Biomedical subjects

Neil Bhattacharyya

Publications and source records attributed to Neil Bhattacharyya.

At least 19 recordsLinked to original sources

PubMed2006

Clinical characteristics and survival for major salivary gland malignancies in children.

OBJECTIVE: Determine presentation and survival rates for malignant pediatric salivary gland neoplasms. METHODS: All cases of malignant neoplasms involving the parotid or submandibular gland in patients ages birth to 18 years were extracted from the Surveillance, Epidemiology, and End Results database (1988-2001). Variables included age, gender, tumor histology, size, follow-up time, and vital status. Kaplan-Meier survival curves were constructed. RESULTS: 113 primary salivary gland malignancies (103 parotid, 10 submandibular) were identified. Mean age at presentation was 13.2 years. Female:male ratio of 5:4. Mean tumor size was 2.5 cm. Among parotid tumors, there were 44 (43%) mucoepidermoid carcinomas and 35 (34%) acinic cell carcinomas. At a mean follow-up of 69.4 months, 6 (5.8%) patients with parotid malignancy were deceased; none of the submandibular malignancies were fatal. Mean Kaplan-Meier survival for parotid gland lesions was 153 months, with rhabdomyosarcomas exhibiting significantly worse survivals as compared to other malignancies (P < 0.001, log-rank test). CONCLUSIONS: Both epithelial and mesenchymal tumors present in the pediatric salivary gland. Survival for both parotid and submandibular gland malignancies is good in children. EBM RATING: C-4.

Adolescent↗

PubMed2006

Passive smoke exposure as a risk factor for airway complications during outpatient pediatric procedures.

OBJECTIVE: Determine if passive smoke exposure (PSE) increases airway complications during outpatient mask anesthesia procedures in children. METHODS: A prospective cohort of children who underwent surgical procedures under mask anesthesia was studied with the American Thoracic Society children's questionnaire on environmental and respiratory factors. Double-blinded outcomes with respect to adverse airway events were recorded both intraoperatively and in the recovery room for patients with and without passive smoke exposure. Multivariate comparisons assessing the likelihood of these airway complications were conducted between the PSE and nonexposed groups. RESULTS: Of 405 children, 168 (41.5%) had PSE. The incidence of airway complications during anesthesia or postanesthetic recovery was higher for all outcome measures for PSE children (all P </= 0.005), except for recovery room breath holding (P = 0.086). Intraoperative laryngospasm and airway obstruction were 4.9 and 2.8 times more likely with PSE, respectively. CONCLUSIONS: PSE significantly increases the risk of anesthesia-related airway complications during outpatient pediatric procedures. EBM RATING: A-1b.

Adolescent↗

PubMed2006

Clinical outcomes after endoscopic sinus surgery.

PURPOSE OF REVIEW: Chronic rhinosinusitis continues to present diagnostic and therapeutic challenges for clinicians. Recently, attention has been focused on reliable and valid measures of outcomes for many sinonasal diseases. As a significant fraction of patients with chronic rhinosinusitis will come to endoscopic sinus surgery, there has been a dedicated focus on determining objective clinical outcomes after medical and surgical treatment for CRS. This has been aided by validated instruments for measuring both symptom outcomes and quality of life after endoscopic sinus surgery. RECENT FINDINGS: Recent studies have demonstrated that endoscopic sinus surgery provides statistically and clinically significant improvements in most sinonasal symptoms. These benefits are maintained more than 1 year after surgery. In addition, the significant adverse effects of chronic rhinosinusitis on quality of life can be reversed with appropriate endoscopic sinus surgery. Certain sub-populations do not fare as well with endoscopic sinus surgery, however; adjunctive medical management is required to maintain symptomatic and quality-of-life improvements for patients with nasal polyposis. Unfortunately, paranasal sinus computed tomography scan findings do not predict symptomatic or quality-of-life improvements after endoscopic sinus surgery. SUMMARY: With reliable objective evidence of the health benefits of endoscopic sinus surgery, patients should be considered for such surgery after failure of medical management. Further work is required to characterize outcomes for sub-populations, and to stage and select patients who will derive appropriate benefit from endoscopic sinus surgery.

