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  • 1
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    Online Resource
    Analysis of Transnasal Endoscopic versus Transseptal Microscopic Approach for Excision of Pituitary Tumors
    SAGE Publications ; 2008
    In:  American Journal of Rhinology Vol. 22, No. 6 ( 2008-11), p. 649-652
    Details
    In: American Journal of Rhinology, SAGE Publications, Vol. 22, No. 6 ( 2008-11), p. 649-652
    Abstract: The traditional method of pituitary tumor excision is transseptal microscopic excision; however, the transnasal transsphenoidal endoscopic approach has shown comparable results with the transseptal microscopic approach at some institutions. The objective of this study is to compare the two types of sellar and parasellar mass resection: transnasal transsphenoidal endoscopic excision versus transseptal microscopic excision. Methods A retrospective cohort analysis was performed on subjects who were referred to a tertiary hospital for surgical management of sellar or parasellar masses. The two groups of patients either underwent a transnasal endoscopic approach with endoscopic excision or transseptal microscopic excision. Demographics, tumor characteristics, operative details, length of hospital stay, intraoperative and postoperative complications, level of postoperative pain, recurrence rate, use of computed tomography (CT) image guidance, and length of follow-up were gathered. The data between the two groups were then compared. Results The analysis included 19 subjects who underwent endoscopic excision and 29 subjects who underwent transseptal microscopic excision. Null macroadenoma was the most common sellar mass followed by prolactinoma. There were no statistical differences in rates of perioperative complications and suprasellar or cavernous sinus invasion. Patients who underwent an endoscopic approach had shorter operative times, lower estimated blood loss, less lumbar drain use, less pain, and a shorter postoperative hospital stay (p 〈 0.05). Conclusion The two approaches show similar intraoperative characteristics and immediate complication rates. Transnasal transsphenoidal endoscopic excision is a reasonable alternative to the traditional method of sellar mass excision.
    Type of Medium: Online Resource
    ISSN: 1050-6586 , 1539-6290
    URL: Article
    DOI: 10.2500/ajr.2008.22.3246
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
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  • 2
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    In-office Placement of Mometasone Furoate Sinus Implants for Recurrent Nasal Polyps: A Pooled Analysis
    SAGE Publications ; 2019
    In:  American Journal of Rhinology & Allergy Vol. 33, No. 5 ( 2019-09), p. 545-558
    Details
    In: American Journal of Rhinology & Allergy, SAGE Publications, Vol. 33, No. 5 ( 2019-09), p. 545-558
    Abstract: A mometasone furoate (MF) sinus implant (1350 mcg) was evaluated in 2 randomized controlled trials (RCTs) in 400 adults with nasal polyps (NP) who were candidates for revision endoscopic sinus surgery (RESS). We conducted a pooled analysis to evaluate the efficacy of MF implant in specific subgroups of NP patients. Methods Pooled data from 2 RCTs for 375 patients were analyzed across prespecified subjective and objective end points through day 90. Results At day 90, patients receiving implants and MF nasal spray (MFNS) experienced significant improvements in nasal obstruction/congestion (NO/C) score ( P = .0095), bilateral polyp grade (BPG, P = .0008), and ethmoid sinus obstruction ( P  〈  .0001) compared to control using MFNS alone. Fewer treatment than control patients remained candidates for RESS (41.0% vs 69.3%, P  〈  .0001). All subgroups experienced significant treatment effects, except NO/C in smokers ( P = .0509) and patients without altered smell ( P = .1873). Subgroups without asthma and with only 1 prior ESS experienced largest treatment effect on NO/C, and those with recent surgery 〈 24 months and BPG 〉 5 showed largest effect on endoscopic end points and RESS. Control patients with ESS 〈 24 months were at 7 times highest risk for RESS ( P  〈  .0001). One (0.4%) patient experienced implant-related serious adverse event (epistaxis). Conclusion On pooled analysis, MF implants with MFNS showed more favorable results than MFNS alone across several subjective and objective end points at day 90 and may play an important role in management of NP patients, especially those who have allergic rhinitis, expanded polyposis, altered smell, or had most recent ESS  〈  24 months.
