bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Chronic Rhinosinusitis Refractory to Other Treatments with Topical Antibiotic Therapy Delivered by Means of a Large‐Particle Nebulizer: Results of a Controlled Trial
Authors: Desrosiers Martin Y. , Salas‐Prato Milagros 
Published: February 2003

OBJECTIVETo study the efficacy of nebulized topical saline‐tobramycin solution in patients with chronic rhinosinusitis refractory to medical and surgical therapy.STUDY DESIGN AND SETTINGTwenty patients in whom endoscopic sinus surgery failed to relieve symptoms entered a randomized, double‐blind trial of tobramycin‐saline solution or saline‐only solution administered thrice daily to the nasal passages by means of a large‐particle nebulizer apparatus for 4 weeks, followed by a 4‐week observation period. Outcome measures of symptoms, quality of life, and endoscopic aspect of sinus mucosa were assessed.RESULTSBoth treatments were well tolerated and produced equivalent improvement in symptoms, quality of life, and mucosal aspect. Treatment with the tobramycin‐saline solution gave more rapid improvement of pain, but led to the development of nasal congestion.CONCLUSIONTherapy with a 4‐week course of large‐particle nebulized aerosol therapy improves symptomatology and objective parameters of rhinosinusitis in patients refractory to surgical and medical therapies. Addition of tobramycin appears of minimal benefit. The mechanism of this effect is unexplained.SIGNIFICANCELarge‐particle nebulized aerosol therapy may offer a safe and effective management alternative for patients with refractory rhinosinusitis.
Patterns of Spread in Recurrent Head and Neck Squamous Cell Carcinoma
Authors: Vaidya Atul M. , Petruzzelli Guy J. , Clark Joseph , Emami Bahman 
Published: February 2003

OBJECTIVETo examine the pattern of spread regarding recurrent disease in primary head and neck squamous cell carcinoma.STUDY DESIGN AND SETTINGA retrospective study reviewed 128 patients who underwent primary tumor resection and postoperative radiation and/or chemoradiation for squamous cell carcinoma at Loyola University Medical Center from July 1993 to August 1998. Patterns of spread of recurrent disease were grouped according to site of recurrence and compared with the histopathology.RESULTSOf 128 patients, 40 (32%) had recurrent disease, 22 (17%) died without disease, and 66 (51%) are disease free. Although the recurrences in patients who were N0 were primarily local‐regional (8/11), the majority of recurrences in patients that were N+ with extracapsular nodal spread involved distant sites (18/24); 17/18 involved metastasis to the lung.SIGNIFICANCEThis study gives the first report at our institution of patterns of spread in recurrent head and neck squamous cell cancer and compares these patterns within subgroups of patients based on the extent of neck disease at the time of primary surgical resection.CONCLUSIONNot only was there a higher rate of recurrent disease in patients with extracapsular nodal spread, there was a much higher involvement of distant metastatic sites as opposed to local‐regional recurrence more often seen with the N0 neck. The most common site of distant metastasis was the lung.
Experimental Co2 Laser Myringotomy
Authors: Valtonen Hannu J. , Poe Dennis S. , Shapshay Stanley M. 
Published: February 2003

OBJECTIVEThe purpose of this study was to compare closure rates of CO2 laser myringotomies with those produced conventionally with a knife.STUDY DESIGN AND SETTINGWe investigated closure rates in 3 experimental groups of chinchillas: (1) semicircular myringotomy in both ears either produced with a knife or CO2 laser; (2) CO2 laser myringotomy, round in one ear and kidney shaped in the other; (3) CO2 laser myringotomy, incisional in one ear and kidney shaped in the other.RESULTSPatency of knife myringotomies was shorter (P < 0.01) than of similar laser myringotomies, means 10.0 and 21.8 days, respectively. The patency of kidney‐shaped laser myringotomies was longer (P < 0.05) than of round ones. Incisional laser myringotomies remained open longer (P < 0.01) than round ones.CONCLUSIONUse of CO2 laser as well as certain geometries delay the closure of myringotomies. By allowing perforations of different shapes and sizes, CO2 laser myringotomy may become an alternative in the treatment of otitis media.
Publication Rate of Abstracts Presented at the Annual Meeting of the American Academy of Otolaryngology‐Head and Neck Surgery
Authors: Larian Babak , Namazie Ali , Agha Neema , Azizzadeh Babak , Blackwell Keith , Wang Marilene B. 
Published: February 2003

