History of frontal sinus surgery.
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Chronic Disease↗
Biomedical subjects
H H Ramadan
Publications and source records attributed to H H Ramadan.
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↗
Congenital nasal pyriform aperture stenosis: clinical review.
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Constriction, Pathologic↗
Adenoidectomy vs endoscopic sinus surgery for the treatment of pediatric sinusitis.
OBJECTIVE: To compare endoscopic sinus surgery with adenoidectomy for the treatment of refractory chronic sinusitis in children. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology service of a university teaching hospital. PATIENTS AND METHODS: Sixty-six children consecutively referred to the pediatric otolaryngology service between 1994 and 1997 with computed tomographic documentation of sinusitis subsequently underwent endoscopic sinus surgery or adenoidectomy. Their ages ranged from 2 to 14 years. Sixty-one children received follow-up. Two main outcomes were documented: (1) symptom status at least 6 months after the intervention and (2) requirement of the alternate procedure or a revision procedure. RESULTS: Twenty-four (77%) of 31 children who underwent endoscopic sinus surgery had improved symptoms, compared with 14 (47%) of 30 children who underwent adenoidectomy (odds ratio [OR], 3.9; P = .01). Multivariable analysis demonstrated that endoscopic sinus surgery was significantly better than adenoidectomy after age, sex, allergy, asthma, day care attendance, and computed tomographic stage were adjusted for (OR, 5.2; P = .03). The diagnosis of asthma also appeared to be an independent predictor of success (OR, 4.37; P = .03). CONCLUSION: Endoscopic sinus surgery is better than adenoidectomy for the treatment of refractory chronic sinusitis in a select group of children.
Adenoidectomy↗
Maxillofacial injuries caused by all-terrain vehicle accidents.
With the rise in popularity of all-terrain vehicles (ATVs), especially in rural America, injuries associated with their use are becoming more commonplace. A retrospective review was conducted of 153 patients with ATV-related injuries seen at West Virginia University Hospitals between January 1990 and June 1996. Of these patients, 33 had maxillofacial injuries. Only 2 of 21 (9.5%) patients noted to be wearing helmets had facial injuries, whereas 17 of 19 (89.5%) patients who had facial injuries were not wearing helmets. Most patients with maxillofacial injuries occurring at night had been drinking alcohol. Injury Severity Scores were worse for those patients with maxillofacial injuries, as well as for those patients who had been drinking alcohol. Patients with maxillofacial injuries were more likely to require a stay in the intensive care unit. Furthermore, children with facial injuries had higher Injury Severity Scores and longer hospital stays than the adults. To reduce these accidents and related injuries, the industry, local and federal governments, and ultimately individuals must change their attitudes regarding these potentially dangerous vehicles.
Adult↗
Surgical causes of failure in endoscopic sinus surgery.
OBJECTIVES: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. STUDY DESIGN: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. METHODS: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. RESULTS: Fifty-two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. CONCLUSION: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.
Adult↗
Management of tracheostomal stenosis.
BACKGROUND: Tracheostomal stenosis following laryngectomy is a distressing complication with major effects on patient rehabilitation. Management ranges from stenting with a prosthetic device to surgical revision. The goal is a widely patent stoma that is amenable to tracheoesophageal puncture. OBJECTIVE: Review the long-term results of different methods of tracheostomal revision. METHODS: Review of 43 patients with symptomatic tracheostomal stenosis. End point was ability to function with no artificial stenting of their stoma. RESULTS: Forty-three patients underwent 55 revisions. The male-to-female ratio was 1.3:1.0. The age range was from 38 to 81 years (mean age, 59.5 y). Median time to revision was 11 months following the initial surgical procedure (range, 1-150 mo). Thirty-three patients underwent one revision; eight patients, two revisions; and two patients, three revisions. In 40 of 43 patients (93%) revision was successful. Of the last 21 patients who underwent revision, 18 had tracheoesophageal punctures placed. Fifteen developed excellent tracheoesophageal speech. The initial rates of success for these procedures were as follows: advancement flaps, 8 of 9; Z-plasty, 13 of 15; V-Y inset, 8 of 8; other procedures, 2 of 4; and dilation, 2 of 7 (P < .05 for dilation vs. all others). The ultimate success rates for these procedures were as follows: advancement flaps, 8 of 11; Z-plasty, 15 of 18; V-Y inset, 12 of 13; other procedures, 3 of 6; and dilation, 2 of 7. Other procedures and dilation were inferior (P < .05) compared with advancement flap, Z-plasty, and V-Y insets. CONCLUSION: Tracheostomal stenosis can be successfully managed in a multitude of ways.