    Type of Medium: Online Resource
    ISSN: 1945-8924 , 1945-8932
    URL: Article
    DOI: 10.1177/1945892419850924
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 3
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    Endoscopic and Three-Dimensional Radiographic Imaging of the Pterygopalatine and Infratemporal Fossae : Improving Surgical Landmarks
    SAGE Publications ; 2014
    In:  Annals of Otology, Rhinology & Laryngology Vol. 123, No. 2 ( 2014-02), p. 111-116
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 123, No. 2 ( 2014-02), p. 111-116
    Abstract: We sought to define the surgical endoscopic anatomy of the pterygopalatine fossa (PPF) and infratemporal fossa (ITF) through endoscopic cadaver dissections and radiographic imaging analysis. Methods: Eleven fresh cadavers were submitted to computed tomography (CT) and endoscopic dissection. We used 3-dimensional (3-D) CT reconstruction and endoscopic video imaging for analysis of the bony and soft tissue landmarks. One fixed cadaver head was grossly dissected to confirm the endoscopic anatomic findings. Results: The CT and 3-D CT reconstruction measurements between the pterygoid canal and the foramen rotundum averaged 4.36 mm and 5.09 mm, respectively. An osseous ridge (pterygoid ridge) was identified on the anterior face of the pterygoid process as a novel identifiable anatomic landmark in all of the specimens. The average length of the pterygoid ridge on 3-D CT reconstruction was 7.84 mm. The internal maxillary artery entered the PPF posteromedial to the temporalis tendon and anterolateral to the lateral pterygoid muscle. The average distance from the anterior edge of the lateral pterygoid plate to the foramen ovale was 17.1 mm. Conclusions: The pterygoid ridge is a novel and reliable osseous landmark that could assist surgeons during endoscopic surgery on the PPF and ITF. The neurovascular and muscular anatomic relationships were characterized for both the PPF and the ITF.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/0003489414523707
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 4
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    Relationship of Snoring and Sleepiness as Presenting Symptoms in a Sleep Clinic Population
    SAGE Publications ; 2005
    In:  Annals of Otology, Rhinology & Laryngology Vol. 114, No. 10 ( 2005-10), p. 762-767
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 114, No. 10 ( 2005-10), p. 762-767
    Abstract: Sleepiness has traditionally been considered medically the cardinal symptom of obstructive sleep apnea syndrome. Snoring is perceived as a social or cosmetic complaint. Without independent medical morbidity, snoring identification and treatment is not a major focus in sleep medicine. We speculate that snoring is a major independent symptom. To evaluate how patients rated snoring symptom severity, we compared the relative significance of a sleep clinic population's presenting symptoms of snoring and sleepiness. Methods: We performed a retrospective analysis of 770 consecutive patients who completed sleep intake evaluation forms at the initial clinic visit, including standardized forms for both sleepiness and snoring using previously validated visual analog scales. Data on symptom magnitude (scale of 1 to 10), symptom importance (scale of 1 to 5), a combined symptom product score consisting of magnitude multiplied by importance (MIP; scale of 1 to 50), the Epworth Sleepiness Scale (ESS; n = 599), and the apnea-hypopnea index (AHI; n = 482; mean ± SD, 35.6 ± 31.9 events per hour) were collected. Results: The mean snoring measures (magnitude, importance, and MIP) were greater than those for sleepiness (MIP snoring of 32.7 ± 14.8 versus MIP sleepiness of 22.4 ± 14.2, p 〈 .001). Snoring scored higher than sleepiness in 72% of individuals. To assess whether sleep apnea or sleepiness severity affected symptom scores, we stratified the subgroup with sleep studies into quartiles by AHI and ESS score. Snoring consistently scored higher than sleepiness in most AHI and ESS quartiles (p 〈 .01). Only in the most severe ESS quartile did any sleepiness measure (importance) score higher than the snoring measure (p 〈 .05). Conclusions: The presenting symptoms of snoring are larger in magnitude, importance, and severity than those of sleepiness in a broad population of patients with sleep disorders and sleep-disordered breathing irrespective of severity of sleep apnea or sleepiness. Symptoms of major significance are clinically relevant to identifying, diagnosing, and treating patients. Failure of medical providers to appreciate the impact of snoring on this population may affect attempts to identify, diagnose, and treat patients with sleep-disordered breathing.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348940511401005
