bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thyroid Gland Management in Total Laryngectomy: Meta‐analysis
Authors: Mendelson Asher Aron , Al‐Khatib Talal Ahmed , Julien Marilyse , Hier Michael P 
Published: August 2008

Objective1. Review the incidence of thyroid gland invasion by squamous cell laryngeal carcinoma in the literature. 2. Correlate thyroid gland invasion with anatomical characteristics of the laryngeal tumor. Do laryngeal tumors which invade the thyroid gland share certain characteristics which can aid in determing the management of the thyroid gland during total laryngectomy?MethodsSystematic review of MEDLINE (1967–2007) and EMBASE (1980–2007) for all total laryngectomy series which commented on thyroid gland invasion according to tumor subsite and pathological characteristics. These results were supplemented with 61 patients from our centers who underwent total laryngectomy with hemi‐ or total thyroidectomy. Eleven series in total (n = 535) were included in the meta‐analysis (fixed effects model).ResultsThyroid gland invasion was present in 47 laryngectomy specimens (9%); the main method of invasion of the gland was by direct extralaryngeal extension. Subglottic extension > 10mm (OR 6.27 [2.16 to 18.19]; p = 0.0007), subglottic subsite (OR 4.32 [1.53 to 12.19]; p = 0.006), and transglottic subsite (OR 4.10 [1.75 to 9.57]; p = 0.001) were significantly correlated with thyroid gland invasion. Cartilagenous invasion by tumor was not a significant predictor of thyroid gland invasion (p>0.05).ConclusionsThyroid gland invasion is not a general feature of squamous cell laryngeal carcinoma. When present, it is strongly associated with anteroinferior spread of laryngeal tumors. Thyroidectomy should only be performed during total laryngectomy for transglottic tumors, subglottic tumors, and tumors with subglottic extension >10mm. In these cases, total thyroidectomy is warranted to maximize locoregional control.
A New Role of Staged Tympanoplasty for Cholesteatoma
Authors: Hinohira Yasuyuki , Yanagihara Naoaki , Hato Naohito 
Published: August 2008

Objective1) Investigate a correlation between pathological findings at the 2nd stage operation and long‐term outcomes in a staged canal wall‐up tympanoplasty (SCUT) for middle ear cholesteatoma. 2) Advocate a new role of the staged manner based on the study.MethodsSCUT was performed on 90 ears with cholesteatoma involving both the ossicles and the mastoid cavity. The 1st stage operation included scutum plasty and mastoid cortex plasty with bone pate following removal of cholesteatoma and ossicles involved. The 2nd stage operation records were reviewed regarding the pathological findings associated with retraction pocket (RP) and residual cholesteatoma (RC) formation. The scutum defect was revised with auricular cartilage, and the mastoid cortex plasty was again performed after removal of RC. Postoperative follow‐up with endoscopic observation and CT was performed for all patients.ResultsAt the 2nd stage, RP was seen in 15 ears (16.7%) which all showed partial or total absorption of the scutum reconstructed. Aeration grade of the mastoid cavity reconstructed did not correlate with RP or RC formation. RC was found in 28 ears (31.1%) regardless of RP formation. The long‐term follow up study revealed that the statistically higher incidence of RP re‐formation (26.7%) and RC (3.2%) was seen in ears which had been identified at the 2nd stage, respectively.ConclusionsThe present study showed that the long‐term outcomes after SCUT were correlated with RP and RC formation at the 2nd stage. This indicates the 2nd stage operation has a role of the long‐term prognosis in addition to exploration of RC.
Complications in Pediatric Cochlear Implants
Authors: Jeyakumar Anita , Clary Randall A 
Published: August 2008

