Rohit Garg

Anthropometric and aesthetic analysis of the Indian American woman's face☆

BACKGROUND This is the first study defining the facial anthropometric and aesthetic measurements in Indian American women (IAW). METHODS This is a prospective cohort study involving evaluation of facial photographs. Frontal, lateral and basal photographs were taken of IAW (n=102), and 30 anthropometric measurements were determined. Proportions were compared with published North American white women (NAWW) norms. Judges (n=6) evaluated the photographs for aesthetics using a visual analogue scale. Attractive IAW (top 15%) were compared with average IAW (remaining 85%) and average NAWW. All completed a facial self-esteem survey. RESULTS There were significant differences between IAW and NAWW in 25 of 30 facial measurements. Six measurements correlated with aesthetic scores: intercanthal distance, mouth width, nasolabial angle, midface height 2, ear length and nasal height. Attractive IAW had nine measurements approximating NAWW features, 15 measurements similar to average IAW values and two measurements distinct from both average IAW and average NAWW. Attractive IAW had higher facial self-esteem scores than average IAW. CONCLUSIONS Facial measurements in IAW are much different from NAWW, and these results will assist in preoperative planning. Several features are correlated with attractiveness in IAW: larger and wider-set eyes, a smaller midface, a smaller nose with greater tip rotation, smaller ears and a larger mouth. Attractive IAW display many measurements typical of average IAW and several measurements that reflect average NAWW values. These results contribute to concepts of transcultural aesthetics--for a minority ethnic group, facial beauty appears to be an assimilation of deep-rooted ethnic features with prevailing cultural traits and aesthetic standards.

Sinonasal respiratory epithelial adenomatoid hamartomas: Series of 51 cases and literature review

Background Respiratory epithelial adenomatoid hamartomas (REAHs) are rare, benign glandular proliferations of the nasal cavity, paranasal sinuses, and nasopharynx. This study aimed to expand our understanding of this entity by presenting a series of REAHs combined with a review of the pertinent literature. Methods A retrospective review was performed on all patients with a diagnosis of REAH from 2002 to 2011. Data were collected with respect to age, gender, clinical presentation, imaging, histopathology, treatment, and outcome. Because olfactory cleft expansion by imaging evaluation has been reported to suggest REAH, maximum olfactory cleft (MOCs) widths were also measured. Results Fifty-one cases of REAH included 37 male (72.5%) and 14 female subjects (27.5%) with a mean age of 58.4 years. Headache, nasal obstruction, rhinorrhea, and hyposmia were the most common presenting symptoms. Although 35(68.6%) were associated with concurrent inflammatory pathology, 16 (31.4%) presented as isolated lesions of the nasal cavity. Enlargement of MOCs was evident on computed tomography, with mean MOCs of 8.64 and 9.4 mm, in the coronal/axial planes, respectively. There were no statistically significant differences between MOCs of isolated (7.96 mm) versus MOCs of associated (9.63 mm) lesions (p = 0.25). Forty-nine were treated with endoscopic resection without evidence of recurrence after a mean follow-up of 27.2 months. Conclusion REAHs are rare sinonasal lesions that may appear as localized, isolated masses or more diffuse when in conjunction with other inflammatory processes. Irrespective of clinical presentation, endoscopic removal appears to be curative. Differentiation from more aggressive lesions is paramount to avoid unnecessarily radical surgery for an otherwise benign process.

Stabilization of Costal Cartilage Graft Warping Using Infrared Laser Irradiation in a Porcine Model

OBJECTIVE To develop a method to rapidly stabilize the shape change process in peripheral slices of costal cartilage by using infrared laser irradiation in a porcine model. METHODS Forty peripheral porcine costal cartilage specimens (40 × 10 × 2 mm) were harvested. Thirty of these specimens were immediately irradiated with an Nd:YAG laser (λ = 1.32 μm; spot size, 2-mm diameter) using 1 of 3 exposure treatments: 6 W, 2 seconds, and 4 spots; 8 W, 3 seconds, and 4 spots; or 6 W, 2 seconds, and 8 spots. Ten control specimens were only immersed in 0.9% saline solution. Angle of curvature was measured from photographs taken at 0 minutes, immediately after irradiation, and at 30 minutes, 1 hour, 5 hours, and 24 hours. Infrared imaging was used to measure surface temperatures during irradiation. Cell viability after irradiation was determined using a live/dead assay in conjunction with fluorescent confocal microscopy. RESULTS Compared with the untreated controls, the irradiated grafts underwent accelerated shape change within the first 30 minutes to reach a stable geometry. Thereafter, irradiated grafts underwent little or no shape change, whereas the control group exhibited significant change in curvature from 30 minutes to 24 hours (P < .001). The average peak irradiated spot temperatures ranged from 76°C to 82°C. Cell viability measurements at the laser spot sites demonstrated a hemispherically shaped region of dead cells with a depth of 0.8 to 1.2 mm and a surface diameter of 1.9 to 2.7 mm. CONCLUSIONS Laser irradiation of peripheral costal cartilage slices provides an effective method for rapidly stabilizing acute shape change by accelerating the warping process. The temperature elevations necessary to achieve this are spatially limited and well within the limits of tolerable tissue injury.

