Background Sinus disease in the intubated patient remains a frequent reason behind otolaryngological consultation to the Intensive Care Unit. Previous prospective studies often have been limited to only one computed tomography (CT) scan of the sinuses. The purpose of this study was to verify the development of sinus disease in the orotracheally intubated patient and determine a radiographic pattern of its progression if present. Methods The charts of all patients admitted to the hospital with a diagnosis of aneurysm or subarachnoid hemorrhage over a 2-year period were evaluated. Patients who were orotracheally intubated with at least one postintubation CT scan of the head were included. CT scans obtained after the initiation of antibiotics or tracheostomy were excluded. The Lund–Mackay staging system was used to evaluate the scans. Results A total of 50 patients with 172 scans were evaluated. Analysis revealed a significant trend toward increasing severity of radiological sinus disease over the first 7 days of intubation (p < 0.001). The presence of a nasogastric tube (NGT) resulted in an increased Lund–Mackay score, but the trend remained significant for patients without an NGT as well. Conclusion This study shows that the presence and progression of sinus findings is fairly common in the intubated patient and that although the placement of an NGT increased the rate of development of sinus findings, the lack of one did not preclude sinus disease. Clinical exam remains a more important indicator of disease when evaluating the Intensive Care Unit patient for rhinosinusitis.

OBJECTIVESThe aim of this study was to verify the correlation of endoscopically directed middle meatal (EDMM) cultures with maxillary sinus tap and culture (MST) in acute bacterial rhinosinusitis (ABRS).STUDY DESIGN AND METHODSMeta‐analysis of the previous literature, unpublished data, and a prospective trial supported by the Sinus & Allergy Health Partnership. EDMM and MST cultures were obtained and their results compared. Inclusion for both the unpublished and prospective trial as well as prior published literature in the meta‐analysis required the studies to compare EDMM versus MST in the acute setting of bacterial rhinosinusitis with both symptomatic and radiologic evidence of ABRS.RESULTSThree articles and 1 national presentation were identified for inclusion. Additional data from unpublished studies and the prospective trial were combined. The pooled data consisted of 126 patients with 131 culture pairs. For known pathogenic bacteria for ABRS and in comparison to MST, EDMM had a sensitivity of 80.9%, a specificity of 90.5%, a positive predictive value of 82.6%, a negative predictive value of 89.4%, and an overall accuracy of 87.0% (95% confidence interval, 81.3%‐92.8%); 70.5% (12/17) of false positive culture pairs were of known pathogens for ABRS that would not be expected to be contaminants.CONCLUSIONS AND SIGNIFICANCEThis meta‐analysis shows that EDMM is a highly sensitive and accurate culture method for acute ABRS and may be more sensitive than MST given the presence of pathogenic bacteria not found on antral lavage. EDMM is a viable, and possibly preferred, culture method for determining antimicrobial efficacy and bacterial resistance patterns.EBM rating: A‐1a

Background: Promoter methylation of tumor suppressor genes has been investigated by a variety of means, recently including pyrosequencing. Methods: Fresh tumor tissue and normal tissue from resection margin were obtained from 79 patients undergoing resection for squamous cell carcinoma. DNA was extracted and bisulphite treated. Polymerase chain reaction primers were designed to amplify 75– to 200– base pair regions of the CpG-rich gene promoters of p16, RAR-beta, E-Cad, CYGB, cyclin A1, MGMT, ATM, hMLH1, STAT1, and TIMP3. Methylation status of 5 to 22 individual CpG sites per gene was determined by pyrosequencing. Reverse transcriptase–PCR was used to correlate these data with mRNA expression. Results: Significant CpG methylation of gene promoters within tumor specimens was found in most genes studied; however, despite previous reports, there was no evidence in the mismatch repair genes ATM, STAT1, or hMLH1. Promoter methylation was in evidence in highly tumor-specific pattern for most genes; however, the quantitative nature of these data revealed that for RAR-beta and E-cadherin, the pattern was not tumor specific. Concordant methylation was demonstrated in this tumor series (P=.03), but it was difficult to identify a true methylator phenotype (CIMP). Cyclin A1 promoter methylation showed an inverse trend with histological grade. Promoter methylation of CYGB is common in head and neck SCC. Conclusions: Promoter methylation analysis using pyrosequencing reveals valuable quantitative data from several CpG sites. In contrast to qualitative data generated from methylation-specific PCR, our data clarify which genes are methylated in a tumor-specific pattern. Cytoglobin is a novel candidate tumor suppressor gene highly methylated in upper aerodigestive tract squamous cancer.