Chronic Disease↗

PubMed2006

Radiographic stage fails to predict symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVE: To determine whether preoperative computed tomography (CT) stage predicts degree of symptom improvement after endoscopic sinus surgery (ESS). METHODS: A series of adult patients undergoing ESS was prospectively evaluated with CT and the rhinosinusitis symptom inventory (RSI) preoperatively and at a minimum of 12 months postoperatively. Symptom domains (nasal, facial, oropharyngeal, systemic, and total) were computed and both absolute change and percentage change in symptom domain scores before and after ESS were correlated with the preoperative CT scan stage according to three staging systems: Lund-MacKay, Kennedy, and Harvard. RESULTS: One-hundred sixty-one patients (mean age, 40.2 years) completed the study with a mean follow-up of 19.4 months. Overall, statistically significant decreases in RSI symptom domains were noted for the nasal (net change -30.1 [range -100 to +100]), facial (-26.1), oropharyngeal (-13.4), systemic (-17.0), and total (-20.8) symptom scores (all P < .001). For the absolute change in total symptom score, no statistically significant correlation with CT stage was demonstrated for any of the staging systems (Lund: Spearman rho = -0.004, P = .962; Kennedy: rho = -0.008, P = .918; Harvard: rho = -0.011, P= .891). Similarly, no significant correlation with CT stage was demonstrated with the other symptom domains. Additionally, no significant correlation was identified between preoperative CT stage and percentage change in symptom domain scores. CONCLUSIONS: Although CT scan is widely accepted as an accurate diagnostic tool for chronic rhinosinusitis, CT scan stage alone does not significantly predict symptom outcomes after chronic rhinosinusitis, regardless of staging system utilized.

Adult↗

PubMed2006

Clinical and symptom criteria for the accurate diagnosis of chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: The objectives of this prospective, double-blind diagnostic cohort study were to explore the relationship between patients' reported symptoms of chronic rhinosinusitis (CRS) and radiographic findings in CRS to define clinically based diagnostic criteria for CRS and to determine a classification scheme that would allow for the accurate diagnosis of patients with CRS. METHODS: A prospective series of adult patients undergoing evaluation for potential chronic rhinosinusitis was studied. Patients' symptoms were tabulated with the Rhinosinusitis Symptom Inventory (RSI), which records symptoms associated with CRS on a Likert scale (5 = maximally severe). Medication and resource utilization were also tabulated. Scores for nasal, facial, oropharyngeal, systemic, and total symptom domains were computed (100 = maximum severity). Concurrent paranasal sinus computed tomography was obtained for each patient and scored according to the Lund-McKay system with reviewer blinding. Patients were classified as normal or representing true CRS according to previously published diagnostic radiographic criteria under two analyses. In analysis 1, Lund scores < or = 1 were considered nondiseased and scores > or = 2 were considered as representing true CRS. In analysis 2, Lund scores < or = 3 represented normal and scores > or = 4 represented true CRS. For each analysis, univariate statistics were computed to determine differences among patients' reported symptoms with and without true CRS. Subsequently, classification analysis using classification regression trees was conducted to determine heuristics among clinically based criteria for the diagnosis of CRS. RESULTS: Seven hundred three adult patients were enrolled (mean age, 43.1 years). The most commonly reported symptoms in order of decreasing severity and presence were nasal obstruction, nasal congestion, discharge, fatigue, headache, facial pressure, and dysosmia, all with mean severity scores > or = 2.0. Patients were previously treated for approximately 3 months each with topical nasal steroids, oral antihistamines, and oral antibiotics. Patients missed substantial workdays (mean, 3.8/year) and incurred significant physician visits (mean, 3.5/year) as a result of CRS. The nasal symptom domain exhibited the greatest severity (51.8) followed closely by the facial symptom domain (47.3). According to the analysis 1, 144 (20.5%) patients were classified as normal and 559 (79.5%) as true CRS. Only the presence of polyps (P < .001) and dysosmia (P = .008) distinguished between normal and diseased patients; there were no significant differences between groups for the other symptoms and RSI domains. Classification analysis revealed that the presence of polyps, absence of dental pain, and low congestion/obstruction scores in the presence of dental pain predicted true CRS. Finally, a history of extended antibiotic courses before presentation also predicted true CRS. In the second analysis, 243 (34.6%) were normal versus 460 (65.4%) with true CRS. Only polyp presence and dysosmia exhibited statistically significant differences between normal and diseased patients (P < .001). The mean RSI nasal domain was higher for true patients with CRS (P = .01). Classification analysis identified polyp presence and dysosmia score >2 effectively predicted CRS. Fatigue < or = 2, discharge < or = 4, and obstruction < or = 3 further predicted for CRS. Symptoms despite a > or = 5.5-week trial of nasal steroids also predicted CRS. Other major and minor symptoms, RSI domains, and resource factors failed to influence diagnostic classification. CONCLUSIONS: The diagnosis of CRS based on symptom criteria is difficult because most symptoms (other than dysosmia) do not distinguish between radiographically normal and diseased patients. A classification scheme for CRS based on the presence or absence of polyps is valid. It is possible to classify patients with true CRS based on symptoms, but this requires complicated heuristics. Corroborating radiographic evidence should be required to establish the diagnosis of CRS before long periods of therapy or surgical intervention.

