Charles Ebert - Academia.edu (original) (raw)

Papers by Charles Ebert

Research paper thumbnail of Prognosis of Sinonasal Squamous Cell Carcinoma by Subsite and Initial Treatment Modality

31st Annual Meeting North American Skull Base Society, 2022

Research paper thumbnail of Pediatric Odontogenic Myxoma of the Maxilla: A Case Report and Review of the Literature

31st Annual Meeting North American Skull Base Society, 2022

Research paper thumbnail of Streamlining care in cystic fibrosis: survey of otolaryngologist, pulmonologist, and patient experiences

International Forum of Allergy & Rhinology, 2020

Introduction: Care coordination for cystic fibrosis (CF) is essential. The objectives of this stu... more Introduction: Care coordination for cystic fibrosis (CF) is essential. The objectives of this study were to: 1) compare otolaryngologists' and pulmonlogists' understanding of long-term chronic rhinosinusitis (CRS) management, and 2) query patient perceptions of otolaryngologic care and CRS. Methods: A cross-sectional survey was administered by the Cystic Fibrosis Foundation in 2018 to patients with CF or their caregivers, otolaryngologists, and pulmonologists. Statistical analysis was performed comparing specialists. Descriptive statistics were computed for patient/caregiverreported data. Results: Respondents included 126 otolaryngologists, 115 pulmonologists, and 186 patients with CF or their caregivers. Pulmonologists had greater experience caring for CF patients compared to otolaryngologists (66.7% vs. 43.2% with 13+ years of experience, respectively), but more otolaryngologists cared for both adult and pediatric CF patients (39.2% vs. 10.4%, respectively). Significantly more otolaryngologists advocated for establishing otolaryngologic care at time of CF diagnosis (64.8%) compared to pulmonologists (14.4%, p<0.001), of whom 60.4% recommended otolaryngologist referral when sinonasal symptoms affect quality of life. More otolaryngologists perceived sinus surgery as beneficial for pulmonary function (74.5% vs 57.7%, p=0.009). 60.8% of patients first sought otolaryngologic care in infancy or childhood (<13 years). Median number of sinus surgeries was 3 (interquartile range: 2-5). Most common perceived benefits of surgery according to patients/caregivers were improved breathing (31.2%) and improved sinonasal symptoms (23.7%). Top patients/caregiver otolaryngologic priorities included symptom/infection control (49.0%) and care coordination (15.0%).

Research paper thumbnail of Comparative study of simulated nebulized and spray particle deposition in chronic rhinosinusitis patients

International Forum of Allergy & Rhinology, 2019

Introduction: Topical intranasal drugs are widely prescribed for Chronic Rhinosinusitis (CRS), al... more Introduction: Topical intranasal drugs are widely prescribed for Chronic Rhinosinusitis (CRS), although delivery can vary with device type and droplet size. The study objective was to compare nebulized and sprayed droplet deposition in the paranasal sinuses and ostiomeatal complex (OMC) across multiple droplet sizes in CRS patients using computational fluid dynamics (CFD). Methods: Three-dimensional models of sinonasal cavities were constructed from computed tomography (CT) scans of three subjects with CRS refractory to medical therapy using imaging software. Assuming steady-state inspiratory airflow at resting rate, CFD was used to simulate 1-120 μm sprayed droplet deposition in the left and right sinuses and OMC with spray nozzle positioning as in current nasal spray use instructions. Zero-velocity nebulization simulations were performed for 1-30 μm droplet sizes, maximal sinus and OMC deposition fractions (MSDF) were obtained, and sizes that achieved at least 50% of MSDF were identified. Nebulized MSDF was compared to sprayed droplet deposition. We also validated CFD framework through in vitro experiments. Results: Among nebulized droplet sizes, 11-14 μm droplets achieved at least 50% of MSDF in all six sinonasal cavities. Five of six sinonasal cavities had greater sinus and OMC deposition with nebulized droplets than with sprayed droplets at optimal sizes. Conclusions: Nebulized droplets may target the sinuses and OMC more effectively than sprayed particles at sizes achieving best deposition. Further studies are needed to confirm our preliminary findings. Several commercial nasal nebulizers have average particle sizes outside the optimal nebulized droplet size range found here, suggesting potential for product enhancement.

Research paper thumbnail of Concordance of Middle Meatal Swab and Maxillary Sinus Aspirate in Acute and Chronic Sinusitis: A Meta-Analysis

American Journal of Rhinology, 2005

Background The medical management of acute and chronic sinusitis is a therapeutic challenge. The ... more Background The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). Methods We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. Results Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultu...

Research paper thumbnail of International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International forum of allergy & rhinology, 2016

Isam Alobid, MD, PhD(1) , Nithin D. Adappa, MD(2) , Henry P. Barham, MD(3) , Thiago Bezerra, MD(4... more Isam Alobid, MD, PhD(1) , Nithin D. Adappa, MD(2) , Henry P. Barham, MD(3) , Thiago Bezerra, MD(4) , Nadieska Caballero, MD(5) , Eugene G. Chang, MD(6) , Gaurav Chawdhary, MD(7) , Philip Chen, MD(8) , John P. Dahl, MD, PhD(9) , Anthony Del Signore, MD(10) , Carrie Flanagan, MD(11) , Daniel N. Frank, PhD(12) , Kai Fruth, MD, PhD(13) , Anne Getz, MD(14) , Samuel Greig, MD(15) , Elisa A. Illing, MD(16) , David W. Jang, MD(17) , Yong Gi Jung, MD(18) , Sammy Khalili, MD, MSc(19) , Cristobal Langdon, MD(20) , Kent Lam, MD(21) , Stella Lee, MD(22) , Seth Lieberman, MD(23) , Patricia Loftus, MD(24) , Luis Macias-Valle, MD(25) , R. Peter Manes, MD(26) , Jill Mazza, MD(27) , Leandra Mfuna, MD(28) , David Morrissey, MD(29) , Sue Jean Mun, MD(30) , Jonathan B. Overdevest, MD, PhD(31) , Jayant M. Pinto, MD(32) , Jain Ravi, MD(33) , Douglas Reh, MD(34) , Peta L. Sacks, MD(35) , Michael H. Saste, MD(36) , John Schneider, MD, MA(37) , Ahmad R. Sedaghat, MD, PhD(38) , Zachary M. Soler, MD(39) , Nevi...