OBJECTIVE To identify the extent and the smallest region of loss for CDKN2B(INK4b), CDKN2A(ARF,INK4a), and MTAP. Homozygous deletions of human chromosome 9p21 occur frequently in malignant cell lines and are common in squamous cell carcinoma of the head and neck (HNSCC). This complex region encodes the tumor suppressor genes cyclin-dependent kinase 2B (CDKN2B) (p15(INK4b)) and CDKN2A (p14(ARF), p16(INK4a)) and the housekeeping gene methylthioadenosine phosphorylase (MTAP). DESIGN A targeted probe panel designed to finely map the region of 9p21 loss comprised 3 probes for CDKN2B(INK4b), 7 for CDKN2A(ARF, INK4a), and 3 for MTAP and was interrogated using the multiplex ligation-dependent probe amplification assay (MLPA). The MLPA genomic copy number alterations for CDKN2A were validated using real-time polymerase chain reaction. SUBJECTS Six HNSCC primary (A) and recurrent or metastatic (B) cell lines were examined: UMSCC-11A/11B, UMSCC-17A/17B, and UMSCC-81A/81B. RESULTS Cell line UMSCC-11B retained all 9p loci tested in the region. Cell lines UMSCC-17A/B indicated homozygous deletion of CDKN2A(ARF, INK4a) starting at p16(INK4) exon 1alpha to include exons 2 and 3. Homozygous loss was indicated for CDKN2B(INK4b) and CDKN2A(ARF,INK4a) in UMSCC-11A, and UMSCC-81A. Cell line UMSCC-81B indicated retention of all 9p loci except for exon 1alpha (p16(INK4a)). Selective loss of the 3' end of MTAP was observed in UMSCC-11A. Genomic alterations by fine-mapping MLPA were validated at the DNA level for CDKN2A. CONCLUSIONS We identified exon 1alpha (p16(INK4a)) as the smallest region of loss in the CDKN2A(ARF, INK4a) gene. The frequency and precise loss of CDKN2B(INK4b), CDKN2A(ARF, INK4a), and MTAP in the prognosis of 9p21-deleted HNSCC may provide impetus for use of these targets as therapeutic biomarkers in head and neck cancer.

Objective: Promoter methylation–mediated silencing is a hallmark of many established tumor suppressor genes. This study uses a novel, multigene approach to examine epigenetic events of aberrant promoter methylation as diagnostic markers in head and neck squamous cell carcinoma (HNSCC).

BackgroundThere is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials.ObjectivesTo develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials.MethodsFive national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials.ResultsCommittee members agreed to adopt the term "rhinosinusitis" and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition.ConclusionThe recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials. There is a need for more research on all forms of rhinosinusitis. Progress in this area has been hampered by a lack of consensus definitions and the limited number of published clinical trials. To develop consensus definitions for rhinosinusitis and outline strategies useful in clinical trials. Five national societies, The American Academy of Allergy, Asthma and Immunology; The American Academy of Otolaryngic Allergy; The American Academy of Otolaryngology Head and Neck Surgery; The American College of Allergy, Asthma and Immunology; and the American Rhinologic Society formed an expert panel from multiple disciplines. Over two days, the panel developed definitions for rhinosinusitis and outlined strategies for design of clinical trials. Committee members agreed to adopt the term "rhinosinusitis" and reached consensus on definitions and strategies for clinical research on acute presumed bacterial rhinosinusitis, chronic rhinosinusitis without polyposis, chronic rhinosinusitis with polyposis, and classic allergic fungal rhinosinusitis. Symptom and objective criteria, measures for monitoring research progress, and use of symptom scoring tools, quality-of-life instruments, radiologic studies, and rhinoscopic assessment were outlined for each condition. The recommendations from this conference should improve accuracy of clinical diagnosis and serve as a starting point for design of rhinosinusitis clinical trials.

