Design  Eighteen-year retrospective review of medical records.

Setting  Tertiary children's hospital.

Patients  A total of 76 patients were identified as having TSS. Twenty-three of them were also diagnosed as having either acute or chronic rhinosinusitis, with no other source of infection in 17 cases.

Interventions  Of the 23 patients with TSS and rhinosinusitis, 10 were admitted to the intensive care unit, 4 required pressors, and 6 received surgical intervention. Surgical intervention for sinus disease included bilateral antral lavage in 5 patients and bilateral maxillary antrostomy and ethmoidectomy in 1 patient.

Main Outcome Measures  Patients with TSS and rhinosinusitis were identified using a rigorous set of definitions and detailed data pertaining to history, imaging studies, microbiologic studies, and hospital course.

Results  Correlation of the data revealed 4 patients who met the criteria for proven TSS and proven rhinosinusitis, 2 patients who met the criteria for probable TSS and proven rhinosinusitis, 7 patients who met the criteria for proven TSS and possible rhinosinusitis, and 3 patients who met the criteria for probable TSS and possible rhinosinusitis.

Conclusions  Rhinosinusitis was found to be the primary cause of TSS 21% of the time in this series. Rhinosinusitis should be considered the primary cause of TSS when another site of infection has not been identified. Once the link is made, prompt otolaryngology consultation and sinus lavage should be considered.

Design  Retrospective case series.

Setting  Tertiary care pediatric hospital.

Patients  Individuals with CA/S.

Main Outcome Measures  Identification of congenital anomalies, neurologic abnormalities, and developmental disabilities in individuals with CA/S.

Results  One hundred twenty-nine individuals with CA/S were evaluated between July 1, 1997, and July 1, 2007. Choanal atresia and stenosis was an isolated finding in 34 patients (26.4%) and was associated with other anomalies in 95 patients (73.6%). Specific conditions were diagnosed in 66 patients (51.2%); CHARGE (coloboma, heart defect, atresia choanae, retarded growth, genitourinary abnormalities, and ear anomalies) syndrome was the most common diagnosis (33 patients [25.6%]). Numerous conditions were seen, including chromosomal abnormalities, single-gene defects, deformations, and those caused by teratogens. Choanal atresia and stenosis was unilateral in 62 patients (48.1%) and was bilateral in 60 patients (46.5%). Unilateral cases were more likely to be isolated (30 patients [53.2%]). Bilateral cases were more likely to be associated with specific disorders or multiple congenital anomalies (60 patients [98.4%]). There was no difference in laterality among unilateral cases.

Conclusions  Choanal atresia and stenosis is associated with a wide range of disorders. Congenital anomalies, neurologic abnormalities, and developmental disabilities are commonly identified in affected individuals. Bilateral CA/S is more commonly seen in patients in whom specific diagnoses or other congenital anomalies are identified. Unilateral CA/S occurs more frequently in isolated cases. A comprehensive evaluation is recommended in individuals with CA/S to evaluate for other congenital anomalies, neurologic abnormalities, developmental delays, and evidence of a specific underlying disorder.

Design  A prospective study.

Setting  Secondary pediatric and otolaryngological university center.

Patients  Of 30 patients evaluated for periodic fever, 18 children with PFAPA syndrome were included in the study.

Interventions  Patients underwent long-term pediatric and otolaryngological assessments, and their parents were asked to keep monthly diaries with reports of any subsequent episodes, symptom, and related sign. Patients received traditional medical therapies, and 9 patients underwent tonsillectomy for the lack of lasting recovery.

Main Outcomes Measures  The association between postoperative outcomes and age at tonsillectomy and the differences in the patients' condition before and after tonsillectomy were statistically tested. In addition, the removed tonsillar tissue was analyzed molecularly to evaluate concomitant infections.

Results  All of the surgical patients reported a symptomatic improvement, with complete clinical recovery in 5 cases (56%) and significant reduction in number (P = .005) and duration (P = .03) of recurrences in the remaining 4 (44%). Results of molecular analysis of tonsillar specimens were negative for bacteria in all but 1 patient.

Conclusion  Otolaryngologists should be trained to recognize PFAPA syndrome, for which management consists of a regular and prolonged second-level pediatric and otolaryngological follow-up, with surgery only after the failure of traditional medical therapy.

Design  Review of archived, paraffin-embedded, noncancerous palatine tonsils.

Setting  A single institution in El Paso County, Colorado.

Patients  Age- and sex-matched patients 21 years and older from 2 different periods: January 1, 1979, to December 31, 1982, (group A) and January 1, 1997, to December 31, 2001 (group B).