Research paper thumbnail of Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial

Rhinology, 2015

To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus ... more To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus surgery (FESS) patients with chronic rhinosinusitis with polyposis (CRSwNP). Currently, no evidence exists for NS+budesonide irrigation over NS irrigation alone. Prospective, single-blind, randomized controlled trial. Subjects were prospectively enrolled to NS or NS+budesonide arms. Patients were evaluated at pre-operative and three post-operative visits (POV): POV1 (1-2 weeks post-op), POV2 (3-8 weeks post-op), and POV3 (3-6 months post-op). Patients were evaluated by three quality of life (QOL) questionnaires (SNOT-22, RSOM-31, and RSDI) and two olfaction scores (UPSIT and the PEA test). Fifty patients were randomized, with 25 patients in the NS arm and 25 patients in the NS+budesonide arm. Two patients had unexpected pathology and were excluded from the study. By POV2 and POV3, patients experienced a significant improvement in all three QOL surveys, although the degree of improvement ...

Research paper thumbnail of Depression and anxiety in chronic rhinosinusitis

International Forum of Allergy & Rhinology, 2015

Both depression and anxiety have been suspected to impact quality of life adversely in patients w... more Both depression and anxiety have been suspected to impact quality of life adversely in patients with chronic rhinosinusitis (CRS). The objective of this work was to assess for the presence of anxiety and/or depression in the setting of CRS and to assess their impact on disease-related quality of life by analyzing the correlation between the Rhinosinusitis Disability Index (RSDI) and the Hospital Anxiety and Depression score (HADS), as well as the Lund-Kennedy nasal endoscopic scores. A total of 124 patients with CRS were prospectively evaluated in the outpatient setting using the RSDI and HADS questionnaires as well as the Lund-Kennedy nasal endoscopy scoring system. The total RSDI and its subscale scores had moderate to very strong correlation with the HADS total score and each of its subscale scores in comparison to their poor correlation with Lund-Kennedy endoscopic score. CRS patients with depression or anxiety scores 8 to 10 (possible case of clinically significant depression or anxiety) and 11 to 21 (probable case) reported worse total RSDI and subscale scores when compared with those with normal scores (0 to 7). There was no significant difference in the Lund-Kennedy endoscopic scores between the different groups of anxiety and depression scores. Depression and anxiety are prevalent in CRS. The total RSDI and its different subscale scores exhibit moderate to very strong correlation with depression/anxiety scores as determined by HADS, whereas poor correlation was seen with the Lund-Kennedy endoscopic score.

Research paper thumbnail of A prospective randomized cohort study evaluating 3 weeks vs 6 weeks of oral antibiotic treatment in the setting of “maximal medical therapy” for chronic rhinosinusitis

International Forum of Allergy & Rhinology, 2015

Background: Surprisingly, li le literature exists evaluating the optimal duration of antibiotic t... more Background: Surprisingly, li le literature exists evaluating the optimal duration of antibiotic treatment in "maximal medical therapy" for chronic rhinosinusitis (CRS). As such, we investigated whether 3 weeks vs 6 weeks of antibiotic therapy resulted in significant differences in clinical response. Methods: A prospective, randomized cohort study was performed with patients assigned to 3-week or 6-week cohorts. Our primary outcome was failure of "maximal medical therapy" and surgical recommendation. Secondary outcomes included changes in pretherapy and pos herapy scores for the Rhinosinusitis Disability Index (RSDI), Chronic Sinusitis Survey (CSS), and computed tomography (CT)-based Lund-Mackay (LM) evaluation. Analyses were substratified based on presence of nasal polyps. Results: Forty patients were randomized to the 3-week or 6-week treatment cohorts, with near-complete clinical follow-up achieved. No significant difference was found between the proportion of patients who failed medical therapy and were deemed surgical candidates between the 2 cohorts (71% vs 68%, p = 1.000). No significant difference was found in the change of RSDI or CSS scores in the 3 vs 6 weeks of treatment groups (mean ± standard error of the mean [SEM]; RSDI: 9.62 ± 4.14 vs 1.53 ± 4.01, p = 0.868; CSS: 5.75 ± 4.36 vs 9.65 ± 5.34, p = 0.573). Last, no significant difference was found in the change of LM scores (3.35 ± 1.11 vs 1.53 ± 0.81, p = 0.829). Conclusion: Based on this data, there is li le difference in clinical outcomes between 3 weeks vs 6 weeks of antibiotic treatment as part of "maximal medical therapy" for CRS. Increased duration of antibiotic treatment theoretically may increase risk from side effects and creates higher healthcare costs.

Research paper thumbnail of Single-blind randomized controlled trial of surfactant vs hypertonic saline irrigation following endoscopic endonasal surgery

International forum of allergy & rhinology, 2013

Recent discussion has revolved around formulations of irrigation in the postoperative functional ... more Recent discussion has revolved around formulations of irrigation in the postoperative functional endoscopic sinus surgery patient, specifically the efficacy of emulsion based nasal irrigations. Forty adult candidates for endoscopic endonasal surgery with chronic rhinosinusitis (CRS) were prospectively randomized. The 22-item Sino-Nasal Outcome Test (SNOT-22) and 31-item Rhinosinusitis Outcome Measure (RSOM-31) quality of life assessments, as well as a phenyl ethyl alcohol (PEA) smell threshold test were obtained preoperatively and over 3 postoperative visits in a 4-month period. Repeated measures analyses and Fisher's exact tests were used to assess statistical differences. Of the 40 patients enrolled, 33, 32, and 26 patients were seen at postoperative visits 1, 2, and 3, respectively. The surfactant (S) and hypertonic saline (HS) irrigation groups both showed significant decreases in scores for both the SNOT-22 and RSOM-31 over time (both p < 0.0001), but no difference was s...

