bluuebunny/crossref_metadata_2025_split huggingface dataset:
Esophagoscopy: Complications in an Academic Training Program
Authors: Tsao Gabriel J , Damrose Edward J 
Published: August 2008

ObjectiveTo assess the efficacy and safety of flexible vs. rigid esophagoscopy in an academic training setting.MethodsA retrospective medical record review was performed on all adult patients undergoing esophagoscopy in a tertiary care academic training center from 2002 to 2007.ResultsA total of 546 procedures were performed using both flexible (n=276) and rigid (n=270) endoscopes. 7 esophageal perforations occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Perforation occurred in 3 patients while searching for a metastatic or synchronous tumor, in 3 patients undergoing dilation or tracheoesophageal puncture, and in 1 patient prior to biopsy of a known esophageal mass. There were no deaths. Esophageal perforation rates were associated with attending level of experience. In 370 patients undergoing esophagoscopy for an unknown primary workup or as part of panendoscopy for the initial evaluation of a head and neck cancer, no synchronous esophageal cancers were found.ConclusionsThe 2.6% esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. All injuries occured in patients with a history of upper aerodigestive tract cancer. The safety of rigid esophagoscopy was commensurate with the experience of the attending physician. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. As fiberoptic techniques are associated with lower complication rates, these should be employed until the novice operator attains some degree of proficiency in esophagoscopy.
Harm and Adverse Events in Otolaryngology Journals
Authors: Bibawy Haidy , Cossu Anne , Sophia Kogan , Rosenfeld Richard M 
Published: August 2008

ObjectiveTo identify the frequency and quality of harm and adverse events reporting in otolaryngology journals.MethodsFour major otolaryngology journals from 2006 and 1996 were reviewed. Clinical research studies offering therapeutic recommendations were evaluated for frequency and quality of harm and adverse events reporting.ResultsOf 1835 total articles reviewed, 576 (31%) offered therapeutic recommendations. Only 65% provided any mention of harm or adverse events; 47% explicitly defined the events and 24% described methodology for collecting harm data. The median number of harms or adverse events reported was 3. Studies concluding a beneficial effect of therapy were more likely to not mention adverse events (odds ratio 2.99, p= 0.007), compared to studies concluding no benefit. Studies of surgical therapy were more likely to report harm or adverse events (odds ratio 1.46, p= 0.046) than medical therapy.ConclusionsHarm and adverse events are under‐reported and poorly described in otolaryngology journals, with about 1/3 of clinical research not mentioning adverse events at all. Most authors do not explicitly describe harm or adverse events (53%), or the methodology behind collecting adverse events data (76%). Under‐reporting is more likely when a therapeutic effect is found to be beneficial.
An Adjustable Implant for the Nasal Valve: 3‐Year Experience
Authors: Hurbis Charles G 
Published: August 2008

Objective1) Measure the effectiveness of the Monarch implant in correcting nasal valve dysfunction. 2) Determine the longevity of effectiveness.MethodsThis study consists of a prospective, cumulative, three‐year experience with the Monarch adjustable nasal implant for correcting nasal valve dysfunction in a total of 46 patients. Implantation success was determined by the use of acoustic rhinomanometry and a subjective NOSE‐type quality of life scale. Data was subjected to the student‐t test.ResultsIn the series of 46 patients spanning 36 months there is a mean 150% improvement in the internal nasal valve areas at 3 years as measured by acoustic rhinomanometry (p<.0001). Using a NOSE‐type questionnaire, patients also noted significant improvements in daytime (p<.0004) and nighttime (p<.0002) nasal airways, a decrease in apnea (p<.01) and snoring (p<.05), and a decrease in the propensity for daytime oral breathing (p<.0002).ConclusionsThe Monarch Implant provides a simple, consistent, adjustable and apparently long‐term correction of the nasal airway in patients suffering from nasal valvular dysfunction.
Computed Tomography Anatomy of the Optic Canal
Authors: Hart Catherine K , Zimmer Lee A 
Published: August 2008

