bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proton Pump Inhibitor Resistance in the Treatment of Laryngopharyngeal Reflux
Authors: Amin Milan R. , Postma Gregory N. , Johnson Paul , Digges Nicholas , Koufman James A. 
Published: February 2003

OBJECTIVETo describe the occurrence of relative proton pump inhibitor (PPI) drug resistance in the treatment of laryngopharyngeal reflux (LPR).STUDY DESIGN AND SETTINGA retrospective review was performed for 1053 consecutive adults undergoing double‐probe (simultaneous esophageal and pharyngeal) pH testing in our laboratory. Two hundred five patients who had pH studies performed while taking at least a daily dose of PPI therapy were identified; 167 qualified for further analysis. The pH data was reviewed for the presence of abnormalities in either esophageal or pharyngeal acid exposure to evaluate drug efficacy.RESULTSForty‐four percent (74/167) of the study patients demonstrated abnormal levels of acid exposure. Results were further analyzed to compare failure rates based on different dosage regimens. Patients on once daily doses of PPI failed at a rate of 56%, with lower failure rates for higher‐dose regimens.CONCLUSIONSA significant number of LPR patients on PPI therapy demonstrate relative drug resistance.
Implications of Sound Levels Generated by Otologic Devices
Authors: Michaelides Elias M. , Kartush Jack M. 
Published: February 2003

OBJECTIVEExposure to loud noise can result in sensorineural hearing loss. In otology, a wide variety of devices are used that have significant noise output, both to the operator and the patient. This study quantifies and compares the sound pressure levels (SPL) of a variety of otologic instruments.METHODSUsing a calibrated sound pressure level meter, the peak and impulse sound pressure levels of several otologic instruments were determined at 1 cm from their application to human temporal bones. Devices measured were an air‐powered drill with a cutting burr, an electric micro‐drill, and KTP, CO2, and erbium lasers.RESULTSImpulse sound pressure levels for the KTP laser, CO2 laser, microdrill, air‐powered drill and erbium laser were 67, 71, 90, 105, and 105 dBA, respectively. Peak sound pressure levels were 81, 89, 102, 118, and 132 dBA, respectively.CONCLUSIONSUse of the KTP laser, CO2 laser, and microdrill result in impulse levels of less than 100 dBA. Although the impulse levels of the erbium laser and the air‐powered drill were equivalent, the peak sound pressure levels of the erbium laser were significantly higher. These high sound pressure levels may increase the chance for hearing loss.Like any tool, lasers and drills have benefits and risks. The results of this study demonstrate significant differences in SPLs of common otologic lasers and drills. Although noise‐induced hearing loss is a function of both SPL and duration of exposure, surgeons should consider these differences when selecting and applying these tools, especially when used on or adjacent to the ossicular chain and stapes footplate.
Bariatric Surgery for Treatment of Sleep Apnea Syndrome in 15 Morbidly Obese Patients: Long‐Term Results
Authors: Scheuller Michael , Weider Dudley 
Published: February 2003

OBJECTIVETo evaluate the long‐term outcomes of bariatric surgery with respect to respiratory disturbance index (RDI) in sleep apnea syndrome (SAS).DESIGNCase series with long‐term follow‐up (1 to 12 years).SETTINGPrivate clinic in an academic tertiary referral center.PATIENTSFifteen morbidly obese patients (10 men, 5 women) who were referred for the treatment of severe SAS.INTERVENTIONFor all 15 patients who presented with severe SAS, nasal positive airway pressure breathing was either not available or was not tolerated by the patient; therefore, bariatric surgery was performed as a means of treatment for SAS.MAIN OUTCOME MEASURESRDIs and minimum oxygen saturation were measured both preoperatively and postoperatively (1 to 12 years after surgery).RESULTSWeight loss ranged from 60 to 220 pounds (27 to 100 kg). RDI decreased by at least 55% in each patient, and all patients with tracheostomies (8 of 15) had their tracheostomy tubes removed. Average RDI preoperatively was 96.9 and average RDI postoperatively was 11.3. Results were similar for all 15 patients in that minimum oxygen saturation increased during sleep from an average preoperative minimum oxygen saturation of 58.7% to an average postoperative minimum oxygen saturation of 85.2%.CONCLUSIONSBariatric surgery as a means of treating SAS in the morbidly obese provides effective long‐term reduction in RDI. Bariatric surgery also significantly improves minimum oxygen saturation in morbidly obese patients with SAS. Biliopancreatic bypass is more effective in reducing RDI to normal values than vertical banded gastroplasty.
Late‐Phase Allergy and Eustachian Tube Dysfunction
Authors: Hardy Stuart M , Heavner S. Brett , White David R. , Mcqueen Chapman T. , Prazma Jiri , Pillsbury Harold C. 
Published: February 2003