Research paper thumbnail of Sinonasal quality-of-life before and after endoscopic, endonasal, minimally invasive pituitary surgery

International Forum of Allergy & Rhinology, 2011

Background: Endoscopic, endonasal, minimally invasive pituitary surgery (MIPS) has proven to be s... more Background: Endoscopic, endonasal, minimally invasive pituitary surgery (MIPS) has proven to be safe and efficacious. However, there are few data that assess the healthrelated or sinonasal-specific quality-of-life (QoL) of those undergoing MIPS. Our hypothesis is that patients undergoing MIPS do not have significantly different sinus disability or change in QoL a er surgery compared to prior to surgery. Methods: This is a retrospective review of patients undergoing MIPS between 2002 and 2009. Rhinosinusitis Disability Index (RSDI) scores, patient demographics, tumor characteristics, surgical outcomes, and intraoperative/postoperative complications were recorded. Preoperative and postoperative mean RSDI scores and the mean absolute change in RSDI were calculated with 95% confidence intervals (CIs). One-way analysis of variance (ANOVA) compared RSDI scores between different tumor subgroups. Results: A total of 50 patients completed the RSDI preoperatively and postoperatively. Analyses revealed no significant difference between preoperative and postoperative scores across all domains (p = 0.84). When the cohort was stratified into functional vs nonfunctional tumor types there was no significant difference between the 2 groups (p = 0.88). Data showed no statistically significant change in RSDI scores postoperatively in all groups. Conclusion: These data show that MIPS with appropriate postoperative care results in li le or no long-term sinonasal quality of life defects.

Research paper thumbnail of Direct Healthcare Cost Analysis of Endoscopic Compared with Sublabial Transseptal Pituitary Surgery

Journal of Neurological Surgery Part B: Skull Base, 2012

Research paper thumbnail of Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery

International Forum of Allergy & Rhinology, 2013

Background-The effects of increases in maxillary sinus (MS) airflow following functional endoscop... more Background-The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures. Methods-A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm 2. Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis OutcomeMeasure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates. Results-CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores. Conclusion-CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS.

Research paper thumbnail of Beyond the “central sinus”: radiographic findings in patients undergoing revision functional endoscopic sinus surgery

International Forum of Allergy & Rhinology, 2012

Background: Functional endoscopic sinus surgery (FESS) is widely used by otolaryngologists to tre... more Background: Functional endoscopic sinus surgery (FESS) is widely used by otolaryngologists to treat chronic rhinosinusitis (CRS). The sinonasal anatomy and pathology found in patients with CRS varies widely, as does the FESS technique practiced by otolaryngologists. Variations in the completeness of cell group dissection, combined with the technical challenge of angled endoscopy, result in a wide variation of the post-FESS cavities harboring persistent disease. The purpose of this study was to identify previously incompletely dissected anatomic structures associated with mucosal thickening found in patients undergoing revision FESS for persistent or recurrent CRS. Methods: Retrospective review of axial, coronal, and sagittal computed tomography (CT) scans of patients undergoing revision FESS by 3 fellowship-trained rhinologists at a tertiary referral center. Results: The CT scans of 55 patients undergoing revision FESS were reviewed. The most frequent radiographic findings were residual anterior and posterior ethmoid cells or septations, found in 65% of sides and 75% of patients. In addition, residual anterior ethmoid agger nasi cells, unopened sphenoid, and residual uncinates were found in 52%, 51%, and 46% of sides, respectively. A large percentage of the patients demonstrated residual ethmoid cells present on the lamina papyracea and skull base, with a lower number found posterior to the middle turbinate basal lamella. A greater number of residual right-sided vs le-sided ethmoid cells was noted, with the difference being significant (p < 0.05) at the skull base. Conclusion: Analysis of CT scans of patients undergoing revision FESS for persistent or recurrent CRS frequently reveals persistent anatomical structures or incompletely resected cells associated with persistent mucosal thickening. Meticulous, complete cell group dissection combined with use of angled endoscopy along with identification of possible predisposing structures may aid in the reduction of need for revision surgery.

Research paper thumbnail of Occupational hazards of endoscopic surgery

International Forum of Allergy & Rhinology, 2011

Minimally invasive surgery has taken its toll on the physical well-being of surgeons. There have ... more Minimally invasive surgery has taken its toll on the physical well-being of surgeons. There have been many physical consequences for surgeons. However, few have been investigated, specifically for otolaryngologists performing endoscopic endonasal surgery (EES). The purpose of this study is to define the prevalence, quality, and severity of physical symptoms that otolaryngologists experience as they relate to the surgeons&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; use of ergonomically designed endoscopic instruments in endonasal surgery. A 25-question survey was administered between September 2010 and March 2011 to practicing otolaryngologists. The questions addressed demographics, physical symptoms, ergonomics, and operating room environment. Data were analyzed using Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact, Wilcoxon rank sum, and Jonckheere-Terpstra statistics. Sixty-two surgeons responded with a median age of 36 years. Responders performed a median of 150 EESs per year and 37% had completed an endoscopic fellowship. The majority (77%) of responders had experienced physical discomfort or symptoms that they attributed to EES. Thirteen percent (13%) of those who had experienced symptoms felt that their symptoms were persistent. Only 23% of those experiencing symptoms had sought medical care. No significant associations were seen between surgeon age, number of cases, standing, or having adjustable video display with experiencing discomfort (all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.49). Interestingly, fewer surgeons completing an endoscopic fellowship experienced discomfort (70% vs 82%, p = 0.35). Our data showed that 77% of physicians who regularly perform EES suffer physical discomfort or symptoms attributable to EES. As expanded endonasal procedures become more prevalent, additional data and ergonomic analysis are necessary to reverse this trend and reduce possible long-term damage for surgeons.

Research paper thumbnail of Plain films in the evaluation of batteries as esophageal foreign bodies

International journal of pediatric otorhinolaryngology, 2008

To determine the sensitivity and specificity of plain films in differentiating coin batteries fro... more To determine the sensitivity and specificity of plain films in differentiating coin batteries from coins. Study was conducted at a tertiary referral university medical center. Eleven radiographs were taken of various objects and independently reviewed by 14 radiologists and otolaryngologists. Reviewers were asked to identify the object filmed as either a battery or not a battery. In addition, otolaryngologists were asked if they would immediately proceed to the operative suite for removal based on the film. Results were tabulated and analyzed using a spreadsheet. Overall, plain films had a sensitivity and specificity of 80.4% and 79.1%, respectively with an overall accuracy of 79.8%. When used as a test to determine urgency of removal, sensitivity increases to 94.4% while specificity decreases to 67.1% with an overall accuracy of 83.1%. Plain films are an effective method of evaluating for the possibility of batteries as esophageal foreign bodies.