BACKGROUNDResearch projects are frequently presented at national meetings not only to make the data available, but also to further critically evaluate the project. The ultimate goal remains publication of the research. We assessed the publication rate of presentations at 1993‐95 annual meetings.METHODSAll presentations at the scientific sessions were searched in the computerized database Melvyl MEDLINE and PubMed. The papers were categorized in 6 broad groups.RESULTSThe overall proportion of presentations that were published was 32%. Clinical papers in pediatrics had the highest publication rate, followed by basic science research in laryngology and plastics.CONCLUSIONThe publication rate of 32% is lower than the rate at meetings in other fields, reflecting variability in selection criteria for the presentations and quality of abstracts presented. Basic science presentations did not have a greater publication rate as compared to clinical presentations.
Office‐Based Esophagoscopy: A Preliminary Report
Authors: Aviv Jonathan E. , Takoudes Thomas G. , Ma Guoguang , Close Lanny G. 
Published: February 2003

OBJECTIVEPreliminary study that describes unsedated, transnasal esophagoscopy (TNE) in an office setting.STUDY DESIGN AND SETTINGTNE was prospectively performed on 14 consecutive out‐patients with dysphagia whose initial oropharyngeal dysphagia evaluation was insufficient to reveal the cause of their swallowing problem. TNE was carried out without conscious sedation while the patients were sitting in an examining chair. Ease of endoscope insertion, optical quality of images, and examination findings were assessed. Heart rate before and after the procedure and incidence of epistaxis and airway compromise was also determined. Patients were asked to rate the level of discomfort of TNE on a validated 10‐point scale (1 representing none/well tolerated and 10 severe/poorly tolerated).RESULTSAll patients completed TNE with the esophagus readily intubated and esophageal mucosa clearly visualized. Findings included esophageal stricture, patulous upper esophageal sphincter, and Zenker's diverticulum. There were no incidences of epistaxis or airway compromise and no significant changes in heart rate. Overall tolerance of TNE was rated by the patients as 2.0 (SD, 1.2).CONCLUSIONSTNE is well tolerated and can be safely performed in patients with dysphagia in an office setting. TNE may have a role in the comprehensive evaluation of the dysphagic patient in the office.
Pharyngoesophageal Pressure Monitoring in Sleep Apnea Syndrome
Authors: Reda Mohamed , Gibson G. John , Wilson Janet Ann 
Published: February 2003

OBJECTIVESThis study tests the sensitivity and the specificity of overnight pharyngoesophageal pressure measurement for identification and classification of obstructive sleep apnea (OSA).METHODSFifty‐nine snoring patients undergoing polysomnography were invited to have simultaneous pharyngo‐esophageal manometry. We used a soft silicone catheter with 4 microtip pressure sensors at different levels.RESULTSThe apnea hypopnea indexes (AHIs) measured by the 2 methods were highly correlated (r = 0.971). Manometry was 100% sensitive and specific in excluding OSA and identifying severe OSA. It was 90% sensitive in identifying moderate OSA and 80% sensitive in identifying mild OSA.Conclusion: Overnight ambulatory pharyngo‐esophageal manometry is a reliable tool for the exclusion of OSA and identification of severe OSA. It has additional advantages of localizing the level of obstruction and identifying the upper airway resistance syndrome and can be performed at home. It is cost‐effective when compared with polysomnography and may aid in treatment selection for individual patients.
Clinical Validation of the Bedbugg™ in Detection of Obstructive Sleep Apnea
Authors: Claman David , Murr Andrew , Trotter Kimberly 
Published: February 2003

OBJECTIVETo validate the accuracy of the Bedbugg™, a new home monitoring device for diagnosis of obstructive sleep apnea.STUDY DESIGN AND SETTINGSimultaneous sleep monitoring was performed by formal polysomnography and by Bedbugg. Monitoring was performed in a university sleep center in 42 subjects who had previously been scheduled for polysomnography.RESULTSThe correlation for the apnea‐hypopnea index (AHI) between polysomnography and Bedbugg was r = 0.96. The sensitivity of Bedbugg for detecting an AHI > 15 was 85.7%. The specificity of Bedbugg for detecting an AHI < 15 was 95.2%.CONCLUSIONThe Bedbugg device provides an accurate assessment of the apnea‐hypopnea index.SIGNIFICANCEAccurate home monitoring for sleep apnea may provide access to care for a higher proportion of undiagnosed sleep apnea patients.
Globe Sparing Orbital Exenteration
Authors: Catalano Peter J. , Laidlaw Douglas , Sen Chandranath 
Published: February 2003