OBJECTIVEThis study investigated the role of late‐phase allergy in the development of otitis media with effusion.METHODSBrown Norway rats were sensitized to ovalbumin and later challenged transtympanically. Eustachian tube ventilatory function was assessed 2, 4, 8, 24, 28, and 32 hours postchallenge by measuring passive opening and closing pressures, active clearance of positive and negative middle ear pressure, and mucociliary clearance.RESULTSThe results demonstrate that exposure to transtympanic allergen induces eustachian tube dysfunction and subsequent formation of effusion. Allergic animals showed significant increases in passive and active opening pressures, as well as a decreased ability to actively clear middle ear pressure. Finally, the mucociliary was significantly impaired in all sensitized rats exposed to transtympanic allergen.CONCLUSIONThese findings demonstrate that late‐phase allergy leads to significant eustachian tube dysfunction and subsequent formation of effusion by impairing the ventilatory and clearance functions of the eustachian tube.
Temperature‐Controlled Radiofrequency Tonsil Reduction: Extended Follow‐Up
Authors: Nelson Lionel M. 
Published: February 2003

OBJECTIVEInitial evaluation has shown that temperature‐controlled radiofrequency submucosal tonsil reduction (Tonsil Somnoplasty) effectively treats obstructive symptoms of tonsillar hypertrophy with minimal associated discomfort and rapid return to normal activity and diet. This study assesses the effects of treatment over an extended follow‐up period of up to a year.STUDY DESIGNTwelve adults with symptomatic chronic tonsil enlargement underwent an average of 1.5 treatments. Evaluation included periodic oropharyngeal airway measurements, and questionnaires on treatment morbidity and symptom improvement.RESULTSData on 12 patients at 3 months and 6 months, and 5 patients at 1 year show sustained increases in oropharyngeal airway size (1.7 cm/3 mo, 1.8 cm/6 mo, 2.4 cm/12 mo) and reduction in obstructive symptoms (Epworth Score decrease of 70%/3 mo, 58%/6 mo, 67%/12 mo; snoring reduction of 81%/3 mo, 79%/6 mo, 78%/12 mo) without significant differences after 3 months. A second treatment reduced tonsil size but gave variable further symptom improvement.CONCLUSIONThe effects of Tonsil Somnoplasty are maintained on follow‐up to 1 year.
Intratympanic Dexamethasone, Intratympanic Gentamicin, and Endolymphatic Sac Surgery for Intractable Vertigo in Meniere's Disease
Authors: Sennaroglu Levent , Sennaroglu Gonca , Gursel Bulent , Dini Farzin Mottaghian 
Published: February 2003

OBJECTIVETo compare the efficacy of intratympanic dexamethasone (ID), intratympanic gentamicin (IG), and decompression of the endolymphatic sac (ESD) for intractable vertigo in Meniere's disease.STUDY DESIGN AND SETTINGThis prospective study was conducted at Hacettepe University Medical Faculty, a tertiary care center. Dexamethasone was applied through a ventilation tube in 24 patients, intratympanic gentamicin (also through a ventilation tube) to 16 patients, and 25 patients underwent ESD.RESULTSSatisfactory control of vertigo was 72%, 75%, and 52%, respectively for the ID, IG, and ESD. Two patients in the gentamicine group had total hearing loss. In the dexamethasone group, hearing level remained the same in 46% of the patients with 16% increase and 38% decrease (30% 10dB and 8% 20 dB).CONCLUSIONIf the vertiginous symptoms still persist after 6 months of medical treatment, ID can be started. If there is no further improvement after 3 months with ID, patients with profound sensorineural hearing loss undergo treatment with IG, ESD is reserved for patients with good hearing. If ESD also fails, patients with good hearing may undergo vestibular nerve section; patients with nonservicable hearing become candidates for labyrinthectomy.
Emerging Perceptions of Facial Plastic Surgery Among Medical Students
Authors: Rosenthal Eben , Clark J. Madison , Wax Mark K. , Cook Ted A. 
Published: February 2003

