ORCID Profile
0000-0002-7719-1832
Current Organisations
Westmead Hospital
,
University of Sydney
,
Western Sydney Local Health District
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Publisher: BMJ
Date: 24-10-2018
Abstract: Sinonasal adenocarcinoma has traditionally been treated with surgery (craniofacial or endoscopic) and adjuvant radiotherapy. Two large series have demonstrated favourable 5-year survival using surgery with adjuvant topical chemotherapy applied repeatedly over several weeks. The authors describe a novel, transnasal application of topical 5-fluorouracil. However, complete coverage of the frontal region of the anterior skull base can be difficult to achieve with a purely transnasal approach in an outpatient setting. We present a novel adjunct method of delivering chemotherapeutic agents into this key area used in a 37-year-old man with T2N0M0 ethmoid adenocarcinoma. The procedure was well tolerated in an outpatient setting and remains disease free at 3 years postoperatively. We suggest that frontal trephination is a useful adjunct to aid accurate placement of adjuvant topical chemotherapeutic agents in the treatment of sinonasal adenocarcinoma.
Publisher: AME Publishing Company
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 15-12-2022
Publisher: BMJ
Date: 10-2019
Abstract: Rhinoliths are calcareous concretions of the nasal cavity formed around a nidus that may be endogenous (eg, dislodged tooth) or an exogenous foreign body (eg, plastic bead inserted by a child). Rhinoliths are often found incidentally on endoscopy or imaging to assess for other pathologies. The incidence is estimated to be 1 in 10 000 of all otolaryngology outpatient presentations, but this is likely to be an underestimate due to the often asymptomatic nature of this condition. We describe the unique case of a rhinolith that developed from a marijuana-filled balloon that the patient attempted to smuggle into a correctional facility. After inserting the package into his nostril, the patient then mistakenly believed it had been accidentally swallowed. Despite experiencing persistent symptoms of nasal obstruction and recurrent sinonasal infections, the marijuana package was only discovered 18 years after insertion following imaging for an unrelated indication
Publisher: Cambridge University Press (CUP)
Date: 30-01-2018
DOI: 10.1017/S0022215118000142
Abstract: Intranasal splints have long been utilised as a post-operative adjunct in septoplasty, intended to reduce the risk of adhesions and haematoma formation, and to maintain alignment during healing. A Medline literature review of the history and evolution of intranasal splint materials and designs was performed. Advantages and disadvantages of various splints are discussed. Intranasal splints fashioned from X-ray film were first reported in 1955. Since then, a variety of materials have been utilised, including polyethylene coffee cup lids, samarium cobalt magnets and dental utility wax. Most contemporary splints are produced from silicon rubber or polytetrafluoroethylene (Teflon). Designs have varied in thickness, flexibility, shape, absorption and the inclusion of built-in airway tubes. Future directions in splint materials and designs are discussed. Intranasal splints have steadily evolved since 1955, with numerous novel innovations. Despite their simplicity, they play an important role in nasal surgery and will continue to evolve over time.
Publisher: Cambridge University Press (CUP)
Date: 29-10-2018
DOI: 10.1017/S0022215118001950
Abstract: Mules and other equine species have been used in warfare for thousands of years to transport goods and supplies. Mules are known for ‘braying’, which is disadvantageous in warfare operations. This article explores the fascinating development of surgical techniques to stop military mules from braying, with particular emphasis on the key role played by the otolaryngologist Arthur James Moffett in devoicing the mules of the second Chindit expedition of World War II. The PubMed database (1900–2017) and Google search engine were used to identify articles related to devoicing mules in the medical and veterinary literature, along with information and images on the Chindit expedition. This paper reviews the surgical techniques aimed at treating braying in mules, ranging from ventriculectomy and arytenoidectomy to Moffett's approach of vocal cordectomy. Moffett's technique of vocal cordectomy provided a quick, reproducible and safe solution for devoicing mules. It proved to be advantageous on the battlefield and demonstrated his achievements outside the field of medicine.