OBJECTIVEOrbital exenteration has long been the oncologic standard for malignant craniofacial lesions that invade the periorbita/orbit from adjacent locations. Although oncologically sound, this radical surgical procedure is cosmetically disfiguring for all patients. Most of the reconstructive options available are complex, requiring further surgery and/or expense. We herein introduce an alternative surgical technique for radical orbital surgery that spares the globe, thereby allowing an early, aesthetic appearance at a nominal cost.STUDY DESIGN AND SETTINGTwenty consecutive patients requiring an oncologic orbital exenteration and meeting the indications for the new procedure underwent surgery at a tertiary care medical center. Follow‐up ranged from 1 to 6 years.RESULTSOnly 1 patient recurred in the orbit due to an error in patient selection. There was no surgical morbidity resulting from the globe‐sparing technique itself.CONCLUSIONGlobe‐sparing orbital exenteration is a one‐step, oncologically sound, aesthetically superior, low‐cost alternative for those patients requiring radical orbital surgery and reconstruction.
Internal Carotid Artery Hemorrhage after Irradiation and Osteoradionecrosis of the Skull Base
Authors: Kwong Lam Henry Chuen , Abdullah Victor James , Wormald Peter John , Van Hasselt Charles Andrew 
Published: February 2003

OBJECTIVETo evaluate the clinical presentation and management of internal carotid artery rupture after irradiation and osteoradionecrosis of the skull base.STUDY DESIGN AND SETTINGA retrospective review of the patients in an otorhinolaryngology‐head and neck secondary and tertiary referral center.METHODOLOGYFrom January 1993 to December 1996, patients with hemorrhage from internal carotid artery as a complication of irradiation and osteoradionecrosis of skull base were reviewed and analyzed.RESULTSFour patients with internal carotid arterial rupture were included in this study. Angiography was performed in all cases. Embolization of the aneurysm was performed on 2 patients and the remaining 2 patients underwent occlusion of their internal carotid arteries. Three of the 4 patients did not survive. The fourth is currently alive and well 18 months after embolization of 1 internal carotid artery.CONCLUSIONSkull base osteoradionecrosis with bleeding from internal carotid artery is a potentially fatal complication of irradiation. Angiography was the mainstay of diagnosis with embolization of the aneurysm and embolization or ligation of the internal carotid artery being the management options. Internal carotid artery occlusion is the definitive treatment provided cross circulation is adequate.SIGNIFICANCEThe advantages and disadvantages of the treatment options are discussed and a management protocol is proposed.
Experimental Trauma to the Malar Eminence: Fracture Biomechanics and Injury Patterns
Authors: Rhee John S. , Posey Lisa , Yoganadan Narayan , Pintar Frank 
Published: February 2003

OBJECTIVESTo document patterns of facial fractures after trauma to the malar eminence and to elucidate biomechanical factors relevant to the injury patterns.STUDY DESIGN AND SETTINGStudies were conducted on 14 cadaver heads. Study variables included impact velocity, contact area, impact force, and zygomatic skin thickness. Bony fractures and clinical injury patterns were documented. A fracture severity rating scale was devised and statistically correlated to the study variables using regression ANOVA analysis.RESULTSA broad spectrum of facial fracture patterns was found. Skin thickness and surface area did not correlate with fracture severity (P = 0.67, P = 0.83, respectively). Impact force demonstrated a trend toward significance (P = 0.14). Velocity was most correlative with fracture severity (P = 0.07). A critical threshold velocity (3.5 m/s) was found to correlate with the most severe fracture patterns.CONCLUSIONSA broad spectrum of facial fracture patterns was demonstrated after experimental trauma to the malar eminence. Contact surface area and zygomatic skin thickness were not found to be significant factors in fracture severity. Velocity, rather than impact force, was most correlative with fracture severity. The most severe fracture patterns were elicited by velocities above 3.5 m/s.
Exploring Health‐Related Quality of Life in Patients with Diseases of the Ear, Nose, and Throat: A Multicenter Observational Study
Authors: Witsell David L. , Dolor Rowena J. , Bolte Jean M. , Stinnett Sandra S. 
Published: February 2003