OBJECTIVES., Radiosurgery precisely delivers a single high dose or a few fractionated doses of radiation to a localized tumor via the stereotactic approach. Some head and neck sites are suitable for radiosurgery since there is minimal or no organ motion. The clinical studies were carried out to determine the accuracy of stereotactic radiosurgery and to demonstrate the effectiveness of radiosurgery in head and neck cancers.MATERIALS AND METHODS: Thirteen patients were treated with either single-dose or fractionated radiosurgery to the tumor. All patients except one with cancer of the lip had received prior treatments including surgery, radiotherapy, and chemotherapy for the primary cancers. The dose ranged 12 to 18 Gy for single-dose radiosurgery and 30 Gy in 5 or 6 fractions twice a week for fractionated radiosurgery. Tumor localization was achieved via the stereotactic approach.RESULTS: Accuracy of radiosurgery was within 1.5 mm. Despite the recurrent disease from previous heavy treatments, 9 patients (70%) showed a significant response (complete or >50% tumor reduction) to radiosurgery, and 3 patients had stable disease. Complete tumor response was achieved in 6 patients. All patients had excellent pain relief with functional and cosmetic preservation. There was no acute and subacute radiation toxicity detected clinically during the minimal follow-up of 6 months.CONCLUSION. Image-guided radiosurgery is effective in achieving the local tumor control, and pain relief. Radiosurgery provided excellent functional and cosmetic preservation with minimal complication. The results indicate the potential of radiosurgery in the treatment of recurrent and selected primary head and neck cancers.

Otolaryngology–Head and Neck SurgeryVolume 131, Issue 3 p. 317-320 New Techniques and Technologies Minor Recurrent Epistaxis: Prevalence and a New Method for Management Dr. Michael S. Benninger MD, Corresponding Author Dr. Michael S. Benninger MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MichiganDr. Benninger and Dr. Marple serve as consultants of Les Laboratoires Brothier S.A., but have no other financial relationships with the companyDepartment of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202; e-mail, [email protected]Search for more papers by this authorDr. Bradley F. Marple MD, Dr. Bradley F. Marple MD University of Texas-Southwestern, Dallas, TexasDr. Benninger and Dr. Marple serve as consultants of Les Laboratoires Brothier S.A., but have no other financial relationships with the companySearch for more papers by this author Dr. Michael S. Benninger MD, Corresponding Author Dr. Michael S. Benninger MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MichiganDr. Benninger and Dr. Marple serve as consultants of Les Laboratoires Brothier S.A., but have no other financial relationships with the companyDepartment of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI 48202; e-mail, [email protected]Search for more papers by this authorDr. Bradley F. Marple MD, Dr. Bradley F. Marple MD University of Texas-Southwestern, Dallas, TexasDr. Benninger and Dr. Marple serve as consultants of Les Laboratoires Brothier S.A., but have no other financial relationships with the companySearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/j.otohns.2004.05.009Citations: 5 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1Dano I, Dangor E, Sichel J, Eliashar R. Experimental surgical treatment for recurrent epistaxis. Am J Otolaryngol 1998; 19: 357–9 10.1016/S0196-0709(98)90036-9 CASPubMedWeb of Science®Google Scholar 2Strachan D, England J. First-aid treatment of epistaxis - confirmation of widespread ignorance. Postgrad Med J 1998; 74: 113–114 10.1136/pgmj.74.868.113 CASPubMedWeb of Science®Google Scholar 3Sparacino LL. Epistaxis management: What's new and what's noteworthy. Lippincott's Prim Care Pract 2000; 4: 498–507 CASPubMedGoogle Scholar 4Tomkinson A, Bremmer-Smith A, Craven C, et al. Hospital epistaxis admission rate and ambient temperature. Clin Otolaryngol 1995; 20: 239–40 10.1111/j.1365-2273.1995.tb01857.x CASPubMedWeb of Science®Google Scholar 5Jaros SH, Dewey JL. Use of an alginate in hyposensitization. An Allergy 1996; 22: 173–179 Google Scholar Volume131, Issue3September 2004Pages 317-320 ReferencesRelatedInformation