Research paper thumbnail of Comparative analysis of cost of endoscopic endonasal minimally invasive and sublabial-transseptal approaches to the pituitary

International forum of allergy & rhinology

Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) appr... more Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) approach using microscopy and the endonasal endoscopic minimally invasive (MIPS) approach. Although outcomes are similar for both procedures, MIPS has become increasingly prevalent over the last 15 years. Limited cost analysis data comparing the 2 alternatives are available. A retrospective analysis of cost and volume data was performed using data from the published literature and University of North Carolina at Chapel Hill (UNC) Hospitals. A sensitivity analysis of the parameters was used to evaluate the uncertainty in parameter estimates. The total cost in real dollars ranges from 11,438to11,438 to 11,438to12,513 and 18,095to18,095 to 18,095to21,005 per patient per procedure for MIPS and SLTS, respectively, with a cost difference ranging between 5582and5582 and 5582and9567 per patient per procedure. The sensitivity analysis indicates that the total cost for MIPS is most sensitive to: (1) average length of stay, (2) nursing costs...

Research paper thumbnail of Endoscopic transnasal balloon dilation of the lacrimal duct

Otolaryngology - Head and Neck Surgery, 2009

by a qualified radiologist. Anthropometry: Standard anthropometric measurements of weight, height... more by a qualified radiologist. Anthropometry: Standard anthropometric measurements of weight, height, arm, hip, waist, and neck sizes were performed. Multiple regression analysis was used to determine which anthropometric measurements best correlated with TTSSTT. RESULTS: The TTSSTT as measured by U/S in the supine position, ranged from 0.65 to 3.53cm. Although the anthropometric measurement most predicative of TTSSTT was waist circumference, a combination of the more practical arm and neck circumferences resulted in an equivalent correlation (rϭ 0.82). The average root mean square error was 0.4cm. From the fitted regression equation, a table predicting TTSSTT from neck and arm circumference was prepared. CONCLUSIONS: TTSSTT can be closely predicted using simple anthropometric tape measures. The predicted TTSSTT can be used to select appropriate tracheostomy tube size in obese patients. Use of this simple tool is expected to significantly reduce the incidence of accidental decannulation in obese patients.

Research paper thumbnail of Immune modulatory oligonucleotides in prevention of nasal allergen–induced Eustachian tube dysfunction in rats

Otolaryngology - Head and Neck Surgery, 2007

OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction (ETD) in a rat ... more OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction (ETD) in a rat and investigate the role of immune modulatory oligonucleotides (IMOs) in the prevention of nasal allergen-induced ETD. STUDY DESIGN AND SETTING: Prospective, randomized study. Brown Norway rats were sensitized to ova albumin (OVA) and randomized to receive pretreatment with IMOs or phosphatebuffered saline. All animals were challenged intranasally with aerosolized OVA. Dynamic measures of Eustachian tube (ET) function were analyzed. RESULTS: Animals that were OVA-sensitized and IMO-pretreated had significantly lower mean passive opening (95% confidence interval [95% CI] 15.0,19.4) and closing (95% CI 4.8,7.8) ET pressures compared with those of (95% CI 24.1,32.7) and (95% CI 12.1,18.8) OVA-sensitized untreated rats, respectively. In addition, the IMO-pretreated animals demonstrated the ability to actively clear a significantly higher proportion of negative pressure (95% CI 0.64,0.96) compared with the untreated animals (95% CI 0.09,0.39). IMO-pretreated animals also demonstrated significantly improved mean mucociliary clearance times in seconds (95% CI 115,195) than those in untreated animals (95% CI 308,668). CONCLUSIONS: Pretreatment with IMOs prevented allergeninduced allergic inflammation around the Eustachian tube (ET) and resulted in improved ventilatory function of the ET compared with sensitized untreated animals. IMOs offer considerable promise in the management of nasal allergic disease as well as otitis media with effusion.

Research paper thumbnail of Nitric oxide in glutamate-induced compound action potential threshold shifts

Hearing Research, 2008

Objective: Investigate the role of NO as a neurotransmitter in the gerbil cochlea and the effects... more Objective: Investigate the role of NO as a neurotransmitter in the gerbil cochlea and the effects of (7-NI) on compound action potential (CAP) threshold elevations induced by L-glutamate, an agonist at the NMDA glutamate receptor subtype, to further elucidate the role of NO in cochlear excitotoxicity. Method: In anesthetized gerbils, CAP thresholds were recorded before and after cochlear perfusions with a control solution of artificial perilymph (APS) and a test solution of L-glutamate (GA) in three experimental groups. Results: The control group showed no CAP threshold elevations (p < 0.05) when APS was perfused after systemic pre-treatment with 7-NI. GA perfusion alone caused significant elevation (p < 0.05) of the mean cochlear CAP threshold (25 dB SPL ± 5.8 dB to 78 dB SPL ± 19.5 dB). The CAP threshold elevation was prevented (p < 0.05) when the animals were pretreated with 7-NI before GA perfusion (24 dB SPL ± 4.2 dB to 27 dB SPL ± 6.7 dB). Conclusion: NO mediates excitotoxicity when the cochlea is perfused with L-glutamate.

