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Biomedical subjects

A R Javer

Publications and source records attributed to A R Javer.

14 recordsLinked to original sources
PubMed2001

Primary endoscopic management of the frontal sinus.

Surgical treatment of the frontal sinus continues to be an area of much interest and controversy. The complex anatomy and confined space of this region require the endoscopic surgeon to be knowledgeable and delicate to obtain a positive result. Proper instrumentation is crucial and continues to evolve over time. Postoperative endoscopic care is integral to the success of endoscopic frontal sinusotomy and the availability of proper office equipment to perform this care is critical. In most instances, the intranasal endoscopic approach can be accomplished successfully without the need for an external procedure.

Endoscopy↗
PubMed2001

Revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement: the frontal sinus rescue procedure.

Frontal sinusitis after middle turbinate resection occurs because of stenosis of the frontal ostium by soft tissue scarring or residual bony fragments (which are pulled to the medial orbital wall by scar contracture). Standard endoscopic techniques cannot address this problem; however, revision endoscopic frontal sinusotomy with mucoperiosteal flap advancement (the frontal sinus rescue procedure) relieves this bony stenosis and incorporates a mucosal flap that minimizes postoperative stenosis.

Endoscopy↗
PubMed2001

The frontal sinus unobliteration procedure.

Although intranasal frontal sinusotomy can now be performed for most cases of chronic frontal sinusitis, the osteoplastic frontal sinus procedure with obliteration, unfortunately, still is considered by many to be the standard for chronic frontal sinusitis against that which other frontal sinus procedures are judged. Unobliterating the previously obliterated sinus is indicated for patients with evidence of frontal sinus pathology on CT or MR images and for patients with chronic symptoms with equivocal radiologic results. The reopened frontal sinus can be reventilated and remucosalized, or reobliterated with the placement of a new fat graft. Complete or partial auto-obliteration by new bone formation or fibrosis is another possible endpoint that can result when unobliteration is attempted.

Adult↗
PubMed2000

Allergic fungal rhinosinusitis: perioperative management, prevention of recurrence, and role of steroids and antifungal agents.

Allergic fungal sinusitis can best be thought of as chronic fungal affectation (not an infection) of the sinuses to which the body's immune system hyperreacts, thereby creating significant inflammation, edema, obstruction, and polyposis. Currently it is felt that allergic fungal sinusitis requires both surgical and medical management. The effectiveness and required duration of the various medical treatments remain unknown and are under active investigation. Both surgical intervention and the use of systemic steroids are recommended in the treatment of allergic fungal sinusitis. Experience with surgical and medical management, follow-up of patients, and proposed treatment protocols are discussed.

Administration, Oral↗
PubMed2000

Geographic variation in allergic fungal rhinosinusitis.

Allergic fungal rhinosinusitis (AFRS) has a worldwide distribution. This survey of 20 otolaryngologic practices throughout the United States confirmed a variation in the frequency of AFRS relative to endoscopic sinus procedures performed for all other diagnoses. The highest incidence occurred in Memphis, Tennessee at 23%, with three other southern practices reporting a frequency of at least 10%. In the northern locations the frequency ranged from 0 to 4%. No correlation with mould counts was demonstrated, possibly because of incomplete mould data relative to most of the surgical locations.

Humans↗
PubMed1996

Efficacy of nuclear scintigraphy in the diagnosis and management of sinusitis.

OBJECTIVE: The purpose of this study was to determine whether or not nuclear scintigraphy is useful in the diagnosis and management of chronic sinusitis. The ideal isotope(s) and drawbacks of the different isotopes in different clinical situations are reviewed and discussed. DESIGN: A retrospective review of patients undergoing nuclear medicine studies to aid in the diagnosis and management of sinus disease was carried out. METHOD: Ideal candidates were chosen from both previously operated and unoperated patients whose computed tomography (CT) scan findings could not differentiate benign mucosal thickening from active inflammation. Nuclear scintigraphy scans using indium (In-111), gallium (Ga-67), and technetium (Tch-99m) were used to differentiate acute infection from chronic inflammation involving bone (osteitis) and/or mucosa. This information was then used to guide the management of their condition. Nuclear scintigraphy results were compared to findings on CT scan and during surgery. RESULTS: In-111 was found to be the best isotope for identifying pus or acute disease in the sinuses whereas Ga-67 was very good for identifying both chronic mucosal disease as well as acute disease. Tch-99m was very sensitive for identifying bony remodelling and was therefore not found to be useful if the patient had undergone previous sinus surgery. CONCLUSION: Although not to be considered, in our view, a first-line diagnostic test, nuclear scintigraphy, is useful in cases where CT results are nondifferentiating.

Adult↗
PubMed1995

Plasticity in human directional hearing.

Interaural time difference (ITD), the main cue for localization of low-frequency sound in azimuth, is widely thought to be evaluated according to Jeffress' model. This theory proposes that each of an array of neurons detects coinciding input from both ears, conducted along axonal delay lines, with the azimuth angle corresponding to the activation of selected neurons. Thus, sound source localization is assumed to depend on axon conduction velocities, a relatively fixed parameter. Clinical experience suggests that directional hearing is adaptable. We investigated if sound localization in azimuth could adapt plastically to altered ITDs. We equipped binaural insert hearing aids with adjustable electronic delay lines. Subjects with normal hearing were required to wear these devices during all waking hours for several days. Localization of an invisible sound source was measured in an anechoic room before and at various intervals after introduction of a constant delay in one ear between 171 and 684 mus. Test sounds were high-pass, low-pass and broad-band noises. Introduction of a delay in one ear lead to an immediate displacement of the perceived sound location towards the opposite side. Within hours of exposure, the displacement was reduced, and further normalization of the perceived localization occurred over several days. After removal of the delays sound localization normalized rapidly. We conclude that ITD alterations can lead to plastic adaptation of directional hearing, which cannot rely exclusively on fixed axon conduction velocities. Our results suggest additional mechanisms for directional hearing on the basis ITD.

