bluuebunny/crossref_metadata_2025_split huggingface dataset:
S253 – Management of Pediatric Skull Base Abscesses
Authors: Kimbrough Tyler G , Meyer Abby C , Finkelstein Marsha , Sidman James D 
Published: August 2008

ObjectivesTo describe the presentation and management of pediatric deep neck space infections located at the skull base.MethodsDesign: Retrospective review. Setting: Tertiary children's hospital. The study population comprised pediatric patients admitted to the hospital for management of deep neck space infections between 2000 and 2007. Main Outcome Measure: Resolution of abscess.ResultsOver the study period, 179 patients were admitted for management of deep neck space infections. Of these, 10 (6%) were localized to the skull base by CT scan. 7 of the 10 met radiographic criteria for an abscess; the remaining 3 were designated edema or phlegmon. Patients ranged in age from 2 to 8 years old. The most common presenting symptoms were sore throat (60%), stiff or sore neck (50%), neck or facial swelling (20%), and drooling (20%). Otitis media and Streptococcal pharyngitis were the most common co‐morbidities found in 40% of patients. Initial treatment consisted of IV antibiotics in all cases. 70% resolved with medical management alone. 3 patients failed to resolve following 48 hrs of IV antibiotics and were taken to the operating room for abscess drainage, which was unsuccessful in all cases. Repeat CT after an additional 48 hours of medical therapy indicated persistent abscess in 2 of the 3 operative cases. Repeat drainage was successful in only 1 of these.ConclusionsSkull base abscesses in children can be effectively managed in most cases by IV antibiotics alone. Surgical drainage is difficult and often unsuccessful and therefore poses unnecessary risk to the patient.
S256 – Microbiology of Pediatric Head and Neck Abscesses
Authors: Meyer Abby C , Kimbrough Tyler G , Finkelstein Marsha , Sidman James D , Helen Finkelstein 
Published: August 2008

ObjectivesTo report the microbiology of pediatric head and neck abscesses.MethodsThe records of a tertiary pediatric hospital were searched and all children with infections of the head and neck region between 2000 and 2007 were identified. Cases of peritonsillar abscess were excluded. Data regarding presentation, physical exam findings, radiographic findings, and treatment were extracted. All children who were diagnosed with abscesses and treated surgically were further identified, and the results of intraoperative cultures were reviewed.ResultsA total of 179 children with infections of the head and neck were treated between the years of 2000 and 2007 of which 57% (102 children) were diagnosed with abscesses. 71% (72 children) with abscesses were treated surgically. Of 62 children with drainable abscesses, culture data was available for 54 children. A single organism was isolated in 24.1% of cultures, 2 organisms in 18.5% of cultures and 3 organisms in 16.7% of cultures. More than 3 organisms were identified in 38.9% of cultures. The most commonly isolated organisms included alpha‐hemolytic streptococci (57.4%), group A streptococci (37.0%), anaerobes (29.6%), hemophilus (22.2%), neisseria (22.2%), and “respiratory flora” (20.4%). Other streptococcal species (14.8%), candida (14.8%), staphylococci (11.1%), stomatococci (11.1%) and other organisms (7.4%) were also identified. One culture showed no growth. No cases of methicillin‐resistant staphylococcus aureus (MRSA) were encountered.ConclusionsIn our series, streptococci and anaerobic bacteria were the most commonly isolated organisms, and almost 40% of cultures identified greater than 3 different organisms. No cases of MRSA were encountered.
S258 – Rapid Intracranial Spread of ENT Infection in B‐thalassaemia
Authors: Tanwee Faiz 
Published: August 2008

