bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Microbiology of Mucopyocele
Authors: Brook Itzhak , Frazier Edith H. 
Published: November 2003

AbstractObjective To evaluate the aerobic and anaerobic microbiology of mucopyocele.Study Design Retrospective review of clinical and microbiologic records of patients with mucopyocele between June 1982 and September 1997.Methods Aspirates of 36 mucopyocele were processed for aerobic and anaerobic bacteria.Results One hundred six bacterial isolates, 42 aerobic and facultatives and 64 anaerobic, were recovered. The predominant aerobic isolates were Staphylococcus aureus (6 isolates), alpha‐hemolytic streptococci (6), Hemophilus spp. (5), and Gram‐negative bacilli (6). The predominant anaerobes were Peptostreptococcus sp. (22), Prevotella sp. (15), Fusobacterium sp. (5), and Propionibacterium acnes (5). Thirty‐three β‐lactamase‐producing bacteria were isolated from 23 patients.Conclusions These findings illustrate the polymicrobial aerobic and anaerobic bacteriology of mucopyocele.
Endoscopic Removal of the Antral Portion of Antrochoanal Polyp by Powered Instrumentation
Authors: Hong Soon Kwan , Min Yang‐Gi , Kim Chong Nahm , Byun Sung Wan 
Published: November 2003

AbstractObjectives To introduce a new surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by measures of relevant patient outcome.Study Design Prospective study in 28 patients undergoing endoscopic sinus surgery for ACP by our surgical technique.Methods Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow‐up period ranging from 12 to 52 months. All symptom scores on a 100‐mm visual analogue scale before operation were compared with those at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three‐point scale ranging from 0 to 2. In surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa.Results Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow‐up period. There were no major complications specific to this technique.Conclusion Our technique provides an attractive alternative to other methods for removing the antral portion of an ACP and is associated with excellent outcomes and minimal morbidities.
Radiofrequency Treatment of Turbinate Hypertrophy in Subjects Using Continuous Positive Airway Pressure: A Randomized, Double‐Blind, Placebo‐Controlled Clinical Pilot Trial
Authors: Powell Nelson B. , Zonato Adriane I. , Weaver Edward M. , Li Kasey , Troell Robert , Riley Robert W. , Guilleminault Christian 
Published: November 2003

AbstractObjectives To estimate the treatment effect of temperature‐controlled radiofrequency (TCRF) reduction of turbinate hypertrophy in patients with sleep‐disordered breathing (SDB) treated with nasal continuous positive airway pressure (CPAP), and to assess the impact of study design on this estimate.Study Design Prospective, randomized, double‐blind, placebo‐controlled clinical pilot trial.Methods Twenty‐two CPAP‐treated patients with SDB with turbinate hypertrophy were randomly assigned to either TCRF turbinate treatment (mean energy 415 ± 37 J/turbinate; n = 17) or placebo control (n = 5). Changes in nasal obstruction were evaluated between pretreatment and 4 weeks post‐treatment. The primary outcome assessed changes in the blinded examiners' findings of nasal obstruction on a visual analogue scale (VAS). Secondary outcomes included blinded patients' and unblinded examiner assessments of nasal obstruction (VAS), nightly CPAP use, adherence, and tolerance, along with sleepiness and general health status scales. The treatment group findings were subtracted from the changes in the placebo group to yield treatment effect.Results The primary outcome treatment effect by VAS was ‐0.9 cm (95% confidence interval [CI], ‐2.4, 0.7), and beyond the placebo effect of ‐1.5 cm (95% CI: ‐3.4, 0.3). The secondary treatment effect of the unblinded examiner was ‐3.0 cm (95% CI, ‐4.9, ‐1.1). A beneficial treatment effect was also seen on every secondary outcome except general health status, but only self‐reported CPAP adherence (P = .03) was statistically significant.Conclusions TCRF turbinate treatment appears to benefit nasal obstruction and CPAP treatment for SDB. Placebo control and double blinding are critical for establishing the true treatment effect. A future definitive trial is feasible to establish statistical significance of these findings.
Complications in Pediatric Tracheostomies
Authors: Carr Michele M. , Poje Christopher P. , Kingston Lucille , Kielma Donna , Heard Christopher 
Published: November 2003