OBJECTIVE: The effectiveness of topical intranasal steroids (INS) sprays for the treatment of allergic and nonallergic rhinitis may. be limited by lack of instruction in the optimal spray technique. To determine whether the technique used affects the efficacy and safety of the product, this review of evidence had the goal of identifying and establishing a preferred method of applying INS sprays.STUDY DESIGN: A MEDLINE search of pertinent literature on 7 INS and 1 intranasal antihistamine spray preparations conducted with the use of appropriate search terms, yielded an initial. 121 articles, 29 of which were identified as appropriate for review and grading for quality of evidence.RESULTS: The analysis provided no definitive evidence regarding how best to instruct patients to use INS or antihistamine spray devices.CONCLUSIONS: On the basis of a lack of clear evidence regarding instructions to maximize efficacy and safety of these drugs, the panel recommended a 7-step standard-technique.

Otolaryngology–Head and Neck SurgeryVolume 129, Issue S3 p. S1-S32 Article Adult Chronic Rhinosinusitis: Definitions, Diagnosis, Epidemiology, and Pathophysiology First published: 22 November 2016 https://doi.org/10.1016/S0194-5998(03)01397-4 The definitions of chronic rhinosinusitis presented in this article have been endorsed by the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Otolaryngic Allergy, the American Rhinologic Society, and the Sinus and Allergy Health Partnership. The efforts of this Task Force were made possible through funding provided for this purpose by the Sinus and Allergy Health Partnership. Reprint requests: Michael S. Benninger, MD, Chair, Board of Advisors, Sinus and Allergy Health Partnership, Department of Otolaryngology–Head and Neck Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202; e-mail, [email protected]. 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Otolaryngology–Head and Neck SurgeryVolume 129, Issue 3 p. 280-283 Clinical Techniques and Technology Laryngeal Microinstrumentation: A Novel Design to Reduce Movement Michael S. Benninger MD, Corresponding Author Michael S. Benninger MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MichiganReprint requests: Michael S. Benninger, MD, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202; e-mail, [email protected].Search for more papers by this author Michael S. Benninger MD, Corresponding Author Michael S. Benninger MD [email protected] Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MichiganReprint requests: Michael S. Benninger, MD, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202; e-mail, [email protected].Search for more papers by this author First published: 21 November 2016 https://doi.org/10.1016/S0194-5998(03)01303-2Citations: 1 Supplementary data associated with this article can be found at doi:10.1016/S0194-5998(02)01303-2 Dr Benninger has a Royalty Agreement with Medtronic Xomed for the instruments described in this manuscript. Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1Zeitels SM. Premalignant epithelium and microinvasive cancer of the vocal fold: The evolution of phonomicrosurgical management. Laryngoscope 1995; 105: 1–51. 2Benninger MS. Microdissection or microspot CO2 laser for limited vocal fold benign pathology: A prospective randomized trial. Laryngoscope 2000; 110(suppl 92): 1–17. 3Hirano M. Phonosurgery. Basic and clinical investigations. Otologia (Fukuoka) 1975; 21: 239–442. 4Benninger MS., Alessi D., Archer S, et al. Vocal fold scarring-current concepts and management. Otolaryngol Head Neck Surg 1996; 115: 474–82. 5Shapshay SM., Healy GB. New microlaryngeal instruments for phonatory surgery and pediatric application. Ann Otol Rhinol Laryngol 1990; 98: 821–3. 6Strong MS. Microscopic laryngoscopy. A review and appraisal. Laryngoscope 1970; 80: 1540–52. Citing Literature Volume129, Issue3September 2003Pages 280-283 ReferencesRelatedInformation