Female↗
The Shaw scalpel and development of facial nerve paresis after superficial parotidectomy.
OBJECTIVE: To evaluate the independent relationship of the Shaw scalpel on the development of facial nerve injury in patients undergoing superficial parotidectomy. METHODS: A retrospective review of 77 cases between 1991 and 1996. Forty-eight percent of the surgical procedures were performed using the Shaw scalpel, and 52% were performed using a cold knife. To assess whether use of the Shaw scalpel is an independent predictor of facial nerve injury, both univariate analysis and regression analysis were used in the statistical analysis of the data. RESULTS: Fifty-four percent of the patients who underwent a parotidectomy in which the Shaw scalpel was used developed postoperative facial weakness, compared with 14% of those who underwent a cold knife parotidectomy (P=.002). CONCLUSION: Multivariate analysis revealed that use of the Shaw scalpel represents an independent risk factor for development of facial nerve weakness after parotidectomy (P=.01), even after other risk factors are controlled for.
Adolescent↗
Relationship between tympanic membrane perforations and retained ventilation tubes.
OBJECTIVES: To determine the effects of prolonged ventilation tube retention on tympanic membrane healing and the efficacy of patching procedures used concomitantly at the time of tube removal. DESIGN: Retrospective chart review. SETTING: Tertiary referral academic institution. PATIENTS: Seventy-six patients aged 12 years and younger, with a total of 99 ears identified from January 1989 to December 1994. All patients underwent ventilation tube removal for prolonged tube retention or infection unresponsive to medical management. A minimum of 6 months of follow-up was required for inclusion. INTERVENTION: Ventilation tube removal under general anesthesia, with or without concomitant patching. OUTCOME MEASURES: All medical charts were reviewed for age, sex, indications for tube removal, tube retention time, type of patch used (if any), type of tube, outcome after removal, other medical problems, and previous surgical history. RESULTS: The perforation rate was significantly higher in children with tubes retained beyond 36 months (P=.02). History of previous adenoidectomy predicted poor outcome, with a rate of 47% vs 17% in patients with no such history (P=.002). Patching did not improve healing. No other patient factors significantly influenced the perforation rate. CONCLUSIONS: Ventilation tube retention longer than 36 months resulted in an increased perforation rate after surgical removal. Paper patching at the time of tube removal does not improve healing. Prospective studies are needed to confirm these findings and to determine the efficacy of other patching techniques.
Child↗
Role of antral puncture in the treatment of sinusitis in the intensive care unit.
OBJECTIVE: The objective of this study was to determine whether maxillary sinus puncture caused an alteration in antibiotic treatment and thus affected the outcome of sinusitis in the intensive care unit. STUDY DESIGN: A retrospective review was done of cases of maxillary sinus puncture between 1991 and 1994. RESULTS: Forty-two patients were identified. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty-five punctures (60%) recovered pus, of which 80% grew organisms. Fourteen patients (33%) had a negative lavage, and 12% of these samples grew organisms (p = 0.001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram-negative organisms were found most commonly, followed by anaerobes. In 57% of the cases antibiotic therapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibiotics only 42% had resolution (p = 0.001). CONCLUSION: A sinus puncture seems to be helpful in patients with fever and positive findings on sinus films. If pus is obtained by maxillary puncture, a positive culture may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.
Adult↗
Outcome and changing cause of unilateral vocal cord paralysis.