Objectives1) To find out the duration of onset of intracranial complications following middle ear and paranasal sinus infection in B‐thalassaemia. 2) To find out the contributory factors for such complications.MethodsA retrospective study of thalassaemic children who suffered from intracranial complication following ear and sinus infections between Jan ′02‐ Oct ‘04, was done at a tertiary hospital Male’, Maldives. Follow‐up data were obtained from National Thalassaemia Centre. Patients' demographic pattern, thalassaemic status, Desferroxamine therapy, duration of the ear/nose symptom, the intracranial complications, the treatment and the outcomes were noted. We didn't include 3 patients, for whom full data were not available.ResultsWe found the records of a series of 5 consecutive patients out of 94 thalassaemic patients which were referred with different ear and nose infections and were treated for intracranial complications. All patients were in the age group of 10–15 years. All were female. Spread of infection from the ear was more common than the spread from sinuses (3 out of 5 patients). The intracranial complications developed in these patients within few days (<5 days) of presentation in the clinic. All of the patients were on regular blood transfusion with desferroxamine therapy but none had spleenectomy. Most common organism found was klebsiella.ConclusionsPersistent anaemia, repeated transfusion, iron overload, and hypersplenism are the major contributory factors for frequent infections in thalassaemics. Natural thinning of the bony cortex and remodelling of skull in thalassaemics can be considered as an additional factor for the rapid development of intracranial complications.
S259 – Pediatric Tracheotomy: Changing Trends in Puerto Rico
Authors: Alameda Yadiel A , Gonzalez‐Aquino Carlos , Ortiz Melissa , Gonzalez Javier 
Published: August 2008

ObjectivesWe chose to review the outcomes of tracheotomies performed at San Jorge Children's Hospital, San Juan, Puerto Rico, over the last 15 years. Our objectives were: 1) Understand changing trends in the indications for tracheotomy and a perceived reduction in decanulation rates. 2) Be able to propose recommendations for the coordinated care of children with tracheotomy.MethodsA retrospective chart review was performed of 189 patients undergoing tracheotomy from January 1991 to December 2006. The data were tabulated for age, diagnosis, complications, and outcome. Patients were divided in groups based on the indication for tracheotomy.Results5 groups were identified based on the indication for tracheotomy: 1) True vocal cord paralysis: 11% of the study population with a 25% decanulation rate. 2) Airway obstruction: 21% of the study population with a 90% decanulation rate. 3) Craniofacial malformation: 8% of the study population with a 0% decanulation rate. 4) Neurological impairment: 46% of the study population with a 0% decanulation rate. 5) Prolonged intubation: 14% of the study population with a 25% decanulation rate. We report no intraoperative complications, an 18% overall complication rate, and a 10% mortality.ConclusionsOver the last decades, the indications for tracheotomy have shifted toward children with underlying neurological impairment and need for prolonged mechanical ventilation. Decanulation rates for these children are significantly lower (approximately 10%) than for children with obstructive airway pathology (90%). Therefore, the care of these children and their tracheotomies will require coordinated multidisciplinary settings. We present several recommendations to achieve this goal.
S262 – Effect of Etiology of Mouth Breathing on Facial Morphology
Authors: Hassanzadeh Nadia , Majidi Mohammadreza , Shakeri Mohammad Taghi 
Published: August 2008

ObjectivesNasal septal deviation and hypertrophy of the adenoids and palatine tonsils are 2 common causes of nasopharyngeal obstruction and consequently mouth breathing in children. It is accepted that chronic mouth breathing influences craniofacial growth and development. The aim of this study was to evaluate the differences of craniofacial morphology in children with 2 different etiological factors of mouth breathing.MethodsStudy design:cross sectional. The research was conducted between 2005–2007 on 47 predominantly mouth‐breathing patients aged 6–10 years. After otorhinolaryngologic examination and flexible nasofibroscopy, patients were divided into 2 groups based on the etiology of nasopharyngeal obstruction: group 1, with adenotonsillar hypertrophy, and group 2 with nasal septal deviation. Lateral cephalometric radiographs were obtained to assess craniofacial development. Data gained were statistically evaluated by Mann‐Whitney and T‐student tests.ResultsWith respect to the inclination of the mandibular and palatal planes, anteroposterior relationship of maxilla and mandible to the cranial base, and indexes of facial height proportions, no significant differences were observed between two groups of children with mouth breathing. Only the angular ArGo. GoMe measurement was significantly larger in children with adenotonsillar hypertrophy (p<0.05).ConclusionsThe present study did not detect significant morphological differences between children with adenotonsillar hypertrophy and those with nasal septal deviation. Mouth breathing seems to have a similar effect on craniofacial morphology irrespective of its etiology. Prospective studies with larger samples including older children are suggested.
S264 – Pediatric Vagal Nerve Stimulator Implantation
Authors: Munson Patrick D , Kress Melissa G 
Published: August 2008

