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1.
Peter J. Ciolek Allen Xu Samantha Anne Katie Geelan-Hansen 《American journal of otolaryngology》2017,38(3):305-308
Objective
To identify clinical characteristics of pediatric patients that failed nasal steroid therapy for management of chronic nasal obstruction and to evaluate the efficacy of adenoidectomy in this subset of patients.Design
Retrospective chart review.Setting
Tertiary care academic center.Subjects
Analysis was performed on children that underwent adenoidectomy between 2011 and 2015 for chronic nasal obstruction refractory to nasal steroids.Results
Seventy-four cases were identified. Average age of presentation was 3.6 years. Pre-operatively, 25.7% of patients had known asthma, 16.2% reported respiratory allergies, and 20.3% reported use of systemic antihistamines. The most common pre-operative symptoms included mouth breathing (82.4%), nasal congestion (81.1%), snoring (71.6%), and rhinorrhea (37.8%). Average adenoid size was 68% pre-operatively. Ninety-eight percent of patients experienced improvement or resolution of their symptoms following adenoidectomy.Conclusions
This study demonstrates average rates of respiratory allergies, but high rates of asthma among patients that fail nasal steroid therapy for chronic nasal obstruction. Adenoidectomy is a highly efficacious intervention in this subset of patients. 相似文献2.
Lin Lin Xinyue Tang Jinjin Wei Fei Dai Guangbin Sun 《American journal of otolaryngology》2017,38(4):383-389
Objective
To evaluate the efficacy of xylitol nasal irrigation (XNI) treatment on chronic rhinosinusitis (CRS) and to investigate the effect of XNI on nasal nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA in maxillary sinus.Materials and methods
Patients with CRS were enrolled and symptoms were assessed by Visual Analog Scale (VAS) and Sino-Nasal Outcome Test 22 (SNOT-22). Nasal NO and iNOS mRNA in the right maxillary sinus were also examined. Then, they were treated with XNI (XNI group) or saline nasal irrigation (SNI, SNI group) for 30 days, after which their symptoms were reassessed using VAS and SNOT-22, and nasal NO and iNOS mRNA in the right maxillary sinus were also reexamined.Results
Twenty-five out of 30 patients completed this study. The scores of VAS and SNOT-22 were all reduced significantly after XNI treatment, but not after SNI. The concentrations of nasal NO and iNOS mRNA in the right maxillary sinus were increased significantly in XNI group. However, significant changes were not found after SNI treatment. Furthermore, there were statistical differences in the assessments of VAS and SNOT-22 and the contents of nasal NO and iNOS mRNA in the right maxillary sinus between two groups.Conclusions
XNI results in greater improvement of symptoms of CRS and greater enhancement of nasal NO and iNOS mRNA in maxillary sinus as compared to SNI. 相似文献3.
Robert I. Henkin Suzanna Hosein William A. Stateman Alexandra B. Knöppel Mona Abdelmeguid 《American journal of otolaryngology》2017,38(2):143-147
Purpose
We previously demonstrated the presence of sonic hedgehog (Shh) in nasal mucus in normal subjects and in patients with smell loss (hyposmia). Nasal mucus Shh levels were found significantly diminished in untreated hyposmic patients of multiple etiologies. Since treatment with oral theophylline has been previously associated with improvement in smell function we wished to study if such treatment increased nasal mucus Shh as well as improved smell function in patients with hyposmia.Methods
Forty-four patients with hyposmia of several etiologies were evaluated for changes in hyposmia by subjective measurements of smell, taste and flavor perception and by olfactometry. Measurements of nasal mucus Shh were made in relationship to each set of sensory measurements. Patients were treated with oral theophylline at doses of 200–800 mg for periods of 2–10 months with sensory function, nasal mucus Shh and serum theophylline levels evaluated at these time intervals. Nasal mucus Shh measurements were made with a sensitive spectrophotometric ELISA assay and theophylline with a fluorometric assay.Results
There was consistent, significant improvement in subjective responses in smell, taste and flavor perception and in olfactometry associated with increased nasal mucus Shh and serum theophylline after theophylline treatment.Conclusions
Improvement in smell function and in nasal mucus Shh was positively correlated in a dose-response relationship after treatment with oral theophylline. Results are consistent with a successful role for theophylline in improvement of smell function in hyposmic patients of multiple etiologies associated with increased nasal mucus Shh which can act as a biochemical marker for smell function. 相似文献4.