Unilateral vocal cord paralysis (UVCP) is relatively common, and previously, thyroidectomy used to be the leading cause. We retrospectively reviewed 98 cases of UVCP. The left vocal cord was involved in 70% of the cases and the right vocal cord in 30%. The cause was neoplastic in 32%, surgical in 30%, idiopathic in 16%, traumatic in 11%, central in 8%, and infectious in 3% of the cases. Only 4 cases were the result of thyroid surgery. Evaluation consisted of a review of the history, a physical examination, and computerized scanning or magnetic resonance imaging, as needed. The functional recovery rate as related to the cause was as follows: surgery 31%, idiopathic 19%, traumatic 18%, and neoplastic 0%. Thirty-five percent of patients required medialization laryngoplasty or Teflon injection. Lung and skull base tumors and their surgical treatment are the most common causes of UVCP.
Adolescent↗
Tracheostomal stenosis revision with simultaneous tracheoesophageal puncture.
OBJECTIVES/HYPOTHESIS: Vocal rehabilitation of patients who have undergone laryngectomy is best accomplished by a tracheoesophageal puncture. Optimal function of the prosthesis requires an adequate stoma. Patients with tracheostomal stenosis require revision of the stoma if vocal rehabilitation is to take place. Revision and tracheoesophageal placement are usually done as two separate procedures. Creating a tracheoesophageal fistula at the time of stomal revision has not been addressed in the literature. STUDY DESIGN: Prospective analysis and follow-up of 10 patients undergoing simultaneous tracheoesophageal puncture and stomal revision for tracheostomal stenosis between 1991 and 1996. METHODS: Ten patients were reviewed. An inferiorly based V-Y advancement flap was used so as not to interfere with the tracheoesophageal puncture. All patients had received radiation prior to revision and tracheoesophageal puncture. Patients were followed for a minimum of 2 years (range, 2-6 y; median, 3 y). RESULTS: All patients maintained an adequate stoma without stenting. Eight of ten patients (80%) developed and maintained good tracheoesophageal speech. Two patients had their speech fistulas removed. There were no intraoperative or postoperative complications. CONCLUSIONS: Creation of a tracheoesophageal fistula at the time of stomal revision allows for vocal rehabilitation with a single visit to the operating room.
Esophagus↗
Second-look endoscopic sinus surgery.
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Child↗
Studies on coccidia species of genus Eimeria from domestic rabbit (Oryctolagus cuniculus domesticus L.) in Jeddah, Saudi Arabia.
Five Eimeria species were reported from domestic rabbits (Oryctolagus cuniculus domesticus L.) caught from Jeddah, Saudi Arabia. According to their prevalences, they were: Eimeria perfarans (65%), E. magna (45%), E. stiedae (25%), E. exigua (20%) and E. piriformis (10%). 90% of the examined rabbits were positive and mixed infection with two or three Eimeria species was most frequent. E. stiedae, E. piriformis and E. exigua were identified and recorded for the first time from rabbits in Saudi Arabia and are considered as new locality or geographical distribution.
Animals↗
Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy.
OBJECTIVE: Hemorrhage after tonsillectomy is a potentially lethal complication. Preoperative assessment consisting of prothrombin time (PT) and activated partial thromboplastin time (PTT) has been used to identify patients at risk for hemorrhage after tonsillectomy and adenoidectomy. We sought to assess the value of PT/PTT screening as a predictor of posttonsillectomy hemorrhage. DESIGN: A retrospective chart review was carried out with a minimum of 1 month follow-up. SETTING: Tertiary academic referral center. PATIENTS: Between January 1992 and June 1995, 382 patients undergoing tonsillectomy were examined; 339 patients with a minimum of 1 month follow-up were reviewed for this study. MAIN OUTCOME MEASURE: Normal and prolonged PT/PTT values were examined. Bleeding in the intraoperative, immediate postoperative, and delayed phases of healing was examined. RESULTS: Two-hundred and twenty-two patients had normal PT/PTT, 39 had prolonged PT/PTT, and 78 had no preoperative studies performed. Bleeding occurred in 2.7%, 2.6%, and 3.3%, respectively, of patients. Eight patients had positive family histories of bleeding tendencies. One patient (12.5%) with a normal PT/PTT experienced a delayed posttonsillectomy bleed. Of 39 patients with abnormal coagulation studies, 30 were borderline elevations with no repeat studies done; one patient experienced postoperative hemorrhage. Nine abnormal results were repeated; three returned to normal, three remained prolonged but underwent tonsillectomy with no intervention, and three received hematology consultations. One patient had lupus anticoagulant, one had Hageman Factor deficiency, and one was cleared for surgery with no diagnosis. All patients underwent tonsillectomy with no episodes of postoperative bleeding. CONCLUSIONS: Preoperative PT/PTT provides no additional information than does a bleeding history for the general pediatric population undergoing tonsillectomy. This should only be done in selective cases where warranted by history.