AbstractObjective To examine complications of pediatric tracheostomy.Study Design Retrospective.Methods Chart review of children undergoing tracheotomy or laryngeal diversion between 1990 and 1999.Results Charts of 142 children were examined. Average age was 2.64 years (standard deviation [SD], 4.73 y) at surgery. Duration of tracheostomy was 2.08 years (SD, 1.72 y) for those decannulated, 3.12 years (SD, 2.5 y) for those still with a stoma, and length of follow‐up for the whole group was 4.14 years (SD, 8.69 y). At last follow‐up, 56% had a tracheostomy, 29% had none, and 15% had died; one death was tracheostomy‐related. Three percent had intraoperative complications, 11% had complications before the first tracheostomy tube change, and 63% had complications after the first tube change. Thirty‐four percent had a trial of decannulation; 85% of these were successful. Fifty‐four percent of those decannulated had complications. Number of complications was not related to duration of follow‐up. In‐hospital mortality was congruent to mortality predicted by PRISM (Pediatric Rate of Mortality) scores.Conclusions Forty‐three percent had serious complications involving loss of the tracheostomy airway (tube occlusion or accidental decannulation) or requiring a separate surgical procedure. Deaths directly attributable to tracheostomy complications occurred in 0.7%.
A Unique Case of Bezold's Abscess Associated With Multiple Dural Sinus Thromboses
Authors: Zapanta Philip E. , Chi David H. , Faust Russell A. 
Published: November 2003

AbstractObjectives/Hypothesis Bezold's abscess and dural sinus thromboses are rare complications of otitis media in the era of antibiotics. Although potentially fatal, they are treatable. We present a unique case report of Bezold's abscess in association with multiple dural sinus thromboses.Study Design Single case report.Methods A young female patient's clinical course is presented and discussed. We review the anatomy, incidence, pathogenesis, and treatment of Bezold's abscess and dural sinus thrombosis.Results After mastoidectomy, neck exploration, broad‐spectrum intravenous antibiotics, and anticoagulation therapy, the patient recovered fully and has remained asymptomatic since her discharge from the hospital at 12 months' follow‐up.Conclusions This is the first reported case of Bezold's abscess associated with a cavernous sinus thrombosis and the third reported case of Bezold's abscess associated with lateral sinus thrombosis. Despite its rarity, Bezold's abscess must be recognized and treated aggressively. Dural sinus thrombosis is relatively more common, and treatment of the underlying cause is essential. The diagnosis and rapid, aggressive treatment of these conditions are essential for an optimal clinical outcome.
Top 10 Reasons for Endoscopic Maxillary Sinus Surgery Failure
Authors: Richtsmeier William J. 
Published: November 2003

AbstractObjective/Hypothesis Endoscopic sinus surgery has enjoyed impressive success curing chronic disease in sinuses and has virtually replaced the Caldwell‐Luc procedure for correction of problems with the maxillary sinus. Unfortunately, a significant number of patients have persistent maxillary symptoms after one or more endoscopic sinus operations. Existing reviews of this issue have identified only a few general causes for surgical failure.Methods The records of 85 patients presenting to the author over a 5‐year period with persistent maxillary sinus symptoms were reviewed.Results In reviewing the causes of persistent disease requiring revision surgery, the author identified 10 categories of reasons for failure to improve. Many patients have multiple causes that could be individually or sequentially identified. Some problems associated with surgical failure were likely present at the time of initial presentation, whereas others were undoubtedly caused by the first surgical procedure. Ten reasons for maxillary sinus surgical failure identified were clustered into the following categories: 1) obstructed natural ostia, 2) disease in the anterior ethmoid or frontal sinus, 3) resistant organisms, 4) intrasinus foreign body, 5) incurable mucosal disease, 6) noncompliant patient, 7) wrong primary diagnosis, 8) maxillary osteitis, 9) mucus maltransport, and 10) fundamental immunodeficiency.Conclusions A careful assessment of each patient with persistent maxillary sinus disease is central to understanding each specific patient and should include a careful history, a detailed endoscopic examination, repeat computed tomography imaging, culture of secretions, and possible revision surgery.
Ambulatory 24‐Hour Double‐Probe pH Monitoring: The Importance of Manometry
Authors: Johnson Paul E. , Koufman James A. , Nowak Lisa J. , Belafsky Peter C. , Postma Gregory N. 
Published: November 2003

