bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autonomic dysfunction, vasomotor rhinitis, and extraesophageal manifestations of gastroesophageal reflux
Authors: Loehrl Todd A. , Smith Timothy L. , Darling Ronald J. , Torrico Laura , Prieto Thomas E. , Shaker Reza , Toohill Robert J. , Jaradeh Safwan S. 
Published: February 2003

OBJECTIVESeveral recent reports suggest there may be a relationship between chronic rhinitis and extraesophageal manifestations of gastroe‐sophageal reflux (EER). It is hypothesized that this relationship is a result of autonomic nervous system (ANS) dysfunction.STUDY DESIGNPatients with isolated vasomotor rhinitis (VR), both VR and EER, and a control group were studied by a battery of tests designed to objectively evaluate ANS function. In addition all 3 groups underwent barium esophagogram and 4‐site (proximal pharynx, distal pharynx, proximal esophagus, and distal esophagus) ambulatory pH monitoring. Adult patients fulfilling diagnostic criteria for VR, and with both VR and EER underwent objective ANS testing in a recently developed ANS testing laboratory. The control group consisted of age‐ and sex‐matched adults without diagnostic criteria for VR or EER.RESULTSIn patients with VR only (n = 9), 2 patients had a positive esophagogram, whereas a positive pharyngeal reflux probe was found in 1 and an abnormal composite autonomic scoring scale (CASS) was found in 8 (mean VR CASS = 1.750 vs control CASS 0.556, P =. 02). The group with VR and EER (n = 12) had a positive esophagogram in 10 patients, positive pharyngeal reflux by probe in 9, and all 12 had an abnormal CASS (mean CASS VR/EER = 2.909 vs CASS control = 0.556, P =. 001 and vs VR CASS = 1.750, P =. 05). The control patients (n = 9) had normal transesopohageal gastroduo‐denoscopy in 8, 1 had a positive pharyngeal probe study, and all 9 had a normal CASS. In addition ANS testing in patients with diagnostic criteria for both VR/EER revealed statistically significant evidence of an adrenergic deficit as compared with control patients on the basis of mean phase II blood pressure response to Valsalva maneuver (mean phase II VR/EER = −16.730 vs control = −7.780, P =. 05). In the VR only group, the phase II blood pressure decrease was greater than in control patients, but did not reach statistical significance (mean phase II VR = −9.370 vs control = − 7.780, P = 0.672).CONCLUSIONPatients with VR and VR/EER have objective evidence of ANS dysfunction when compared with a group of age‐ and sex‐matched control patients. Patients with both VR/EER demonstrate a significantly greater degree of ANS dysfunction than patients with isolated VR. The mechanism by which VR and EER interact is not entirely clear, but ANS dysfunction is objectively associated with both disorders. In addition, patients with VR/EER seem to demonstrate hypo‐function of the adrenergic component of the ANS, in contrast to the generally held hypothesis that VR results from increased cholinergic activity. Further characterization of the type of ANS abnormality may allow the development of novel pharmacologic therapies for these disorders.
Evidence‐based medicine in otolaryngology journals
Authors: Bentsianov Boris L. , Boruk Marina , Rosenfeld Richard M. 
Published: February 2003

OBJECTIVEWe set out to assess, within the context of evidence‐based medicine, the levels of supporting evidence for therapeutic recommendations made in leading otolaryngology journals.DESIGNWe used a cross‐sectional survey of clinical research articles published in 1999 in 4 high‐circulation otolaryngology journals.OUTCOME MEASURESWe used study design methodology and level of evidence for clinical research articles with therapeutic recommendations. Outcomes were stratified by type of recommendation (positive vs negative) and by study focus (medical vs surgical therapy).RESULTSOf the 1019 articles identified, 737 (72%) were clinical research and 268 (36%) made therapeutic recommendations. Median sample size was modest (27 subjects), with only 38% of studies reflecting planned research and 22% including an internal control or comparison group. positive studies were 20 times more prevalent than negative ones, but were 69% less likely to have an internal control group (P =. 042) and 93% less likely to include confidence intervals (P =. 020). Moreover, the level of evidence for positive studies was lower than for negative studies (P =. 037), with twice as many negative recommendations supported by analytic research. Similarly, the level of evidence for operation was lower than for medical therapy (P <. 001), with 3 times as many medical recommendations supported by analytic research.CONCLUSIONSMost therapeutic recommendations in otolaryngology journals are on the basis of descriptive case series (80%) and least often on randomized controlled trials (7%). A dual standard appears to exist for negative versus positive studies and for medical versus surgical recommendations. Greater scrutiny of the breadth and quality of evidence levels supporting therapeutic recommendations is likely to occur as the popularity of—and demand for—evidence‐based medicine increases.SIGNIFICANCEEvaluation of levels of evidence in otolaryngology decision making.
Hydroxyapatite Cement Cranioplasty in Translabyrinthine Acoustic Neuroma Surgery
Authors: Arriaga Moisês A. , Chen Douglas A. 
Published: February 2003