Child↗
Endoscopic treatment of allergic fungal sinusitis.
Fungal sinusitis has been seen increasingly in immunocompetent individuals. The literature has stressed the importance of diagnosing these cases. Surgical debridement is the treatment of choice. Six immunocompetent individuals with allergic fungal sinusitis were seen at West Virginia University between January 1992 and December 1993. After adequate evaluation, endoscopic surgical debridement was performed. After surgery they were treated with systemic or topical steroids and oral antibiotics for several weeks. Two patients required a second procedure within a year. Four of our six patients had positive fungal cultures for Aspergillus or Curvularia. None of our patients had evidence of invasive disease on histopathology, and systemic antifungal therapy was not required. Patient course and response will be discussed in detail along with a brief review of allergic fungal sinusitis.
Adult↗
Contemporary management of cerebrospinal fluid rhinorrhea.
Management of patients with cerebrospinal fluid rhinorrhea (CSF) remains controversial. Most studies recommend either an endoscopic or an external extracranial approach, depending on the surgeon's preference. Eighteen patients with CSF rhinorrhea have been managed at our institution since 1990. The causes of the CSF rhinorrhea consisted of functional endoscopic sinus surgery (7), lateral rhinotomy with excision of a benign nasal tumor (3), spontaneous rhinorrhea (7), and secondary repair after intranasal ethmoidectomy (1). In 11 patients the CSF leak was recognized at the time of surgery; in 10 of these patients it was repaired during the primary surgery, whereas one patient underwent secondary repair after failure of conservative management of his CSF fistula. Seven patients underwent exploration for spontaneous CSF rhinorrhea. Four patients had computer tomography scans that showed the leak, and two patients had cisternography to localize the leak. One patient underwent magnetic resonance cisternography. Both of these leaks were identified with cisternography and were then confirmed intraoperatively. Repair methods included a pedicled septal mucosal flap (4), a free mucosal graft from the septum (7), and a middle turbinate (5). Two patients had obliteration of the sinus with muscle/fascia and fibrin glue. Eight patients were repaired endoscopically. The remainder underwent repair through external approaches. Seventeen patients (at a minimum 1 year follow-up) remain free from leakage. One patient required a second repair 8 months after surgery. Iatrogenic trauma remains the most common cause of CSF rhinorrhea. Management at the initial setting is the least morbid approach and is successful in 95% of cases. Whether an endoscopic or external approach is used depends on surgical expertise and experience.
Adult↗
Adenovirus and respiratory syncytial virus in chronic sinusitis using polymerase chain reaction.
The aim of this study is to investigate the role of adenovirus and respiratory syncytial virus (RSV) in chronic sinusitis using the polymerase chain reaction (PCR) to assay for the viruses. PCR has proved to be more sensitive and specific than viral cultures and immunoassays in the detection of viruses. Adenovirus and RSV are among the most common viruses to cause upper respiratory tract infections. Sinus mucosa biopsies from 20 patients undergoing endoscopic sinus surgery were sterilely collected. Four specimens (20%) tested positive for RSV by PCR and none tested positive for adenovirus. Only one specimen tested positive for RSV and one for adenovirus by viral culture and immunofluorescence. Bacterial cultures tested positive in 40% of the 20 specimens. PCR can be used to detect RSV in patients with chronic sinusitis and PCR is more sensitive than viral culture and immunofluorescence techniques on sinus polyps and mucosa.
Adenoviridae↗