Research paper thumbnail of Prognosis of Sinonasal Squamous Cell Carcinoma by Subsite and Initial Treatment Modality

31st Annual Meeting North American Skull Base Society, 2022

Research paper thumbnail of Pediatric Odontogenic Myxoma of the Maxilla: A Case Report and Review of the Literature

31st Annual Meeting North American Skull Base Society, 2022

Research paper thumbnail of Streamlining care in cystic fibrosis: survey of otolaryngologist, pulmonologist, and patient experiences

International Forum of Allergy & Rhinology, 2020

Introduction: Care coordination for cystic fibrosis (CF) is essential. The objectives of this stu... more Introduction: Care coordination for cystic fibrosis (CF) is essential. The objectives of this study were to: 1) compare otolaryngologists' and pulmonlogists' understanding of long-term chronic rhinosinusitis (CRS) management, and 2) query patient perceptions of otolaryngologic care and CRS. Methods: A cross-sectional survey was administered by the Cystic Fibrosis Foundation in 2018 to patients with CF or their caregivers, otolaryngologists, and pulmonologists. Statistical analysis was performed comparing specialists. Descriptive statistics were computed for patient/caregiverreported data. Results: Respondents included 126 otolaryngologists, 115 pulmonologists, and 186 patients with CF or their caregivers. Pulmonologists had greater experience caring for CF patients compared to otolaryngologists (66.7% vs. 43.2% with 13+ years of experience, respectively), but more otolaryngologists cared for both adult and pediatric CF patients (39.2% vs. 10.4%, respectively). Significantly more otolaryngologists advocated for establishing otolaryngologic care at time of CF diagnosis (64.8%) compared to pulmonologists (14.4%, p<0.001), of whom 60.4% recommended otolaryngologist referral when sinonasal symptoms affect quality of life. More otolaryngologists perceived sinus surgery as beneficial for pulmonary function (74.5% vs 57.7%, p=0.009). 60.8% of patients first sought otolaryngologic care in infancy or childhood (<13 years). Median number of sinus surgeries was 3 (interquartile range: 2-5). Most common perceived benefits of surgery according to patients/caregivers were improved breathing (31.2%) and improved sinonasal symptoms (23.7%). Top patients/caregiver otolaryngologic priorities included symptom/infection control (49.0%) and care coordination (15.0%).

Research paper thumbnail of Comparative study of simulated nebulized and spray particle deposition in chronic rhinosinusitis patients

International Forum of Allergy & Rhinology, 2019

Introduction: Topical intranasal drugs are widely prescribed for Chronic Rhinosinusitis (CRS), al... more Introduction: Topical intranasal drugs are widely prescribed for Chronic Rhinosinusitis (CRS), although delivery can vary with device type and droplet size. The study objective was to compare nebulized and sprayed droplet deposition in the paranasal sinuses and ostiomeatal complex (OMC) across multiple droplet sizes in CRS patients using computational fluid dynamics (CFD). Methods: Three-dimensional models of sinonasal cavities were constructed from computed tomography (CT) scans of three subjects with CRS refractory to medical therapy using imaging software. Assuming steady-state inspiratory airflow at resting rate, CFD was used to simulate 1-120 μm sprayed droplet deposition in the left and right sinuses and OMC with spray nozzle positioning as in current nasal spray use instructions. Zero-velocity nebulization simulations were performed for 1-30 μm droplet sizes, maximal sinus and OMC deposition fractions (MSDF) were obtained, and sizes that achieved at least 50% of MSDF were identified. Nebulized MSDF was compared to sprayed droplet deposition. We also validated CFD framework through in vitro experiments. Results: Among nebulized droplet sizes, 11-14 μm droplets achieved at least 50% of MSDF in all six sinonasal cavities. Five of six sinonasal cavities had greater sinus and OMC deposition with nebulized droplets than with sprayed droplets at optimal sizes. Conclusions: Nebulized droplets may target the sinuses and OMC more effectively than sprayed particles at sizes achieving best deposition. Further studies are needed to confirm our preliminary findings. Several commercial nasal nebulizers have average particle sizes outside the optimal nebulized droplet size range found here, suggesting potential for product enhancement.

Research paper thumbnail of Concordance of Middle Meatal Swab and Maxillary Sinus Aspirate in Acute and Chronic Sinusitis: A Meta-Analysis

American Journal of Rhinology, 2005

Background The medical management of acute and chronic sinusitis is a therapeutic challenge. The ... more Background The medical management of acute and chronic sinusitis is a therapeutic challenge. The use of endoscopic middle meatal cultures as a noninvasive method to determine the bacteriology of the maxillary sinus has not accurately been established. The aim of this study was to review the literature that compares cultures obtained by endoscopic middle meatal swabs with those obtained from maxillary sinus aspirates (MSAs). Methods We reviewed studies published between January 1966 and October 2003 that were identified from searches of multiple databases, bibliographies, and original articles. Studies were included for analysis if they compared the results of endoscopic middle meatal cultures to aspirate cultures. All clinical variables and test performances were independently extracted by two reviewers. Results Middle meatal culture had a per isolate accuracy of 82% (95% confidence interval, 0.64, 0.92) compared with MSA (excluding coagulase negative staphylococcus and fungal cultu...

Research paper thumbnail of International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International forum of allergy & rhinology, 2016

Isam Alobid, MD, PhD(1) , Nithin D. Adappa, MD(2) , Henry P. Barham, MD(3) , Thiago Bezerra, MD(4... more Isam Alobid, MD, PhD(1) , Nithin D. Adappa, MD(2) , Henry P. Barham, MD(3) , Thiago Bezerra, MD(4) , Nadieska Caballero, MD(5) , Eugene G. Chang, MD(6) , Gaurav Chawdhary, MD(7) , Philip Chen, MD(8) , John P. Dahl, MD, PhD(9) , Anthony Del Signore, MD(10) , Carrie Flanagan, MD(11) , Daniel N. Frank, PhD(12) , Kai Fruth, MD, PhD(13) , Anne Getz, MD(14) , Samuel Greig, MD(15) , Elisa A. Illing, MD(16) , David W. Jang, MD(17) , Yong Gi Jung, MD(18) , Sammy Khalili, MD, MSc(19) , Cristobal Langdon, MD(20) , Kent Lam, MD(21) , Stella Lee, MD(22) , Seth Lieberman, MD(23) , Patricia Loftus, MD(24) , Luis Macias-Valle, MD(25) , R. Peter Manes, MD(26) , Jill Mazza, MD(27) , Leandra Mfuna, MD(28) , David Morrissey, MD(29) , Sue Jean Mun, MD(30) , Jonathan B. Overdevest, MD, PhD(31) , Jayant M. Pinto, MD(32) , Jain Ravi, MD(33) , Douglas Reh, MD(34) , Peta L. Sacks, MD(35) , Michael H. Saste, MD(36) , John Schneider, MD, MA(37) , Ahmad R. Sedaghat, MD, PhD(38) , Zachary M. Soler, MD(39) , Nevi...

