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Biomedical subjects

Eric A Mair

Publications and source records attributed to Eric A Mair.

33 records · Page 2Linked to original sources
PubMed2004

Popular snore aids: do they work?

OBJECTIVE: The study goal was to critically evaluate 3 popular noninvasive treatments for snoring: an oral spray lubricant applied before bedtime, a nasal strip designed to maintain nasal valve patency, and a head-positioning pillow. STUDY DESIGN: Prospective, randomized blinded clinical trial of 3 popular noninvasive snore aids using objective acoustic snoring analysis and subjective patient and bed-partner questionnaires in 40 snoring patients. A digital recorder allowed snoring analysis with data collected in the home environment over 1 week. RESULTS: There is neither objective nor subjective benefit to the use of tested popular noninvasive snore aids. Palatal snoring, palatal loudness, average loudness of snoring, averaged palatal flutter frequency, and respiratory disturbance index did not significantly change when comparing the 3 snoring aids with no treatment. Subjective comments and complications are reviewed as well. CONCLUSION: This is the first prospective comparison trial of popular noninvasive snoring aids. There is no significant objective or subjective snoring improvement in the anti-snoring aids studied compared with the use of no aid. SIGNIFICANCE: Outcome studies aid in verifying or refuting claims made by popular noninvasive snore aids.

Double-Blind Method↗
PubMed2004

Smallpox: what every otolaryngologist should know.

OBJECTIVE: In light of recent terrorist events and the potential threat of smallpox as a biological agent, we present information concerning smallpox to better inform the otolaryngologist concerning this disease and its prevention. STUDY DESIGN: We performed a review of the smallpox and smallpox vaccination literature over the past 200 years using MEDLINE, PREMEDLINE, Centers for Disease Control and Prevention Internet site, World Health Organization Internet site, and references found in previous publications not found in MEDLINE or PREMEDLINE. Our search focused on the pathogenesis, clinical presentation, course, unique manifestations in the head and neck, diagnosis, and treatment of smallpox, as well as the method of smallpox vaccination, vaccination contraindications, and complications. RESULTS: Smallpox is a viral disease with a high mortality rate. Its clinical course, manifestations, and methods of prevention are carefully analyzed in light of otolaryngology practice. CONCLUSION: Smallpox manifestations in the head and neck often presented as acute airway obstruction and also as long-term sequelae such as ectropion, nasal vestibular stenosis, conductive hearing loss, and blindness. Most chronic sequelae involve the head and neck. Smallpox vaccination is effective but not without potential serious risks.

Adult↗
PubMed2004

Image-guided surgical drainage of medial parapharyngeal abscesses in children: a novel adjuvant to a difficult approach.

Surgical drainage of localized infections in deep neck spaces in children is often completed without a high degree of technical difficulty. However, abscess drainage within the superior parapharyngeal space medial to the great vessels is particularly challenging for otolaryngologists. Drawbacks to both the intraoral and external approaches to this area have led us to develop a new adjunctive technique that utilizes intraoperative image-guided technology to augment the intraoral approach. Here we present a case series of 12 children in whom this technique was successfully used.

Abscess↗
PubMed2003

Endoscopic laser-assisted excision of juvenile nasopharyngeal angiofibromas.

BACKGROUND: Juvenile nasopharyngeal angiofibromas (JNAs) are highly vascular tumors that originate in the nasopharynx of young males. The primary treatment is surgical excision. Traditional surgical approaches are associated with significant morbidity and facial deformity. We introduce and outline the clinical advantages of an endoscopic surgical approach to JNAs using the Nd:YAG laser with image-guided surgery. DESIGN: Case series. SETTING: Tertiary care medical center. PATIENTS AND METHODS: Our study included 5 male patients (age range, 8-21 years) with extensive JNAs. Their tumors were large and ranged from Fisch stage IIA to IIIA. Embolization of tumor-feeding vessels was performed before surgery. The tumors were photocoagulated via a transnasal endoscopic approach using a Nd:YAG laser. Devascularized, lased tumor was removed with a microdebrider. Image-guided navigation systems were used to assist skull base tumor removal, and sublabial and buccolabial incisions were used as needed to gain lateral endoscopic tumor access. Endoscopic tumor margins were obtained for frozen section. RESULTS: All patients achieved symptomatic remission, with no complications. No blood transfusions were necessary. The patients were ready for discharge 1 to 2 days after surgery. Postoperative and magnetic resonance imaging scans showed 2 skull base recurrences, which were removed endoscopically. Follow-up ranged between 2 and 3 years. CONCLUSIONS: Traditional external surgical approaches to large JNAs may result in significant morbidity. Laser-assisted image-guided endoscopic excision of JNAs is a safe and effective minimally invasive surgical treatment. Its distinct advantages include (1) diminished blood loss, (2) superior cosmesis without observed altered facial growth, (3) direct access of skull base with minimal morbidity, and (4) ease of endoscopic follow-up.

Adolescent↗
PubMed2003

Endoscopic photography: digital or 35 mm?

