Anna Butrymowicz

Impact of 13-valent pneumococcal conjugate vaccine on otitis media bacteriology☆

OBJECTIVES To determine the microbiology of otitis media (OM) since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in February 2010. METHODS Middle ear effusion from a pediatric Otolaryngology population undergoing pressure equalization tube (PET) placement was obtained and sent for aerobic culture and antibiotic susceptibility testing between August 2012 and April 2013. Vaccination records were obtained and statistical analysis was completed. RESULTS During the 8-month period, 236 ears were evaluated, and of those 39 ears were found to have positive cultures. The single nonvaccine Streptococcus pneumoniae (serotype 16) isolate was obtained from a PCV7-only vaccinated patient and was penicillin susceptible. The three most common isolates were Staphylococcus coagulase negative (57%), Haemophilus influenzae (17%), and Moraxella catarrhalis (7%). CONCLUSIONS This study is the first to assess the bacteriology of OM in a pediatric population undergoing PET placement in the immediate post-PCV13 era. Our study is limited by sample size; however, the lack of S. pneumoniae cultures indicates that PCV13 has had a significant impact on pneumococcal infections during these initial years following licensure.

Split-calvarial osteopericranial flap for reconstruction following endoscopic anterior resection of cranial base

To conceive and critically evaluate an adaptation of the split calvarial osteopericranial flap for reconstruction following endoscopic endonasal resection of the anterior skull base.

Transnasal endoscopic medial maxillary sinus wall transposition with preservation of structures

To evaluate the increase in access to the maxillary sinus (MS) with transnasal endoscopic medial maxillary sinus wall transposition (TEMMT), while preserving major structures of the nasal cavity.

Endoscopic endonasal greater palatine artery cauterization at the incisive foramen for control of anterior epistaxis.

To describe the anatomy of the incisive foramen and the transnasal endoscopic approach to the greater palatine artery at this foramen, and to evaluate the importance of the greater palatine artery as a cause of recurrent anterior epistaxis.

Ambulatory Surgical Management of Obstructive Sleep Apnea: Is It Safe?

Objectives: Determine the safety of ambulatory oropharyngeal surgery in adults with obstructive sleep apnea. Methods: Retrospective cohort study. Relevant data were collected from patients aged 18+ years with obstructive sleep apnea (OSA) receiving head and neck airway surgery between September 1, 2005, and September 15, 2012. Results: Out of 315 patients with complete data, 243 (77.14%) were managed as inpatients and 72 (22.86%) in an ambulatory manner. The mean Apnea/Hypopnea Index (AHI) for the inpatient and ambulatory groups were 35.99 and 18.43, respectively (P < .00). The mean body mass index (BMI) for the inpatient and ambulatory groups was 34.12 and 30.79, respectively (P < .0002). When calculating the incident risk ratio of changes in AHI or BMI, AHI exhibited a significantly increased contribution. There were no complications in the ambulatory cohort. Conclusions: When evaluating body habitus and polysomnographic data, OSA patients who underwent oropharyngeal procedures and were discharged on the same day were significantly different than those who were admitted to the hospital. It appears from this data that patients with mild-moderate sleep apnea, even for patients with mild obesity, are safe to have these procedures performed in an ambulatory setting. This data could potentially assist practitioners in determining which procedures could be safely planned for an ambulatory setting and therefore decrease health care expenditures and patient inconvenience while maintaining patient safety. Future studies investigating what, if any, inpatient interventions were provided for those patients that were admitted to the hospital could potentially further expand the group of patient who could be safely managed in an ambulatory setting.

Endoscopic Approach to Greater Palatine Artery to Control Recurrent Anterior Epistaxis

Objectives: (1) Describe the anatomy of the incisive foramen. (2) Describe the endoscopic approach to the greater palatine artery. (3) Recognize the importance of the greater palatine artery as a cause of recurrent anterior epistaxis. Methods: Cadaveric and radiographic study of the incisive foramen; illustrative case series. Seventy computed tomography (CT) scans were reviewed, and measurements were made of the incisive foramina’s distance to the anterior nasal spine and subnasale. An endoscopic approach to the incisive foramen was completed in 20 cadavers, and measurements of the distance from the anterior nasal spine to the incisive foramen were documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery. Results: Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Cadaveric measurements preliminarily correspond to radiographic measurements. Conclusions: Endoscopic cauterization of the greater palatine artery is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Preoperative evaluation of a CT scan can help aid a surgeon in determining the relative contribution of the greater palatine artery to the anterior septal blood supply, and guide surgical approach to control recurrent anterior epistaxis. Our case series corroborates the above.