Objective(1) Analyze the radiographic anatomy of the optic canal in relationship to the sphenoid sinus. (2) Understand the role variation in optic canal anatomy may have in the variability of outcomes in optic nerve decompression.MethodsFine cut computed tomography images of the sinuses were obtained with an IRB waiver. Optic canal dimensions were measured on sinus computed tomography images of 96 patients. 191 optic canals were analyzed (111 females, 80 males). Student T‐test calculations were performed for statistical analysis on computer software.ResultsThe average medial canal wall length was 1.48 centimeters (range 0.7–2.3). The length in males was 1.61 centimeters (1.1–2.3) as compared to 1.39 centimeters (0.7–2.0) in females (p=8.0–7). The average degree of exposure of the optic canal exposed to the sphenoid sinus was 101.3 degrees (56–176). The degree of exposure was 105.6 in males versus 98.2 in females (p=.01). The potential area of canal exposed to the sphenoid sinus was 0.66 centimeters squared or 28% of the total surface area. The potential area exposed to the sphenoid sinus in males was 0.76cm2 (28%) and 0.58 centimeters squared (27%) in females.ConclusionsA wide range in medial canal wall length and exposure of the bony optic canal to the sphenoid sinus exists on CT images. The variation in medial canal wall length and in optic canal exposure to the sphenoid sinus may contribute to the variability in success rates of endoscopic optic nerve decompression for optic neuropathy.
Endoscopic Closure of CSF Rhinorrhea: 193 cases in 21 years
Authors: Banks Caroline Amber , Kennedy David W , Palmer James N , Chiu Alexander G , O'Malley Bert W , Woodworth Bradford A. 
Published: August 2008

ObjectiveOver the past 2 decades, endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine treatment. The goal of this study is to describe endoscopic closure of a large series of traumatic and spontaneous CSF leaks over a 21‐year period, focusing on perioperative management, surgical technique, and long‐term outcomes.MethodsRetrospective chart review of CSF leak patients treated by the senior author and at the Hospital of the University of Pennsylvania from 1987 to 2008. The data analyzed included BMI, etiology, defect location, graft material, presence of encephalocele, use of lumbar drain, history of meningitis, evidence of intracranial hypertension, recurrence rates, and follow‐up.Results193 cases were identified. Follow‐up ranging from 1 month to 9 years (mean 20 months) was available on 166 patients. The etiology was spontaneous in 77 patients (40%), traumatic in 109 (56%), and congenital in 7 patients (4%). The average BMI of spontaneous CSF leak patients (35) was significantly greater (p<0.001) than both traumatic (30) and congenital patients (23). Defects were most commonly located in the sphenoid sinus (n = 62, 32%) and the ethmoid roof (n = 60, 31%). The initial success rate was 88% (n = 170) and the overall success rate was 98% (n = 190). 45 patients (23%) had a history of meningitis, and 4 patients (2%) developed meningitis after repair.ConclusionsThe overall success rate (98%) and low incidence of morbidity in this large series strongly support the endoscopic approach as standard of care for CSF leak closure.
Endoscopic Repair of Supraorbital CSF Leaks
Authors: Purkey Michael , Chiu Alexander G , Woodworth Bradford A. , Palmer James N 
Published: August 2008

ObjectiveThe supraorbital ethmoid and lateral frontal sinus are difficult to approach endoscopically. Their location, superior and lateral to the orbit, can make access technically challenging. In this study, we examined clinical and anatomical characteristics of patients with supraorbital CSF leaks and encepholeceles and identified specific considerations unique to their management.MethodsRetrospective review of patients who underwent repair of supraorbital CSF leaks at our institution from 2003–2007.ResultsEight patients were surgically treated. Seven were spontaneous leaks with an associated encepholecele and one was post‐craniotomy. The majority of patients were women (5/8), middle‐aged (mean: 54.9 years), and had a mean BMI of 42.3 kg/m2. Intracranial pressures were elevated in 6/8 patients and an empty sella was present in each of the 7 patients with a spontaneous leak. Anatomically, 6/8 patients had defects medial to a sagittal plane drawn through the medial orbital wall (mean distance: 4.15 mm) and 2/8 patients had defects lateral to the sagittal plane (mean distance: 8.14 mm). 7/8 were successfully repaired endoscopically and one patient with a lateral defect required conversion to a supra‐orbital trephination. All defects were repaired successfully with a mean follow‐up of 27.8 months.ConclusionsPatients with supraorbital CSF leaks have unique clinical characteristics that include obesity and elevated ICP. Endoscopic repair produces acceptable results with low morbidity. Extension of a skull base defect lateral to a sagittal plane through the medial orbital wall is a technical obstacle to endoscopic repair and may require an adjunctive external approach.
Endoscopic Transnasal Study of the Infratemporal Fossa
Authors: Germani Ross M. , Herzallah Islam , Casiano Roy R 
Published: August 2008