ObjectiveBe able to retrospectively review the complications of pediatric patients undergoing cochlear implantation at a tertiary referral center.MethodsIRB permission was obtained. Retrospective analysis of all children who underwent cochlear implantation from January 2001 to December 2005 at a major academic cochlear implantation center. The patients were reviewed for demographic information, type of hearing loss, cochlear implant device, and complications, including implant failure, meningitis, hematomas (intracranial and extracranial), implant extrusion, cerebrospinal fluid leaks, facial palsy, and wound infections.ResultsA total of 165 patients records were reviewed. 53.5% of the patients were male. The most common device used was the Freedom NucleusTM (60%). The most common etiology of hearing loss was non‐syndromic, non‐genetic, congenital sensorineural hearing loss (60.6%) All patients had a follow‐up of at least 1 year. The most common complication seen was device failure (3.0%), followed by flap infections (2.6%), and immediate postoperative hematomas (1.9%). There was no difference between the kind of device which failed, statistically. There was only one case of Ps. aeruginosa meningitis in a child with a Mondini deformity, who had the implant removed.ConclusionsCochlear implantation in children continues to be reliable and safe, with a low percentage of severe complications, in experienced hands. The patients should have lifetime follow‐up.
Otologics Fully Implantable Hearing Device Phase II Results
Authors: Horlbeck Drew M , Jenkins Herman A , Balough Ben J , Hoffer Michael E 
Published: August 2008

ObjectiveThe efficacy of the Otologics Fully Implantable Hearing Device (MET) was assessed in adult patients with bilateral moderate to severe sensorineural hearing loss.MethodsSurgical insertion of this totally implanted system was identical to the Phase I study. A repeated‐measures within‐subjects design assessed aided sound field thresholds and speech performances with the subject's own, appropriately fit, walk‐in hearing aid(s) and the Otologics Fully Implantable Hearing Device.ResultsSix‐ and 12‐month Phase II data will be presented. Ten patients were implanted and activated as part Phase II clinical trial. Three patients were lost to long term follow‐up due to two coil failures and one ossicular abnormality preventing proper device placement. No significant differences between preoperative (AC = 59 dB, BC = 55 dB) and postoperative (AC = 61 dB, BC = 54 dB) unaided pure tone averages were noted (p < 0.05). Pure tone average implant aided thresholds (41 dB) were equivalent to that of walk‐in‐aided (37 dB) condition with no significant difference (p < 0.05) between patients’ walk‐in‐aided individual frequency thresholds and implant‐aided thresholds. Word recognition scores and hearing in noise scores were similar between the walk‐in‐aided and for the implant‐aided condition. Patient benefit scales will be presented at all end points.ConclusionsResults of the Otologics MET Fully Implantable Hearing Device Phase II trial provide evidence that this fully implantable device is a viable alternative to currently available hearing aids in patients with sensorineural hearing loss.
Simulator Enhances Drilling Skills in Inexperienced Surgeons
Authors: Samy Ravi N , Murugappan Shanmugam , Stredney Don , Wiet Gregory 
Published: August 2008

Objective1) Validate whether a PC‐based simulation program can be used to enhance temporal bone skills in those without any anatomical knowledge or surgical experience. 2) Understand the complexities of adapting simulator technology to educate novice and experienced temporal bone surgeons.MethodsIn this prospective, pilot study, individuals performed a craniectomy (measuring approximately 1”x2”) from the squamosa of cadaveric temporal bone specimens using typical otologic drills and instrumentation; the goals were to remove the bone, create straight lines along the edges of the craniectomy, and perform dural decompression without violating the dura. After performing this, the individuals then spent the next 2 weeks performing virtual temporal bone surgery on the OSC/OSU simulator. The individuals then performed the craniectomy a second time. A blinded observer (neurotologist) then assessed performance on the pre‐ and post‐simulation tested bones.ResultsIn all 6 sets of bones (12 bones total), the blinded observer was able to correctly determine which was the presimulation temporal bone and the post‐simulation temporal bone. This was based primarily on the objective criteria of adequacy of dural decompression and the avoidance of dural tears. The assessment of linear edges of the craniectomy was not felt to be of sufficient importance.ConclusionsThe temporal bone simulator was able to improve the surgical skills in individuals with no prior temporal bone surgical experience or anatomy knowledge. The preliminary data from this study will be extended to a larger study group for statistical significance. Additional performance measures will need to be created to improve objective evaluation.
Single Vertical Incision for BAHA: Preliminary Results
Authors: Wilkinson Eric P , Luxford William M , House John W , De la Cruz Antonio , Slattery William H , Fayad Jose N 
Published: August 2008

