traditional multidetector CT scanners. This imaging modality may help patients avoid unnecessary radiation to sensitive organs.
Inferior Meatus Endoscopy and Treatment for Epiphora
Authors: Rogers Gamwell A , DelGaudio John M 
Published: August 2008

ObjectiveEpiphora can result from obstruction anywhere along the nasolacrimal (NL) system. The inferior meatus (IM) is not routinely evaluated despite the ease of nasal endoscopy. We propose the IM pathology is common in patients with epiphora, and surgery can be directed at the IM.MethodsConsecutive patients referred for epiphora between July 2006 and July 2007 underwent endoscopic evaluation of the IM. All patients then underwent intervention to address the NL duct orifice obstruction.ResultsThere were 14 patients, 11 females, mean age 53 years. Four patients had bilateral epiphora, for 18 total lacrimal systems. Two patients were treated in clinic, one for a dacryolith and one, a thick mucoid plug. At the time of surgery, 4 NL duct orifices were obstructed by a cyst. The remaining 12 nasolacrimal ducts were obstructed by hypertrophied mucosa. In 4, hypertrophic mucosa was found proximal to Hasner's valve, and 3 of these had early recurrent symptoms requiring revision (2 DCR's). 13 of 14 sides with pathology at Hasner's valve had resolution or dramatic improvement with patent NL ducts with inferior meatal treatment alone. Mean follow‐up was 5 months.ConclusionsRoutine endoscopic evaluation of the inferior meatus in epiphora uniformly identified pathology at the NL duct orifice. At the time of surgery, identification of pathology at the NL duct orifice and distal NL duct portends a better outcome with endoscopic treatment of the IM, whereas identification of proximal NL duct obstruction had a poorer outcome with treatment through the IM.
Nasoseptal Flap Takedown in Endoscopic Skull Base Surgery
Authors: Zanation Adam Mikial , Snyderman Carl H , Carrau Ricardo L , Amin Kassam 
Published: August 2008

Objective1) Understand the importance of the nasoseptal flap in endoscopic skull base reconstruction. 2) Learn the techniques and limitations of nasoseptal flap takedowns and reuse during second stage and revision endoscopic skull base surgery.MethodsProspective consecutive analysis of CSF leak outcomes with nasoseptal flap takedown and reuse during endoscopic skull base surgery at a tertiary care skull base center.Results16 consecutive cases of nasoseptal flap takedown and reuse for endoscopic endonasal intradural tumor surgery were collected prospectively and evaluated for CSF leak outcomes. 10 of these cases were planned second‐stage surgeries and 6 were for revision or recurrent tumors. All 16 cases had intradural tumor extension and intra operative CSF leak. 15 of 16 had successful skull base reconstruction without postoperative CSF leak. One patient required revision endoscopic CSF leak repair and bolstering of the defect with a fat graft on post operative day 3. No flap deaths occurred. Endoscopic skull base reconstructive techniques and limitations of flap takedowns are discussed.ConclusionsAs the limits of endoscopic skull base surgery increases, the limits of endoscopic skull base reconstruction must also increase. The pedicled nasoseptal flap has shown great promise (4% leak rate in over 300 nasoseptal flap skull base reconstructions) at the time of the initial resection. This report illustrates the ability to takedown and reuses the nasoseptal flap in revision cases with great success (94%) and minimal additional nasal morbidity.
Outcome of Endoscopic Sinus Surgery
Authors: Al Badaai Yahya Nasser , Samaha Mark 
Published: August 2008

Objective1) Determine the effect of surgical therapy for Chronic Rhinosinusitis (CRS) on patient quality of life in a tertiary care centre in Quebec. 2) Compare the outcome of endoscopic sinus surgery on patients with different comorbidities.MethodsProspective cohort study. Subjects were consecutive patients with a diagnosis of CRS who failed medical treatment and were undergoing Endoscopic Sinus Surgery (ESS). General health (SF‐12 v2) and disease‐specific (chronic sinusitis survey (CSS)) outcomes questionnaires were filled out pre‐operatively and postoperatively.Results152 patients were enrolled in a 7‐month period. 120 patients completed the postoperative surveys. The most common co‐morbidity was asthma (40%). 72% had clinical improvement, 12% worsened, and 15% were unchanged. The average improvement of CSS scores was 17%.ConclusionsSignificant improvement in quality of life was achieved after ESS for patients with CRS.
Polymorphisms in the IL22RA1 Gene and Chronic Rhinosinusitis
Authors: Mfuna Endam Leandra , Bossé Yohan , Cormier Chantale , Boisvert Pierre , Boulet Louis‐Philippe , Hudson Thomas J. , Desrosiers Martin 
Published: August 2008