OBJECTIVESHydroxyapatite cement cranioplasty (HAC) after translabyrinthine resection of acoustic neuroma is a promising new technique for wound reconstruction. This study reviews the efficacy of HAC for the prevention of cerebrospinal fluid (CSF) leakage and the long‐term wound outcomes of HAC versus abdominal fat graft (AFG) reconstruction.METHODSThis retrospective study of 108 consecutive acoustic neuromas operated on by Pittsburgh Ear Associates uses chart review, telephone interview, and mail questionnaire data. Fifty‐four patients received AFG dural repair, and 54 patients received HAC.RESULTSSeven AFG patients (12.5%) had CSF leaks versus 2 (3.7%) of the overall group of 54 HAC patients. However, none (0%) of the 47 HAC patients had CSF leakage with current HAC techniques. HAC also produced significantly less postauricular wound depression and superior cosmetic results in comparison with AFG. Although HAC patients experienced less postoperative discomfort, wound complications requiring medical or surgical intervention were extremely uncommon in both groups.Conclusion: HAC offers significant CSF leakage control and long‐term cosmetic and comfort advantages over AFG alone. We recommend HAC as the standard closure technique for translabyrinthine acoustic neuroma surgery.
Surfer's Ear: External Auditory Exostoses are More Prevalent in Cold Water Surfers
Authors: Kroon David F. , Lawson M. Louise , Derkay Craig S. , Hoffmann Karen , McCook Joe 
Published: February 2003

OBJECTIVEThe study goal was to demonstrate the prevalence and severity of external auditory exostoses (EAEs) in a population of surfers and to examine the relationship between these lesions and the length of time surfed as well as water temperature in which the swimmers surfed. It was hypothesized that subjects who predominantly surfed in colder waters had more frequent and more severe exostoses.METHODSTwo hundred two avid surfers (91% male and 9% female, median age 17 years) were included in the study. EAEs were graded based on the extent of external auditory canal patency; grades of normal (100% patency), mild (66% to 99% patency), and moderate‐severe (<66% patency) were assigned. Otoscopic findings were correlated with data collected via questionnaires that detailed surfing habits.RESULTSThere was a 38% overall prevalence of EAEs, with 69% of lesions graded as mild and 31% graded as moderate‐severe. Professional surfers (odds ratio 3.8) and those subjects who surfed predominantly in colder waters (odds ratio 5.8) were found to be at a significantly increased risk for the development of EAEs. The number of years surfed was also found to be significant, increasing one's risk for developing an exostosis by 12% per year and for developing more severe lesions by 10% per year. Individuals who had moderate‐severe EAEs were significantly more likely to be willing to surf in colder waters than were those who had mild EAEs (odds ratio 4.3).CONCLUSIONSEAEs are more prevalent in cold water surfers, and additional years surfing increase one's risk not only for developing an EAE but also for developing more severe lesions.
Maxillary Sinus Puncture and Culture in the Diagnosis of Acute Rhinosinusitis: The Case for Pursuing Alternative Culture Methods
Authors: Benninger Michael S. , Appelbaum Peter C. , Denneny James C. , Osguthorpe David J. , Stankiewicz James A. 
Published: February 2003

OBJECTIVETraditional assessments of the microbial flora associated with acute bacterial rhinosinusitis have relied on maxillary sinus punctures (taps) and culture. These taps are now considered the gold standard for obtaining cultures and are used as the method of identifying bacterial pathogens in antimicrobial trials. Maxillary sinus taps are limited by discomfort to the patients and technical concerns. Because of these factors, the standard of performing taps has limited antibiotic trials and microbial surveillance. Alternatives to maxillary sinus taps have been explored.STUDY DESIGNWe conducted a retrospective, systematic review of the literature from 1950 to 2000 of articles comparing culture techniques in the nose and paranasal sinuses for acute bacterial rhinosinusitis.RESULTSNasal cultures have poor correlation to maxillary sinus cultures, whereas there is 60% to 85% concordance between endoscopically guided middle meatal cultures and maxillary sinus cultures. These studies, however, are all limited by small sample sizes and therefore are inadequate to make any concrete recommendations regarding the relative role of endoscopically guided middle meatal cultures as a formal method of pathogen identification in acute bacterial rhinosinusitis.CONCLUSIONA formal prospective study with sufficient sample size to assess the concordance between the microbial flora of the maxillary sinus punctures and middle meatal cultures in acute rhinosinusitis is recommended.
Immune Mediators in Allergic Rhinitis and Sleep
Authors: Krouse Helene J. , Davis Jean E. , Krouse John H. 
Published: February 2003