Research paper thumbnail of Post-operative budesonide irrigations for patients with polyposis: a blinded, randomized controlled trial

Rhinology, 2015

To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus ... more To compare normal saline (NS) vs. NS+budesonide irrigations in post- functional endoscopic sinus surgery (FESS) patients with chronic rhinosinusitis with polyposis (CRSwNP). Currently, no evidence exists for NS+budesonide irrigation over NS irrigation alone. Prospective, single-blind, randomized controlled trial. Subjects were prospectively enrolled to NS or NS+budesonide arms. Patients were evaluated at pre-operative and three post-operative visits (POV): POV1 (1-2 weeks post-op), POV2 (3-8 weeks post-op), and POV3 (3-6 months post-op). Patients were evaluated by three quality of life (QOL) questionnaires (SNOT-22, RSOM-31, and RSDI) and two olfaction scores (UPSIT and the PEA test). Fifty patients were randomized, with 25 patients in the NS arm and 25 patients in the NS+budesonide arm. Two patients had unexpected pathology and were excluded from the study. By POV2 and POV3, patients experienced a significant improvement in all three QOL surveys, although the degree of improvement ...

Research paper thumbnail of Depression and anxiety in chronic rhinosinusitis

International Forum of Allergy & Rhinology, 2015

Both depression and anxiety have been suspected to impact quality of life adversely in patients w... more Both depression and anxiety have been suspected to impact quality of life adversely in patients with chronic rhinosinusitis (CRS). The objective of this work was to assess for the presence of anxiety and/or depression in the setting of CRS and to assess their impact on disease-related quality of life by analyzing the correlation between the Rhinosinusitis Disability Index (RSDI) and the Hospital Anxiety and Depression score (HADS), as well as the Lund-Kennedy nasal endoscopic scores. A total of 124 patients with CRS were prospectively evaluated in the outpatient setting using the RSDI and HADS questionnaires as well as the Lund-Kennedy nasal endoscopy scoring system. The total RSDI and its subscale scores had moderate to very strong correlation with the HADS total score and each of its subscale scores in comparison to their poor correlation with Lund-Kennedy endoscopic score. CRS patients with depression or anxiety scores 8 to 10 (possible case of clinically significant depression or anxiety) and 11 to 21 (probable case) reported worse total RSDI and subscale scores when compared with those with normal scores (0 to 7). There was no significant difference in the Lund-Kennedy endoscopic scores between the different groups of anxiety and depression scores. Depression and anxiety are prevalent in CRS. The total RSDI and its different subscale scores exhibit moderate to very strong correlation with depression/anxiety scores as determined by HADS, whereas poor correlation was seen with the Lund-Kennedy endoscopic score.

Research paper thumbnail of A prospective randomized cohort study evaluating 3 weeks vs 6 weeks of oral antibiotic treatment in the setting of “maximal medical therapy” for chronic rhinosinusitis

International Forum of Allergy & Rhinology, 2015

Background: Surprisingly, li le literature exists evaluating the optimal duration of antibiotic t... more Background: Surprisingly, li le literature exists evaluating the optimal duration of antibiotic treatment in "maximal medical therapy" for chronic rhinosinusitis (CRS). As such, we investigated whether 3 weeks vs 6 weeks of antibiotic therapy resulted in significant differences in clinical response. Methods: A prospective, randomized cohort study was performed with patients assigned to 3-week or 6-week cohorts. Our primary outcome was failure of "maximal medical therapy" and surgical recommendation. Secondary outcomes included changes in pretherapy and pos herapy scores for the Rhinosinusitis Disability Index (RSDI), Chronic Sinusitis Survey (CSS), and computed tomography (CT)-based Lund-Mackay (LM) evaluation. Analyses were substratified based on presence of nasal polyps. Results: Forty patients were randomized to the 3-week or 6-week treatment cohorts, with near-complete clinical follow-up achieved. No significant difference was found between the proportion of patients who failed medical therapy and were deemed surgical candidates between the 2 cohorts (71% vs 68%, p = 1.000). No significant difference was found in the change of RSDI or CSS scores in the 3 vs 6 weeks of treatment groups (mean ± standard error of the mean [SEM]; RSDI: 9.62 ± 4.14 vs 1.53 ± 4.01, p = 0.868; CSS: 5.75 ± 4.36 vs 9.65 ± 5.34, p = 0.573). Last, no significant difference was found in the change of LM scores (3.35 ± 1.11 vs 1.53 ± 0.81, p = 0.829). Conclusion: Based on this data, there is li le difference in clinical outcomes between 3 weeks vs 6 weeks of antibiotic treatment as part of "maximal medical therapy" for CRS. Increased duration of antibiotic treatment theoretically may increase risk from side effects and creates higher healthcare costs.

Research paper thumbnail of Single-blind randomized controlled trial of surfactant vs hypertonic saline irrigation following endoscopic endonasal surgery

International forum of allergy & rhinology, 2013

Recent discussion has revolved around formulations of irrigation in the postoperative functional ... more Recent discussion has revolved around formulations of irrigation in the postoperative functional endoscopic sinus surgery patient, specifically the efficacy of emulsion based nasal irrigations. Forty adult candidates for endoscopic endonasal surgery with chronic rhinosinusitis (CRS) were prospectively randomized. The 22-item Sino-Nasal Outcome Test (SNOT-22) and 31-item Rhinosinusitis Outcome Measure (RSOM-31) quality of life assessments, as well as a phenyl ethyl alcohol (PEA) smell threshold test were obtained preoperatively and over 3 postoperative visits in a 4-month period. Repeated measures analyses and Fisher's exact tests were used to assess statistical differences. Of the 40 patients enrolled, 33, 32, and 26 patients were seen at postoperative visits 1, 2, and 3, respectively. The surfactant (S) and hypertonic saline (HS) irrigation groups both showed significant decreases in scores for both the SNOT-22 and RSOM-31 over time (both p < 0.0001), but no difference was s...