OBJECTIVEThe purpose of this study was to examine the perceptions of medical students regarding facial aesthetic surgery and those specialists most likely to perform aesthetic or reconstructive facial surgery.METHODSA survey was designed based on a review of the literature to assess the desirable characteristics and the perceived role of the facial plastic and reconstructive surgeon (FPRS). The surveys were distributed to 2 populations: medical students from 4 medical schools and members of the general public.RESULTSA total of 339 surveys were collected, 217 from medical students and 122 from the general public. Medical students and the public had similar responses. The results demonstrated that respondents preferred a male plastic surgeon from the ages of 41 to 50 years old and would look to their family doctor for a recommendation. Facial aesthetic and reconstructive surgery was considered the domain of maxillofacial and general plastic surgeons, not the FPRS.CONCLUSIONIntegration of the FPRS into the medical school curriculum may help to improve the perceived role of the specialty within the medical community. It is important for the specialty to communicate to aspiring physicians the dedicated training of an otolaryngologist specializing in FPRS.
Complications of Radiofrequency Ablation in the Treatment of Sleep‐Disordered Breathing
Authors: Pazos George , Mair Eric A. 
Published: February 2003

OBJECTIVETo evaluate complications of radiofrequency ablation (RFA) in the treatment of sleep‐disordered breathing and to outline complication avoidance strategies.STUDY DESIGN AND SETTINGRetrospective review of 51 consecutive RFA treatment sessions for SDB to the soft palate and tongue base by a single surgeon at a tertiary medical center.RESULTSOver 2 years, 51 treatments comprising 26 palatal and 25 tongue base RFA treatments were performed for sleep‐disordered breathing on 30 patients. Complications included palatal mucosal breakdown (11 cases), temporary tongue base neuralgias (4 cases), uvular sloughing (2 cases), tongue base abscesses (2 cases), and floor of mouth edema with airway compromise (2 cases). CONCLUSIONS/SIGNIFICANCE: This is the first paper focusing on complications of RFA. While complications from soft palate RFA present rapidly and are self‐limiting, complications from tongue base RFA may be delayed and life threatening. A detailed strategy is provided to avoid and treat these complications.
Investigation of Skeletal Muscle Denervation and Reinnervation Using Magnetic Resonance Spectroscopy
Authors: Dort Joseph C. , Fan Yan , McIntyre Deane D. 
Published: February 2003

OBJECTIVETo determine changes in skeletal muscle metabolism after nerve transection and repair and to correlate metabolic changes with functional recovery.STUDY DESIGN AND SETTINGMale Wistar rats were divided into 6 experimental groups plus a control group. The posterior tibial nerve was transected and reapproximated. At varying times after surgery (1, 2, 4, 6, or 8 weeks) animals were sacrificed, the gastrocnemius muscle was harvested, and proton nuclear magnetic resonance (NMR) spectroscopy was performed. Functional recovery was measured using the sciatic function index.RESULTSAnimals undergoing nerve repair all showed functional recovery whereas the nonrepaired nerve group did not. Concentration of glucose and lactate increased after denervation and then returned toward normal. Choline concentration decreased and then returned toward normal. In animals not undergoing nerve repair, the metabolic abnormalities persisted and showed no sign of recovery over the 8‐week observation period.CONCLUSIONS1H NMR spectroscopy is a potentially useful tool to study changes in skeletal muscle metabolism after motor nerve injury.SIGNIFICANCENMR spectroscopy is rapidly developing into a clinically useful tool. High‐field magnets have improved resolution and data acquisition. Basic experiments, such as those described here, will help guide the use of NMR spectroscopy in clinical medicine and will also lead to a better understanding of basic mechanisms of nerve injury and repair.
Molecular Typing of Paired Bacterial Isolates From the Adenoid and Lateral Wall of the Nose in Children Undergoing Adenoidectomy: Implications in Acute Rhinosinusitis
Authors: Bernstein Joel M. , Dryja Diane , Murphy Timothy F. 
Published: February 2003

OBJECTIVERecent studies have suggested that the origin of bacteria that enter the lateral wall of the nose and paranasal sinuses arise from the nasopharynx. The purpose of this study was to compare the molecular biological profiles of potential pathogens found in the nasopharynx and lateral wall of the nose concomittantly in children undergoing surgery for upper respiratory tract disease.STUDY DESIGN AND SETTINGFifty‐two children undergoing adenoidectomy for either tonsillectomy or adenoidectomy (hypertrophy) or otitis media with effusion were studied. Bacterial cultures were taken from the crypts of the adenoids and from the lateral wall of the nose under endoscopic control after sterilization of the vestibule and inferior turbinate. Routine cultures of these areas were performed in the bacteriology laboratory of the Children's Hospital of Buffalo.RESULTSBacterial pathogens were isolated from 79% of adenoids and 46% of lateral walls of the nose. Molecular typing of pairs of nontypable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis revealed that in 16 of 18 pairs (89%) the identical strain was present in both sites simultaneously.CONCLUSIONSThese results support the concept that when potential bacterial pathogens that may cause acute bacterial rhinosinusitis are found con‐comitantly in the nasopharynx and lateral wall of the nose, they are usually identical.
The Evaluation of Rhytidectomy Flap Healing After CO2 Laser Resurfacing in a Pig Model
Authors: Park Gregory C. , Wiseman Joe B. , Hayes David K 
Published: February 2003