OBJECTIVEOur study goal was to examine polysomnography, indices of sleep and allergy, and serum and nasal cytokines in allergic and nonallergic subjects.STUDY DESIGN AND SETTINGIn this descriptive, exploratory study, 4 allergic and 4 nonallergic subjects underwent 2 nights of polysomnographic recording with serial measurements of cytokines and completed measures of sleep quality and allergic symptoms.RESULTSThree serum cytokines (interleukin (IL)‐1β, IL‐4, and IL‐10) were higher in allergic subjects and were termed proallergic. Three serum cytokines (IL‐1ra, IL‐2, and IL‐12) were higher in nonallergic subjects and were termed allergy inhibitory. Proallergic serum cytokines correlated with increased latency to rapid eye movement sleep, decreased time in rapid eye movement sleep, and decreased latency to sleep onset. Low levels of allergy‐inhibitory serum cytokines were associated with increased allergic symptoms.CONCLUSIONSDifferences in serum cytokines between allergic and nonallergic individuals are associated with variations in polysomnography and allergic symptoms.SIGNIFICANCEUnderstanding these mechanisms may suggest novel approaches to alleviating drowsiness and other symptoms in allergic patients.
Expression of p63 and 14‐3‐3σ in Normal and Hyperdifferentiated Mucosa of the Upper Aerodigestive Tract
Authors: Sniezek Joseph C. , Matheny Keith E. , Burkey Brian B. , Netterville James L. , Pietenpol Jennifer A. 
Published: February 2003

OBJECTIVEOur goal was to analyze p63 and 14‐3‐3σ expression in normal and hyperdifferentiated head and neck mucosa.STUDY DESIGNCompare the in vivo expression of p63 and 14‐3‐3σ by immunohistochemistry in normal mucosa and oral lichen planus, a benign mucosal lesion marked by hyperdifferentiation and apoptosis.RESULTS AND CONCLUSIONp63 is underexpressed and 14‐3‐3σ is overexpressed in lichen planus on immunohistochemical analysis.SIGNIFICANCEThe findings support the hypothesis that p63 plays an antidifferentiation role, whereas 14‐3‐3σ plays a prodifferentiation role in the upper aerodigestive tract epithelium. Lichen planus is a valuable model for the study of p63, 14‐3‐3σ, and mucosal differentiation. p63 and 14‐3‐3σ may be molecular markers for oral lichen planus.
Adenotonsillar Enlargement in Pediatric Organ Transplant Recipients: A Cross‐Sectional Analysis
Authors: Chiang Scott , Chau Vu Minh , Nguyen Mychelle , Strocker Ali , Horvath Stefan , Shapiro Nina 
Published: February 2003

OBJECTIVEOur goal was to statistically correlate adenotonsillar hypertrophy (ATH) in the pediatric posttransplant population with potential risk factors and to monitor the progression of ATH over time.STUDY DESIGN AND SETTINGParticipants were evaluated for ATH through a standardized 65‐point questionnaire and an 8‐point physical examination. They were also evaluated for current age, age at time of transplantation, type of organ transplant, gender, tacrolimus use, history of transplant rejection, Epstein‐Barr virus (EBV) serology, and cytomegalovirus (CMV) serology. We evaluated 243 pediatric solid organ transplant recipients, with 116 patients undergoing repeat evaluation.RESULTSA statistically significant negative correlation was noted between age at time of transplantation and both questionnaire scores (P = 0.0075) and examination scores (P = 0.013). A significant negative correlation was also seen between age at time of evaluation and questionnaire score (P = 0.028) but not examination score (P = 0.49). Recipient EBV seronegativity significantly increased questionnaire score (P = 0.05). Liver transplant recipients also had a significantly higher questionnaire score than did kidney transplant recipients (P = 0.0048). Gender, CMV recipient status, and tacrolimus (immunosuppressant) use did not significantly impact questionnaire or examination scores. Repeat evaluation of 116 patients after a 2‐to 9‐month interval did not demonstrate any significant increases in questionnaire scores. A statistically significant drop in examination scores was noted (P = 0.003).CONCLUSIONS AND SIGNIFICANCEThese findings support previous reports in the literature that correlate EBV seronegativity, younger age at transplant, and liver versus kidney transplantation with increased incidence of PTLD.
Clinical Staging for Sleep‐Disordered Breathing
Authors: Friedman Michael , Ibrahim Hani , Bass Lee 
Published: February 2003