Objectives1) Learn the indications and procedure for vagal nerve stimulator implantation (VNSI) in pediatric patients with refractory seizures. 2) Understand the surgical outcomes and complications for the procedure.MethodsA retrospective review of prospectively collected data from 2002–2007 was undertaken on VNSI. The cohort consisted of all pediatric patients ages 0–21 at a single institution tertiary children's hospital. All patients were included if they had treatment resistant seizures and had not previously undergone VNSI. The surgical indications, outcomes, complications, and follow‐up were recorded.ResultsOver the 5‐year period, 36 patients underwent VNSI. Age at surgery ranged from 3 to 20 years (mean 10.5 years). The indications for surgery for all patients included seizures refractory to antiepileptic medications (>5 medications). There were no intraoperative complications and all patients had successful electrode placement as measured by intraoperative testing. After an overnight hospital stay, patients were discharged and programmed by the pediatric neurologist at 2 weeks postoperatively. There were 2 postoperative complications (5.5%), scar hypertrophy of a chest incision and left‐sided Horner's syndrome. Both patients have been managed conservatively without sequelae. Follow‐up ranged from 6 to 72 months (mean 42 months). There were no device failures and all patients and families were subjectively satisfied with the postoperative result. Intraoperative and postoperative photos will demonstrate technique and outcomes.ConclusionsPediatric VNSI is a reliable procedure for refractory seizures with a low complication rate and can be performed safely by otolaryngologists. This represents the largest cohort of pediatric patients in the otolaryngology literature.
S265 – Tracheostomy in Bronchopulmonary Dysplasia
Authors: Chelius Daniel C. , Kocdor Pelin , Elidemir Okan , Giannoni Carla M 
Published: August 2008

ObjectivesTo characterize pediatric patients undergoing tracheotomy for bronchopulmonary dysplasia (BPD). To examine the effects of tracheomalacia on tracheostomy outcomes in these patients.MethodsThe medical records of 95 patients with BPD who underwent tracheotomy in an academic tertiary care children's hospital over 8 years were evaluated for gestational age, birthweight, ethnicity, gender, co‐morbid conditions, duration of ventilator support, duration of hospitalization, number of failed extubation attempts before tracheotomy, age at tracheotomy, and time to decannulation.ResultsThe average gestational age was 28.9 weeks and the average postnatal age at tracheotomy was 27.6 weeks after having failed an average of 1.2 extubation attempts. The patients averaged 268.2 days of hospitalization, with 41.6% still requiring ventilator support and 57.1% still having tracheostomy at the end of the study. Of 27 patients with tracheomalacia, 4 (15%) were eventually decannulated vs. 36 of 68 patients without tracheomalacia (53%). The average time to decannulation among patients with tracheomalacia was 27.4 months and without tracheomalacia was 25.7 months. Decreased gestational age correlated with increased time to decannulation (Cox regression analysis, p=0.035). Of patients with genetic anomalies, 22.7% were eventually decannulated vs. 49.3% of patients without genetic anomalies (p = 0.027).ConclusionsThis study describes the characteristics of patients undergoing tracheotomy for BPD and begins to clarify the relationship between BPD and tracheomalacia. The presence of tracheomalacia in patients with BPD correlates with decreased likelihood of decannulation, but does not significantly affect time to decannulation. As such, tracheomalacia may be an independent risk factor for worse tracheostomy prognosis.
S270 – Maxillaly Sinusitis Caused by Dental Treatments
Authors: Hideaki Aoki , Mohri Daisuke 
Published: August 2008