OBJECTIVEThis study was conducted to determine when it becomes safe to perform laser resurfacing after rhytidectomy flap elevation.STUDY DESIGNEighty‐four sites on 12 domestic Yorkshire pigs were selected; 4 × 10‐cm skin flaps were elevated in 72 of the 84 sites and shortened 10%. The 12 remaining sites (controls) were treated with laser resurfacing alone. Laser resurfacing was also performed at days 0, 7, 14, 21, and 28 after closing the skin flaps. The healing time for the laser‐resurfaced sites without flap elevation were compared to that of the skin flaps treated with the laser at days 0, 7, 14, 21, and 28. Twelve “skin flap” controls were elevated, shortened 10%, and closed without laser treatment. Resurfacing was performed using 2 passes with the Sharplan Silk Touch CO2 laser.RESULTSThe average healing time for the skin flaps treated with the laser at day 0 was 23.9 days. All of these flaps showed skin slough with delayed healing followed by scar formation. The areas treated with the laser alone (controls), and the subsequent skin flaps treated with the laser postoperatively at days 7, 14, 21, and 28 days completely re‐epithelialized in an average of 7.8, 8.1, 7.3, 7.4, and 7.3 days, respectively. There were no statistically significant differences in healing time between the controls and flaps treated with the laser on or after 7 days (P > 0.05). However, there were statistically significant differences in healing time between the laser‐treated skin flaps at day 0 and the controls, between the laser‐treated flaps on day 0 and day 7, and between the laser‐treated flaps on day 0 and day 14 (P < 0.001). Because there was little difference in healing time after 14 days, only the healing times for laser‐treated skin flaps up to 14 days were compared using paired t tests.CONCLUSIONSFrom our observations using a pig model, we conclude that skin flaps may be safely laser resurfaced about 1 week postoperatively. On the other hand, simultaneous flap elevation and laser resurfacing results in delayed healing with subsequent scar formation.
Transcolumellar Approach in Transsphenoidal Pituitary Surgery for Patients with Small Nostril
Authors: Kim Sun Ho , Yoon Joo‐Heon , Choi Joong Uhn , Chung Sang Sup , Lee Kyu Chang 
Published: February 2003

OBJECTIVESublabial approach has been widely used as the standard technique for transsphenoidal pituitary surgery. But it has several possible drawbacks, such as; postoperative flat nose deformity, hypesthesia of upper gum, and feeding difficulty until 2 to 3 weeks after surgery. As an alternative, an endonasal approach was adopted for patients who had large nostrils, such as white or acromegalic patients. In patients with small nostrils, especially oriental people, it requires an additional tension release incision that leaves a definitely visible scar at the base of nose.STUDY DESIGNWe applied the transcolumellar approach, which modified the external rhinoplasty approach on the 136 cases of transsphenoidal pituitary surgery that were performed from 1994 to June 1999.RESULTSIn all patients, we found we could reach the anterior portion of nasal septum in 7 to 8 mm in depth from the skin surface and eliminate the disadvantages of sublabial and endonasal approach. Also, this method can markedly reduce the surgical dissection time and blood loss.CONCLUSIONSWe concluded that this technique was relatively simple and more than adequate in most transsphenoidal pituitary surgery, even in patients with small nostrils.
An Anatomic Classification of the Ethmoidal Bulla
Authors: Setliff Reuben C. , Catalano Peter J. , Catalano Lisa A. , Francis Chad 
Published: February 2003