Objective1)Introducing a new endoscopic orientation to the medial portion of the infratemporal fossa (ITF) which is not infrequently involved in sinonasal and related skull base pathologies. 2) Describing the anatomical details and measurement variations of some key ITF landmarks from the unique transnasal endoscopic perspective.MethodsUsing an extended endoscopic approach, the pterygopalatine and infratemporal fossae were dissected in 10 sides of 5 adult cadaver heads. After an extended transethmoid and transmaxillary approach, a plane of dissection along the pterygoid base and the infratemporal surface of the greater sphenoid wing was developed. The related masticatory muscles were dissected through the endoscopic approach. High quality images have been produced by coupling the video camera to a digital recording system.ResultsThe foramen rotundum, ovale and spinosum were identified and new landmarks were described from the surgical endoscopic point of view. The sphenomandibularis muscle, recently named in anatomic literature, was also highlighted. Along with various neurovascular structures, the maxillary and mandibular divisions of the trigeminal nerve as well as the middle meningeal artery were identified. Columellar measurements to the foramen rotundum and ovale ranged from 6.1 to 8.0 cm for the former and 7.0 to 9.1 cm for the latter, with a mean of 6.75 cm and 7.78 cm respectively.ConclusionsThe current study provides a novel endo‐scopic orientation to the medial ITF. Such knowledge should provide an anatomic basis for experienced surgeons to endo‐scopically address this complex region with more safety and efficacy.
Genotype and Mucosal Disease in Skull Base Pneumatization
Authors: Seifert Clarice Marie , Mathews Joseph Wolfgang , Harvey Richard J. , Woodworth Bradford A. , Ahn Chadwick Neal , Meyer Ted A , Schlosser Rodney J 
Published: August 2008

Objective(1) Compare paranasal sinus pneumatization (PSP) and temporal bone pneumatization (TBP) in cystic fibrosis (CF), chronic rhinosinusitis (CRS) and normal patients. (2) Determine impact of genotype and inflammatory mucosal disease on development of skull base pneumatization.MethodsA case‐control study using CF, CRS, and control patients from a tertiary rhinology clinic was conducted. TBP and PSP was assessed by computed tomography (CT) using a previously validated scale. Genotype data, including DF508 status, for CF patients was determined.Results186 temporal bones and paranasal sinuses from 93 adult patients were assessed. Mean age 43.4 ± 14.9yrs. Inter‐observer correlation for TB scoring was 0.86. TBP did not differ between CF, CRS, and normals (X2=6.93, p=0.38). PSP was significantly less in the CF group (X2=34.2, p<0.001). CRS and normals did not differ in PSP. 51.6% of CF patients were homozygous for DF508 and 16.1% were heterozygous. DF508 status was associated with poorer SP (X2=34.2, p<0.001) but greater TBP (X2=19.2, p=0.004).ConclusionsPSP is significantly impaired in CF, and DF508 homozygosity is associated with poor development. Conversely, TBP is well preserved in the CF population, and DF508 homozygosity might even be related to enhanced TBP. Although this difference is striking, the underlying mechanisms are unclear. Genotype may play a significant role in the development of skull base pneumatization.
Radiologic Staging System for Allergic Fungal Rhinosinusitis
Authors: Rogers Gamwell A , Wise Sarah K , Ghegan Mark D , Harvey Richard J , DelGaudio John M , Schlosser Rodney J 
Published: August 2008