ObjectivesDental implant therapy has been widely performed in clinical setting to improve esthetics and mastication disorders due to tooth loss by embedding such artificial materials as titanium and BioCelum into the jawbone. Recently, orthodontic specialists make the anchor a fixed source that teeth are moved. The presenters therefore clinically investigated implant‐induced maxillary sinusitis because the number of dental treatment is increasing.MethodsSubjects were 42 patients with 43 cases of maxillary sinusitis caused by a dental implant between 1973 and 2007.Results1) Gender and age: The 42 patients comprised 16 men and 26 women. Mean age was 52.6 years. 2) Cause: Dental implant: 42, Anchor treatment by orthodontist: 1. 3) Duration from implant surgery to onset of maxillary sinusitis: Mean duration was 36.3 months (range, 1 month to 12years). 4) Treatment methods: Therapy comprised implant removal, Caldwell‐Luc procedure and fistula closure in 20 cases, implant removal and fistula closure in 10 cases, implant or anchor removal and conservative therapy in 11 cases, and conservative therapy alone in 2 cases.Conclusions1) In the treatment of maxillary sinusitis caused by a dental implant, the basic strategy was based on the Caldwell‐Luc procedure. 2) It is thought that the generation of maxillary sinusitis by the anchor treatment increases in the future. 3) For prevention, thorough anatomical and morphological examinations of the maxilla and proper selection of materials and procedures matching each patient are important.
S272 – Diagnostic and Staging Accuracy of MRI vs. CT in CRS
Authors: Lin Harrison W , Bhattacharyya Neil 
Published: August 2008

ObjectivesDetermine the correlation between computed tomography (CT)‐ and magnetic resonance imaging (MRI)‐based staging and classification of chronic rhinosinusitis (CRS).MethodsPaired CT and MRI scans of 89 adult patients who were imaged by both modalities within a 3‐month time period for evaluation of pituitary disease were scored for sinus disease using the Lund‐Mackay system in a randomized and blinded fashion. The Lund scores were compared for similarity, correlation, and diagnostic classification between modalities.ResultsThe mean Lund scores were 2.3 ± 0.6 (95% CI) for CT‐based staging and 2.1 ± 0.5 for MRI‐based staging with a median time interval between scans of 3 days. The difference in means was not statistically significant (p=0.444, paired t‐test). Correlation analysis revealed a significant association between CT‐ and MRI‐based scores (Pearson's r=0.837, p<0.001). Disease classification agreement analysis using published Lund score cutoffs (3 versus 4) for the likelihood of true sinus disease revealed that CT‐ and MRI‐based scoring agreed on 76 cases (85.4%). Disagreement in disease classification occurred in 13 cases (7 MRI positive but CT negative and 6 CT positive but MRI negative) for a kappa value of 0.557 (p<0.001).ConclusionsLund‐Mackay staging of sinus disease by MRI is closely correlated to corresponding staging based on CT. MRI does not significantly over‐stage or over‐classify patients with sinus disease.
S277 – The Role of Helicobacter Pylori in Nasal Poliposis
Authors: Çekin Engin , Erkul Bulent Evren , Cincik Hakan , Dogru Salim , Gungor Atila , Poyrazoglu I. Ethem 
Published: August 2008

Objectives1) To investigate the role of Helicobacter pylori in etiopathogenesis of nasal polyposis. 2) To compare the severity of nasal polyposis disease with presence of Helicobacter pylori.MethodsThis study was performed on 35 patients (29 male, 6 female; aged between 17 and 77) who applied to GATA Haydarpasa Training Hospital Otolaryngology Clinic in 2006 and 2007. They all complained of nasal obstruction and were diagnosed as nasal polyposis after examination. Samples taken from all patients during endoscopic sinus surgery were subjected to cetyl metil amonium bromur (STAB) method to purify DNA of Helicobacter pylori(H. pylori). All patients were evaluated for reflux disease. Severity of nasal polyposis disease was compared with presence of H. pylori by performing endoscopic nasal examination and computerized tomography.ResultsH. Pylori was found negative for 24 patients (%68,6) and positive for 11 patients (%31,4). There was no statistically significant difference between presence of H. pylori and that of reflux disease in nasal polyposis (p>0.05). Difference between presence of H. pylori and results of endoscopic nasal examination and computerized tomography was not statistically significant (p>0.05).ConclusionsWe found that presence of H. pylori and reflux disease are not associated with etiopathogenesis of nasal polyposis.
S278 – Management Strategies for Sinonasal Inverted Papilloma
Authors: Hoa Michael , Bianca Gruber , Krouse John H 
Published: August 2008