OBJECTIVEThe ethmoid bone is arguably the most complex and varied osseous structure in the human body. The partitions within form a unique labyrinth of lamellae and spaces from specimen to specimen or, as in this study, from patient to patient. The surgical anatomy of the ethmoid bone, and the ethmoidal bulla in particular, is ill‐defined and heretofore largely unclassified. In an attempt to better understand the ethmoid labyrinth, a prospective anatomic study of 107 patients undergoing primary intranasal endoscopic ethmoidectomy was undertaken.STUDY DESIGNTwo hundred fourteen ethmoidal bullae were dissected intraoperatively with video‐documentation obtained in over 90% of cases. Based on these dissections, the compartments or cells formed by the partitioning within the ethmoidal bulla and the respective communication with adjacent spaces were the parameters used to develop the classification system.SETTINGPrivate midwestern rhinologic referral practice.RESULTSThree main categories of ethmoidal development were identified: simple, compound, and complex. Forty‐seven percent of bullae were of the simple type, 26% were compound, and 27% complex. Sixty‐eight percent of ethmoidal bullae had a single opening into the hiatus semilunaris superior; 6 (2.8%) ethmoidal bullae had a single anterior opening to the ethmoidal infundibulum. The remaining 28.7% had multiple cells with multiple openings, at least 1 of which opened into the hiatus semilunaris superior 98.4% of the time. There was a cell in the complex bulla opening anteriorly to the ethmoidal infundibulum in 46.5%. In 58% of cases, there was symmetry from side to side.CONCLUSIONA novel anatomic classification for the ethmoidal bulla is presented, with examples of the 3 types of sinus development encountered. We believe that understanding ethmoid sinus anatomy and potential drainage pathways is a core principle to functional sinus surgery.
Radiofrequency versus Laup for the Treatment of Snoring
Authors: Blumen Marc B. , Dahan Serge , Wagner Isabelle , De Dieuleveult Thibault , Chabolle Frédéric 
Published: February 2003

OBJECTIVETo compare efficacy and tolerance of controlled temperature radiofrequency and laserassisted uvulopalatopharyngoplasty (LAUP) for the treatment of snoring.METHODSThis was a prospective, nonrandomized study on 30 patients who snored. All patients had a sleep night study. Only patients with simple snoring or mild sleep apnea and soft palate obstruction were included. Efficacy was subjectively evaluated by the bed partner 2 months after the last treatment. Tolerance was estimated daily by the patient during 18 first postoperative days. Discomfort, pain, medication intake, diet, and number of days off from work were assessed.RESULTSBoth treatments were effective on snoring. Mean discomfort and pain as well as mean intake of analgesics were significantly greater with laserassisted uvulopalatopharyngoplasty.CONCLUSIONControlled temperature radiofrequency was as effective as laser‐assisted uvulopalatopharyngoplasty on snoring on a short‐term basis but was better tolerated.
Rhinolithiasis: A Forgotten Entity
Authors: Hadi Usamah , Ghossaini Soha , Zaytoun George 
Published: February 2003

OBJECTIVETo review the clinical presentation of patients with rhinoliths, which are calcareous concretions with an unclear pathogenesis.STUDY DESIGN AND SETTINGUsing retrospective chart review we analyzed clinical, radiological, and demographic data as well as our diagnostic work‐up and management of 8 patients.RESULTSMost patients presented with nonspecific nasal complaints; most commonly, purulent rhinorrhea and nasal obstruction. The rhinolith was discovered incidentally in some patients.CONCLUSIONRhinoliths are rare and can have various clinical presentations. The treatment of choice is surgical removal.SIGNIFICANCEA high index of suspicion is required for the diagnosis of such a forgotten entity.
Bell's Palsy in Pregnancy: A Study of Recovery Outcomes
Authors: Gillman Grant S. , Schaitkin Barry M. , May Mark , Klein Susan R. 
Published: February 2003

OBJECTIVETo study facial nerve recovery in patients with Bell's palsy of pregnancy compared with that of the nonpregnant population.METHODSA retrospective chart analysis was conducted of all patients seen within 6 weeks of the onset of Bell's palsy of pregnancy, with a minimum of 1‐year follow‐up. Recovery outcomes were compared with similarly chosen randomly selected groups of nonpregnant females 15 to 40 years old (group 1), nonpregnant females of all ages (group 2), males 15 to 40 years old (group 3), and males of all ages (group 4), all of whom were also seen within 6 weeks of onset. Recovery was categorized as satisfactory (House‐Brackmann grade I to II) or unsatisfactory (House‐Brackmann grade III or IV). The 2‐tailed Fisher exact test was used to statistically analyze differences between groups.RESULTSFifty‐two percent of women with Bell's palsy of pregnancy whose facial palsy progressed to complete paralysis within 10 days of onset recovered to a satisfactory level compared with 77% to 88% of comparison patients. These differences were statistically significant in all cases. Recovery for those with an incomplete palsy was satisfactory in virtually 100% of all patients studied.CONCLUSIONThe prognosis for a satisfactory recovery for women who develop a complete facial paralysis with Bell's palsy while pregnant is significantly worse than for that for the general population. This information should be taken into consideration by all physicians involved in the counseling of these patients.