Acoustic Stimulation↗
PubMedDate not supplied

Stereotactic computer-assisted navigational sinus surgery: accuracy of an electromagnetic tracking system with the tissue debrider and when utilizing different headsets for the same patient.

The InstaTrak system by Visualization Technologies, Inc. (Woburn, MA) has recently introduced attachments that can be utilized to localize the tip of the XPS Straightshot debrider (Xomed Industries, Jacksonville, FL) during image-guided surgery. The accuracy of these newer attachments has not been objectively tested in a clinical setting. Our primary objective was to compare the actual instrument (XPS debrider tip) location with its computer screen location in the coronal, sagittal, and axial views. This was considered to be the "accuracy" of the instrument being tested. We secondarily compared its accuracy with the accuracy of the 0 degree and 45 degrees curved localizing aspirators in a prospective study. The manufacturer also recommends that the same headset used during scanning be utilized during surgery. A second objective therefore was to determine if a headset other than the one used during CT scanning could be used intraoperatively with an acceptable level of accuracy. Accuracy of the instruments between the patients' own headset (used during CT scanning) and a generic or research headset (not used during scanning) was compared intraoperatively. The third and final objective was to determine if the same headset could be used repeatedly with an acceptable level of accuracy. Generic "research" headsets were therefore utilized for a total of five surgeries per headset and visual accuracy between the multiply utilized research headsets and the patients' own headsets was recorded and compared. Anatomic localization accuracy was 1.06 mm for the XPS debrider, 0.89 mm for the 0 degree aspirator, and 1.05 mm for the 45 aspirator when the patients own headset was utilized. When the research (generic) headset was utilized the respective values were 0.69 mm for the debrider, 0.77 mm for the 0 degree aspirator, and 0.99 mm for the 45 degrees aspirator. With multiple utilization of a single headset, there was no significant loss in accuracy. In conclusion, the accuracy of the newly marketed attachment for the debrider was found to be comparable to the standard aspirators. Accuracy remained acceptable when a headset other than the one used during CT scanning was used intraoperatively. No loss in accuracy was noted when a headset was utilized more than once.

Debridement↗
PubMedDate not supplied

The frontal sinus rescue procedure: early experience and three-year follow-up.

The frontal sinus rescue (FSR), first described in 1997, has now been performed on 24 patients (32 sides) over a period of three years. It is a functional endoscopic surgical approach to correct an iatrogenically scarred and obstructed frontal recess, which cannot be successfully opened via a normal endoscopic frontal sinusotomy approach. It is utilized primarily for patients whose only remaining option is either a Draf-type drill-out (modified intranasal Lothrop) procedure or frontal sinus obliteration. The FSR is a technically challenging procedure, but faster, less difficult, and less destructive for the patient than a "drill-out" or frontal sinus obliteration. Once learned, it can save the patient from undergoing the more radical drill-out or obliterative procedure. The early experience and three-year follow-up with this new endoscopic procedure is presented in our first 24 patients (32 sides).

Adult↗
PubMedDate not supplied

The endoscopic management of chronic frontal sinusitis associated with frontal sinus posterior table erosion.

Expansile inflammatory diseases of the frontal sinuses may produce erosion of the posterior table of the frontal sinus. In these instances, the bone between sinus mucosa and intracranial dura is absent. Over the past decade, endoscopic frontal sinusotomy has emerged as the preferred technique for the treatment of refractory chronic frontal sinusitis. Endoscopic approaches also have a role in the most advanced instances of frontal sinusitis. A retrospective chart review of patients who were treated for frontal sinusitis with erosion of the frontal sinus posterior table was performed. Eight patients were identified. All patients underwent endoscopic frontal sinusotomy; some patients required multiple endoscopic procedures. Complete frontal recess dissection with identification of the frontal ostium was achieved for all involved frontal sinuses. In all cases, this postoperative result was monitored by CT scans (where indicated) and serial nasal endoscopy, which demonstrated good frontal sinus aeration and normal mucociliary clearance. Antibiotics were administered for culture-documented bacterial exacerbations, and systemic steroids were given for management of allergic fungal sinusitis and sinonasal polyposis associated with asthma. No patient underwent frontal sinus obliteration or cranialization. No suppurative intracranial complications were noted during the postoperative period. Endoscopic frontal sinusotomy can be used safely for the definitive management of frontal sinusitis associated with posterior table erosion. In fact, endoscopic techniques may represent the preferred approach for the treatment of this problem. Such an approach avoids the morbidity of more destructive alternatives (such as obliteration), and serves to create a frontal sinus with normal mucociliary clearance.

Adult↗
PubMedDate not supplied

Allergic fungal sinusitis: a four-year follow-up.

Allergic fungal sinusitis (AFS), first described over 18 years ago and subsequently identified using established criteria, remains a challenge to treat. Our protocol has included complete functional endoscopic sinus surgery to remove the fungal load and restore physiologic mucous clearance. The patient is treated with prednisone for several months and followed monthly with total serum IgE levels and an established endoscopic mucosal staging system. A group of 11 patients first treated in 1994 and presented at the 1995 American Rhinology Society Spring meeting are being presented again to provide an update on their progress over the past four years. A great deal of experience has been gained from their treatment and has continued to modify our postoperative medical management. An overview of AFS, our evolving and current treatment protocol, and possible future trends are discussed in this paper.

Anti-Inflammatory Agents↗