Adult↗

PubMed2006

Surgical treatment of chronic recurrent rhinosinusitis: a preliminary report.

OBJECTIVE: The objective of this study was to determine if endoscopic sinus surgery (ESS) is effective in the management of chronic recurrent rhinosinusitis (CRRS). METHODS: A consecutive series of patients with CRRS diagnosed according to stringent criteria was prospectively examined before and at least 1 year after ESS. Paranasal sinus computed tomography scans were staged and ESS was performed targeting radiographic disease and the ostiomeatal complex. Preoperative and postoperative disease severities in terms of symptom scores, medicine utilization, and resource factors were assessed using the rhinosinusitis symptom inventory (RSI). Improvements in RSI symptom domains, medical and economic resource factors were determined using effect sizes and statistical comparison before and after ESS. RESULTS: Nineteen patients (mean age, 42.3 years) completed the study with a mean follow up of 19.1 months. The mean Lund score was 3.42 (standard deviation, 4.09). Statistically significant decreases in nasal (-36.1), facial (-28.4), oropharyngeal (-34.6), systemic (-24.7), and total (-31.9) RSI symptom domain scores were observed (all P < .003) with effect sizes ranging from 0.87 to 1.63 (strong surgical effect). Statistically significant decreases in antihistamine use (-30%, P = .031), number of workdays missed as a result of CRRS (-1.9, P = .035), and number of acute infectious episodes (-2.5, P = .006) were also observed. However, declines in weeks of antibiotic use (-2.8 weeks, P = .293) and number of antibiotic courses (-1.7, P = .118) were not significant. CONCLUSIONS: Patients with CRRS may substantially benefit both symptomatically and medically from ESS. Although surgery should be used cautiously in treating CRRS, further trials of ESS for CRRS are warranted.

Adult↗

PubMed2006

Risk of second primary malignancy after radioactive iodine treatment for differentiated thyroid carcinoma.

OBJECTIVES: The association between second primary malignancy (SPM) and radioactive iodine (RAI) is controversial. We examined the association between RAI and SPM after treatment of differentiated thyroid carcinoma (DTC) using a large cohort from a national cancer database. METHODS: From the Surveillance, Epidemiology and End Results (SEER) database, all index cases of DTC (papillary or follicular) were extracted for the years 1988 to 2001. Two cohorts were constructed: 1) patients with DTC who were not treated with RAI, and 2) patients with DTC who were treated with RAI. For each cohort, we tabulated all subsequent malignancies for each patient, identifying patients in each group with 1 or more SPMs. RESULTS: According to inclusion criteria, 18,882 cases of DTC treated without RAI (mean follow-up, 55.5 months) and 10,349 cases treated with RAI (mean follow-up, 61.8 months) were identified. The most common SPM sites were breast or prostate followed by colon or lung for both groups. On univariate analysis, SPMs developed in 6.7% of patients without RAI versus 4.8% of those with RAI (p < .001, univariate chi-squared). However, on multivariate analysis, only age and male gender had statistically significant hazard ratios (1.052 and 1.438, respectively; p < .001); follicular carcinoma histology and use of RAI did not influence occurrence of SPM after DTC (p = .180 and p = .789, respectively). CONCLUSIONS: Use of RAI does not elevate the risk of SPM. Concern about SPM induction should not adversely affect the decision to administer RAI for DTC.

Adenocarcinoma, Follicular↗

PubMed2006

An assessment of risk factors for the development of a second primary malignancy in the head and neck.

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1%). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.