Model for estimating the threshold mechanical stability of structural cartilage grafts used in rhinoplasty

Characterizing the mechanical properties of structural cartilage grafts used in rhinoplasty is valuable because softer engineered tissues are more time‐ and cost‐efficient to manufacture. The aim of this study is to quantitatively identify the threshold mechanical stability (e.g., Youngs modulus) of columellar, L‐strut, and alar cartilage replacement grafts.

Nasopharyngeal acid reflux and eustachian tube dysfunction in adults

Objective: This study aimed to evaluate the relationship between nasopharyngeal pH and Eustachian tube dysfunction (ETD) in adults. Study Design: Unmatched case-control study. Methods: Forty-one subjects, 20 adults with a diagnosis of ETD and 21 healthy adults as controls, were enrolled from an outpatient clinic. All subjects had a Dx–pH probe placed near the torus tubarius in the posterior nasopharynx for 24 hours. The pH values were recorded every 0.5 second. Decreases in pH were considered as reflux events if the pH dropped below 5.5. Results: The average nasopharyngeal pH value was 6.90 (range, 5.33-7.73) in the subjects with ETD and 7.07 (range, 5.99-7.94) in the controls. The difference between the 2 groups was not statistically significant (P = .30). The ETD group, on average, had a higher number of nasopharyngeal reflux events (2.3 ± 1.6 vs 0.8 ± 1.2, respectively; P = .002) and higher reflux finding score (3.6 ± 2.7 vs 0.4 ± 1.4, respectively; P < .001) than the control group. Conclusion: By using a novel pH probe that allows detection of acidity in a nonliquid environment, a comparison of nasopharyngeal pH between control patients and those with ETD was performed. Eustachian tube dysfunction was more likely to be associated with a higher number of nasopharyngeal reflux events and higher reflux finding score. Nasopharyngeal reflux may have a role in the pathogenesis of ETD.

Assessment of epithelial innate antimicrobial factors in sinus tissue from patients with and without chronic rhinosinusitis.

Airway secretions contain endogenous antimicrobial factors (AMFs) that contribute to the innate host defense of the respiratory tract. Antibacterial peptides as well as host‐derived lipids including cholesteryl esters have been detected in maxillary lavage fluid. Sterol O‐acyltransferase 1 (SOAT1) is a key enzyme in cholesteryl ester production. The purpose of this study is to determine if such intrinsic microbicidal molecules are acutely expressed within sinus tissue and to compare levels of expression between patients with and without chronic rhinosinusitis (CRS).

Detecting nasopharyngeal reflux: a novel pH probe technique.

Objectives: We sought to ascertain the normal pH values in the aerosolized environment of the nasopharynx in healthy subjects and utilize a novel pH probe that allows measuring acidity in a nonliquid environment. Methods: Between November 2009 and February 2011, healthy volunteers without a history of reflux or eustachian tube dysfunction were enrolled in the prospective study. A total of 20 subjects had a Dx–pH Measurement System Probe (Respiratory Technology Corp) placed near the torus tubarius. The pH probe records the pH throughout the 24-hour study. A pH below 5.5 while the subject was upright or below 5.0 while the subject was supine was used as a criterion to determine a reflux event. Recording was stopped during meals. Results: For normal individuals with no history of reflux or eustachian tube dysfunction, the pH values obtained from the nasopharynx ranged from 6.10 to 7.92. The average pH was 7.03 (SD, 0.67). Eight subjects (40%) had at least 1 reflux event during the 24-hour pH study. Conclusions: By utilizing a novel self-condensing pH probe, we were able to perform a 24-hour pH study in the nasopharynx of 20 healthy individuals. In our study, the average pH for individuals without symptomatic reflux or eustachian tube dysfunction was 7.03. Interestingly, 8 control subjects had at least 1 episode of pH below 5.5 while awake or below 5.0 while asleep, which was considered to be a reflux event in our study.