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
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  • 5
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    Level of Complete Dissection of the Ethmoid Sinuses with a Computed Tomographic Image Guidance System
    SAGE Publications ; 2010
    In:  Annals of Otology, Rhinology & Laryngology Vol. 119, No. 1 ( 2010-01), p. 17-21
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 119, No. 1 ( 2010-01), p. 17-21
    Abstract: We sought to determine the adequacy of endoscopic total ethmoidectomy with the use of a computed tomographic (CT) image guidance system. Methods: Endoscopic ethmoid sinus dissections were performed on cadavers by otolaryngologists. All cadavers were scanned before dissection. On each side of the cadaver, the ethmoid sinuses were examined independently. A complete endoscopic ethmoidectomy was performed with a CT image guidance system. After the endoscopic ethmoidectomy, the cadaver underwent a postdissection CT scan. The postdissection CT images were then evaluated for the level of complete dissection of the anterior and posterior ethmoid sinuses. Results: There were 18 ethmoid sinuses in the study. One specimen underwent a complete total ethmoidectomy with no residual cells. There were 4 complete anterior ethmoidectomies and 5 complete posterior ethmoidectomies. Overall, the average numbers of residual anterior ethmoid and posterior ethmoid air cells were 1.39 and 1.22, respectively. This difference was not statistically significant. The skull base was dissected more completely than the lamina papyracea, with a significant difference (p = 0.03). There was no difference in terms of residual cells between the left and right ethmoid sinuses (p 〉 0.05). Conclusions: Even with the use of a CT image guidance system, a complete ethmoidectomy was still difficult to achieve. Residual ethmoid sinus cells were more commonly found along the lamina papyracea than along the skull base.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348941011900103
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
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  • 6
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    Initial Surgical Treatment for Chronic Frontal Sinusitis: A Pilot Study
    SAGE Publications ; 2007
    In:  Annals of Otology, Rhinology & Laryngology Vol. 116, No. 4 ( 2007-04), p. 286-289
    Details
    In: Annals of Otology, Rhinology & Laryngology, SAGE Publications, Vol. 116, No. 4 ( 2007-04), p. 286-289
    Abstract: The initial surgical treatment for chronic frontal sinusitis is not well defined. Our objective was to determine the effectiveness of anterior ethmoidectomy for chronic frontal sinusitis. Methods: Patients with chronic frontal sinusitis who underwent anterior ethmoidectomy as initial surgical treatment were reviewed. Data were collected from computed tomography scans with use of the Lund-Mackay scale. Data on demographics, comorbidities, management, postoperative recovery, and follow-up were collected. Results: Seventy-seven patients representing 121 diseased frontal sinuses met the inclusion criteria. The respiratory comorbidities were asthma alone (8.3%), asthma and polyps (6.6%), aspirin triad (5.8%), and cystic fibrosis (0.8%). Nineteen of 121 frontal sinuses (15.7%) belonged to smokers. Fourteen of 121 frontal sinuses (11.5%) exhibited postoperative evidence of disease. Of these 14 frontal sinuses, 10 (8.3%) underwent revision surgery. Frontal sinuses of patients with aspirin triad, with both nasal polyposis and asthma, or with inter-frontal sinus septal cells were more likely to fail Draf I surgery (p 〈 .05). Conclusions: Anterior ethmoidectomy for drainage of frontal sinuses appears to be effective initial surgical treatment for chronic frontal sinusitis. Patients with aspirin triad, both asthma and polyposis, or inter-frontal sinus septal cells are more likely to fail this procedure.