AbstractObjective Historically, manometry has been used for sphincter localization before ambulatory 24‐hour double‐probe pH monitoring to ensure accurate placement of the probes. Recently, direct‐vision placement (DVP), using transnasal fiberoptic laryngoscopy (TFL), has been offered as an alternative technique. Presumably, DVP might be used to precisely place the proximal (pharyngeal) pH probe; however, using DVP, there appears to be no way to accurately position the distal (esophageal) probe. The purpose of this study was to evaluate the accuracy of DVP for pH probe placement using manometric measurement as the gold standard.Methods Thirty patients undergoing pH monitoring participated in this prospective study. Each subject underwent manometric examination of the esophagus to determine the precise location of the upper and lower esophageal sphincters (UES and LES). In addition, external anatomic landmarks were used to estimate interprobe distances. A physician blinded to the manometry results then placed a pH catheter using DVP so that the proximal probe was located just above the UES. The results were recorded and compared with those obtained by manometry.Results Accurate DVP of the proximal pH probe was achieved in 70% (23 of 30) of the subjects. The use of external anatomic landmarks to estimate interprobe distance resulted in accurate positioning of the distal probe in only 40% (12 of 30) of the subjects. Using fixed interprobe distances of 15 cm and 20 cm, distal probe position accuracy was 3% (1 of 30) and 40% (12 of 30), respectively. Therefore, using DVP, the distal esophageal probe was in an incorrect position in 60% to 97% of subjects.Conclusion For double‐probe pH monitoring, the proximal probe can be accurately positioned by DVP; however, there is no precise way to determine the interprobe distance required to correctly position the distal pH probe. Failure to accurately position the distal probe results in grossly inaccurate esophageal acid‐exposure times. Thus, manometry is needed to ensure valid double‐probe pH monitoring data.
Preoperative Computed Tomography Scans for Parotid Tumor Evaluation
Authors: Urquhart Andrew , Hutchins Lawrence G. , Berg Richard L. 
Published: November 2003

AbstractObjective We sought to determine whether an advantage is obtained in the routine use of computed tomography (CT) scans in preoperative assessments of parotid tumors.Methods A prospective study of 32 consecutive cases of patients who underwent evaluation for parotidectomies was performed. Twenty‐nine received preoperative CT scans. The scans were systematically reviewed to see if they correlated with the clinical findings. Specifically, we compared clinical and CT assessments of tumor size, location, density, and malignancy. Further comparisons were performed based on postoperative tissue pathology.Results In our series of patients, routine preoperative CT scans resulted in the discovery of details not revealed on clinical examination: some masses were found to be extra‐parotid rather than primary parotid tumors, some tumors deemed to be deep were superficial, tumor density was more clearly identified, and certain pathology correlates were clarified. Most importantly, there were instances of detection of additional tumors in the same lobe, and in one instance in the opposite lobe, that were not otherwise noticed.Conclusions To reduce errors of omission in the treatment of suspected parotid tumors, it would seem appropriate to consider the inclusion of CT scans for the routine preoperative evaluation of all parotid masses.
Value of Fine‐Needle Aspiration Cytology of Parotid Gland Masses
Authors: Zbären Peter , Schär Catherine , Hotz Michel A. , Loosli Heinz 
Published: November 2003