ObjectiveA single vertical skin incision with subcutaneous tissue undermining is a cosmetic alternative to standard dermatome skin graft elevation for bone anchored hearing aid (BAHA) placement. A vertical incision minimizes alopecia and simplifies wound closure, while maintaining thin skin flaps. We aimed to determine the preliminary complication rate using a 4cm skin inicsion with 4⋉4 cm of subcutaneous tissue removal.MethodsA retrospective chart review of patients undergoing BAHA placement from January 2006 to August 2007 was performed. This search was filtered to include only vertical incision BAHA patients. Complications including skin irritation or infection, skin overgrowth, and implant extrusion were tallied. Pertinent patient risk factors were identified. 71 patients underwent vertical incision surgery, with a mean followup time of 6.8 months. 50 patients had sensorineural hearing losses and 21 had conductive hearing losses.ResultsNo patient had spontaneous extrusion of the titanium abutment. There were 5 minor complications (skin irritation 3, wound infection requiring oral antibiotics 1, postoperative hematoma 1) and 7 major complications (irritation requiring abutment removal 1, skin overgrowth or infection requiring flap revision 6). Total complication rate was 16% and major complication rate was 9.8%.ConclusionsA single vertical incision for BAHA placement has a similar complication rate to traditional dermatome use in this preliminary study, though more follow‐up is necessary to identify cases of late skin overgrowth. Patients with thick scalps or risk factors for hypertrophic scarring may require placement of longer abutments.
Drainage Post‐TGD Remnant Surgery: Source and Analysis
Authors: Bakar Saraiza Abu , Mankarious Leila A , Martinez‐Alvernia Efrain A 
Published: August 2008

ObjectiveMucopurulent drainage following thyroglossal duct remnant (TGD) surgery can occur in spite of meticulous technique. We hypothesize that there may be some patients whereby the drainage is due to transected, normal salivary tissue located within the posterior tongue base, close to the hyoid. 1) To establish the distance between tongue base salivary tissue and hyoid. 2) To identify tissue‐specific markers of TGD remnants as well as salivary tissue in order to distinguish drainage source.MethodsPilot study/tertiary care facility. The anterior neck block was obtained from 10 adult cadavers with no known TGD remnant. The distance between the normal salivary tissue and hyoid was measured. Immunohistochemistry (IHC) was performed on 5 archived tissue blocks from pediatric patients with post‐Sistrunk mucopurulent drainage to identify the presence of amylase and MUC 7 (a mucin specific to salivary tissue) within the excised specimen.ResultsAverage distance between salivary tissue and the hyoid within cadavers was 3.3mm (range 1.0–4.2mm). IHC revealed all 5 excised TGD remnants contained amylase; however, none (2 specimens with high background signal) contained MUC 7. Both amylase and MUC 7 were present within adjacent salivary tissues.ConclusionsNormal salivary tissue of the tongue base normally resides an average of 3.3mm from the hyoid within the adult. Preliminary IHC indicates that MUC 7 may be a sensitive and tissue‐specific marker of drainage due to transected salivary tissue. Testing for amylase does not appear to provide any tissue‐specific information as to the source of post‐Sistrunk mucopurulent drainage.
Pediatric Tympanoplasties: Anatomical and Functional Results
Authors: Ribeiro João , Cerejeira Rui , Soares Vera , Gapo Carla , Romao Jose , Paiva Antonio‐Manuel D 
Published: August 2008

ObjectiveThe purpose of this study was to analyze the anatomical and functional results in 167 tympanoplasties performed in children.MethodsA retrospective study of the anatomical and functional results of 167 tympanoplasties in children was performed. 91 ears had full records and were included in the study. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, preoperative and postoperative hearing levels, postoperative follow‐up time, and postoperative complications were recorded. Hearing results were reported using a 5‐frequency (500,1,000, 2,000, 3,000, 4000 Hz) pure‐tone average air‐bone gap.ResultsAnatomical success was achieved in 85% of cases. 71% of the reperforations occurred during the first year of follow‐up. The anatomical and functional success was 76% after a mean follow‐up of 26.4 ± 16.2 months. The mean postoperative air conduction threshold significantly improved in the successful cases, with a mean audiological improvement of 12.54 ±7.3dB (p<0.05). The maximum mean postoperative gain was seen at 500 Hz 14.9 ±10.1 dB (P<.05). No postoperative sensorineural hearing loss was observed. 18% of minor postoperative complications were seen. Surgeon experience, intact and mobile ossicular chain, dry ear, and follow‐up longer than 12 months (p<0.05) improves functional outcome.ConclusionsWe conclude that tympanoplasty in children is safe with anatomical and functional results comparable to that reported for adults. Dry ear over 6 months, surgeon experience, intact and mobile ossicular chain and follow‐up >12 months significantly improves functional outcome.
Severe OSA and Prolonged PICU Admissions after Tonsillectomy
Authors: Anstead Amy S. , Wong Hau Sin , Schroeder James W. 
Published: August 2008

