William W. Carroll

Clinical and quality-of-life outcomes following gland-preserving surgery for chronic sialadenitis.

Gland‐preserving salivary surgery utilizing salivary endoscopy has been proposed as a treatment alternative in the management of chronic sialadenitis. This study seeks to determine medium‐term clinical and quality‐of‐life (QOL) outcomes following a gland‐preserving approach for chronic sialadenitis.

Reduced sinonasal levels of 1α-hydroxylase are associated with worse quality of life in chronic rhinosinusitis with nasal polyps.

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have deficiencies in circulating and sinonasal levels of the inactive form of vitamin D3, 25‐hydroxycholecalciferol (25VD3). Moreover, CRSwNP patients have reduced epithelial cell–specific expression of 1α‐hydroxylase; the enzyme responsible for the conversion of 25VD3 to its metabolically active form, 1α,25‐dihydroxyvitamin D3 (1,25VD3). The objective of this work was to determine the impact of sinonasal 1α‐hydroxylase levels combined from all cellular sources on subjective disease severity and to identify variables influencing its expression.

Vitamin D deficiency is associated with increased human sinonasal fibroblast proliferation in chronic rhinosinusitis with nasal polyps.

Vitamin D3 (VD3) is a steroid hormone with known antiproliferative properties. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have been shown to be VD3‐deficient. Moreover, VD3 deficiency is associated with worse disease in patients with CRSwNP. One cell type thought to play a role in chronic rhinosinusitis (CRS) is the human sinonasal fibroblast (HSNF). The aim of this study was to investigate VD3 deficiency and HSNF proliferation in CRSwNP.

Fibroblast levels are increased in chronic rhinosinusitis with nasal polyps and are associated with worse subjective disease severity.

Fibroblasts are implicated in tissue remodeling and recruitment of inflammatory cells in chronic rhinosinusitis (CRS). Populations of fibroblasts remain unquantified in CRS subtypes. The objectives of this study were to measure fibroblast populations in subtypes of CRS, and to investigate the association between fibroblasts and disease severity.

Transfacial Ultrasound-Guided Gland-Preserving Resection of Parotid Sialoliths

Objective Review surgical techniques and outcomes of ultrasound-guided, transfacial, gland-preserving removal of difficult parotid stones. Study Design Case series with chart review. Setting Two academic tertiary care centers. Methods Patients who underwent ultrasound-guided, combined transfacial-endoscopic operation for symptomatic parotid sialolithiasis from June 2010 through June 2012 at 2 tertiary care university hospitals were evaluated. Outcome measurements included stone size, stone location, complications, symptom relief, and gland preservation rate. Results A total of 14 patients underwent ultrasound-guided, transfacial operation for symptomatic parotid sialolithiasis. Ten of 14 patients (71%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Three of the 4 patients without complete symptom resolution did endorse symptom improvement, whereas the fourth patient eventually underwent parotidectomy. Needle localization was used to aid in transfacial stone retrieval in 57% of cases. Conclusion Ultrasound-guided, combined transfacial-endoscopic removal of certain parotid stones is an alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Needle localization is a useful adjunct in stone retrieval.

Snoring management with nasal surgery and upper airway radiofrequency ablation.

Objective. To review techniques and outcomes of nasal surgery with upper airway radiofrequency ablation (RFA) when used for socially disruptive snoring, including the rate of infection with reused RFA applicator tips. Study Design. Case series with chart review. Setting. Community-based sleep-disordered breathing clinic. Methods. A prospectively acquired sleep quality assurance database was reviewed to determine demographics, complications, snoring outcomes, level of daytime sleepiness, and sleep-related quality of life in patients with socially disruptive snoring treated with nasal surgery and upper airway RFA. Results. One hundred thirty patients (48 women; 82 men) with a mean age of 50 years (range, 24-83 years) underwent nasal surgery and upper airway RFA for the treatment of chronic nasal blockage with socially disruptive snoring. All patients underwent septoplasty with or without inferior turbinate reduction and RFA to the soft palate and/or base of tongue. Patients received a mean of 2.2 (range, 1-4) applications of upper airway RFA during the course of treatment. No infections occurred with reuse of applicator tips. Fifty-four bed partners (42%) reported complete snoring resolution, whereas 68 (52%) reported residual snoring that was improved. Snoring resolution was more common in patients who underwent repeated applications of upper airway RFA (odds ratio 2.39; 95% confidence interval, 1.09-5.26). Conclusion. Nasal surgery combined with upper airway RFA improved snoring with few complications in this series of patients with anatomic nasal obstruction with socially disruptive snoring. Reuse of RFA applicator tips at palatal sites reduces cost without an observed increase in the risk of upper airway infection.

Cost‐effectiveness of transfacial gland‐preserving removal of parotid sialoliths

Examine outcomes of transfacial gland‐preserving removal of difficult parotid stones and compare the cost and operative time to traditional parotidectomy.

Cervical internal carotid artery pseudoaneurysm complicating malignant otitis externa: first case report.

Pseudoaneurysm of the internal carotid artery (ICA) is a rare complication of head and neck infections. To date, three cases of petrous ICA pseudoaneurysm have been described as a complication of otogenic infection, including only one secondary to malignant otitis externa. We present here the first case of cervical ICA pseudoaneurysm as a complication of malignant otitis externa, and stress the importance of timely diagnosis to avoid fatal outcomes. Laryngoscope, 125:733–735, 2015

Internal Right Ventricular Band for Multiple Ventricular Septal Defects in a Neonate Undergoing Arterial Switch and Aortic Arch Repair

A neonate presented with d-transposition of the great arteries, aortic arch hypoplasia, aortic coarctation, and multiple ventricular septal defects. During the arterial switch procedure and the aortic arch repair, a fenestrated Gore-Tex disk (W.L. Gore & Assoc, Flagstaff, AZ) was sewn into the right ventricular outflow tract to restrict pulmonary blood flow. The internal right ventricular band successfully controlled the pulmonary blood flow, maintaining a systemic oxygen saturation of 88% to 92%, and allowing growth from 3.5 to 10.5 kg. At 8 months of age, the internal band in the patient was removed, and the ventricular septal defects were successfully closed.

C3a receptor antagonism as a novel therapeutic target for chronic rhinosinusitis

Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease with an unknown etiology. Recent studies have implicated the complement system as a potential modulator of disease immunopathology. We performed proteomic pathway enrichment analysis of differentially increased proteins, and found an enrichment of complement cascade pathways in the nasal mucus of individuals with CRSwNP as compared to control subjects. Sinonasal mucus levels of complement 3 (C3) correlated with worse subjective disease severity, whereas no significant difference in systemic C3 levels could be determined in plasma samples. Given that human sinonasal epithelial cells were the predominate sinonasal source of C3 and complement anaphylatoxin 3a (C3a) staining, we focused on their role in in vitro studies. Baseline intracellular C3 levels were higher in CRSwNP cells, and following exposure to Aspergillus fumigatus (Af) extract, they released significantly more C3 and C3a. Inhibition of complement 3a receptor (C3aR) signaling led to a decrease in Af-induced C3 and C3a release, both in vitro and in vivo. Finally, we found in vivo that C3aR deficiency or inhibition significantly reduced inflammation and CRS development in a mouse model of Af-induced CRS. These findings demonstrate that local sinonasal complement activation correlates with subjective disease severity, and that local C3aR antagonism significantly ameliorates Af-induced CRS in a rodent model.