ObjectiveRecently, a pooling‐based genome wide association (pGWAS) scan idenfied the interleukin‐22 receptor alpha 1 (IL22RA1) gene as a promising candidate for chronic rhinosinusitis (CRS). The relevance of this gene in CRS is also substantiated by previous biological studies 1) that stimulation of the gene product increases the innate immune responses in some inflammatory diseases, and 2) a reduced level of the gene transcript in patients with recalcitrant CRS with nasal polyposis. We explore whether single nucleotide polymorphisms (SNPs) in the IL22RA1 gene are associated with CRS.MethodsDNA extracted from a population of 206 patients with severe CRS and 196 postal‐code matched controls was used. The 23 tagging SNPs in the IL22RA1 gene were selected from positive results in the pGWAS and completed with tagging SNPs from the CEU HapMap dataset and genotyped in our population. The haploview software was used to determine association.Results22 SNPs were genotyped successfully with a genotype distribution in agreement with the Hardy‐Weinberg equilibrium. Seven (rs10751768, rs10794665, rs16829225, rs3936073, rs4292900, rs4648936, rs7418238) out of 22 genotyped‐SNPs were significantly associated with CRS (p‐value: 0.0009 to 0.0337; OR: 1.44 to 1.76).ConclusionsPolymorphisms in the IL22RA1 gene are associated with severe CRS. This may help better understand the pathophysiology of CRS and identify new targets for therapy. Replication in a second population with CRS is in progress to validate these findings.
Postoperative Hemorrhage after Endoscopic Sinus Surgery
Authors: Woodard Troy D. , Stankiewicz James A 
Published: August 2008

Objective1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication.MethodsRetrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations.Results29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient's right side and involved the sphenopalatine or posterior septal arteries.ConclusionsEndoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication.
Expansion SphincterPlasty & Multilevel OSA Surgery
Authors: Peter Pang Kenny , Mok Paul Kan‐Hwei , Woodson Tucker 
Published: August 2008

ObjectiveTo review multilevel surgery involving the Expansion SphincterPlasty (ESP) with tongue base surgery in the treatment of severe OSA.MethodsProspective non‐randomized collection of 39 consecutive patients with severe OSA. Patients were >18 years old, type II Fujita with lateral pharyngeal wall collapse, small tonsils, BMI <30. Mean follow‐up was 9.3 months.ResultsAll 39 patients were male, with mean age of 44.1 years (range of 26 to 49 years), mean BMI was 25.7 (range of 21.1 to 29.1). 22 patients had ESP/Hyoid/RF Tongue Base procedure, while 17 patients had the ESP/Hyoid/Tongue Suspension procedure. The mean pre‐operative AHI for the entire group improved from 56.3 ± 18.1 to 19.2 ± 14.0 postoperatively. There was a greater AHI improvement in the ESP/Hyoid/TS group than the ESP/Hyoid/RFBOT group. The 17 patients in the ESP/Hyoid/TS group had a mean pre‐operative AHI that improved from 52.2 ± 18.7 to 18.0 ± 12.8 (p<0.05), compared to the ESP/Hyoid/RFBOT group, where AHI improved from 48.1 ± 17.9 to 25.6 ± 17.1 (p<0.05). Oxygen saturations also improved in both groups. When using the success criteria of a reduction in 50% of the pre‐operative AHI and an AHI <20, the overall success rate for both groups was 71.2%. The success rate for the ESP/Hyoid/TS group was 74.8%, while the success rate for the ESP/Hyoid/RFBOT group was 67.5%.ConclusionsThe use of the ESP with tongue surgery is effective in the management of patients with severe OSA.
Mod. Cautery‐Assisted Palatoplasty in OSA: 3‐Year Results
Authors: Pang Kenny Peter , Terris David J 
Published: August 2008