Research paper thumbnail of Sinonasal quality-of-life before and after endoscopic, endonasal, minimally invasive pituitary surgery

International Forum of Allergy & Rhinology, 2011

Background: Endoscopic, endonasal, minimally invasive pituitary surgery (MIPS) has proven to be s... more Background: Endoscopic, endonasal, minimally invasive pituitary surgery (MIPS) has proven to be safe and efficacious. However, there are few data that assess the healthrelated or sinonasal-specific quality-of-life (QoL) of those undergoing MIPS. Our hypothesis is that patients undergoing MIPS do not have significantly different sinus disability or change in QoL a er surgery compared to prior to surgery. Methods: This is a retrospective review of patients undergoing MIPS between 2002 and 2009. Rhinosinusitis Disability Index (RSDI) scores, patient demographics, tumor characteristics, surgical outcomes, and intraoperative/postoperative complications were recorded. Preoperative and postoperative mean RSDI scores and the mean absolute change in RSDI were calculated with 95% confidence intervals (CIs). One-way analysis of variance (ANOVA) compared RSDI scores between different tumor subgroups. Results: A total of 50 patients completed the RSDI preoperatively and postoperatively. Analyses revealed no significant difference between preoperative and postoperative scores across all domains (p = 0.84). When the cohort was stratified into functional vs nonfunctional tumor types there was no significant difference between the 2 groups (p = 0.88). Data showed no statistically significant change in RSDI scores postoperatively in all groups. Conclusion: These data show that MIPS with appropriate postoperative care results in li le or no long-term sinonasal quality of life defects.

Research paper thumbnail of Direct Healthcare Cost Analysis of Endoscopic Compared with Sublabial Transseptal Pituitary Surgery

Journal of Neurological Surgery Part B: Skull Base, 2012

Research paper thumbnail of Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery

International Forum of Allergy & Rhinology, 2013

Background-The effects of increases in maxillary sinus (MS) airflow following functional endoscop... more Background-The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures. Methods-A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm 2. Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis OutcomeMeasure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates. Results-CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores. Conclusion-CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS.

Research paper thumbnail of Beyond the “central sinus”: radiographic findings in patients undergoing revision functional endoscopic sinus surgery

International Forum of Allergy & Rhinology, 2012

Background: Functional endoscopic sinus surgery (FESS) is widely used by otolaryngologists to tre... more Background: Functional endoscopic sinus surgery (FESS) is widely used by otolaryngologists to treat chronic rhinosinusitis (CRS). The sinonasal anatomy and pathology found in patients with CRS varies widely, as does the FESS technique practiced by otolaryngologists. Variations in the completeness of cell group dissection, combined with the technical challenge of angled endoscopy, result in a wide variation of the post-FESS cavities harboring persistent disease. The purpose of this study was to identify previously incompletely dissected anatomic structures associated with mucosal thickening found in patients undergoing revision FESS for persistent or recurrent CRS. Methods: Retrospective review of axial, coronal, and sagittal computed tomography (CT) scans of patients undergoing revision FESS by 3 fellowship-trained rhinologists at a tertiary referral center. Results: The CT scans of 55 patients undergoing revision FESS were reviewed. The most frequent radiographic findings were residual anterior and posterior ethmoid cells or septations, found in 65% of sides and 75% of patients. In addition, residual anterior ethmoid agger nasi cells, unopened sphenoid, and residual uncinates were found in 52%, 51%, and 46% of sides, respectively. A large percentage of the patients demonstrated residual ethmoid cells present on the lamina papyracea and skull base, with a lower number found posterior to the middle turbinate basal lamella. A greater number of residual right-sided vs le-sided ethmoid cells was noted, with the difference being significant (p < 0.05) at the skull base. Conclusion: Analysis of CT scans of patients undergoing revision FESS for persistent or recurrent CRS frequently reveals persistent anatomical structures or incompletely resected cells associated with persistent mucosal thickening. Meticulous, complete cell group dissection combined with use of angled endoscopy along with identification of possible predisposing structures may aid in the reduction of need for revision surgery.

Research paper thumbnail of Occupational hazards of endoscopic surgery

International Forum of Allergy & Rhinology, 2011

Minimally invasive surgery has taken its toll on the physical well-being of surgeons. There have ... more Minimally invasive surgery has taken its toll on the physical well-being of surgeons. There have been many physical consequences for surgeons. However, few have been investigated, specifically for otolaryngologists performing endoscopic endonasal surgery (EES). The purpose of this study is to define the prevalence, quality, and severity of physical symptoms that otolaryngologists experience as they relate to the surgeons&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; use of ergonomically designed endoscopic instruments in endonasal surgery. A 25-question survey was administered between September 2010 and March 2011 to practicing otolaryngologists. The questions addressed demographics, physical symptoms, ergonomics, and operating room environment. Data were analyzed using Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact, Wilcoxon rank sum, and Jonckheere-Terpstra statistics. Sixty-two surgeons responded with a median age of 36 years. Responders performed a median of 150 EESs per year and 37% had completed an endoscopic fellowship. The majority (77%) of responders had experienced physical discomfort or symptoms that they attributed to EES. Thirteen percent (13%) of those who had experienced symptoms felt that their symptoms were persistent. Only 23% of those experiencing symptoms had sought medical care. No significant associations were seen between surgeon age, number of cases, standing, or having adjustable video display with experiencing discomfort (all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.49). Interestingly, fewer surgeons completing an endoscopic fellowship experienced discomfort (70% vs 82%, p = 0.35). Our data showed that 77% of physicians who regularly perform EES suffer physical discomfort or symptoms attributable to EES. As expanded endonasal procedures become more prevalent, additional data and ergonomic analysis are necessary to reverse this trend and reduce possible long-term damage for surgeons.