Higher antineutrophil cytoplasmic antibody (C-ANCA) titers are associated with increased overall healthcare use in patients with sinonasal manifestations of granulomatosis with polyangiitis (GPA).

Background Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous airway inflammation and vasculitis. Sinonasal involvement occurs in more than 80% cases, with antineutrophil cytoplasmic antibody (C-ANCA) titers used as a marker of disease severity. The purpose of this study was to determine whether C-ANCA levels impact radiographic findings and healthcare use in patients with sinonasal GPA. Methods A retrospective review was performed on GPA patients evaluated in a multidisciplinary rheumatologic/otolaryngologic clinic from 2008 to 2013. Data were collected with respect to age, gender, clinical presentation, C-ANCA titers, Lund-Mackay (LM) scores, surgical interventions, and healthcare use, the latter of which were determined by assessing the number of rheumatology/otolaryngology clinic visits, computed tomography (CT) scans, and email/telephone encounters. Results A total of 44 patients were identified, 11 male and 33 female. Sinonasal manifestations were evident in 70.4%, with chronic rhinosinusitis (CRS) (41.9%), septal perforation (38.7%), and crusting (32.2%) the most common findings. No significant differences in number of CT scans (p = 0.10) or mean LM scores (p = 0.47) were found between patients with more than or equal to 1:80 and less than 1:80 C-ANCA titers, respectively. However, overall healthcare use was increased in the more than or equal to 1:80 C-ANCA group (n = 28) compared with less than 1:80 (n = 16), with a significantly greater number of rheumatologic/otolaryngologic encounters (mean 121 versus 69.2, p = 0.03) noted. When otolaryngologic healthcare use was specifically examined, the average number of encounters was also higher in more than or equal to 1:80 C-ANCA patients (31.9 versus 22.9), but this difference was not statistically significant (p = 0.16). Conclusion Sinonasal GPA patients with presenting C-ANCA titers more than or equal to 1:80 demonstrated significantly greater overall healthcare use than their lower C-ANCA level counterparts (less than 1:80). However, no significant differences in otolaryngology resource use or LM scores were evident between the two titer groups.

Intratympanic Injection of Autologous Blood for Traumatic Perilymphatic Fistulas

Aperilymphatic fistula (PLF) is any abnormal communication between the middle ear or mastoid and the inner ear. Trauma, prior stapes surgery, and barotrauma are accepted etiologies; however, controversy exists over the existence of spontaneous PLF. Typical symptoms include fluctuating sensorineural hearing loss, tinnitus, aural fullness, vertigo, and disequilibrium. PLF diagnosis is based on history, complete examination, and a positive fistula test. A positive fistula test is confirmed by the elicitation of nystagmus or a sense of motion. Treatment options include conservative management or surgical treatment depending on the severity and duration of the symptoms. Medical management includes bed rest, head elevation, stool softeners, and avoidance of straining, coughing, or sneezing. Surgical management consists of exploratory tympanotomy and grafting of the oval and round windows. This paper retrospectively analyzes three cases of a novel approach to treatment of traumatic PLFs when medical management had failed.

Detecting Reflux in Adults with Eustachian Tube Dysfunction

Objective: 1) Ascertain whether adult patients with Eustachian tube dysfunction (ETD) have a higher incidence of reflux into the nasopharynx compared with controls. 2) Utilize recent advances in pH probe technology to detect acidity at the Eustachian tube orifice for direct comparison. Method: A prospective study was performed on 38 adult patients in an outpatient setting between November 2009 and February 2011. Seventeen patients with Eustachian tube dysfunction and 21 control subjects had a Dx-pH probe (Restech, San Diego, California 2006) placed near the torus tubarius in the posterior nasopharynx for 24 hours. Results: The average pH value obtained from the nasopharynx of adults with no history of ETD was 7.03 (range, 6.10-7.92; SD, 0.69). In comparison, the average pH for patients with ETD was 6.90 (range, 5.33-8.06; SD, 0.77). This P value for this difference was .48. The average number of reflux events for subjects was 0.55 events over a 24-hour period for controls and 2.1 for patients with ETD. Decreases in pH were considered reflux events if the pH dropped below 5.5 while in the upright position or below 5.0 in the supine position. Conclusion: By utilizing a novel pH probe that allows detection of acidity in a non-liquid environment, a comparison of nasopharyngeal pH between control patients and those with ETD was performed. A trend toward higher numbers of reflux events was found in patients with ETD when compared to control subjects.