ObjectiveDetermine the factors that increase the rate of a complicated postoperative course for children undergoing adenotonsillectomy for polysomnogram (PSG) proven severe OSA.MethodsA retrospective chart review of children with PSG‐verified severe OSA admitted to PICU after adenotonsillectomy was completed for the years 2002–2006. Data gathered: complications, style of tonsillectomy, direct laryngoscopy and bronchoscopy (DLB) findings, length of stay in PICU and hospital, age, co‐morbidities, American Society of Anesthesiologists (ASA) grading, PSG indices: AI, RDI, ETCO2, and nadir O2. Two groups were separated and compared: those that remained intubated after surgery and those extubated and managed with conservative postoperative airway intervention.Results70 children with PSG‐verified severe OSA were admitted to PICU after adenotonsillectomy. 53 children were extubated postoperatively. 43% of these children required oxygen supplementation, BiPAP or CPAP, and none required re‐intubation. 17 children remained intubated postoperatively. The style of tonsillectomy and all of the PSG indices were not significantly different between the two groups. Postoperative complication rates among children who remained intubated was 47%, compared to children who were not intubated at 2%. Intubated children's PICU and total hospital stay was longer. They were younger, and their ASA grading was higher. All of these differences were statistically significant.ConclusionsChildren who remain intubated after adenotonsillectomy have more postoperative complications and stay in the hospital longer. Every attempt should be made to extubate children postoperatively and manage them with conservative airway management after tonsillectomy.
The Microbiology of Complicated Pediatric Rhinosiniusitis
Authors: Gaines Ryan , Weatherly Robert A , Harrison Christopher Joseph 
Published: August 2008

ObjectiveTo determine the pathogens causing complicated rhinosinusitis over 10 years at a tertiary pediatric hospital, with a focus on methicillin‐resistent Staphylococcus aureus (MRSA).MethodsChart review for patients admitted for complicated rhinosinusitis from 1997–2007.Results179 patients were diagnosed with complicated rhinosinusitis. Of those, 67(37.4%) required surgical treatment in addition to antimicrobials. 51 surgical cultures (76.1%) were positive. Single organisms were isolated from 28 cultures (54.9%), while 23 of 51 were polymicrobial. The most frequently isolated pathogen was from the Streptococcus anginosus/milleri/constellatus group, comprising 29.4% of positive cultures. Anaerobes were identified in 23.5% of cultures and group A streptococcus in 19.6%. Organisms common to normal human oral flora accounted for 80.3% of isolates. Staphylococci were isolated from 17 cultures (33.3%). Three (5.8%) of 51 isolates were MRSA. No MRSA isolate was part of a polymicrobial infection. All occurrences of MRSA were within the last 2 years of the review.ConclusionsAt our institution, MRSA accounted for 5.8% of culture positive complicated rhinosinusitis cases in the last 10 years, but all presented within the last 2 years. This suggests a potential recent increase in MRSA prevalence in this clinical presentation. Therefore, MRSA should be considered as a potential pathogen in these children, although the overall 10‐year frequency is low. Most pathogens were common oral commensal organisMS This suggests that host factors play an important role in the pathogenesis of complicated rhinosinusitis.
Device‐Related Risk of Airway Fire in Oropharyngeal Surgery
Authors: Smith Lee P. , Roy Soham 
Published: August 2008