Publisher: SAGE Publications
Date: 12-06-2022
DOI: 10.1177/19458924221105933
Abstract: Nonallergic rhinitis (NAR) is characterized by rhinorrhea, nasal obstruction, and sneezing, in the absence of systemic sensitization to allergens. For cases refractory to medical therapy and conservative surgical interventions, more targeted procedures, such as endoscopic vidian neurectomy (EVN) and posterior nasal neurectomy (PNN), including surgical (SPNN) and cryoablative (CPNN) methods, may reduce symptoms of NAR. The purpose of this study was to compare the efficacy, side effect profile, and complication rate between EVN and PNN for NAR. A systematic review of primary articles that reported original patient data for either EVN or PNN was conducted using Embase, Medline, PubMed, and Cochrane databases since 2006, according to PRISMA guidelines. The primary outcome of the study was an improvement in NAR symptom severity. Secondary outcomes included the incidence of postoperative side effects or complications. In total, 58 articles met the search criteria with a total of 9 studies (including 2 RCTs) eligible for inclusion. There was a pooled s le of 229 NAR patients that underwent EVN (n = 65 28.4%), SPNN (n = 50 21.8%), or CPNN (n = 114 49.8%). For all 3 techniques, there was a statistically significant improvement in nasal symptoms, particularly rhinorrhea, nasal congestion, and obstruction along with quality of life. Heterogeneity in outcome reporting prevented meta-analysis and direct comparison of efficacy. The pooled incidence of postoperative complications for EVN (n = 65), SPNN (n = 50), and CPNN (n = 70) was 30.8% versus 0% versus 2.9% for dry eye, 16.9% versus 0% versus 1.4% for palatal/cheek numbness, and 0% versus 6% versus 4.3% for bleeding. EVN, SPNN, and CPNN are similarly efficacious for patients with NAR refractory to medical management. SPNN and CPNN are associated with lower rates of complications (dry eye and palatal/cheek numbness) compared with EVN.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 13-03-2023
DOI: 10.1002/ALR.23150
Publisher: Elsevier BV
Date: 12-2023
Publisher: AIP Publishing
Date: 11-2022
DOI: 10.1063/5.0112223
Abstract: The flow characteristics and heat transfer during nasal breathing in the complete human upper airway were investigated through the respiratory cycle using transient numerical simulations. We postulate that the complete airway from the nasal cavity to the trachea most accurately represents dynamic airflow patterns during inhalation and exhalation as they are likely to be affected by downstream anatomical structures. A 3D model was constructed from a healthy adult computed tomography scan. Computational fluid dynamics simulations were performed with Ansys Fluent software [ANSYS Fluent, R1 User's Guide (ANSYS, Inc., 2020)] using the stress-blended eddy simulation turbulence model looking at airflow patterns, velocity, mucosal temperature, and humidity (H2O fraction). One and a half breathing cycles were simulated for a total of 5.65 s, where the first inhalation cycle was discarded to avoid start-up effects. The results demonstrated that airway geometry structures, including the turbinates, the soft palate, and the glottic region, affect the flow patterns differently during inspiration and expiration. It also demonstrated phenomena not seen in steady flow simulations or in those without the lower respiratory tract geometry, including the nasopharyngeal temperature imprint during inhalation, the nasopharyngeal jet during exhalation, and the flow structures of the larynx and laryngeal jet. The inclusion of the exhalation phase demonstrates airflow preconditioning before inhalation, which we postulate contributes to achieving alveolar conditions. Alveolar temperature and humidity conditions are not achieved by the nasal cavity alone, and we demonstrate the contribution of the nasopharynx and larynx to air conditioning. Including the complete airway with realistic anatomy and using transient airflow modeling provided new insights into the physiology of the respiratory cycle.