Objective(1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups.MethodsPatients from two tertiary care rhinology practices with classic AFRS and available CTs (2001–2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points.Results111 CTs were reviewed. Mean score across all patients was 7.8 (range 0–24). Males scored significantly higher than females (mean 9.3 vs 5.6, p < 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p < 0.001). There was also a trend towards younger patients exhibiting higher scores (p = 0.07).ConclusionsA radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes.
Surgeon Radiation Exposure in ESS Using Balloon Catheters
Authors: Albritton Ford D , Smith Joseph L. , Zahurullah Fazlur R. , Armstrong Michael , Duplan Don A , Gershow James A , Kuhn Frederick A 
Published: August 2008

ObjectiveLess invasive instruments such as balloon catheters are now available to dilate sinus ostia during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization, which emits ionizing radiation. Radiation exposure has long been an area of concern. This study was initiated to determine radiation exposure to surgeons who used fluoroscopy with balloon catheters during ESS.MethodsA multi‐center, prospective evaluation of surgeon radiation exposure was conducted. For 3 months, each sinus surgeon (9 surgeons) wore 2 dosimeters to record radiation exposure when using C‐arm fluoroscopy during surgery utilizing balloon catheter instruments. One dosimeter was placed at collar level (chest badge), outside the lead surgical apron and another dosimeter was placed on a finger (extremity badge). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated.Results9 chest badges recorded annualized averages of 104, 100, and 104 millirems for deep, eye, and shallow exposure respectively. 8 ring badges recorded 312 millirems.ConclusionsA recent publication has reported low levels of surgeon radiation exposure during a clinical study. This study further validates that radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit (Shallow Dose Equivalent) of 50,000 millirem. With vigilant technique and education, reliance on fluoroscopy can be minimized.
Symptom Specific Outcomes of Endoscopic Sinus Surgery
Authors: Antisdel Jastin L , Sindwani Raj , Chester Alexander C 
Published: August 2008

Objective1) Learn the relative effectiveness of endoscopic sinus surgery (ESS) regarding improving individual major chronic rhinosinusitis (CRS) symptoms and headache. 2) Be able to more effectively counsel patients undergoing ESS.MethodsA literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web‐based sources from 1980–2008 was performed. Additional articles were identified by reviewing relevant bibliographies. Studies with more than 10 adult CRS patients that used symptom severity scores to analyze at least 4 major criteria (facial pressure, congestion, nasal obstruction, nasal discharge, and hyposmia/anosmia) or 3 major criteria as well as headache were included. 265 studies were identified and reviewed. 22 of these met inclusion criteria and their data were analyzed. After conversion of the symptom severity scores used in each study to a relative percent value, symptom categories were averaged, and compared in aggregate.ResultsThis analysis included 1641 CRS patients (average of 74 pts/study). The patients were followed an average of 19.4 months (range, 1 week to 76 months) postoperatively. All 6 evaluated symptoms showed non‐weighted, relative improvements in symptom scores. Overall, symptoms improved synchronously with a relative improvement over preoperative levels ranging from 27% to 36%. ESS provided the greatest relief from nasal obstruction (relative improvement of 36%), which was a significantly larger change than with facial pain (p<0.034) or nasal discharge (p<0.034).ConclusionsThe relative improvement in major CRS symptoms and headache after surgery is similar. Nasal obstruction improves slightly more than facial pain and nasal discharge.
Multicenter Study of Adjustable Tongue Advancement Device
Authors: Woodson B Tucker , Mickelson Samuel A , Huntley Tod C , Steward David L , Goldberg Andrew N 
Published: August 2008