Importance
Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.Objective
To report a novel method of closing anterior septal perforations using an inferiorly based mucosal rotation flap and an acellular dermal interposition graft, as well as expand upon a previous series.Design
The study includes patients who underwent surgical repair for septal perforations by the senior author between 2003 and 2015.Setting
The study took place at MetroHealth Medical Center in Cleveland, Ohio.Participants
Thirty-nine patients (15 male) with septal perforations of various size and etiology underwent endonasal repair using rotation flaps. The average age of patients was 42-years old (range 10–67 years).Intervention for clinical trials or exposure for observational studies
Five patients had perforations such that we used inferiorly based flaps, while 35 cases utilized posteriorly based flaps. Acellular dermis was used in addition to a unilateral rotation flap.Main outcomes and measures
The primary outcome desired was a complete closure of the septal perforation. The success, or lack thereof, was monitored after healing from surgery.Results
Thirty-seven of the forty surgical procedures demonstrated complete closure of the perforation, a 92.5% success rate. Perforations were separated based upon size. Small perforations (< 1 cm) had a 93.3% success rate, medium (1–2 cm) 88.9%, and all seven large perforations (> 2 cm) were closed successfully. In addition, all five of the inferiorly based procedures resulted in complete closure of the perforation. Of the failed repairs, one required revision surgery to repair a recurring perforation, while the other two were asymptomatic following the procedure.Conclusions and relevance
Endonasal repair using inferiorly based mucosal rotation flaps coupled with an acellular dermal interposition graft is a valid technique for the repair of septal perforations. Posterior rotation flaps are preferred due to major septal blood supply from branches of the sphenopalatine artery, but inferiorly based flaps are also viable options for repair for perforations located in the anterior septum. 相似文献5.
Shizhi He Pingdong Li Qi Zhong Lizhen Hou Zhenkun Yu Zhigang Huang Xuejun Chen Jugao Fang Xiaohong Chen 《American journal of otolaryngology》2017,38(2):157-162
Purpose
This study was to investigate clinicopathologic characteristics and prognostic factors in adenoid cystic carcinoma of head and neck minor salivary glands.Materials and methods
We conducted a retrospective review of 130 patients with adenoid cystic carcinoma of head and neck minor salivary glands that were evaluated between 2000 and 2013 in Beijng Tongren Hospital.Results
Five-year overall survival and disease-free survival rates were 80.8% and 55.6%. Local recurrence rate was 40%, regional recurrence 3.8%, and distant metastasis was 28.5%. On univariate analysis, solid histological subtype, perineural invasion, positive surgical margins and advanced stages were found to be poor prognostic indicators. On multivariate analysis, solid histological subtype and positive surgical margins were significant prognostic factors of worse overall survival.Conclusions
Solid histological subtype and positive surgical margins were the most important predictors of poor outcome in adenoid cystic carcinoma of minor salivary glands. Surgery with postoperative radiation were recommended treatment and offered durable local control. 相似文献6.