Publisher: Wiley
Date: 15-03-2022
DOI: 10.1111/COA.13925
Abstract: To summarise the accuracy of artificial intelligence (AI) computer vision algorithms to classify ear disease from otoscopy. Systematic review and meta‐analysis. Using the PRISMA guidelines, nine online databases were searched for articles that used AI computer vision algorithms developed from various methods (convolutional neural networks, artificial neural networks, support vector machines, decision trees and k‐nearest neighbours) to classify otoscopic images. Diagnostic classes of interest: normal tympanic membrane, acute otitis media (AOM), otitis media with effusion (OME), chronic otitis media (COM) with or without perforation, cholesteatoma and canal obstruction. Accuracy to correctly classify otoscopic images compared to otolaryngologists (ground truth). The Quality Assessment of Diagnostic Accuracy Studies Version 2 tool was used to assess the quality of methodology and risk of bias. Thirty‐nine articles were included. Algorithms achieved 90.7% (95%CI: 90.1–91.3%) accuracy to difference between normal or abnormal otoscopy images in 14 studies. The most common multiclassification algorithm (3 or more diagnostic classes) achieved 97.6% (95%CI: 97.3–97.9%) accuracy to differentiate between normal, AOM and OME in three studies. AI algorithms outperformed human assessors to classify otoscopy images achieving 93.4% (95%CI: 90.5–96.4%) versus 73.2% (95%CI: 67.9–78.5%) accuracy in three studies. Convolutional neural networks achieved the highest accuracy compared to other classification methods. AI can classify ear disease from otoscopy. A concerted effort is required to establish a comprehensive and reliable otoscopy database for algorithm training. An AI‐supported otoscopy system may assist health care workers, trainees and primary care practitioners with less otology experience identify ear disease.
Publisher: AME Publishing Company
Date: 07-2022
DOI: 10.21037/AJO-22-6
Publisher: SAGE Publications
Date: 17-03-2014
Abstract: Continuous positive airway pressure (CPAP) is the gold standard treatment for moderate to severe obstructive sleep apnoea (OSA). Eye-related side effects of CPAP are commonly attributed to a poorly sealed mask, allowing leaked air to blow over the eye. We present 3 cases where attended polysomnography (A-PSG) demonstrated CPAP-associated retrograde air escape via the nasolacrimal system (CRANS) in the absence of any mask leaks. Symptoms included dry eye, epiphora, air escape from the medial canthus, and eyelid flutter. Symptoms were controlled with a variety of surgical and nonsurgical techniques. CRANS represents a previously undescribed clinical entity. CRANS may be responsible for some CPAP-related eye side effects and possibly for rarer secondary eye complications, including conjunctivitis and corneal ulceration. CRANS should be suspected in any patient on CPAP complaining of eye symptoms. CRANS may be diagnosed through careful observation during A-PSG and confirmed by performing a “saline bubble test.” Management options include nonsurgical (mask alternatives, humidification, nasopharyngeal airway) and surgical techniques (nasal airway surgery, inferior turbinate out-fracture and adhesion, injection of bulking agent around Hasner’s valve).
Publisher: Elsevier BV
Date: 06-2022
Publisher: Public Library of Science (PLoS)
Date: 05-08-2020
Publisher: MDPI AG
Date: 13-10-2022
DOI: 10.3390/PH15101259
Abstract: Pulmonary drug delivery aims to deliver particles deep into the lungs, bypassing the mouth–throat airway geometry. However, micron particles under high flow rates are susceptible to inertial impaction on anatomical sites that serve as a defense system to filter and prevent foreign particles from entering the lungs. The aim of this study was to understand particle aerodynamics and its possible deposition in the mouth–throat airway that inhibits pulmonary drug delivery. In this study, we present an analysis of the aerodynamics of inhaled particles inside a patient-specific mouth–throat model generated from MRI scans. Computational Fluid Dynamics with a Discrete Phase Model for tracking particles was used to characterize the airflow patterns for a constant inhalation flow rate of 30 L/min. Monodisperse particles with diameters of 7 μm to 26 μm were introduced to the domain within a 3 cm-diameter sphere in front of the oral cavity. The main outcomes of this study showed that the time taken for particle deposition to occur was 0.5 s a narrow stream of particles (medially and superiorly) were transported by the flow field larger particles 20 μm deposited onto the oropharnyx, while smaller particles 12 μm were more disperse throughout the oral cavity and navigated the curved geometry and laryngeal jet to escape through the tracheal outlet. It was concluded that at a flow rate of 30 L/min the particle diameters depositing on the larynx and trachea in this specific patient model are likely to be in the range of 7 μm to 16 μm. Particles larger than 16 μm primarily deposited on the oropharynx.