Carcinoma, Squamous Cell↗

PubMed2006

Associations between fatigue and medication use in chronic rhinosinusitis.

We conducted a prospective study of 586 adults to determine if associations exist between fatigue symptom scores and three classes of medications prescribed for the treatment of chronic rhinosinusitis (CRS): prescription nonsedating antihistamines, topical nasal steroids, and antibiotics. Patients were assessed with the assistance of the Rhinosinusitis Symptom Inventory and Likert-scale fatigue symptom scores. On multivariate analysis and correcting or disease severity, we found that significantly higher fatigue symptom scores were associated with the use of nonsedating antihistamines (mean Likert score: 2.75 vs. 2.27 for patients not taking a nonsedating antihistamine; p = 0.029). Higher fatigue scores were also associated with a greater number of antibiotic courses and more total weeks of antibiotic use (p < 0.001 in both cases). No association was seen between fatigue scores and the use of topical nasal steroids (mean Likert score: 2.65 vs. 2.24; p = 0.658). We recommend that long-term use of a nonsedating antihistamine be scrutinized in CRS patients who report symptoms of fatigue.

Adult↗

PubMed2005

Survival outcomes for second primary head and neck cancer: a matched analysis.

OBJECTIVE: Determine whether survival for second primary head and neck cancer is truly poorer than survival for first primaries. METHODS: From the Surveillance, Epidemiology and End Results database, 2 cohorts were constructed. One cohort consisted of patients with exactly 1 head and neck primary malignancy; the second cohort consisted of patients with exactly 2 head and neck primaries, restricted to second primaries of the tongue, tonsil, glottic larynx, and hypopharynx with squamous cell carcinoma (SCCA) histology. Demographic and extent of disease data were extracted. For each primary site, matched Kaplan-Meier survival analysis was conducted comparing overall survival between the two cohorts matching for primary site, year of diagnosis, age, gender, and cancer stage. RESULTS: A total of 242 cases of second head neck primary were successfully matched to patients with single primary disease. Among 96 patients with oral tongue SCCA, mean (median) survival was 40.1 (28) months after the second primary diagnosis versus 52.2 (32) months for matched single primary patients ( P = 0.552, log-rank test). Among 45 tonsillar carcinomas, mean survival was 42.8 (30) versus 90.9 (NA) months for the second primary and single primary cohorts, respectively ( P = 0.028). Among 52 matched glottic carcinomas, mean survival was 46.4 (27) versus 103.5 (120) months for the 2 cohorts, respectively ( P < 0.001). Among 49 hypopharyngeal carcinomas, mean survival was 35.6 (19) versus 53.9 (21) months, respectively ( P = 0.373). CONCLUSIONS: Survivals for second primary head and neck malignancies may be poorer than survivals for comparable first primaries, but in this analysis we did not find this difference to be statistically significant for all subsites. Second primary survival will vary from site to site. EBM RATING: B-3.

Carcinoma, Squamous Cell↗

PubMed2005

Symptom and disease severity differences between nasal septal deviation and chronic rhinosinusitis.

OBJECTIVE: To determine whether patients with chronic rhinosinusitis (CRS) exhibit more severe sinonasal symptom scores as compared with patients with nasal septal deviation (NSD) alone. METHODS: Two patient cohorts were prospectively identified: patients undergoing surgery for NSD alone and those undergoing endoscopic sinus surgery for CRS without NSD. Patients in the NSD group were required to have normal paranasal sinus CT scans, whereas patients in the CRS group were required to have radiographic evidence of CRS. All patients completed the Rhinosinusitis Symptom Inventory (RSI). Statistical comparisons were conducted between cohorts with respect to RSI symptom domains and medical resource utilization. RESULTS: A total of 42 patients were identified in the NSD group (mean age, 40.8 years) and 155 patients were identified in the CRS group (mean age, 44.9). Patients with CRS demonstrated higher severity scores for the nasal symptom domains (60.3 [CRS] versus 53.9 [NSD], P = 0.037). Oropharyngeal symptoms and total symptoms were also worse for the CRS group versus the NSD group (29.8 versus 23.1, P = 0.014 and 43.0 versus 37.0, P = 0.030). Facial and systemic symptom scores did not differ between groups. Patients with CRS demonstrated significantly higher utilization rates for topical nasal steroids (21.2 versus 12.2 weeks, P = 0.006) and oral antibiotics (7.9 weeks versus 2.1 weeks, P < 0.001), but not for oral antihistamines (P = 0.420). CONCLUSIONS: Although patients with CRS manifest higher sinonasal symptom scores than patients with NSD alone, differentiating these 2 diagnoses on the basis of symptoms alone is difficult. These data suggest that as a disease process, CRS confers a significant disease burden with more significant negative symptom impact.

