Thomas S. Higgins

Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis.

To compare by meta‐analysis the effect of recurrent laryngeal nerve (RLN) monitoring versus RLN identification alone on true vocal fold palsy rates after thyroidectomy.

Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors

Background The traditional method of pituitary tumor excision is transseptal microscopic excision; however, the transnasal transsphenoidal endoscopic approach has shown comparable results with the transseptal microscopic approach at some institutions. The objective of this study is to compare the two types of sellar and parasellar mass resection: transnasal transsphenoidal endoscopic excision versus transseptal microscopic excision. Methods A retrospective cohort analysis was performed on subjects who were referred to a tertiary hospital for surgical management of sellar or parasellar masses. The two groups of patients either underwent a transnasal endoscopic approach with endoscopic excision or transseptal microscopic excision. Demographics, tumor characteristics, operative details, length of hospital stay, intraoperative and postoperative complications, level of postoperative pain, recurrence rate, use of computed tomography (CT) image guidance, and length of follow-up were gathered. The data between the two groups were then compared. Results The analysis included 19 subjects who underwent endoscopic excision and 29 subjects who underwent transseptal microscopic excision. Null macroadenoma was the most common sellar mass followed by prolactinoma. There were no statistical differences in rates of perioperative complications and suprasellar or cavernous sinus invasion. Patients who underwent an endoscopic approach had shorter operative times, lower estimated blood loss, less lumbar drain use, less pain, and a shorter postoperative hospital stay (p < 0.05). Conclusion The two approaches show similar intraoperative characteristics and immediate complication rates. Transnasal transsphenoidal endoscopic excision is a reasonable alternative to the traditional method of sellar mass excision.

Systematic review of topical vasoconstrictors in endoscopic sinus surgery

The objective of this study is to systematically review the literature and examine the safety for the use of topical vasoconstrictors in endoscopic sinus surgery.

Management of orbital complications in endoscopic sinus surgery.

Purpose of reviewMinor and major complications can occur during endoscopic sinus surgery. Even though major complications are rare, orbital complication is one of the more common major complications that can lead to devastating consequences. This article summarizes the orbital complications that can occur during endoscopic sinus surgery, how to manage the complication when it occurs, and more importantly how to avoid these complications. Recent findingsOne of the orbital complications during endoscopic sinus surgery is retrobulbar hematoma. Retrobulbar hematoma can be classified as spontaneous, traumatic, and iatrogenic. Iatrogenic hematoma, which can be caused by endoscopic sinus surgery, is more likely to have an arterial source, so these hematomas have higher tonometric pressure and may require more aggressive management. However, medical management can be an option for some of these iatrogenic retrobulbar hematomas. Tonometric pressure may be the best indicator to decide which intervention to use for this complication. Another distressing orbital complication is injury to the oculomotor muscles. With prompt medical and surgical intervention, the ocular dysmotility can be compensated. SummaryConsequences of orbital injury during endoscopic sinus surgery can be devastating; however, with proper medical or surgical treatment potential morbidities can be minimized.

Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis†

Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled‐data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies.

Bacterial pathogens in the nasopharynx, nasal cavity, and osteomeatal complex during wellness and viral infection.

Background Viral sinusitis can precede acute bacterial sinusitis, but the influence of viral infection on bacterial colonization is unclear. The objective of this study was to evaluate the presence of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the osteomeatal complex (OMC), nasal cavity, and nasopharynx in adults during wellness and viral upper respiratory illness (URI). Methods Subjects were recruited for the study during wellness and at the time of acute viral rhinosinusitis. Swab cultures were obtained from the OMC, nasal cavity, and the nasopharynx. Swab eluates were inoculated on selective agars to detect S. pneumoniae, H. influenzae, and M. catarrhalis. Results The study included 237 subjects, 100 adults with URI and 137 well adults. Positive culture results were found for any site in 70% (n = 70) of ill subjects and 64% (n = 88) of well subjects (p = 0.393). Of the 91 OMC cultures, positive cultures were over five times more likely to be found in ill subjects than in well subjects (31% versus 8%; p = 0.010). The nasal cavity cultures were positively statistically significant more often in ill subjects versus well subjects (39% versus 25%; p = 0.022). The overall nasopharyngeal cultures did not show a statistically significant difference (65% versus 60%; odds ratio, 1.2; p = 0.461). S. pneumoniae was positively cultured in at least one site in 15% of ill subjects and 31% of well subjects (p = 0.006). H. influenzae was positively cultured in at least one site in 45% of ill subjects and 31% of well subjects (p = 0.027). M. catarrhalis was positively cultured in at least one site in 42% of ill subjects and 27% of well subjects (p = 0.018). Conclusion This study defines the carriage rates of the three most common bacterial pathogens for acute sinusitis in the nasopharynx, nasal cavity, and OMC during illness and in the healthy state.

Laryngeal mucous membrane pemphigoid: A systematic review and pooled‐data analysis

To perform a systematic pooled‐data analysis of literature data involving laryngeal mucous membrane pemphigoid (MMP).

Medical decision analysis: Indications for tympanostomy tubes in RAOM by age at first episode

Objective To compare utility estimates between tympanostomy tubes (TT) and short-courses of antibiotics in children with recurrent acute otitis media (RAOM) stratified by age at first episode. Study Design and Setting Formal decision analysis. Results The model recommended TT sooner in children with a history of a first episode of AOM occurring early in life. In children over 12 months old at onset, TT were recommended with seven episodes in 24 months, five episodes in 12 months, and three episodes in six months. In children under six months old at onset, TT were recommended with three episodes in 24 months and two episodes in a six-month or 12-month time span. Conclusions Earlier TT may be indicated in children who developed a first episode of AOM at a very young age because of the higher risk of AOM recurrence. Significance This study is the first formal decision analysis to compare tympanostomy tubes and short-courses of antibiotics stratified by age at onset of the first AOM episode.

R096: Medical Decision Analysis: Indications of Tympanostomy Tubes

transfected with a mammalian expression vector with SCCA1cDNA. Quantitative RT-PCR, western blot and active site labeling of cathepsins were performed. RESULTS: In the HNSCC cell lines, SCCA1 mRNA and protein levels were significantly lower than normal squamous epithelial cells. There were no significant differences in cathepsin activity between SCCA1 clones and control clones. However, the activity of cat L or S was significantly lower following IFN-gamma stimulation in SCCA1 over-expressing HNSCC cells. CONCLUSION: SCCA1 protein is an efficient intracellular inhibitor of cathepsins. SIGNIFICANCE: SCCA1 may function to inhibit the invasive potential of HNSCC. Loss of expression of SCCA1 may play a role in the malignant progression of HNSCC.