OBJECTIVE: To compare off-the-shelf digital imaging equipment with a standard single lens reflex 35-mm endoscopic camera in a busy pediatric ears, nose, and throat setting. DESIGN: Two digital cameras with an endoscope adapter and a step-down ring were evaluated to obtain optimal settings for digital endoscopic photography. The equipment was used in various clinical and surgical settings to include otoscopy, sinonasal endoscopy, laryngoscopy, and bronchoscopy. The overall quality, color, brightness, and diagnostic quality of the endoscopic digital photographs were compared with those of the single-lens reflex 35-mm flash-generated photographs by experienced endoscopists. Cost analysis and ease of use were also compared. Subjects Initial digital endoscopic settings were formulated from cadaveric tests. These settings were then studied in multiple patients during endoscopy. RESULTS: Endoscopic digital photography resulted in high-quality images in all settings. Digital images were comparable to 35-mm images. The digital system was easier to use and less expensive than the 35-mm system. CONCLUSIONS: We introduce a simple, inexpensive, and easily available endoscopic digital photography system. Digital photography offers numerous advantages over analog photography in a clinical practice. Digital imaging and archiving is more durable and easier to incorporate into patient records and clinical presentations. As the demand for high-quality digital imaging increases, easy-to-use inexpensive digital endoscopic photography will soon replace 35-mm camera technology.

Endoscopy↗
PubMed2003

Revision choanal atresia repair.

OBJECTIVE: Since the first description of choanal atresia (CA) in 1755, multiple surgical techniques have been proposed to repair the malformation. Today, the transnasal endoscopic method is the most widely accepted repair technique. The bony choanal plates are perforated, the lateral choanae are drilled, and a portion of the vomer removed. Unfortunately, the problem of re-stenosis is a significant issue, and as a result, revision surgery may be a recurring theme in some children. We describe a successful revision endoscopic technique utilizing a microdebrider with straight and 120 degrees telescopes, image guided surgery, and topical mitomycin-C to permanently open the choanae without stenting. METHODS: Described are six children (1-15 years old) with CA or stenosis who have collectively undergone 25 choanal procedures at various institutions. A microdebrider carefully removes the bony septum under direct nasal and intraoral telescopic visualization. No lateral drilling is performed. Image guidance is helpful when excessive scar tissue is present. Topical mitomycin-C minimizes post-operative scarring. The cartilaginous septum is left intact. RESULTS: 2-4-year clinical and endoscopic follow-up on all children revealed a widely patent nasal airway with no complications (epistaxis, crusting, or re-stenosis). Synechiae or re-stenosis did not occur as circumferential mucosal stripping was avoided. No stenting was needed since the bony septum is removed. CONCLUSION: Near total endoscopic removal of the bony septum provides long-term nasal patency for revision CA/stenosis repairs. The endoscopic 'common choanae' technique is aided by transnasal and transoral telescopic visualization with precise microdebrider removal of the bony septum. The technique is safe with no complications in our case series.

Administration, Topical↗
PubMed2003

Evaluation of palatal snoring surgery in an animal model.

OBJECTIVE: We introduce an animal model to reproduce and measure palatal snoring and to assess the effectiveness of cautery-assisted palatal stiffening operation and injection snoreplasty versus a control (no palatal intervention) on treatment of palatal flutter snoring. Study design and setting An anesthetized laboratory canine model uses 2 simultaneous temporary tracheotomies. An inferior tracheotomy is cannulated with an endotracheal tube for ventilation. A superior tracheotomy is cannulated with a tube passed cephalad and seated in the hypopharynx. Negative pressure applied to the upper tube leads to partial collapse of the upper airway with palatal fluttering, and the anesthetized dog snores. Videostroboscopy records palatal flutter frequency before and after surgical intervention. Preoperative and postoperative palatal assessments are made on 15 beagles. RESULTS: Cautery-assisted palatal stiffening operation and injection snoreplasty objectively stiffen the canine soft palate with diminished snoring compared with controls. Conclusion and significance We provide a reproducible animal model to experimentally measure new interventions to treat palatal flutter snoring.

Animals↗
PubMed2003

Complications of tracheobronchial airway stents.

OBJECTIVE: Our goal was to identify and analyze airway stent complications and to devise approaches to manage stent complications. STUDY DESIGN AND SETTING: We conducted a retrospective review of patients from a tertiary medical center. METHODS: Twenty-eight airway stents were placed in 23 patients for benign (n = 15) and malignant (n = 13) tracheobronchial diseases. All patients were followed clinically for signs of complications. RESULTS: Nine complications (8 in those with benign disease and 1 in a patient with malignant disease) were identified and included stent migration (n = 3), excessive granulation tissue (n = 2), stent fracture (n = 1), poor patient tolerance (n = 2), and inability to place (n = 1). Avoidance and management strategies for stent complications are introduced. CONCLUSION: Tracheobronchial stents provide minimally invasive therapy for significant airway obstruction. Stent complications are more frequently encountered in the long-term treatment of benign conditions. Stents can be successfully removed endoscopically if complications arise, but the longer a metallic stent is in place, the more difficult it is to remove. SIGNIFICANCE: As airway stent use increases, proper management will be required to avoid and manage complications. This is the first report to focus on stent complications and their management.