Adult↗

PubMed2005

Chronic recurrent rhinosinusitis: disease severity and clinical characterization.

OBJECTIVES/HYPOTHESIS: The objective was to clinically characterize and determine disease severity parameters for chronic recurrent rhinosinusitis (CRRS). STUDY DESIGN: Prospective. METHODS: A consecutive series of adult patients undergoing evaluation for CRRS was prospectively evaluated. Patients with four or more acute rhinosinusitis episodes in the previous calendar year with an absence of symptoms between episodes were considered as manifesting CRRS. Symptom severity and disease data from the Rhinosinusitis Symptom Inventory was obtained, as well as Lund staging information from the paranasal sinus CT scan. The Lund staging scores for patients with CRRS were compared with a control group of patients without CRRS. Symptom domain scores and disease severity parameters were compared between the CRRS group and a third group of patients with chronic persistent rhinosinusitis. RESULTS: In all, 30 patients met inclusion criteria for the diagnosis of CRRS. Mean age was 40.9 years with a 3:1 female preponderance. The mean Lund score for patients with CRRS was 3.79. Patients with CRRS failed to demonstrate a statistically different Lund score from control patients (mean Lund score, 4.26 [P = .538]). Symptom severity scores according to Rhinosinusitis Symptom Inventory domains were largely similar for the nasal, facial, and total symptom domains between patients with CRRS versus chronic persistent rhinosinusitis. However, patients with CRRS demonstrated statistically significant increases in oropharyngeal and systemic symptom domain scores. Patients with CRRS also had significant increases in number of antibiotic courses (4.8 vs. 2.9 [P < .001]) and number of missed workdays (8.8 vs. 4.6 d [P = .046]) attributable to rhinosinusitis. CONCLUSION: Chronic recurrent rhinosinusitis is a distinct form of chronic rhinosinusitis differing somewhat from chronic persistent rhinosinusitis. However, patients with CRRS still experience significant symptoms associated with this diagnosis, which results in significant medication usage and workplace impact.

Adult↗

PubMed2005

Population-based outcomes for pediatric thyroid carcinoma.

OBJECTIVES/HYPOTHESIS: The objective was to determine clinical features and clinical outcomes for pediatric thyroid carcinoma. STUDY DESIGN: Cross-sectional analysis of national cancer database. METHODS: The Surveillance, Epidemiology, and End Results database (1988-2000) was surveyed, extracting all cases of pediatric thyroid carcinoma. Clinical features including age, gender, tumor type, tumor size, nodal disease, treatment modality, and survival variables were retrieved. Kaplan-Meier survival analysis was conducted to determine actuarial survival according to histological type. Cox regression analysis was conducted to determine prognostic factors affecting survival in pediatric carcinoma. RESULTS: In all, 566 cases of thyroid carcinoma were extracted for the time period. Mean patient age at presentation was 16.0 years, with a female predominance (84.8%). There were 378 cases of papillary carcinoma, 137 cases of follicular variant of papillary carcinoma, and 51 cases of follicular carcinoma. The average tumor size was 2.6 cm, and 37.1% of patients presented with positive nodal disease. Overall survival was excellent with mean survivals greater than 145 months for each histological type. Follicular carcinoma exhibited a slightly poorer survival that was statistically significant (P = .017) CONCLUSION: Pediatric thyroid carcinoma primarily affects girls. Clinical features of tumor presentation are similar to those of adults with thyroid carcinoma. However, overall survival for pediatric thyroid carcinoma is excellent, with few patients dying of disease.

Adenocarcinoma, Follicular↗

PubMed2005

Effectiveness of chemotherapy and radiotherapy in sterilizing cervical nodal disease in squamous cell carcinoma of the head and neck.