Main Outcome Measures  Prevalence of oncogenic HPV-16 and HPV-18 in noncancerous palatine tonsils in relation to the incidence of HPV-positive oropharyngeal SCC.

Results  All specimens in both groups were negative for HPV-16 and HPV-18. Thus, the prevalence of HPV infection in the palatine tonsils of the general adult population was zero in both group A and group B.

Conclusions  This analysis shows a low prevalence of HPV infection in the palatine tonsils of the general adult population in a single county in Colorado known to have an increasing rate of HPV-positive oropharyngeal SCC. Analysis of oropharyngeal tissues from individuals at highest risk of developing HPV-positive oropharyngeal SCC (middle-aged men) is likely to provide a higher prevalence rate.

Data Sources  A MEDLINE, EMBASE, Cochrane Library, and CENTRAL database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied.

Study Selection  Prospective RCTs on the treatment of patients with Bell palsy.

Data Extraction  Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported.

Data Synthesis  Five studies were eventually identified and systematically reviewed. Meta-analysis was performed for 4 studies. Regarding the complete recovery rate of facial nerve paralysis 3 months after initiation of therapy, the current systematic review and meta-analysis suggests that the addition of an antiviral agent does not provide any benefit (OR, 1.03 [95% CI, 0.74-1.42]; P = .88). The same conclusion emerged at posterior (fourth, sixth, and ninth) months of assessment. Subgroup analysis, conducted on the basis of time point of therapy initiation, type of antiviral agent, and blindness of assessments did not change the results obtained. The occurrence rate of adverse effects attributable to therapy choice was not significantly different between patients receiving corticosteroids and those following combined treatment.

Conclusion  The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.

Design  Clinical survey conducted between 2001 and 2007.

Setting  Secondary referral ambulatory center and hospital.

Patients  The study population comprised 2523 consecutive adult patients, mainly white, referred to the Department of Otolaryngology–Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway, for evaluation of sleep-related disorders (eg, snoring, sleep apnea) or chronic nasal complaints.

Intervention  The subjects underwent AR and PNIF at baseline and after decongestion of the nasal mucosa with xylometazoline hydrochloride. Questionnaires and height and weight measurements were obtained prior to the nasal recordings.

Main Outcome Measure  Associations between measures of AR (volume and area) and PNIF.

Results  Nearly linear relationships were found between PNIF in 4 categories and nasal cavity volumes and minimal cross-sectional areas (analysis of variance, P < .001; post hoc analysis, P < .01). Adjusted associations between 5 of 6 AR measures and PNIF both at baseline and after decongestion were significant (P < .001 in 9 cases and P = .03 in 1 case).

Conclusions  Our study indicates statistically significant associations between nasal cavity dimensions and PNIF. The most important structural determinant for PNIF is the minimal cross-sectional area of the nasal cavity.

Design  An anonymous, Internet-based survey of current rhinology fellows and those from the past 5 years.

Main Outcome Measure  A 5-point ordinal Likert scale was used, with higher scores being more favorable.

Results  Complete responses were collected from 46 of 70 eligible participants (66%), representing 19 fellowship programs. High overall satisfaction with the fellowship experience was reported (mean score, 4.7). Pooled scores for comfort levels with the management of medical issues (mean, 4.8) and surgical procedures (mean, 4.5) were also positive. Following completion of training, lesser levels of comfort were associated with craniofacial procedures (P <.001), frontal sinus obliteration (P <.001), and dacryocystorhinostomy (P = .002) compared with all surveyed procedures. Respondents reported a greater interest in (mean score, 4.3 vs 2.4; P <.001) and preparation for (4.3 vs 3.5; P <.001) a career in academic medicine compared with private practice.

Conclusions  The rhinology fellowship experience appears to be generally favorable in terms of meeting stated training goals and helping fellows achieve subjective comfort with medical and surgical management of rhinological disorders. Continued discussion of the goals of rhinology fellowship training is necessary.

Design  Fifty guinea pigs were randomly assigned to 4 test groups of 10 animals each and 2 control groups of 5 animals each. The 4 test groups were treated twice daily for 4 weeks with 10 µL of (1) ciprofloxacin hydrochloride, 0.3%, plus dexamethasone, 0.1%; (2) ciprofloxacin hydrochloride, 1.0%, plus dexamethasone, 0.3%; (3) ciprofloxacin hydrochloride, 0.3%, or (4) vehicle. The positive and negative control groups were treated with neomycin sulfate, 10%, or isotonic sodium chloride solution, respectively.