Objectives1) To compare endoscopic and external approaches in the management of sinonasal inverted papilloma at our institution. 2) To discuss the relationship of these management strategies to disease stage and malignancy.MethodsRetrospective chart review of 18 patients who had operations performed to remove sinonasal inverted papilloma. Demographic, imaging and intraoperative data were collected from clinic charts. All patients had a definitive procedure performed between 2001 and 2007, with preoperative staging by CT, MRI or both. The primary outcome measure was recurrence and secondary outcome measures included association with malignancy and intraoperative complications.ResultsCT and MRI scanning were utilized for staging in 88% and 53% of cases, respectively. Mean follow‐up was 16.3 months. All T1 lesions were managed by functional endoscopic sinus surgery (FESS). 71% of T3 lesions were managed by transnasal endoscopic medial maxillectomy (TEMM). 33% and 67% of large T3 and T4 lesions were managed with external procedures and TEMM, respectively. Recurrence rates for T1, T3, and T4 lesions were 0%, 16.7%, and 100%, respectively. Recurrence by surgical method were 0%, 18% (1 T3 and 1 T4), and 0% for FESS, TEMM and external approaches, respectively.ConclusionsInverted papilloma tended to present at more advanced stage. T1 and T3 lesions were generally managed by FESS and TEMM, respectively. Large T3 and T4 lesions were generally managed via external approaches or required further definitive management via an external approach. MRI, especially with frontal disease, may augment CT scanning, identifying true tumor mass, and thus provide indications for or against supplementary procedures.
S280 – Current Management of Juvenile Nasopharyngeal Angiofibroma
Authors: Bleier Benjamin Saul , Bloom Jason D. , Chiu Alexander G , Palmer James N , Kennedy David W , Bert O'Malley 
Published: August 2008

ObjectivesTo report on the management of a large series of patients presenting with juvenile nasopharyngeal angiofibroma (JNA) in an effort to further define the optimal treatment algorithm in this patient population.MethodsRetrospective, IRB approved, review of 18 patients presenting to a tertiary care institution with histologically confirmed juvenile nasopharyngeal angiofibroma between 1999 and 2007, with a mean follow‐up of 732 days. Patients were catagorized by Andrews stage and data was collected on presentation, operative technique, and postoperative course.ResultsAll patients underwent preoperative embolization. Stage 1, 2, and one 3a lesions were approached endoscopically, while the remainder underwent open resection. There were no significant differences in mean operative time between the endoscopic and open groups (312 vs. 365 minutes). In the endoscopic group, the intraoperative blood loss was almost half that of the open group (506 vs. 934cc) and the average length of hospital stay was 1 day less (3 vs. 4 days). There were 4 recurrences, all of which occurred in the open treatment group.ConclusionsEndoscopic resection is reasonable for Andrews stage 1, 2, and select 3a lesions and may allow for less bleeding and shorter hospital stay. This study supports the current trend of expansion of indications for endoscopic JNA resection and suggests that this approach leads to an improved postoperative course.
S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas
Authors: Alameda Yadiel A , Busquets Jose , Portela Juan C. 
Published: August 2008

Objectives1) Describe the presenting symptoms, etiology, treatment, and long‐term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications.MethodsA retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test.ResultsEndoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow‐up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow‐up, none of the patients reported episodes of meningitis postoperatively.ConclusionsEndoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.