OBJECTIVE: Determine effects of chemoradiotherapy on nodal disease in head and neck squamous cell carcinoma (SCCA). STUDY DESIGN: Matched case-control study. METHODS: A series of neck dissections (ND) performed for SCCA of the head and neck was retrospectively reviewed. Three groups were identified: 1) planned ND after chemoradiotherapy, 2) ND after radiotherapy alone, and 3) ND before adjuvant therapy (control group). Demographic data, tumor-node-metastasis stage, and pathology were reviewed. Total number of nodes recovered, number of positive nodes, and extracapsular spread (ECS) were recorded. To each patient in the chemoradiotherapy group, a randomly matched dissection in the control group was identified, matching for preoperative N stage and ND type (comprehensive, supraomohyoid, or selective). Comparisons were conducted for total nodes, presence of positive nodes, and ECS. Similar matched comparisons were conducted for ND after radiotherapy alone versus the control group. RESULTS: Ninety-seven NDs (N0 = 10 cases, N1 = 9, N2 = 69, and N3 = 9) were matched to control NDs without previous therapy. Total nodal yield was not statistically different between chemoradiotherapy and control groups (23.5 vs. 23.0 nodes, respectively, P = .77). Positive nodal yield was significantly lower for chemoradiotherapy versus control dissections (0.76 vs. 3.0, P < .001). The percent of chemoradiotherapy dissections recovered as positive nodes was 24.7% versus 68.0% of the control group (P < .001). ECS was identified in 13.4% of the chemoradiotherapy group versus 32.0% of the control group (P = .002). Radiotherapy alone produced less pronounced nodal reductions. CONCLUSIONS: Chemoradiotherapy substantially decreases nodal disease and ECS in SCCA. However, a significant percentage of necks contain positive nodes after therapy, meriting consideration for ND.

Antineoplastic Agents↗

PubMed2005

The completely opacified frontal or sphenoid sinus: a marker of more severe disease in chronic rhinosinusitis?

OBJECTIVE: Determine whether complete opacification of the sphenoid or frontal sinus is associated with increased clinical severity of chronic rhinosinusitis (CRS). METHODS: Adult patients undergoing evaluation for CRS prospectively completed the rhinosinusitis symptom inventory (RSI) and underwent computed tomography of the paranasal sinuses. A cohort with at least one completely opacified frontal sinus was identified. To each patient in this opacified cohort, a control patient without complete frontal sinus opacification was matched with corresponding Lund score. Symptom scores for headache, facial pressure, RSI symptom domains, and medical resource consumption were statistically compared. Similar analysis was conducted for patients with complete sphenoid sinus opacification. RESULTS: Fifty-four patients with at least one completely opacified frontal sinus were matched for Lund score to the control group (mean Lund score 17.1). There was no statistically significant difference in headache (2.1 vs. 2.8) or pressure scores (2.0 vs. 2.3) or in the RSI symptom domains between those patients with completely opacified frontal sinuses and controls, respectively. Although completely opacified patients received more antibiotic treatment and missed more workdays, only the increased numbers of physicians visits (4.0 vs. 2.1, P = .02) was significant. Thirty-four of 35 completely opacified sphenoid patients were matched to control patients (mean Lund score 16.7). Again, differences in symptom scores for headache (2.5 vs. 2.5), facial pressure (2.3 vs. 2.3), and RSI symptom domains were not statistically significant. Increased use of antibiotics (9.6 vs. 3.9, P = .036) and physician visits (5.8 vs. 1.8, P = .024) for sphenoid opacification patients was statistically significant. CONCLUSIONS: Patients with a completely opacified sphenoid or frontal sinus do not necessarily manifest more severe clinical symptoms of CRS. Thus, a higher radiographic stage should not be automatically assigned to patients with a completely opacified sphenoid of frontal sinus in CRS.

Adult↗

PubMed2004

The risk of development of antimicrobial resistance in individual patients with chronic rhinosinusitis.