Remzi Dogan Erol Senturk Orhan Ozturan Yavuz Selim Yildirim Selahattin Tugrul Aysenur Meric Hafiz 《American journal of otolaryngology》2017,38(6):678-682
Objective
The aim of this study is to evaluate the effects of these two methods (Nasal corticosteroids (NCS) and radiofrequency (RF) application) on conchal contractility utilizing objective rhinologic measurement parameters.Methods
82 patients were presented with the complaint of nasal obstruction and diagnosed with inferior turbinate hypertrophy and were included in the study. Patients in Group 1 received NCS for 12 weeks. Patients in Group 2 were administered RF to their inferior turbinates. Acoustic rhinometry and rhinomanometry tests with and without decongestant were performed.Results
In the evaluation of the contractility difference of rhinometry parameters, there was not a significant difference among pre and postoperative acoustic rhinometric parameters in Group 1. Whereas in Group 2, postoperative contractility difference was significantly decreased compared to preoperative values.In the evaluation of the contractility difference of rhinomanometric parameters, no significant difference was found between pre and postoperative values in Group 1. However, postoperative contractility difference was significantly decreased compared to preoperative values in Group 2 in terms.Conclusion
Because the RF procedure produces fibrosis in the vascular tissues, inferior turbinates do not have a shrinking response to decongestant administration. Administration of NCS administration maintains the contractility function compared to RF application. 相似文献7.
Judith S. Kempfle Benjamin Fiorillo Vivek V. Kanumuri Samuel Barber Albert S.B. Edge Marybeth Cunnane Aaron K. Remenschneider Daniel J. Lee Elliott D. Kozin 《American journal of otolaryngology》2017,38(5):518-520
Purpose
A transcanal endoscopic infracochlear surgical approach to the internal auditory canal (IAC) in a human temporal bone model has previously been described. However, the proportion of patients with favorable anatomy for this novel surgical technique remains unknown. Herein, we perform a quantitative analysis of the transcanal endoscopic infracochlear corridor to the IAC based on computed tomography.Materials and methods
High resolution computed tomography scans of adult temporal bones were measured to determine the accessibility of the IAC when using an endoscopic transcanal, cochlear-sparing surgical corridor.Results
This approach to the IAC was feasible in 92% (35 of 38) specimens based on a minimum distance of 3 mm between the basilar turn of the cochlear and the great vessels (jugular bulb and carotid artery).Conclusions
Infracochlear access to the IAC is feasible in the majority of adult temporal bones and has implications for future hearing preservation drug delivery approaches to the IAC. 相似文献8.
Giuseppe Brescia Giorgia Saia Federico Apolloni Gino Marioni 《American journal of otolaryngology》2017,38(1):92-95
Introduction
Over the last 30 years, dental implants have become widespread all over the world. Though the implantation procedure is standardized and safe, the displacement of implants into the maxillary sinus can occur. The aim of the study has been to describe a novel combined nasal endoscopic approach through the middle and lower meatus for managing dental implants displaced into the maxillary sinus.Methods/results
A 40-year-old man was examined for a titanium osteo-integrated implant displaced within the alveolar recess of the left maxillary sinus. The indications and procedure are reported in detail. The pros and cons of this approach are compared with those of other standard surgical methods.Conclusions
The main strength of the technique described here lies in the ample view and ideal control of the displaced dental implant achieved by fashioning a second window at the lower meatus that enables enlargement of the natural ostium to be minimized, thereby ensuring an anatomically and functionally better result. 相似文献9.
Jay Agarwal Sameep Kadakia Abbas Agaimy Anna Ogadzanov Azita Khorsandi Raymond L. Chai 《American journal of otolaryngology》2017,38(4):505-507
Background
Pleomorphic liposarcoma (PL) is an exceedingly rare tumor of the head and neck. This aggressive liposarcoma variant portends a poorer prognosis compared to more typical sarcomatous tumors.Methods
Multi-institutional study including two cases of PL, the first case occurring in the post-auricular region and the second in the cheek with later recurrence within the parotid bed.Results
Both patients were treated surgically with wide local excision. One patient required reoperation to obtain negative margins. The other patient underwent a total parotidectomy with neck dissection for recurrent intraparotid nodal disease. Both patients underwent adjuvant radiotherapy. No patient had evidence of recurrent disease with minimum one year follow-up.Conclusion
Although the literature is sparse on this disease, wide surgical extirpation with negative margins and adjuvant radiation is recommended. Increased reports of this pathology can be helpful in providing practitioners with experienced-based information that can aid in early detection and treatment. We present the first case series of PL of the head and neck in the literature. 相似文献10.