    Type of Medium: Online Resource
    ISSN: 0003-4894 , 1943-572X
    URL: Article
    DOI: 10.1177/000348940711600412
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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  • 7
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    Management of Retrobulbar Hematoma
    SAGE Publications ; 2008
    In:  American Journal of Rhinology Vol. 22, No. 5 ( 2008-09), p. 522-524
    Details
    In: American Journal of Rhinology, SAGE Publications, Vol. 22, No. 5 ( 2008-09), p. 522-524
    Abstract: Retrobulbar hematoma (RH) is a complication that can result from both otolaryngic and ophthalmologic procedures. RH can occur during endoscopic sinus surgery and improper treatment can result in several morbidities, including visual loss. Despite serious consequences, management for RH is not well evaluated. However, lateral canthotomy with cantholysis is generally recommended. The objective of this study is to review the management for RH. Methods A retrospective study was performed at our tertiary hospital from 1979 to 2006 for patients with the ICD-9 code for orbital hematoma. The demographic information, comorbidities, presentation, management, follow-up period, and outcomes were evaluated. Data were analyzed. Results Twenty-two patients were identified with 13 male patients and an average age of 43 years (range, 11–80 years). The RH was broken into three categories: iatrogenic, six cases; trauma, eight cases; and spontaneous, eight cases. The most common symptom was diplopia followed by orbital pain. The average pretreatment and posttreatment tonometric pressures were 25.3 mm Hg (range, 11–60 mm Hg) and 14.5 mm Hg (range, 10–22 mm Hg), respectively. The average proptosis was 4.3 (range: 0–8) mm. Treatments were observation (13 cases), medical treatment alone (4 cases), and surgical treatment with and without medical treatment (5 cases). Sixty-eight percent of the patient's visual acuity improved with these treatments. Twenty-seven percent had no visual changes from the RH. The average follow-up was 5 years. Conclusion Traditionally, lateral canthotomy with cantholysis is recommended for the treatment for RH. However, in certain patients and settings, there may be an acceptable alternative option for the management of RH.
    Type of Medium: Online Resource
    ISSN: 1050-6586 , 1539-6290
    URL: Article
    DOI: 10.2500/ajr.2008.22.3217
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
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  • 8
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    Microarray Analysis of Distinct Gene Transcription Profiles in Non-eosinophilic Chronic Sinusitis with Nasal Polyps
    SAGE Publications ; 2008
    In:  American Journal of Rhinology Vol. 22, No. 6 ( 2008-11), p. 568-581
    Details
    In: American Journal of Rhinology, SAGE Publications, Vol. 22, No. 6 ( 2008-11), p. 568-581
    Abstract: Recent literature has indicated the feasibility of microarray analysis in the characterization of chronic sinusitis. We hypothesized that previously unexplored inflammatory mechanisms would be involved in the pathophysiology of noneosinophilic chronic rhinosinusitis with nasal polyps (NE-CRSwNP) and that this technology could be used to identify the gene expression of these novel and previously known mediators. Methods Patients with CRSwNP failing medical therapy were prospectively enrolled and NP tissue was removed at time of surgery. NE-CRSwNP was diagnosed based on clinical parameters including absence of allergic disease and confirmed with histopathology showing lack of eosinophilic infiltration. Messenger RNA (mRNA) transcripts extracted from study and control patients were then subjected to microarray analysis using Affymatrix based chips. Validation of findings was then confirmed via quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results Microarray analysis revealed activation of pathways involved in antigen presentation, cellular movement, hematopoiesis, carcinogenesis, apoptosis, and cell signaling. Previously unexplored genes of interest were identified and their differential regulation was validated via qRT-PCR. Our data showed up-regulation of innate inflammation genes (IL-6, IL-8, and monocyte chemoattractant protein 1), hypoxia-induced inflammation 1α, and fibrosis (tenascin) and lack of up-regulation of genes associated with allergic, eosinophilic inflammation (IL-4 and IL-13). Additionally, the genes for CXCL1 and autocrine motility factor receptor were novelly identified to be up-regulated Conclusion This study explores the utility of gene microarray technology in identifying unexplored targets of immune dysregulation in NE-CRSwNP. Furthermore, the data characterize the immunologic profile of NE-CRSwNP as it differs from other forms of CRSwNP, in particular, those known to be associated with eosinophilic inflammation.