OBJECTIVE: To determine if individual patients with chronic rhinosinusitis (CRS) demonstrate an increasing prevalence of antimicrobial resistance over time. PATIENTS: A prospectively maintained database of microbiologic culture results for adult patients with CRS was sequentially analyzed, extracting patients who underwent multiple serial sinus cultures over time. Antimicrobial resistance patterns were identified and quantified for each bacterium. Sequential culture results were compared for individual patients to determine if increasing overall bacterial resistance, gram-positive resistance, gram-negative resistance, or a shift toward gram-negative organisms was manifested within individual patients. RESULTS: During a 7-year period, 90 adult patients were identified with 224 serial cultures (mean, 2.5 cultures per patient) obtained, with a median time between cultures of 157 days. Four hundred twenty-nine organisms were isolated from these serial cultures, consisting of 255 gram-positive organisms, 120 gram-negative organisms, 48 anaerobes, and 6 fungi. Pairwise analysis of sequential cultures revealed no significant trend toward increasing bacterial resistance within individual patients (P = .57, runs test). Similarly, no significant trend toward increasing gram-positive or gram-negative resistance was demonstrated. There was no shift toward gram-negative organisms (P>.15 for all). CONCLUSIONS: Individual patients with CRS do not necessarily develop increasing levels of bacterial resistance over time. The use of culture-directed antimicrobial therapy may "protect" against the development of sequentially increasing antimicrobial resistance for patients with CRS.

Adult↗

PubMed2004

A comparison of ocular protective measures during carbon dioxide laser laryngoscopy.

OBJECTIVE: To determine the efficacy of various eye protection measures during carbon dioxide laser laryngoscopy. DESIGN: A standard medical mannequin was equipped with indicator paper over the eyes and subjected to multiple passes of direct carbon dioxide laser beam contact at 400-mm focal length with powers ranging from 2.5 to 4.0 W during simulated laser microlaryngoscopy. Several different eye protection materials, including silk tape, paper tape, cloth tape, occlusive dressing, and eye pads, were used to cover the eyes and tested for their degree of protection against the laser beam. Thermal injuries were quantified and compared among these protective materials. SETTING: Academic medical center. MAIN OUTCOME MEASURE: Degree of eye protection against the laser beam injury on a scale of 0 to 4. RESULTS: The carbon dioxide laser beam at both 2.5 and 4.0 W produced considerable thermal damage to the indicator paper in the absence of any protective barrier. Among the adhesive protective barriers, moistened cloth tape was the most effective adhesive material against laser beam-induced thermal damage (P<.001). Silk tape and paper tape offered poor protection. Moist eye pads, although not adhesive and therefore unable to maintain eye closure, were very effective barriers against the laser beam. Dry paper tape and dry eye pads were imminently flammable. CONCLUSION: A combination of moistened cloth tape to maintain eye closure coupled with placement of well- moistened cotton-based eye pads over the tape provides excellent eye protection during carbon dioxide laser laryngoscopy.

Eye Protective Devices↗

PubMed2004

Symptom outcomes after endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVE: To determine the effectiveness of endoscopic sinus surgery (ESS) for individual symptoms, medication use, and related factors in patients with chronic rhinosinusitis (CRS). DESIGN: Nonrandomized, prospective, clinical trial. INTERVENTIONS: Adult patients with medically refractory CRS were examined before ESS with the Rhinosinusitis Symptom Inventory to catalog major and minor symptoms, medication use, physician visits, and missed workdays due to CRS. After a minimum 6-month follow-up after ESS, patients were examined to determine response to therapy. After computation of Rhinosinusitis Symptom Inventory domains, comparisons were conducted and effect sizes were computed for the change in symptoms after surgery. RESULTS: One hundred adults completed the examination, with a mean follow-up of 19.0 months. Before surgery, the mean major symptom scores ranged from 2.5 to 3.5 (Likert scale, from 0 [symptom absent] to 5 [maximum severity]) and the minor symptom scores ranged from 0.8 to 2.8. After surgery, statistically significant decreases in major and minor symptoms were noted (P<.001 for all). The largest effect sizes were noted for the decreases in facial pressure, congestion, nasal obstruction, rhinorrhea, and headache (absolute value of effect size >0.85 for all). Similarly, large effect sizes were noted for decreases in symptoms in the nasal (-1.30), facial (-1.13), and total (-1.25) symptom domains of the Rhinosinusitis Symptom Inventory. Medication use actually increased for topical nasal corticosteroids, but decreased for prescription antihistamines. A mean reduction of 1.1 antibiotic courses (mean decrease of 2.3 weeks taking antibiotics) was noted after ESS. CONCLUSIONS: Endoscopic sinus surgery provides significant symptom relief for the nasal and facial symptoms associated with CRS. Patients will often still require topical nasal corticosteroids for the management of their CRS, but can expect decreases in antibiotic requirements after ESS.

Absenteeism↗