Research paper thumbnail of Plain films in the evaluation of batteries as esophageal foreign bodies

International journal of pediatric otorhinolaryngology, 2008

To determine the sensitivity and specificity of plain films in differentiating coin batteries fro... more To determine the sensitivity and specificity of plain films in differentiating coin batteries from coins. Study was conducted at a tertiary referral university medical center. Eleven radiographs were taken of various objects and independently reviewed by 14 radiologists and otolaryngologists. Reviewers were asked to identify the object filmed as either a battery or not a battery. In addition, otolaryngologists were asked if they would immediately proceed to the operative suite for removal based on the film. Results were tabulated and analyzed using a spreadsheet. Overall, plain films had a sensitivity and specificity of 80.4% and 79.1%, respectively with an overall accuracy of 79.8%. When used as a test to determine urgency of removal, sensitivity increases to 94.4% while specificity decreases to 67.1% with an overall accuracy of 83.1%. Plain films are an effective method of evaluating for the possibility of batteries as esophageal foreign bodies.

Research paper thumbnail of Comparative analysis of cost of endoscopic endonasal minimally invasive and sublabial-transseptal approaches to the pituitary

International forum of allergy & rhinology

Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) appr... more Two surgical approaches to the pituitary are commonly used: the sublabial-transseptal (SLTS) approach using microscopy and the endonasal endoscopic minimally invasive (MIPS) approach. Although outcomes are similar for both procedures, MIPS has become increasingly prevalent over the last 15 years. Limited cost analysis data comparing the 2 alternatives are available. A retrospective analysis of cost and volume data was performed using data from the published literature and University of North Carolina at Chapel Hill (UNC) Hospitals. A sensitivity analysis of the parameters was used to evaluate the uncertainty in parameter estimates. The total cost in real dollars ranges from 11,438to11,438 to 11,438to12,513 and 18,095to18,095 to 18,095to21,005 per patient per procedure for MIPS and SLTS, respectively, with a cost difference ranging between 5582and5582 and 5582and9567 per patient per procedure. The sensitivity analysis indicates that the total cost for MIPS is most sensitive to: (1) average length of stay, (2) nursing costs...

Research paper thumbnail of Endoscopic transnasal balloon dilation of the lacrimal duct

Otolaryngology - Head and Neck Surgery, 2009

by a qualified radiologist. Anthropometry: Standard anthropometric measurements of weight, height... more by a qualified radiologist. Anthropometry: Standard anthropometric measurements of weight, height, arm, hip, waist, and neck sizes were performed. Multiple regression analysis was used to determine which anthropometric measurements best correlated with TTSSTT. RESULTS: The TTSSTT as measured by U/S in the supine position, ranged from 0.65 to 3.53cm. Although the anthropometric measurement most predicative of TTSSTT was waist circumference, a combination of the more practical arm and neck circumferences resulted in an equivalent correlation (rϭ 0.82). The average root mean square error was 0.4cm. From the fitted regression equation, a table predicting TTSSTT from neck and arm circumference was prepared. CONCLUSIONS: TTSSTT can be closely predicted using simple anthropometric tape measures. The predicted TTSSTT can be used to select appropriate tracheostomy tube size in obese patients. Use of this simple tool is expected to significantly reduce the incidence of accidental decannulation in obese patients.

Research paper thumbnail of Immune modulatory oligonucleotides in prevention of nasal allergen–induced Eustachian tube dysfunction in rats

Otolaryngology - Head and Neck Surgery, 2007

OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction (ETD) in a rat ... more OBJECTIVES: Develop a model of nasal allergen-induced Eustachian tube dysfunction (ETD) in a rat and investigate the role of immune modulatory oligonucleotides (IMOs) in the prevention of nasal allergen-induced ETD. STUDY DESIGN AND SETTING: Prospective, randomized study. Brown Norway rats were sensitized to ova albumin (OVA) and randomized to receive pretreatment with IMOs or phosphatebuffered saline. All animals were challenged intranasally with aerosolized OVA. Dynamic measures of Eustachian tube (ET) function were analyzed. RESULTS: Animals that were OVA-sensitized and IMO-pretreated had significantly lower mean passive opening (95% confidence interval [95% CI] 15.0,19.4) and closing (95% CI 4.8,7.8) ET pressures compared with those of (95% CI 24.1,32.7) and (95% CI 12.1,18.8) OVA-sensitized untreated rats, respectively. In addition, the IMO-pretreated animals demonstrated the ability to actively clear a significantly higher proportion of negative pressure (95% CI 0.64,0.96) compared with the untreated animals (95% CI 0.09,0.39). IMO-pretreated animals also demonstrated significantly improved mean mucociliary clearance times in seconds (95% CI 115,195) than those in untreated animals (95% CI 308,668). CONCLUSIONS: Pretreatment with IMOs prevented allergeninduced allergic inflammation around the Eustachian tube (ET) and resulted in improved ventilatory function of the ET compared with sensitized untreated animals. IMOs offer considerable promise in the management of nasal allergic disease as well as otitis media with effusion.

Research paper thumbnail of Nitric oxide in glutamate-induced compound action potential threshold shifts

Hearing Research, 2008

Objective: Investigate the role of NO as a neurotransmitter in the gerbil cochlea and the effects... more Objective: Investigate the role of NO as a neurotransmitter in the gerbil cochlea and the effects of (7-NI) on compound action potential (CAP) threshold elevations induced by L-glutamate, an agonist at the NMDA glutamate receptor subtype, to further elucidate the role of NO in cochlear excitotoxicity. Method: In anesthetized gerbils, CAP thresholds were recorded before and after cochlear perfusions with a control solution of artificial perilymph (APS) and a test solution of L-glutamate (GA) in three experimental groups. Results: The control group showed no CAP threshold elevations (p < 0.05) when APS was perfused after systemic pre-treatment with 7-NI. GA perfusion alone caused significant elevation (p < 0.05) of the mean cochlear CAP threshold (25 dB SPL ± 5.8 dB to 78 dB SPL ± 19.5 dB). The CAP threshold elevation was prevented (p < 0.05) when the animals were pretreated with 7-NI before GA perfusion (24 dB SPL ± 4.2 dB to 27 dB SPL ± 6.7 dB). Conclusion: NO mediates excitotoxicity when the cochlea is perfused with L-glutamate.