Objective
The aim of this study was to evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS (allergic fungal rhinosinusitis) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery.Subjects and methods
Thirty-five patients were recruited into this study. Final diagnoses were reached using Bent and Kuhn's criteria. The eligible patients were randomly divided into two groups: the budesonide transnasal nebulization group (group A) and the topical nasal steroids group (group B). Nasal symptoms, Lund-Mackay scores, and Kupferberg grades were evaluated before surgery, after surgery and during the follow-up to assess the effects of these two approaches.Results
A total of 30 patients with AFRS who were eligible were included in the study. Four of the 15 patients in group B (26.67%) developed recurrent disease, whereas no patients in group A developed recurrent disease. This difference was statistically significant (p = 0.032).Conclusion
Nebulized budesonide is an effective and safe treatment for patients with AFRS following endoscopic sinus surgery, as evidenced by the reduced recurrence rate observed in the budesonide transnasal nebulization group relative to the topical nasal steroids group. 相似文献11.
Peter Milad Marwa Elbegiermy Tamer Shokry Heba mahmoud Ihab Kamal Mohamed Shehata Taha Nermeen Keriakos 《American journal of otolaryngology》2017,38(1):13-20
Objective
To evaluate the added value of diffusion weighted magnetic resonance imaging (DW-MRI) in characterization of salivary gland lesions.Study design
A prospective study was carried out between January 2013, and March 2015.Methods
The study included 46 patients. The consultant radiologist, who reviewed the scans to comment on the apparent diffusion coefficient (ADC) value and ADC histogram was blind to the suspected pathology. Radiological findings were then compared to clinical and histological findings.Results
The diagnostic performance of DW-MRI for identification of malignant lesions showed that the sensitivity, specificity, and positive and negative prediction value were 100%, 92%, 91.3%, and 100%, respectively.Conclusion
The specific ability of DW-MRI to probe tissue microstructures is an interesting complement to the currently used imaging procedures in the characterization, and even grading of malignancies. ADC mapping is an easy, cost effective promising tool that has neither radiation exposure, nor amalgam artifacts and can be used in helping characterization of salivary glands lesions.Level of evidence
1B. 相似文献12.
Peter J. Ciolek Kate Clancy Michael A. Fritz Eric D. Lamarre 《American journal of otolaryngology》2017,38(4):433-437
Background
Limited data exists on cardiac complications following head and neck free flaps.Design
A retrospective review was performed on patients that underwent free flap reconstruction from 2012 to 2015.Results
368 flaps were performed. 12.5% of patients experienced a cardiac event. Hypertension, coronary artery disease, heart failure, venous thromboembolism, and anticoagulation were associated with cardiac complications. ASA class was not predictive of cardiac events. 7.6% of patients required anticoagulation, which exhibited a strong association with surgical site hematoma. Cardiac complications led to a significantly increased length of stay.Conclusions
There is a significant rate of cardiac events in this cohort. When estimating risk, a patient's total burden of comorbidities is more important than any one factor. ASA Class fails to demonstrate utility in this setting. Cardiac events have implications for quality-related metrics including length of stay and hematoma rate. 相似文献13.