AbstractObjective To evaluate the usefulness and accuracy of fine‐needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.Study Design Retrospective chart review of patients undergoing FNAC.Methods Between January 1990 and December 1998, 410 parotid glands were resected at the Department of Otorhinolaryngology–Head and Neck Surgery at the University of Berne, Inselpital (Berne, Switzerland). Included in the study were 228 cases with preoperative FNAC. In a retrospective study the results of FNAC were analyzed and compared with the corresponding histopathological diagnosis.Results Histological evaluation revealed 65 malignant tumors and 163 benign lesions (150 neoplasms and 13 nonneoplastic lesions). The cytological findings were nondiagnostic in 13 (5.7%), true‐negative in 146 (64%), true‐positive in 39 (17%), false‐negative in 22 (9.8%) and false‐positive in 8 (4.5%) cases in detecting malignant tumors. Nineteen of 39 (49%) malignant tumors (true‐positive) and 123 of 146 (84%) benign lesions (true‐negative) were classified accurately. The accuracy, sensitivity, and specificity were 86%, 64%, and 95% respectively.Conclusions Fine‐needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.
Mycobacterial Infection of the Head and Neck: Presentation and Diagnosis
Authors: Al‐Serhani Awad M. 
Published: November 2003

AbstractObjective To increase the awareness of the different presentations of head and neck mycobacteriosis, especially in apparently immunocompetent patients, and discuss its diagnostic difficulties.Study Design A retrospective analysis from an otolaryngology service in a university hospital.Methods Retrospective analysis of head and neck mycobacterial infections diagnosed at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 1983 and 1997.Results The study group consisted of 75 apparently immunocompetent patients (41 female and 34 male patients). The mean age at presentation was 32.6 years. Mycobacterial cervical lymphadenitis constituted 62 cases (82.7%); pharyngeal tuberculosis, 8 cases (10.7%); and sinonasal disease, 5 cases (6.7%). The presenting complaints were neck mass in 86.3%, nasal obstruction in 5.3%, sore throat or discomfort in 5.3%, and external nasal lesion in 4% of patients. There was a history of previous tuberculosis in 10 patients (13.3%), and 5 patients (6.7%) had history of contact with infected individuals. Constitutional symptoms were recorded in 24 cases (32%). The diagnosis was established on the basis of positive smear in 26.5% of patients and on the basis of positive culture in 33.3% of patients, and caseating granuloma consistent with tuberculosis was found in all patients.Conclusion The present study is a report of a series of cases of mycobacterial infection of the head and neck in non‐immunocompromised patients. It presents diagnostic and therapeutic problems. Awareness of the different presentations, as well as development of modern, efficient diagnostic methods, is required.
A Hearing Preservation Technique for the Resection of Extensive Jugular Foramen Tumors
Authors: Kim Chang Jin , Yoo Seung Joo , Nam Soon Yuhl , Kim Sang Yoon 
Published: November 2003

AbstractObjective To describe a modified surgical approach for patients who maintain hearing function with jugular foramen tumors that extend to the posterior cranial fossa and the neck.Study Design A retrospective review of 6 patients with jugular foramen tumors that were resected by a combined suboccipital and infralabyrinthine–transcervicomastoid approach.Methods A combined suboccipital and infralabyrinthine–transcervicomastoid approach is characterized as follows: 1) There is no ablation of ear structures except the infralabyrinthine mastoid bone; the auricle is retracted anteriorly while preserving the bony wall and skin of the ear canal. 2) After superficial parotidectomy, a limited length of nerve VII from the intratemporal vertical segment is rerouted to divisions of the parotid portion. 3) The tumor is removed along with the internal jugular vein and sigmoid sinus, then the extended intracranial mass is resected through an additional suboccipital approach.Results Five of the 6 patients had complete removal of all gross tumors. There were no major complications or mortalities. The preoperative levels of hearing were preserved in 5 of the 6 patients. Favorable facial function in the immediate postoperative period was noted in 4 of the 6 patients. Incomplete paralysis of 2 patients recovered eventually.Conclusion We propose that a combined suboccipital and infralabyrinthine–transcervicomastoid approach to the jugular foramen can provide sufficient exposure to resect most dumbbell‐shaped tumors, and it could be the initial treatment of choice for patients with remnant hearing.
Early Versus Late Gold Weight Implantation for Rehabilitation of the Paralyzed Eyelid
Authors: Snyder Mary C. , Johnson Perry J. , Moore Gary F. , Ogren Frederic P. 
Published: November 2003