OBJECTIVEThe purpose of this study was to identify prognostic indicators that would lead to stratification of patients likely to have successful surgery for sleep‐disordered breathing (SDB) versus those destined to fail.STUDY DESIGNWe retrospectively reviewed 134 patients to correlate palate position and tonsil size to the success of the UPPP as based on postoperative polysomnography results. Similar to our previously published data on the Friedman Score as a predictor of the presence and severity of SDB, the palate position was determined on physical examination of the oral cavity and was graded for each patient. This grade combined with tonsil size was used to stage the patients. Stage I was defined as having palate position 1 or 2 combined with tonsil size 3 or 4. Stage II was defined as having palate position 3 or 4 and tonsil size 3 or 4. Stage III patients had palate position 3 or 4 and tonsil size 0, 1, or 2. Any patient with body mass index of greater than 40 was placed in the stage III group. The results of uvulopalatopharyngoplasty (UPPP) were then graded as success or failure and success rates were compared by stage.SETTINGAcademically affiliated tertiary care referral center.RESULTSStage I patients who underwent UPPP had a success rate of 80.6%, stage II patients had a success rate of 37.9%, and stage III patients had a success rate of 8.1%.CONCLUSIONA clinical staging system for SDB based on palate position, tonsil size, and body mass index is presented. It appears to be a valuable predictor of the success of UPPP. Additional studies and wider use of the staging system will ultimately define its role in the treatment of SDB.
Virtual Temporal Bone Dissection: An Interactive Surgical Simulator
Authors: Wiet Gregory J. , Stredney Don , Sessanna Dennis , Bryan Jason A. , Welling D. Bradley , Schmalbrock Petra 
Published: February 2003

OBJECTIVEOur goal was to integrate current and emerging technology in virtual systems to provide a temporal bone dissection simulator that allows the user interactivity and realism similar to the cadaver laboratory.STUDY DESIGNIterative design and validation of a virtual environment for simulating temporal bone dissection.SETTINGUniversity otolaryngology training program with interdisciplinary interaction in a high‐performance computer facility.RESULTSThe system provides visual, force feedback (haptic), and aural interfaces. Unlike previous “fly through” virtual systems, this environment provides a richer emulation of surgical experience.CONCLUSIONThe system provides a high level of functional utility and, through initial evaluations, demonstrates promise in adding to traditional training methods.SIGNIFICANCEThe system provides an environment to learn temporal bone surgery in a way similar to the experience with cadaver material where the subject is able to interact with the data without constraints (nondeterministic). Eventually, it may provide the “front end” to a large repository of various temporal bone pathologies that can be accessed through the Internet.
Fungus‐Specific IgG and IgE in Allergic Fungal Rhinosinusitis
Authors: Stewart Alexander E. , Hunsaker Darrell H. 
Published: February 2003

OBJECTIVEOur study goal was to study fungus‐specific immunoglobulins G (sIgG) and E (sIgE) in polypoid rhinosinusitis with and without evidence of allergic fungal rhinosinusitis (AFS).STUDY DESIGN AND SETTINGA prospective analysis was conducted of fungal sIgG and sIgE using a 9‐mold RAST panel in 13 AFS, 11 AFS‐like, and 27 non‐AFS polypoid rhinosinusitis patients. Nonpolyp controls included 17 volunteers with allergic rhinitis and 11 with no atopic history.RESULTSAll groups had elevated fungal sIgG levels. Polyps, increasing polyp severity, and AFS were associated with elevated fungal sIgG to a greater number of molds. The AFS group had sIgE elevations (≥class II) to an average of 5 molds versus only 0.1 in the non‐AFS polyp group. Total IgE was 971 U/mL versus 64 U/mL, respectively.CONCLUSIONSMultiple elevations of fungal sIgE are adequate diagnostic evidence of these fungi when fungal cultures and histologic examinations are negative in diagnosing AFS. The significance of increased fungal sIgG remains unclear.SIGNIFICANCEEarly recognition of AFS may be facilitated by screening polypoid rhinosinusitis patients with total serum IgE and RAST testing.
Transoral Radiofrequency Treatment of Snoring
Authors: Johnson Jonas T. , Pollack Gabrielle L. , Wagner Robin L. 
Published: February 2003

