Current otolaryngologic applications of the novel self-assembling RADA-16 peptide matrix.

A novel bioresorbable agent on the market is PuraGel® (3-D Matrix, Tokyo, Japan), a RADA-16 product that acts as a synthetic hemostatic and space-filling gel that promotes wound healing and prevents adhesion formation. Given the reported benefits of accelerated wound healing and scar tissue prevention, there are multiple otolaryngologic applications where RADA-16 might improve outcomes. Our study highlights current utilization and associated post-operative complications with this product.

The Yale Center for Biomedical Innovation and Technology (CBIT): One Model to Accelerate Impact From Academic Health Care Innovation.

The process of translating academic biomedical advances into clinical care improvements is difficult, risky, expensive, and poorly understood. Notably, many clinicians who identify health care problems do not have the time or expertise to solve the problems, and many academic researchers are unaware of important gaps in clinical care to which their expertise may apply.Recognizing an opportunity to connect people who can identify health care problems with those who can solve them, the Yale Center for Biomedical Innovation and Technology (CBIT) was established in 2014 to educate and enhance the impact of health care innovators.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis.

Background: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

Methods: Using previously described methodology, specific topics were developed relating to AR.

A Systems Approach to Healthcare Innovation Using the MIT Hacking Medicine Model.

MIT Hacking Medicine is a student, academic, and community-led organization that uses systems-oriented "healthcare hacking" to address challenges around innovation in healthcare. The group has organized more than 80 events around the world that attract participants with diverse backgrounds. These participants are trained to address clinical needs from the perspective of multiple stakeholders and emphasize utility and implementation viability of proposed solutions.

Gluten sensitivity: fact or fashion statement?

Purpose Of Review: In recent years, the concern over food sensitivities in general and gluten intolerance in particular has sharply increased. Patients and medical providers are awash in various claims about the potential implications of including or excluding gluten from the diet.

Recent Findings: Three main conditions are described with respect to gluten: wheat allergy, celiac disease, and nonceliac gluten sensitivity (NCGS).

Association of Vitamin D Status and Acute Rhinosinusitis: Results From the United States National Health and Nutrition Examination Survey 2001-2006.

Although vitamin D status may be a modifiable risk factor for various respiratory ailments, limited data exists regarding its role in sinonasal infections. Our goal was to investigate the association of 25-hydroxyvitamin D (25OHD) levels with acute rhinosinusitis (ARS) in a large, nationally representative sample of non-institutionalized individuals from the United States. In this cross-sectional study of individuals ≥ 17 years from the National Health and Nutrition Examination Survey 2001-2006, we used multivariable regression analysis to investigate the association of 25OHD levels with ARS, while adjusting for season, demographics (age, sex, race, and poverty-to-income ratio), and clinical data (smoking, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and neutropenia).

Stepwise management of asthma.

Background: Stepwise management of asthma remains an area of evolving research. Asthma is one of the most expensive chronic diseases in the United States; stepwise management is an important area of focus, with several recent guidelines recommending management.

Methods: This is a review of published English language literature, focusing on management guidelines for asthma in adult and pediatric patients.

Clinical practice guideline: Bell's palsy.

Objective: Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face.

Clinical practice guideline: Bell's Palsy executive summary.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy.

Surgery for chronic rhinosinusitis may improve sleep and sexual function.

Objectives/hypothesis: This study was designed to evaluate the impact of surgery on the sexual function and sleep function of patients with chronic rhinosinusitis (CRS).

Study Design: A retrospective review of a cohort of prospectively enrolled patients with chronic rhinosinusitis who have undergone endoscopic sinus surgery.

Methods: Each patient completed the Rhinosinusitis Disability Index (RSDI) prior to surgery and at least nine months following endoscopic sinus surgery, and the preoperative and postoperative scores for the questions related to sleep and sexual activity were evaluated.

Outcomes of sinus surgery in ambulatory patients with immune dysfunction.

Background: Previous outcomes studies of patients with chronic rhinosinusitis (CRS) have mostly excluded subjects with immunodeficiency or autoimmune disease. Although expert opinion suggests these patients are often refractory to therapy, outcomes after endoscopic sinus surgery (ESS) are not well delineated. We evaluated improvement in objective and quality of life (QoL) measures after ESS in adult patients treated in the ambulatory setting with immune dysfunction including immunodeficiency and autoimmune diseases.

Fracture of bony lamellae within the frontal recess after balloon catheter dilatation.

Background: The precise manner in which balloon catheter dilatation (BCD) alters the dimensions of the frontal recess and frontal sinus outflow tract is not well characterized. The purpose of this investigation was to determine whether BCD within the frontal recess is associated with reproducible patterns of fracture in bony lamellae, to characterize changes between pre- and postintervention measurements of the frontal sinus outflow tract, and to compare the degree of change seen with endoscopic Draf I dissection.

Methods: Eight cadaver heads underwent pre- and postintervention endoscopic visualization and computed tomography (CT) of the frontal recess and frontal sinus outflow tract.