Publisher: Wiley
Date: 10-12-2014
DOI: 10.1002/LARY.24502
Publisher: Wiley
Date: 08-10-2009
DOI: 10.1111/J.1398-9995.2009.02060.X
Abstract: Immunoglobulin E is a signalling molecule within the environment of the respiratory tract, the high affinity receptor for which, FcepsilonRI, is expressed by dendritic cells (DC). Little is known, however, of the expression and function of FcepsilonRI on DC in the human respiratory tract. CD1c(+) DC were purified from surgically resected nasal turbinates of 11 atopic and 12 nonatopic patients with chronic rhinosinusitis. Expression of FcepsilonRI was determined by flow cytometry. Cytokine production by DC was determined by cytometric bead array. Expression of FcepsilonRI was significantly elevated on respiratory tract dendritic cells (RTDC) from atopic as compared to nonatopic patients. Activation of RTDC through FcepsilonRI induced production of the pro-inflammatory cytokines IL-6 and TNF-alpha, and the anti-inflammatory cytokine IL-10. The production of IL-6 and TNF-alpha was elevated in atopic compared to nonatopic patients studied. Conversely IL-10 production was elevated in nonatopic patients. Concomitant activation of FcepsilonRI and stimulation of RTDC with IL-4 inhibited production of IL-10 by RTDC. Neutralization experiments with anti-IL-10 Ab enhanced whereas addition of exogenous IL-10 to RTDC inhibited FcepsilonRI-mediated inflammatory cytokine production. The function of FcepsilonRI on RTDC from patients with rhinosinusitis is susceptible to counter regulation by IL-4 and IL-10.
Publisher: AIP Publishing
Date: 2021
DOI: 10.1063/5.0036095
Abstract: Airflow through the nasal cavity exhibits a wide variety of fluid dynamic behaviors due to the intricacy of the nasal geometry. The flow is naturally unsteady and perhaps turbulent, despite Computational Fluid Dynamics (CFD) in the literature being assumed as having a steady laminar flow. Time-dependent simulations can be used to generate detailed data with the potential to uncover new flow behavior, although they are more computationally intensive than steady-state simulations. Furthermore, verification of CFD results has relied on a reported pressure drop (e.g., nasal resistance) across the nasal airway although the geometries used are different. This study investigated the unsteady nature of inhalation at flow rates of 10 l/min, 15 l/min, 20 l/min, and 30 l/min. A scale resolving CFD simulation using a hybrid Reynolds-averaged Navier–Stokes--large eddy simulation model was used and compared with experimental measurements of the pressure distribution and the overall pressure drop in the nasal cavity. The experimental results indicated a large pressure drop across the nasal valve and across the nasopharynx, with the latter attributed to a narrow cross-sectional area. At a flowrate of 30 l/min, the CFD simulations showed that the anterior half of the nasal cavity displayed dominantly laminar but disturbed flow behavior in the form of velocity fluctuations. The posterior half of the nasal cavity displayed turbulent activity, characterized by erratic fluctuating velocities, which was enhanced by the wider cross-sectional areas in the coronal plane. At 15 l/min, the flow field was laminar dominant with very little disturbance, confirming a steady-state laminar flow assumption is viable at this flow rate.