Adolescent↗
PubMed2003

Injection snoreplasty: extended follow-up and new objective data.

OBJECTIVE: Injection snoreplasty was recently introduced as a safe, effective, and minimally invasive treatment for primary snoring. Extended follow-up data (19 months) are presented from the initial pilot study cohort, and pretreatment/posttreatment objective data are presented on a new prospective patient cohort. STUDY DESIGN AND SETTING: The successfully treated patients from the initial pilot study (n = 25) were surveyed regarding their current snoring level, overall discomfort, and overall satisfaction. A new patient cohort with primary snoring (Respiratory Disturbance Index <10) was prospectively treated with injection snoreplasty. Snoring was objectively measured pretreatment and posttreatment using a take-home acoustical analysis device. RESULTS: Subjective success dropped from 92% to 75% at a mean of 19-month follow-up with a snoring relapse rate of 18%. Objective analysis of a new patient cohort (n = 17) confirmed statistically significant decreases in palatal flutter snoring and palatal loudness after injection. Preprocedure measurements were highly correlated to eventual treatment success. CONCLUSIONS AND SIGNIFICANCE: Success and snoring relapse rates of injection snoreplasty are similar to those of other current treatments. Objective analysis confirms the procedure is effective in reducing palatal flutter snoring. Preprocedure snoring analysis may predict patient response to palatal stiffening treatments.

Female↗
PubMed2003

Avoiding perils and pitfalls in velocardiofacial syndrome: an otolaryngologist's perspective.

Velocardiofacial syndrome is classically characterized by clefting of the secondary palate, cardiac defects, learning disabilities, and facial dysmorphism. Knowledge of this syndrome is of significant importance to otolaryngologists because a failure to recognize it prior to head and neck surgery can result in serious iatrogenic injury, including velopalatal insufficiency and damage to anomalous carotid arteries. To illustrate these issues, we describe the case of a 5-year-old boy with velocardiofacial syndrome. We also review the literature on velocardiofacial syndrome, which is not very extensive, perhaps because it is often difficult to recognize.

Abnormalities, Multiple↗
PubMed2002

Tracheal bronchus: classification, endoscopic analysis, and airway management.

OBJECTIVE: Tracheal bronchus (bronchus suis) is an unusual congenital anomaly in which the right upper lobe has its origin in the trachea rather than distal to the carina. We sought to analyze the anatomy, presentation, and airway management principles of tracheal bronchi, and we present the first endoscopically documented tracheal diverticulum. STUDY DESIGN/METHODS: Retrospective case series. RESULTS: The tracheal bronchus is located at the junction of the mid and distal thirds of the right lateral trachea, is more common in males and children with other congenital anomalies, and may be associated with right main bronchus stenosis. Bronchoscopy provides a clear definitive view of the anomaly, which we found in 5 children during a 12-year period (0.5% of pediatric bronchoscopy procedures). We illustrate 3 types of tracheal bronchi: (1) vestigial tracheal diverticulum (newly described), (2) high apical lobe, and (3) fully developed supranumerary aerated tracheal bronchus. Endoscopic documentation of each type is presented. Children with tracheal bronchi may present with stridor, cough, and/or recurrent right-sided pneumonia and/or to have foreign body aspiration ruled out. Treatment is based on the severity of symptoms and ranges from observation to right upper lobectomy. CONCLUSIONS: Otolaryngologists should be aware of the tracheal bronchus, to include classification, endoscopic analysis, and airway management of this uncommon anomaly. Bronchoscopy with selected radiographic imaging allows the otolaryngologist to fully evaluate the child with a tracheal bronchus and to present timely therapeutic options.

Bronchi↗
PubMed2002

Endoscopic image-guided transethmoid pituitary surgery.

OBJECTIVE: We describe a new endoscopic transethmoid approach for pituitary surgery and to compare it with other surgical techniques. STUDY DESIGN AND SETTING: Eleven patients undergoing pituitary surgery from September 2000 through January 2002 underwent an image-guided endoscopic transethmoid procedure to remove pituitary tumors. Ease of approach, resection, exposure of the surgical field, and operative complications were documented. RESULTS: Endoscopic ethmoidectomy permits enhanced exposure and simplified tumor resection. The use of one nostril to stabilize the endoscope and the other to pass instruments affords a bimanual procedure that avoids the difficulty of small nares and keeping the scope fixed while exchanging instruments. Operative morbidity was low with no significant complications in this pilot study. CONCLUSIONS: This approach opens a generous operative exposure while safely allowing room to endoscopically maneuver and affords direct access should revision surgery be needed. SIGNIFICANCE: This procedure uses a technique familiar to otolaryngologists and may be used for pituitary and other skull base tumors.

Adenoma↗