Jia Hui Jang Hiang Khoon Tan N. Gopalakrishna Iyer Khee Chee Soo Ngian Chye Tan 《American journal of otolaryngology》2017,38(1):82-86
Background
Nasopharyngectomy for excision of nasopharyngeal tumors is challenging, as access to the nasopharynx is difficult. Recently our institution embarked on two new approaches – robotic nasopharyngectomy and open nasopharyngectomy with operating microscope (NOM) via maxillary swing approach. This article proposes that the novel approach of NOM via maxillary swing aids visualization for resection of locally invasive nasopharyngeal tumors.Methods
Over a thirteen-month period, eight patients required nasopharyngectomy in our single Asian institution. Four underwent robotic nasopharyngectomy and four underwent NOM via maxillary swing approach. The latter four were retrospectively reviewed, and their clinical characteristics and surgical outcomes reported. Tips and pearls for operative setup and patient selection were also discussed.Results
All four patients who underwent NOM had negative intraoperative frozen sections with subsequent negative paraffin sections. All patients remained disease free post-salvage surgery.Conclusion
NOM via maxillary swing allows better visualization and aids in augmentation of open nasopharyngectomy. This enables achievement of adequate resection margins and fewer surgical complications in locally invasive nasopharyngeal tumors. 相似文献14.
Objective
To evaluate outcomes of cochlear implantation of patients with otosclerosis of the otic capsule.Study design
A retrospective case series of 6 patients (7 ears).Patients
6 patients (7 ears), 5 patients with severe to profound sensorineural hearing loss; 1 patient with mild to profound sensorineural hearing loss, with radiologic evidence of otosclerosis. All patients were adult males, with or without history of stapes surgery.Intervention
Cochlear implantation of 7 ears. 5 patients with severe to profound sensorineural hearing loss received the Nucleus Contour Advance peri-modiolar electrode array with binaural implantation performed in one patient. One patient with mild to profound sensorineural hearing loss received a Cochlear® Nucleus Hybrid L24 device.Methods
Preoperative temporal bone CT, audiometric and speech perception testing scores were reviewed, confirming presence of otosclerosis of the cochlea as well as cochlear implant candidacy. Speech perception testing included CNC words, HINT sentences and AZ Bio scores to measure hearing outcomes post implantation.Results
All recipients of the contour advance device had a significant improvement in hearing at both 3 and 6 month follow up.The hybrid device recipient experienced loss of residual hearing in the implanted ear without improvement at 3 months and mild improvement at 6 months.Conclusion
Cochlear implantation has proven to be effective in the treatment of patients with sensorineural hearing loss, including those with otosclerosis of the cochlea.Hybrid candidacy in the setting of otosclerosis of the cochlea may require consideration of alternative electrode devices, most likely a peri-modiolar device. 相似文献15.
Maxwell P. Kligerman Yohan Song David Schoppy Vasu Divi Uchechukwu C. Megwalu Bruce H. Haughey Davud Sirjani 《American journal of otolaryngology》2017,38(5):533-536
Purpose
The most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls.Materials and methods
A retrospective chart review at Stanford Hospital was conducted to identify retrograde parotidectomies between February 2012 and October 2014 that were staffed by the senior author (DS) with resident involvement. Facial nerve (FN) outcomes and other post-surgical parameters were recorded.Results
We identified 44 consecutive cases and found that 18.2% (n = 8) of patients experienced temporary paresis and 2.3% (n = 1) experienced minor (HB 2) permanent paresis limited to one branch. The average hospital length of stay was 0.64 days and complication rate was 6.8%.Conclusion
The retrograde technique has complication rates comparable to historical rates for the prograde technique and is amenable to minimally invasive outpatient superficial parotidectomy. 相似文献16.
D.T. Nguyen C. Rumeau M. Felix-Ravelo P.-L. Nguyen-Thi R. Jankowski 《European annals of otorhinolaryngology, head and neck diseases》2017,134(1):19-22
Objective
Assessment of sinonasal symptoms on a self-reported questionnaire is thoroughly subjective, but indispensable for quantifying symptoms. The present study sought to compare responses on the DyNaChron questionnaire just before and just after consultation for chronic sinonasal dysfunction.Materials and methods
78 patients (mean age, 43.1 ± 16.9 years) consulting for chronic sinonasal dysfunction took part in a prospective study, responding to the computerized version of the DyNaChron self-reported questionnaire, in a dedicated room, just before and just after medical interview and physical examination.Results
Most patients tended to grade symptoms as less severe after consultation. Significant differences in mean score were found for nasal obstruction (difference of 0.94/10), anterior (0.40) and posterior rhinorrhea (0.26), olfactory disorder (0.65), and facial pain and headache (0.65), but not for chronic cough.Conclusion
Self-reported scores for chronic sinonasal dysfunction differ slightly from before to after consultation. They are therefore to be interpreted with caution, taking account of possible factors of bias. 相似文献17.