ObjectiveTo review the long‐term results of the Modified Cautery Assisted Palatoplasty (ModCAP) procedure for the treatment of OSA.MethodsProspective non‐randomized trial in 43 consecutive patients with OSA. All patients were >18 years old, type I Fujita, BMI <30, Friedman clinical stage II, with AHI from 1.0 to 30.0. The mean follow time was 32.4 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under GA if the tonsils were removed as well, and done under LA if the tonsils were small or not present.ResultsThere were 41 men and 2 women, the mean age was 39.2 years old (range of 21 to 49), mean BMI was 25.7 (range of 20.7 to 26.8). All patients had pre‐operative PSG, only OSA patients had post‐operative PSG repeated. There were 15 snorers and 28 OSA patients. The AHI improved in the patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 (p<0.05). The overall success rate for this OSA group was 65.1% (at mean 32.4 months). The mean snore scores (VAS) improved from 8.4 to 3.5 (for all 43 patients). Post‐operative pain scores were fairly low, from a range of 4.5 to 6.6 (at 5th POD). Lowest oxygen saturation also improved in all the OSA patients. Subjectively, all the patients felt less tired.ConclusionsThis technique has been shown to be effective in the management of patients with OSA and simple snoring.
Pulse Arterial Tone and Airway Obstruction in Sleep Apnea
Authors: Barrera Jose E , Holbrook Andrew B. , Santos Juan , Popelka Gerald R 
Published: August 2008

ObjectiveDetermine if continuous pulse arterial tone (PAT) amplitude correlates with upper airway obstructions observed during simultaneous real‐time magnetic resonance imaging (RT‐MRI) in subjects with Obstructive Sleep Apnea (OSA).MethodsA prospective series of 20 subjects diagnosed with mild to severe OSA by polysomnography, Fujita classification, Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Score (ESS) underwent continuous RT‐MRI during a 90‐minute nap without sedation. The upper airway at the mid‐saggittal plane was visualized in real time (33 fps) using a sliding window algorithm (RTHawk system). Continuous pulse arterial tone amplitude was simultaneously monitored (Watch‐PAT, Itamar Inc, Israel).ResultsChanges in PAT amplitude were in phase with upper airway narrowing and obstruction from tongue, soft palate, and epiglottis movements. Airway obstructive events occurred coincident to 60% or greater decreases in PAT amplitude. The image sequence associated with each PAT amplitude decrease demonstrated the precise location of the obstruction. Pre‐surgical site of airway obstruction and post‐surgical cause of persistent obstruction was clearly identified.ConclusionsRT‐MRI with simultaneous and continuous PAT signal recording during natural sleep is an innovative and improved method for more precisely characterizing airway obstructions in patients with mild to severe OSA. This approach may be valuable for planning surgical treatments, potentially improving the success of these procedures.
Reliability of Holter Oximetry for Home Sleep Apnea Testing
Authors: Stern Jordan C , Heneghan Conor , Shouldice Redmond 
Published: August 2008

ObjectiveTo test the reliability of the Holter Oximeter for home testing of obstructive sleep apnea. Previous reports have shown a 96% correlation with simultaneous polysomnography and Holter Oximetry in the sleep laboratory. This study was designed to measure reliability of data obtained at home, as well as to obtain information from patients regarding comfort of the device.MethodsA prospective study of 120 consecutive patients (ages 5 to 85) presenting to an otolaryngology practice during a 4‐month period with complaints of snoring or sleep apnea symptoms. Device: The Holter Oximeter produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram and pulse oximeter. The reliability of the test was determined by the number of tests completed without interruption due to patient discomfort, electrode or device failure.ResultsThere was 97% data recovery from the home testing device. Data failure was due to faulty memory cards in the device or surface electrode failure. All patients tolerated wearing the device at home, and there were no voluntary interruptions of the tests by patients. On a discomfort scale of 0 to 10 (0: no discomfort and 10: maximal discomfort), the average discomfort score was 2.ConclusionsHolter Oximetry represents a new, easy to use, and reliable device for the home diagnosis of obstructive sleep apnea. It can also be used to measure outcomes for the surgical and non‐surgical treatment of obstructive sleep apnea in adults and children.