ObjectiveSurgical tongue advancement and stabilization is limited by morbidity and lack of adjustability. This study was designed to assess the feasibility and effectiveness of a novel titratable minimally invasive tongue advancement system. The objectives of the multicenter prospective study were to assess: 1) clinical effect on AHI, sleepiness and snoring, and 2) procedure morbidity.MethodsPreviously untreated patients (N=42) with evidence of tongue obstruction (BMI<32, AHI <60) underwent placement of a bone anchor attached to the mandible, tethered to a tissue anchor in the tongue base. Tissue anchor advancement was performed several weeks later under local or sedation anesthesia. Outcome measures included baseline and follow‐up PSG, home sleep testing, and questionnaire data.ResultsTitration advanced the anchor up to 1.5 cm. There were no acute or long‐term significant effects in speech, swallowing or taste. In 13 patients, tissue anchor barb fractures were observed on x‐ray. AHI significantly decreased in the total group (29.1 to 23.1, p<0.01). The barb‐intact group improved (29.6 to 22.1, p<0.01) but no change was observed in the barb fracture group (28.1 to 25.3, p = 0.17). Improvements were observed in snoring (7.3 to 3.6, p < 0.01), ESS (11.5 to 7.5, p < 0.01). Postoperative average pain scores decreased from 4.4 to 1.5 on day 5 (10 point scale).ConclusionsSoft tissue anchor failure occurred and was associated with less effect and warrants correction prior to widespread application. Titrable tongue suspension is feasible, well tolerated, and significantly improves multiple measures of sleep apnea.
S100 – Mometasone Furoate Reduces Ocular Symptoms of Seasonal AR
Authors: Prenner Bruce , Shekar Tulin , Teper Ariel 
Published: August 2008

ObjectivesTo demonstrate clinical efficacy in reducing the ocular symptoms of SAR using mometasone furoate nasal spray (MFNS).MethodsA phase III, double‐blind, randomized, placebo‐controlled, multi‐center study compared the efficacy of MFNS 200 mcg QD, dosed in the morning (AM), for treatment of ocular symptoms associated with SAR. Subjects were at least 12 years old with at least a 2‐year history of SAR. In daily diaries, subjects evaluated AM ocular symptom severity on a scale of 0 (none) to 3 (severe) on treatment Days 1 to 15. Co‐primary endpoints included change from baseline in average instantaneous (AM) total nasal symptom score (sum of individual nasal symptom scores for congestion, rhinorrhea, sneezing, and itching) and instantaneous (AM) total ocular symptom score (iTOSS) (sum of individual eye symptom scores for itching/burning, tearing/watering, redness), Days 2 to 15.ResultsSubjects (429) with similar baseline characteristics and moderate‐to‐severe ocular symptoms received MFNS 200 mcg QD or placebo. MFNS 200 mcg QD demonstrated superiority over placebo in least squares mean changes from baseline in subject‐rated, average AM iTOSS from Day 2 to 15 (−1.71 [−25.1%] and −1.37 [−20.1%], respectively; P equal to 0.026). MFNS was well tolerated.ConclusionsMFNS 200 mcg QD demonstrated statistically significant improvements in AM iTOSS associated with SAR. These are the first prospective results demonstrating that MFNS significantly reduces ocular symptoms in subjects with SAR.
S102 – Mometasone Furoate Reduces Severity of Adenoidal Hypertrophy
Authors: Nsouli Talal 
Published: August 2008

ObjectivesAllergic rhinitis (AR) is a risk factor for adenoidal hypertrophy—the adenoids are the lymphoid tissue closest to the nasal mucosa—and results in upper airway obstruction and snoring. The efficacy of mometasone furoate nasal spray (MFNS) in reducing gland size and degree of snoring in subjects with adenoidal hypertrophy and concomitant AR was assessed.MethodsChildren 5 to 10 years old with adenoidal hypertrophy and a history of chronic nasal obstruction and snoring received MFNS 50 mcg QD in each nostril. 16 subjects with AR diagnosed by positive skin prick test to environmental allergens comprised the treatment group, and 8 subjects with no history of AR and a negative skin prick test comprised the control group. Efficacy variables, assessed at Weeks 0 (baseline), 4, and 8, were change in size of the adenoid gland, evaluated by flexible fiber‐optic and graded as a percentage according to degree of obliteration of the choanae, and change in degree of snoring, evaluated on a 3‐point scale (0 absent, 1 intermittent, or 2 continuous).ResultsSignificant improvements in the treatment group vs. baseline at Week 8 were an 84% decrease in mean average adenoidal‐tissue size, compared with a 5% decrease in the control group (P less than 0.05) and an 80% decrease in snoring compared with a 5% decrease in the control group (P less than 0.05).ConclusionsOnce‐daily MFNS 50 mcg is beneficial in the treatment of adenoidal hypertrophy and in reducing snoring in pediatric patients with AR.