OBJECTIVESThis study was undertaken to explore which diseases of the ear, nose, and throat impact daily functioning of patients in an outpatient setting and to observe how specific demographic variables affect health‐related quality of life (HRQOL) in these patients.METHODSThis multicenter observational study was conducted anonymously during a 6‐week period at outpatient clinics in adults ≥ 18 years of age. The Short Form‐12 (SF‐12) was used to assess HRQOL. Demographic and clinical variables were recorded for each patient.RESULTSIn data from 5806 patients, the SF‐12 physical component score was 43.8, and the mental component score was 49.4. SF‐12 physical and emotional functioning scores for ENT patients were poorer than established standards (50 ± 10) for the U.S. population (P < 0.001).CONCLUSIONSENT diseases adversely affect the HRQOL in patients visiting their otolaryngologist. Clinical and demographic variables are important considerations in the measurement of HRQOL.
A Multi‐Institutional Study of Radiofrequency Volumetric Tissue Reduction for OSAS
Authors: Woodson B. Tucker , Nelson Lionel , Mickelson Samuel , Huntley Tod , Sher Aaron 
Published: February 2003

OBJECTIVESRadiofrequency volume reduction (RFTVR) is a minor procedure directed at reducing the tongue base volume to treat obstructive sleep apnea. Subjective and objective treatment effectiveness was evaluated.STUDY DESIGN AND SETTINGTwo separate prospective, matched, nonrandomized, open enrollment treatment groups (RFTVR, n = 73 and nasal continuous positive airway pressure (CPAP, n = 99) were concurrently enrolled in a multicenter study.RESULTSFifty‐six (76.7%) RFTVR completed PSG with a mean 5.4 ± 1.8 treatments (13,394 ± 5459 joules). Perioperatively, acute pain was mild to moderate; edema, mucosal erosion, paresthesia, tinnitus were infrequent; and speech, swallowing taste, or throat irritation were unchanged. Self‐reported outcomes did not differ between RFTVR and CPAP groups. Mean apnea/hypopnea index decreased (40.5 ± 21.5 to 32.8 ± 22.6 events/hr, P < 0.01). Electrolyte solution injected predicted results (r = 0.43, P < 0.001). The most severe complication was abscess (1.1%).CONCLUSIONRFTVR improves apnea/hypopnea index. Improvement may be related to solution injected with treatment. RFTVR and CPAP clinical outcomes improvement were similar.CLINICAL SIGNIFICANCEIn mild obstructive sleep apnea, treatment of symptomatic outcomes with RFTVR may be an alternative to CPAP.
Temperature‐Controlled Radiofrequency Tissue Volume Reduction in the Human Soft Palate
Authors: Sher Aaron E. , Flexon Phillip B. , Hillman David , Emery Brian , Swieca John , Smith Timothy L. , Cartwright Rosalind , Dierks Eric , Nelson Lionel 
Published: February 2003

OBJECTIVETo validate the use of temperature‐controlled radiofrequency energy applied to the soft palate in a multicenter setting for reduction of snoring in a minimally morbid manner.METHODSProspective, nonrandomized multicenter study of 113 patients who had a respiratory disturbance index less than 15 and minimum oxygen saturation not less than 85% and who were seeking treatment for habitual disruptive snoring. Patients were given either single or multiple lesions to the soft palate during each treatment session.RESULTSPatients received 1978 J on average with an overall average of 2.4 treatments. Snoring scores went from an average of 7.8 (visual analog scale [VAS], 0–10) pretreatment to 3.2 posttreatment. Pain was minimal, averaging 1.7 (VAS 0–10) on days 1 to 6. Complications were few and transient, and mild.CONCLUSIONSThe multiple lesion protocol was the most successful; reducing snoring from 7.6 to 2.7, on a VAS with an average of 1232 J delivered over 1.6 treatments. Temperature‐controlled radiofrequency was found to be a minimally invasive, well‐tolerated procedure that was safe and efficacious in this study group.
Inhalant Allergy and Meniere's Disease: Use of Electrocochleography and Intranasal Allergen Challenge as Investigational Tools
Authors: Noell Courtney A. , Roland Peter S. , Mabry Richard L. , Shoup Angela G. 
Published: February 2003