AbstractObjectives/Hypothesis The purpose of this study is to evaluate the outcomes and complications associated with early gold weight implantation for management of the paralyzed eyelid.Study Design A retrospective review of clinical charts was conducted to analyze results and complications in patients who underwent gold weight implantation within 30 days of onset of facial nerve paralysis and to compare these outcomes with those of patients who received gold weights after a traditional waiting period.Methods The charts of 67 patients who underwent gold weight implantation during the time period of this study were reviewed. Patients were categorized into “early” or “late” groups based on whether gold weights were implanted before or after 30 days following onset of facial nerve paralysis. Etiology of facial nerve paralysis, degree of paralysis, timing of surgery, and outcomes of the procedure, including degree of lid closure and complication rates, were compared between the two groups.Results Of the 67 patients, 49.3% underwent gold weight implantation within 30 days of onset of paralysis and 50.7% received gold weights after 30 days. A total of 89.2% of all patients who underwent implantation in this study achieved satisfactory lid closure after the initial procedure. Both early and late implantation groups had statistically similar lid closure and complication rates.Conclusions Implantation of gold weights within 30 days of paralysis is as effective for the management of paralytic lagophthalmos as delayed implantation and is not associated with higher complication rates. Early implantation of gold weights should be considered in all patients with paralytic lagophthalmos.
Complications of Static Facial Suspensions With Expanded Polytetrafluoroethylene (ePTFE)
Authors: Constantinides Minas , Galli Suzanne K. Doud , Miller Philip J. 
Published: November 2003

AbstractBackground Expanded polytetrafluoroethylene (ePTFE) is a synthetic porous material that has been used for static suspension in facial paralysis. It is manufactured in thin (1‐mm or 2‐mm) sheets that can be cut into strips and implanted through keyhole facial incisions. Regional deformities are addressed by multiple suspensions that provide cosmetic and functional therapy. The use of ePTFE eliminates donor site morbidity associated with the traditional harvest of fascia from either the temporal area or fascia lata. However, properties unique to this alloplast contribute to the complications that have occurred after its use in facial reanimation.Objective To describe complications with the use of ePTFE for facial suspension.Setting Academic medical center.Method Retrospective chart review and review of literature.Results Six patients with facial paralysis who were treated with the ePTFE sling procedure had complications. Five slings failed because of stretch despite prestretching at implantation. One patient developed a late wound infection requiring removal of the sling.Conclusion An ePTFE facial sling is an option for static facial suspension that can be therapeutic for patients with seventh nerve damage. There is a high rate of complications leading to revision surgery. Future studies are needed to evaluate alloplastic alternatives to ePTFE.
Gastroesophageal Reflux and Obstructive Sleep Apnea
Authors: Senior Brent A. , Khan Mumtaz , Schwimmer Craig , Rosenthal Leon , Benninger Mike 
Published: November 2003

AbstractObjective To determine the extent to which gastroesophageal reflux (GER)‐initiated laryngeal chemoreflexes contribute to obstructive sleep apnea (OSA).Methods Prospective, nonrandomized clinical trial of an antireflux treatment protocol as a means of reducing the severity of OSA. Population consisted of 10 males aged 20 to 64 years with confirmed OSA (by overnight polysomnography) and GER (by ambulatory pH probe monitoring). Patients were treated with omeprazole and standard antireflux protocol for 30 days and pre‐ and posttreatment polysomnography variables were compared.Results Mean apnea index declined 31% (45–31, P = .04); mean respiratory disturbance index declined 25% (62–46, P = .06). Three patients (30%) are “treatment responders” as defined by traditional OSA treatment definitions.Conclusions These results suggest a potential relationship between OSA and GER, the treatment of which may be an effective adjunctive in those with both disorders. Treatment of GER may significantly impact OSA in select individuals.