Community-acquired bacterial respiratory tract infections are among the most common health disorders requiring medical care and are associated with substantial morbidity, mortality, and direct and indirect costs. Recent increases in the prevalence of antimicrobial resistance have resulted in reduced susceptibility of the most common respiratory tract bacterial pathogens to a number of antimicrobials. Amoxicillin/clavulanate potassium extended release (ER) tablets (Augmentin XR™, GlaxoSmithKline) is a new formulation of amoxicillin/clavulanate that retains activity against β-lactamase-producing organisms whilst increasing the activity against Streptococcus pneumoniae through elevated and sustained plasma amoxicillin concentrations. The bilayer tablet provides immediate release of clavulanate and both immediate and sustained release of amoxicillin to maintain therapeutic concentrations of amoxicillin over longer periods of the dosing interval. In clinical trials of acute bacterial sinusitis (ABS) and community-acquired pneumonia (CAP), amoxicillin/clavulanate ER was shown to have excellent bacteriological and clinical success rates, even in patients infected with antimicrobial-resistant pathogens, and was found to be generally well tolerated. Amoxicillin/clavulanate ER is approved in the US for the treatment of patients with ABS or CAP caused by β-lactamase-producing pathogens (ie, Haemophilus influenzae, Moraxella catarrhalis, Haemophilus parainfluenzae, Klebsiella pneumoniae, or methicillin-susceptible Staphylococcus aureus) and S. pneumoniae with reduced susceptibility to penicillin (penicillin minimum inhibitory concentration = 2.0 μg/ml).

OBJECTIVE To identify altered gene targets that characterize disease progression in squamous cell carcinoma (SCC) of the head and neck (HNSCC). Genetic alterations in HNSCC cell lines reflect the tumor in vivo and can serve as valuable tools to study the development and progression of HNSCC. Identification of key molecular events may be useful for more accurate distinction of prognostic groups for selection and targeting of therapy. DESIGN Individual gene loci were analyzed for genetic alterations using a novel genomewide strategy. SUBJECTS Head and neck squamous cell carcinoma primary (A) and recurrent or metastatic (B) cell lines UMSCC-11A/11B, UMSCC-17A/17B (previously karyotyped), and UMSCC-81A/81B are described. RESULTS At the genome level, loss and gain of genetic loci concurred with tumor karyotypes. Several abnormal gene loci not apparent by cytogenetics were also identified. All except 11B indicated loss of CDKN2A (encodes p14 and p16), with concomitant loss of CDKN2B (encodes p15) in 11A, 17B, and 81A. All 6 cell lines showed gain of PIK3CA (encodes a PI3 kinase) located at 3q26.3. CONCLUSIONS We provide evidence for the role of 3 critical pathways in the development and progression of HNSCC. The CDKN2A/B genes encode various components of the Rb and p53 pathways, and the PIK3CA gene makes a catalytic subunit of the protein phosphatidylinositol 3-OH kinase (PI3K), which is known to be involved in the PI3K/ATK signaling pathways. Molecular events may ultimately serve to achieve genomic alterations that set off an interplay among key gene loci along discrete genetic pathways used by tumor cells in HNSCC.

OBJECTIVE:To examine whether obtaining bacterial Gram stain and aerobic/anaerobic cultures alters management of patients with peritonsillar abscess.STUDY DESIGN:Retrospective study.MATERIALS AND METHODS:A total of 221 cases of suspected peritonsillar abscess from July 1990 to February 1999 were analyzed with regard to outcomes and management patterns of those who had bacteriologic studies performed and those who did not.RESULTS:Pus was aspirated in 153 (69%). Eighty-two had bacterial studies performed whereas 71 did not. Of patients that followed up, all patients had complete resolution in the first group based on initial management. Three patients of the latter group had a complicated course secondary to dehydration and antibiotic noncompliance (P =.24). Of the 82 cultures sent, sensitivities were conducted on only 17 (21%). Nine of 17 grew organisms that were penicillin-resistant. No patient in the study had any treatment decisions based on microbiologic studies.CONCLUSION:In the routine management of peritonsillar abscess, bacteriologic studies are unnecessary on initial presentation. They should be reserved for patients with a high likelihood of infection by resistant organisms, i.e., diabetics, immunocompromised patients, and patients with recurrent peritonsillar abscess.