James R. Martin Peter Filip Eric J. Thorpe John P. Leonetti 《American journal of otolaryngology》2017,38(4):380-382
Purpose
In this study we review our institution's experience and outcomes with temporal bone resection and parotidectomy in the treatment of advanced parotid malignancies.Methods
Patients undergoing lateral temporal bone resection and parotidectomy from 2007–2013 were identified in the EPIC electronic medical record. Primary tumor location, staging, surgical procedure, and patient demographic and outcome data were collected retrospectively.Results
Fifteen patients underwent combined temporal bone resection and parotidectomy for parotid malignancy. Carcinoma ex-pleomorphic and squamous cell carcinoma were the most common pathologies. Two year disease free survival was 40%. Distant metastases were the most common site of disease recurrence. Only nodal disease was predictive of reduced disease free survival, though pre-operative facial paralysis showed a trend towards significance. Margin status and operating for recurrent tumor did not influence outcome in our series.Conclusion
Local and regional tumor controls are attainable with combined skull base approaches to advanced parotid malignancies. Unfortunately these cases have a high rate of distant recurrence despite negative margins and local control. 相似文献18.
Emily N. Ahadizadeh Nauman F. Manzoor Jay Wasman Pierre Lavertu 《American journal of otolaryngology》2017,38(4):496-497
Background
Primary hyperparathyroidism (PHPT) is a frequently encountered endocrine disorder due to benign neoplastic lesions or gland hyperplasia. It is often discovered incidentally when routine lab work reveals hypercalcemia.Methods
This case presents a 55-year-old male with a neck mass and electrolyte irregularities consistent with PHPT. However, his laboratory values suddenly normalized prior to surgery.Results
Post-operative pathologic analysis of the specimen demonstrated massive infarction of the affected gland, and explained the spontaneous resolution of the patient's electrolyte derangements.Conclusions
The objective of this case study is to demonstrate the importance of further investigation in patients with fluctuating lab values and emphasize the potential dangers of gland infarction. 相似文献19.
Andy Bertolin Marco Lionello Gianni Salis Giuseppe Rizzotto Marco Lucioni 《American journal of otolaryngology》2017,38(2):183-187
Purpose
The aim of the present paper was to investigate the oncological safety of two-stage bilateral cordectomy for the treatment of cT1b glottic SCC, and to compare its oncological outcome and synechia development rate with those of single-stage procedures.Materials and methods
A retrospective cohort study was performed at the Otolaryngology Unit of Vittorio Veneto Laryngeal Cancer Center (Italy). The prognostic significance of clinical, pathological and surgical factors was also investigated, in terms of recurrence rate and disease-free survival, in a univariate statistical setting.Results
Our results indicate that patients treated with primary two-stage bilateral cordectomy achieved local control in 96% of cases, with 95% disease-specific and 88% overall survival rates, and a 95% organ preservation rate, with anterior synechiae developing in 1 case. Involvement of the deep surgical margins correlated with a worse prognosis. Patients developed anterior synechiae less frequently after two-stage bilateral cordectomy, and experienced no higher recurrence rate or shorter disease-free survival than patients treated with a single-stage procedure.Conclusions
Two-stage bilateral cordectomy is a safe and effective procedure. In selected patients it could be considered the primary approach for the treatment of early glottic cT1b carcinomas. 相似文献20.
Cameron C. Wick Rod P. Rezaee Tammy Wang Andrea M. Garcia-Jarchow Chad A. Zender Michael Gibson Min Yao Pierre Lavertu 《American journal of otolaryngology》2017,38(1):72-76