Outcomes of sinus surgery in adults with cystic fibrosis.

Objectives: Adults with cystic fibrosis (CF) represent a challenging subset of patients with chronic rhinosinusitis (CRS). While data suggest that endoscopic sinus surgery (ESS) may benefit pediatric CF patients, there remains a paucity of data regarding the impact of endoscopic sinus surgery on adult CF patients with CRS. Our purpose was to evaluate objective and quality-of-life measures in adult CF patients with CRS following ESS.

Middle turbinate hinge flap for frontal recess obliteration following prior cranialization.

Frontal sinus cranialization is an established procedure utilized in instances wherein the posterior table has been irreversibly compromised. A known complication of this procedure is pneumocephalus, which may develop if the frontal recess has not been fully separated from the cranialized sinus. We report 3 cases wherein massive pneumocephalus developed after cranialization of the frontal sinus.

Accuracy and definitive interpretation of preoperative technetium 99m sestamibi imaging based on the discipline of the reader.

Background: Technetium 99m sestamibi scans have become a principal means of localizing parathyroid adenomas. Its accuracy and reliability has allowed for the proliferation of minimal access parathyroidectomy. Localizing interpretation of these scans often drives referral of hyperparathyroid patients for surgery.

Physiologic alterations in the murine model after nasal fungal antigenic exposure.

Objective: To determine whether a recently developed murine model of fungus-induced sinonasal inflammation demonstrated alterations in ciliary activity and expression of inflammatory cytokines.

Study Design: A prospective randomized controlled study of rhinosinusitis after fungal antigenic sensitization was performed with intraperitoneal aspergillus antigen injection followed by intranasal antigen challenge for 4 weeks. Saline solution was used in a parallel fashion for control animals.

Prevalence of biofilm-forming bacteria in chronic rhinosinusitis.

Background: Recently, biofilms have been implicated in the pathogenesis of recalcitrant chronic rhinosinusitis (CRS). We sought to determine the prevalence of biofilm-forming cultures obtained from patients with CRS and clinical factors that may contribute to biofilm formation.

Methods: Endoscopically guided sinonasal cultures were obtained in duplicate from CRS patients with evidence of mucopurulence.

Fine-needle aspiration biopsy versus ultrasound-guided fine-needle aspiration biopsy: cost-effectiveness as a frontline diagnostic modality for solitary thyroid nodules.

Background: Ultrasound-guided fine-needle aspiration biopsy (ultrasound-guided FNAB) is considered the diagnostic test of choice when a fine-needle aspiration biopsy (FNAB) returns an inconclusive diagnosis because of cytologic ambiguity or paucity of specimen.

Methods: Cost-effectiveness analysis utilizing a decision tree was used to model the diagnostic strategies. The decision analysis model was parameterized using costs from a large, academic medical center and probabilities from existing literature.

Color doppler ultrasonography is a reliable predictor of free tissue transfer outcomes in head and neck reconstruction.

Objective: The purpose of our investigation was to report our experience with a color flow doppler (CFD) ultrasonography for postoperative monitoring of free tissue transfers.

Methods: A retrospective analysis of head and neck free tissue transfers at a single institution between 2000 and 2005 (n = 84; 80 successful, 4 failures). CFD measured blood flow velocity (cm/sec) and resistance to flow in the pedicle vein and artery on postoperative days 1, 3, and 7.

The cost-effectiveness of iodine 131 scintigraphy, ultrasonography, and fine-needle aspiration biopsy in the initial diagnosis of solitary thyroid nodules.

Objective: To compare the cost-effectiveness of fine-needle aspiration biopsy, iodine 131 scintigraphy, and ultrasonography for the initial diagnostic workup of a solitary palpable thyroid nodule.

Design: A deterministic cost-effectiveness analysis was conducted using a decision tree to model the diagnostic strategies.

Setting: A single, mid-Atlantic academic medical center.

The Health Policy and Legislative Awareness Initiative at the Pennsylvania State University College of Medicine: theory meets practice.

In a constantly evolving health care landscape shaped by many voices--including those of third party payers and government--physicians must learn to play a more proactive role to become better advocates for their patients and to uphold the basic tenets of their noble profession. As legislation and public health become increasingly intertwined with the practice of medicine, educators must provide future physicians with the tools to meet these new challenges. Accordingly, in 1996 Pennsylvania State University College of Medicine embarked on its Health Policy and Legislative Awareness Initiative, a medical school elective designed to provide theoretical knowledge as well as practical experience in legislative and policy issues for future physicians early in their careers.

Long-term quality of life measures after functional endoscopic sinus surgery.

Background: Chronic rhinosinusitis (CRS) is a common disease that has a significant impact on quality of life (QOL). The aim of this study was to evaluate the longer-term effects of combined medical and surgical therapy for CRS on overall health status and QOL.

Methods: We used a prospective study that utilized the Short-Form 36 Survey at baseline presentation and at a mean time of 3 years post-functional endoscopic sinus surgery to assess the general health status of patients who presented for their initial visitfrom 1996 to 1998.