    Type of Medium: Online Resource
    ISSN: 1050-6586 , 1539-6290
    URL: Article
    DOI: 10.2500/ajr.2008.22.3233
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
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  • 9
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    Sagittal and Coronal Dimensions of the Ethmoid Roof: A Radioanatomic Study
    SAGE Publications ; 2005
    In:  American Journal of Rhinology Vol. 19, No. 4 ( 2005-07), p. 348-352
    Details
    In: American Journal of Rhinology, SAGE Publications, Vol. 19, No. 4 ( 2005-07), p. 348-352
    Abstract: Understanding the anatomy of the ethmoid roof is critical to safe surgical outcomes. Normative data regarding the height and slope of this region have been somewhat limited, derived primarily from cadaveric coronal computed tomography (CT) studies. With triplanar imaging programs, precise multidimensional measurements of the ethmoid roof are now possible. We present a radioanatomic study to characterize normative sagittal and coronal dimensions of the ethmoid roof. Methods Bilateral measurements were taken in 100 consecutive sinus CT scans using ThinClient 3D software. In the sagittal plane, the height of the ethmoid roof was measured in quadrants at five equidistant points between the frontal beak and sphenoid face, referencing the nasal floor. In the coronal plane, the ethmoid roof was measured at three points at the level of the anterior ethmoid artery and at two points at the junction of the posterior ethmoid and sphenoid sinuses. Results When examined sagittally, the right side showed significantly lower skull base heights in the anterior ethmoid compared with the left side (59.0 mm versus 59.8 mm, p = 0.017; 53.7 mm versus 54.5 mm, p = 0.0004). Coronal measurements of the anterior ethmoid roof showed similar significant differences. The anterior ethmoid roof had greater asymmetries of height compared with the posterior ethmoid roof, which was fairly constant. Conclusion This study provides numerical correlates to accepted concepts regarding the shape and slope of the ethmoid roof. Differences in height of the skull base between right and left sides, especially in the anterior ethmoid sinus, may be an important surgical consideration. The posterior ethmoid roof appears to be relatively constant and should serve as a reliable surgical landmark.
    Type of Medium: Online Resource
    ISSN: 1050-6586 , 1539-6290
    URL: Article
    DOI: 10.1177/194589240501900405
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
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    detail.hit.zdb_id: 2554548-6
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  • 10
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    Analysis of Histopathological Endotyping for Chronic Rhinosinusitis Phenotypes Based on Comorbid Asthma and Allergic Rhinitis
    SAGE Publications ; 2019
    In:  American Journal of Rhinology & Allergy Vol. 33, No. 5 ( 2019-09), p. 507-512
    Details
    In: American Journal of Rhinology & Allergy, SAGE Publications, Vol. 33, No. 5 ( 2019-09), p. 507-512
    Abstract: An emerging trend in clinical research has centered on improving the characteristics of chronic rhinosinusitis (CRS) according to phenotypes and endotypes. The objective of this study is to utilize histopathological markers to better characterize CRS phenotypes that are defined by the presence or absence of comorbid bronchial asthma (BA) and allergic rhinitis (AR). Methods A prospective case-controlled study of CRS patients was conducted. For the CRS cohort, mucosal biopsies were obtained during endoscopic sinus surgery, while samples of ethmoid mucosa were collected in control patients undergoing endoscopic skull base surgery. Histopathological analysis of tissue samples determined the relative frequency of inflammatory cell types, including eosinophils, lymphocytes, neutrophils, mast cells, and plasma cells. The presence and absence of comorbid BA and AR were used to further divide CRS, allowing for further subgroup analysis. Results Of 82 recruited patients, there were 67 CRS patients and 15 controls. Significantly increased eosinophil ratios were found in CRS patients with AR, BA, or both, when compared with controls ( P  〈  .001). Conversely, CRS patients with neither comorbid diagnosis failed to demonstrate statistically significant elevations in eosinophil ratios ( P  〉  .05). Lymphocyte ratios showed a significantly inverse correlation with trends demonstrated by eosinophil ratios in all patient subgroups ( P  〈  .001). Neutrophil, mast cell, and plasma cell ratios did not show significant differences across the evaluated subgroups. Conclusions The clinical diagnosis of comorbid BA and AR may aid in better characterizing CRS endotypes without invasive testing and better direct management of the disease.
    Type of Medium: Online Resource
    ISSN: 1945-8924 , 1945-8932
    URL: Article
    DOI: 10.1177/1945892419846263
    RVK:
    XA 20278
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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