INTRODUCTIONIn an earlier study, we demonstrated the feasibility of using electrocochleography (ECoG) to document changes in inner ear function objectively after intranasal challenge of patients with inhalant allergy (with no prior immunotherapy) and Meniere's disease, using the antigen to which they were most sensitive.OBJECTIVEWe expand on this earlier study and continue to investigate the feasibility of this model in a subset of patients with inhalant allergy and Meniere's disease after immunotherapy.STUDY DESIGNProspective study of 11 patients identified with both Meniere's disease and inhalant allergy in the practices of 2 neurotologists at our institution. Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen to which they were most sensitive. This was followed by a second ECoG.RESULTSSix of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11 had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2 patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG experienced vestibular symptoms after allergen challenge, whereas 2 of group 1 and 2 of group 2 had vestibular symptoms with abnormal ECoGs.CONCLUSIONThis protocol is a useful tool for investigating the relationship of inhalant allergy and Meniere's disease, but needs a larger group of patients and further study to draw valid statistical conclusions.
Cochlear implant/Deaf World dispute: Different bottom elephants
Authors: Gonsoulin Thomas P. 
Published: February 2003

OBJECTIVETo examine the controversy between the proponents of cochlear implantation in children and the Deaf World opponents with the hope of offering a method for decreasing the acrimony of opposing positions.STUDY DESIGN AND SETTING (METHODS)The opposing arguments will be presented from a review of pertinent literature. The systemic philosophic process of bottom elephant analysis will be elucidated. Contrasting models of power will be described.RESULTSThe application of the bottom elephant analysis of each group's position plus a paradigm shift in the utilization of power offers possibilities for the implementation of mutually respectful dialogue that does not undermine each group's stature.CONCLUSION AND SIGNIFICANCEPhilosophic analysis and paradigm shift could lead to improvement in the interaction of cochlear implant proponents and Deaf World opponents.
Aquatic Activities after Total Laryngectomy
Authors: Karamzadeh Amir M. , Armstrong William B. 
Published: February 2003

OBJECTIVETo assess the techniques used by patients who have undergone laryngectomies to enable them to participate in aquatic activities.STUDY DESIGNUnstructured interviews.METHODSThe case histories of 4 patients who have returned to swimming and other aquatic activities after total laryngectomy were obtained by non‐structured interviews emphasizing techniques used to swim, safety precautions taken, any accidents or near accidents, and perceived effect of aquatic activities on sense of well being and quality of life.RESULTSAll 4 of the interviewed subjects swim regularly using commercial breathing aids or manual tracheostomal occlusion. One of the four is a regular surfer, who uses a homemade breathing aid. All were active swimmers prior to the development of laryngeal cancer. A single aquatic‐related accident was reported by 1 of the 4 swimmers. All subjects describe feeling an enhanced quality of life resulting from their participation in aquatic activities.CONCLUSIONDespite recommendations of most clinicians, a small number of highly motivated patients will return to aquatic activities after laryngectomy.
Implications of the AHRQ Evidence Report on Acute Otitis Media
Authors: Rosenfeld Richard M. , Casselbrant Margaretha L. , Hannley Maureen T. 
Published: February 2003

OBJECTIVETo familiarize otolaryngologists with the Agency for Healthcare Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) that reviews the natural history and role of antibiotics in management. The report, by the Southern California Evidence‐Based Practice Center (SC‐EPC), is the most recent of 15 literature syntheses published by the AHRQ.DATA SOURCESMEDLINE (1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other computerized databases; manual reference search of proceedings, articles, reports, and guidelines.STUDY SELECTIONRandomized trials and cohort studies relevant to the natural history of AOM and the efficacy of antimicrobial therapy. AOM was defined by the 11‐member technical expert panel (including 2 authors, RMR and MLC) as middle‐ear effusion with the rapid onset of signs or symptoms of middle ear inflammation.DATA EXTRACTIONTwo physician reviewers at the Southern California Evidence‐Based Practice Center independently rated the articles and extracted data.DATA SYNTHESISChildren receiving placebo or no antimicrobial had a pooled clinical success rate of 81% at 1 to 7 days (95% CI, 72% to 90%), with no increase in suppurative complications when followed closely. Amoxicillin or ampicillin increased the absolute success rate by 12.3% (95% CI, 2.8% to 21.8%) in 5 studies pooled using random effects meta‐analysis. The antimicrobial benefit was robust to sensitivity analysis. In contrast, success rates were not influenced by the choice or duration of therapy.CONCLUSIONSThe AHRQ report emphasizes middle‐ear effusion as a preeminent criteria for AOM diagnosis and provides extensive evidence tables on natural history and antimicrobial impact. About 8 children must receive antibiotics to avoid 1 clinical failure, but children younger than age 2 years or with severe symptoms may benefit more. The report is a starting point for organizations seeking to develop AOM guidelines, performance measures, and other quality improvement tools.