OBJECTIVES/HYPOTHESISRadiofrequency ablation (RFA) may effectively treat snoring with acceptable patient tolerance.STUDY DESIGNA cohort of patients with unacceptable snoring underwent RFA to the soft palate between October 1997 and May 2000. Before the therapy, a family member or significant other person was interviewed to rate snoring loudness.METHODSSnoring was rated on a visual analog scale of 0 to 10 (in which 0 was no snoring and 10 was horrific snoring) before and after therapy. All patients were treated with transoral RFA administered under local anesthesia at 6‐week intervals.RESULTSComplete data were available for 60 of the 75 treated patients. The average number of treatment sessions per patient was 1.8. These patients received an average energy of 1845 J. Overall the average snoring score was 8.9 before therapy and 3.5 after therapy. Fifty‐one patients (85%) were considered to have major improvement in snoring loudness. A total of 9 patients (15%) were nonresponders.CONCLUSIONSRFA to the soft palate is a viable option to treat socially unacceptable snoring. Inadequate response to therapy may reflect misdiagnosis or delivery of an insufficient amount of energy.
Temperature‐Controlled Radiofrequency Tongue Base Reduction for Sleep‐Disordered Breathing: Long‐Term Outcomes
Authors: Li Kasey K. , Powell Nelson B. , Riley Robert W. , Guilleminault Christian 
Published: February 2003

OBJECTIVEOur goal was to evaluate the long‐term outcomes of temperature‐controlled radiofrequency reduction of the tongue base in sleep‐disordered breathing.METHODSThe 18 patients from our initial pilot study were reevaluated. Clinical examinations, polysomnography (PSG), questionnaires, visual analog scales, and a comparative SF‐36 were used to assess long‐term outcomes.RESULTSSixteen of the original 18 patients completed this study; 2 patients were lost to follow‐up. The mean follow‐up was 28 months. There was a mean weight increase of 3.1 ± 7.9 kg. The original pretreatment Respiratory Disturbance Index (RDI) was a mean of 39.5 with a mean mean oxygen saturation nadir (LSAT) of 81.9%, and the posttreatment RDI was a mean of 17.8 with a mean LSAT of 88.3%. Follow‐up PSG data showed a persistent improvement of the mean Apnea Index compared with pretreatment (5.4 vs 22.1) without significant changes compared with posttreatment (4.1). However, there were changes in the follow‐up Hypopnea Index (HI) of 22.9 compared with the pretreatment and posttreatment HI values of 17.4 and 13.6, respectively. This resulted in a relapse of the RDI from a posttreatment value of 17.8 to 28.7. The LSAT also worsened from 88.3% to 85.8%. However, there was no significant deterioration in the quality‐of‐life measurements by SF‐36 or in daytime sleepiness by Epworth Sleepiness Scale.CONCLUSIONThe success of temperature‐controlled radiofrequency tongue base reduction for sleep‐disordered breathing may reduce with time. PSG demonstrated that long‐term relapse is primarily reflected in the HI without significant detrimental effects on the patient's quality of life (SF‐36) and sleepiness (Epworth Sleepiness Scale). Continual evaluation of this treatment modality is warranted.
DNA Microarrays in Otolaryngology‐Head and Neck Surgery
Authors: Whipple Mark Eliot , Kuo Winston Patrick 
Published: February 2003

OBJECTIVESOur goal was to review the technologies underlying DNA microarrays and to explore their use in otolaryngology‐head and neck surgery.STUDY DESIGNThe current literature relating to microarray technology and methodology is reviewed, specifically the use of DNA microarrays to characterize gene expression. Bioinformatics involves computational and statistical methods to extract, organize, and analyze the huge amounts of data produced by microarray experiments. The means by which these techniques are being applied to otolaryngology‐head and neck surgery are outlined.RESULTSMicroarray technologies are having a substantial impact on biomedical research, including many areas relevant to otolaryngology‐head and neck surgery.CONCLUSIONSDNA microarrays allow for the simultaneous investigationof thousands of individual genes in a single experiment. In the coming years, the application of these technologies to clinical medicine should allow for unprecedented methods ofdiagnosis and treatment.SIGNIFICANCEThese highly parallel experimental techniques promise to revolutionize gene discovery, disease characterization, and drug development.