ObjectiveIntraoperative fires are a well‐described and devastating complication of oropharyngeal and airway surgery. We utilized a physical model to study the fire risk for an electrosurgical device (Bovie) as compared to a bipolar radio‐frequency ablation wand (Coblator)MethodsA 6.0 endotracheal tube was inserted into the cranial end of a degutted whole raw chicken through which 100% oxygen was piped at 10 L/min. Three tonsil sponges were placed inside the cavity. An electrosurgical device (15 watts, coagulate mode) and bipolar radiofrequency ablation wand (9, 7 and 3 in ablate mode; 5 and 3 in coagulate mode) were activated in the central cavity of the chicken through its caudal opening. All experimental conditions were tested for 4 minutes, or until a positive result was achieved. All trials were repeated in another chicken to ensure accuracy.ResultsIgnition of the tonsil sponges and endotracheal tube was obtained with a sustained fire in the cavity of the chicken when using the electrosurgical device for between 45 and 80 seconds. Under all 5 experimental conditions, no ignition or sustained fire could be produced using the radiofrequency plasma ablation wand. After 20 sustained minutes of continuous plasma ablation in the chicken cavity without ignition, the electrosurgical device was able to ignite a fire within 45 seconds in the same cavity.ConclusionsWhile electrosurgical devices present a significant risk of fire during open cavity surgery in oxygen‐enriched environments, that risk appears to be eliminated with bipolar radiofrequency plasma ablation. Compelling video and photographic evidence will be provided.
Association of Vitamin D Levels and Chronic Rhinosinusitis
Authors: Pinto Jayant , John Schneider , Rosanne Perez , De Tineo Marcy L , Baroody Fuad M , Naclerio Robert M 
Published: August 2008

ObjectiveVitamin D decreases the risk of chronic illnesses and has been implicated in asthma, allergic rhinitis, and anaphylaxis. We questioned whether vitamin D levels might be associated with chronic rhinosinusitis (CRS), using a case‐control sample.MethodsSerum 25(OH)‐vitamin D (25(OH)D) levels were measured in African‐American (n=65) and Caucasian (n=89) adults with and without CRS, recruited at an urban, tertiary care, academic hospital. Case definition met consensus diagnostic criteria and included endoscopy and imaging, with normal imaging studies in controls. Data were stratified by sex, race, season, and body‐mass index (BMI), factors known to affect levels.ResultsThere were no significant differences in 25(OH)D levels between Caucasian cases and controls in either sex, including when analyzed by season. Levels in African‐Americans with CRS were significantly lower than controls (males: cases 15.4 ± 2.1 ng/mL, controls 26 ± 2.6, P?0.01; females: cases 13.5 ± 2.0, controls 20.8 ± 2.6, P?0.03). Accounting for season, African‐Americans with CRS continued to show significantly lower 25(OH)D levels as compared to controls (winter: males: cases 22.3 ± 3.3 ng/mL, controls, P?0.03; females: cases 8.5 ± 0.96, controls 17.4 ± 2.5, P?0.003), with similar but nonsignificant trends in summer. Demographics were similar across comparisons (age, BMI).ConclusionsOur data suggest that low levels of vitamin D may be involved in CRS in African‐Americans, a role that is biologically plausible, given its immunologic effects and its putative association with susceptibility to viral infections and other related diseases. Further study of this phenomenon may provide novel hypotheses for the development of CRS.
Bacterial Origin of Ostiomeatalcomplex after Viral Infection
Authors: Han Joseph , Hendley Joseph Owen , Winther Birgit 
Published: August 2008

ObjectiveAfter a viral infection in the nasal cavity or sinus, superimposed bacteria infection is likely to occur. Therefore the carriage rate of bacterial pathogen in the nasal cavity (NC), nasopharynx (NP), and ostiomeatal complex (OMC) were determined during wellness and upper respiratory viral infection.MethodsThere were 2 groups in the study. The control group was well with no nasal or sinus problems. The cohort group had an upper respiratory viral infection. The NC, NP, and OMC cultures were taken from each study group. Agars cultured were used to detect S. pneumoniae, H. influenzae, and M. catarrhalis. Statistical comparison was made between the groups. The bacterial pathogens were also compared between the various sites of culture within a group.ResultsThere were 91 subjects in the study‐51 subjects with an upper respiratory viral infection and 40 control participants. 59% of participants were female. There was no statistical difference in the rate of bacterial pathogen in the NP (p=0.2) or NC (p=0.06) between the control and cohort group. There was a significant increase (p<0.008) of bacterial pathogen in the OMC of viral illness group versus the control group. Bacterial pathogen present in the OMC had a similar pathogen in either the NC or NP.ConclusionsThis study defines the reservoir of bacteria in the NC or NP for the bacterial pathogen in the OMC during wellness and upper respiratory viral infection.