Setting  Academic research laboratory.

Interventions  Study animals were implanted with a drug delivery cannula to the middle ear, terminating in the round window niche for direct delivery to the round window membrane.

Main Outcome Measures  Auditory brainstem responses were collected at baseline and following 2 and 4 weeks of dosing. At the termination of the study, inner ear tissues were evaluated microscopically.

Results  No biologically relevant hearing losses were observed after either 2 or 4 weeks of treatment with vehicle, ciprofloxacin alone, or combinations of ciprofloxacin plus dexamethasone. Examination of the organ of Corti revealed normal hair cell counts in all animals that received isotonic sodium chloride solution, vehicle, ciprofloxacin, or combinations of ciprofloxacin and dexamethasone. Conversely, the neomycin sulfate positive control group demonstrated a significant elevation in hearing threshold and profound hair cell loss (P <.001, P  = .02, and P <.001 at 2, 8, and 16 kHz, respectively).

Conclusion  The results of this preclinical study support the safety of ciprofloxacin hydrochloride, 0.3%, plus dexamethasone, 0.1%, for clinical use in the open middle ear cavity.

Design  Retrospective cohort study.

Setting  Data from the PharMetrics Patient-Centric Database from June 2000 through June 2006.

Patients  The study included patients with ASCCHN and an indication of a secondary malignant neoplasm (both identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes), 124 of whom were treated with radiotherapy alone and 77 of whom were treated with chemoradiotherapy (including 53 with cisplatin plus radiotherapy, 26 with carboplatin plus radiotherapy, and 2 with cisplatin and carboplatin plus radiotherapy). The patients were assigned to 1 of 2 cohorts based on treatment type—radiotherapy only and platinum-based chemoradiotherapy—and were followed up for 6 months.

Main Outcome Measures  Incidence and costs of treatment-related complications associated with chemotherapy in ASCCHN.

Results  We found significantly (P < .001) higher rates of treatment-related complications among patients receiving chemoradiotherapy (86%) than among patients receiving only radiotherapy (51%). The mean per-patient costs associated with treatment-related complications were approximately $10 000 higher among patients who received chemoradiotherapy than among those treated with radiotherapy alone (P < .001). These costs represented 17% of the total costs during follow-up for patients who received chemoradiotherapy and 11% of costs for those who received radiotherapy. The most expensive complications were dehydration and/or electrolyte imbalance and oral complications.

Conclusions  Our study results suggest that the attributable incidence and costs of treatment-related complications associated with chemotherapy in ASCCHN are substantial. The emergence of safer treatments may have the advantage of alleviating this cost burden.

Design  Immunohistochemical analysis of 83 normal thyroid tissue and of 83 follicular neoplasms (26 follicular adenomas, 25 follicular variant of papillary thyroid carcinoma, 23 follicular thyroid carcinomas, and 9 papillary thyroid carcinomas) was performed using an antibody to TFF3 on tissue microarray sections composed of formalin-fixed, paraffin-embedded tissue samples.

Setting  Academic research.

Patients  Thyroid tissue samples collected from patients over a 15-year period were obtained from the University of North Carolina Hospitals Division of Surgical Pathology archives.

Main Outcome Measures  Thyroid tissue samples were graded by a pathologist based on intensity of antibody staining and on percentage of cells stained. Localization of TFF3 antibody was noted. Data were analyzed for semiquantitative differences in immunohistochemical intensity of antibody staining and in percentage of cells stained among normal thyroid tissue samples, follicular adenoma, follicular thyroid carcinoma, follicular variant of papillary thyroid carcinoma, and papillary thyroid carcinoma.

Results  Semiquantitative analysis demonstrated that immunohistochemistry detects significant levels of TFF3 expression in normal thyroid tissue samples compared with that in follicular lesions based on intensity of antibody staining (P < .05). Only follicular thyroid carcinoma demonstrated a significant reduction in percentage of cells stained compared with that in normal thyroid tissue samples (P = .03). No significant differences in intensity of antibody staining or in the percentage of cells stained were noted among follicular adenoma, follicular thyroid carcinoma, follicular variant of papillary thyroid carcinoma, or papillary thyroid carcinoma. Trefoil factor 3 staining localized to the cytoplasm.

Conclusions  Protein expression data validate gene expression findings that follicular neoplastic lesions have decreased expression of TFF3 compared with that in normal thyroid tissue samples. These findings contribute to evidence suggesting that TFF3 may have a role in normal thyroid tissue function and that thyroid carcinomas may have reduced expression of TFF3, in contradistinction to other carcinomas that overexpress TFF3.