Publisher: Cambridge University Press (CUP)
Date: 27-08-2015
DOI: 10.1017/S0022215114001911
Abstract: Immunoglobulin G4 related disease is a rare condition. Cases involving the sinonasal region are exceptionally uncommon. This paper describes a case of immunoglobulin G4 related disease isolated solely to the nasal cavity. Case report and literature review. A 34-year-old man presented with painless, progressive bilateral nasal obstruction. Clinical examination and imaging findings demonstrated bilateral submucosal swelling of the anterior septum and right external nasal wall. Biopsy revealed immunoglobulin G4 related disease. The patient responded to oral corticosteroids initially, followed by long-term methotrexate. To the best of our knowledge, this case represents the first report in the literature of immunoglobulin G4 related disease isolated solely to the nasal cavity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-03-2022
DOI: 10.1097/MAO.0000000000003484
Abstract: To develop an artificial intelligence image classification algorithm to triage otoscopic images from rural and remote Australian Aboriginal and Torres Strait Islander children. Retrospective observational study. Tertiary referral center. Rural and remote Aboriginal and Torres Strait Islander children who underwent tele-otology ear health screening in the Northern Territory, Australia between 2010 and 2018. Otoscopic images were labeled by otolaryngologists to classify the ground truth. Deep and transfer learning methods were used to develop an image classification algorithm. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under the curve (AUC) of the resultant algorithm compared with the ground truth. Six thousand five hundred twenty seven images were used (5927 images for training and 600 for testing). The algorithm achieved an accuracy of 99.3% for acute otitis media, 96.3% for chronic otitis media, 77.8% for otitis media with effusion (OME), and 98.2% to classify wax/obstructed canal. To differentiate between multiple diagnoses, the algorithm achieved 74.4 to 92.8% accuracy and an AUC of 0.963 to 0.997. The most common incorrect classification pattern was OME misclassified as normal tympanic membranes. The paucity of access to tertiary otolaryngology care for rural and remote Aboriginal and Torres Strait Islander communities may contribute to an under-identification of ear disease. Computer vision image classification algorithms can accurately classify ear disease from otoscopic images of Indigenous Australian children. In the future, a validated algorithm may integrate with existing telemedicine initiatives to support effective triage and facilitate early treatment and referral.
Publisher: AMPCo
Date: 12-2017
DOI: 10.5694/MJA17.00198
Publisher: Wiley
Date: 07-04-2022
DOI: 10.5694/MJA2.51496
Publisher: AVES YAYINCILIK A.Ş.
Date: 06-05-2020
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JBIOMECH.2019.109434
Abstract: The engineering discipline of in silico fluid dynamics delivers quantitative information on airflow behaviour in the nasal regions with unprecedented detail, often beyond the reach of traditional experiments. The ability to provide visualisation and analysis of flow properties such as velocity and pressure fields, as well as wall shear stress, dynamically during the respiratory cycle may give significant insight to clinicians. Yet, there remains ongoing challenges to advance the state-of-the-art further, including for ex le the lack of comprehensive CFD modelling on varied cohorts of patients. The present article embodies a review of previous and current in silico approaches to simulating nasal airflows. The review discusses specific modelling techniques required to accommodate physiologically- and clinically-relevant findings. It also provides a critical summary of the reported results in the literature followed by an outlook on the challenges and topics anticipated to drive research into the future.
Publisher: Wiley
Date: 04-2007
DOI: 10.1016/J.OTOHNS.2006.10.042
Abstract: To review the clinical presentation, predisposing factors, prevention strategies, management, and outcomes of innominate artery hemorrhage following tracheostomy. We report the case of an 80-y-old patient who experienced sudden massive innominate artery hemorrhage 11 days post tracheostomy. We review the literature and present recommendations for management and prevention. Emergency median sternotomy with ligation and resection of the affected segment was performed with no neurological or vascular sequelae. The risk of innominate artery hemorrhage may be minimized with simple measures. Management by ligation and resection of the pathological segment of artery has superior outcomes to primary vascular reconstruction with maintenance of blood flow. Bypass procedures are not routinely required and have not been shown to confer any significant benefit. Resection without reconstruction is associated with a surprisingly low incidence of neurological sequelae.
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/S0022215120000444
Abstract: Convolutional neural networks are a subclass of deep learning or artificial intelligence that are predominantly used for image analysis and classification. This proof-of-concept study attempts to train a convolutional neural network algorithm that can reliably determine if the middle turbinate is pneumatised (concha bullosa) on coronal sinus computed tomography images. Consecutive high-resolution computed tomography scans of the paranasal sinuses were retrospectively collected between January 2016 and December 2018 at a tertiary rhinology hospital in Australia. The classification layer of Inception-V3 was retrained in Python using a transfer learning method to interpret the computed tomography images. Segmentation analysis was also performed in an attempt to increase diagnostic accuracy. The trained convolutional neural network was found to have diagnostic accuracy of 81 per cent (95 per cent confidence interval: 73.0–89.0 per cent) with an area under the curve of 0.93. A trained convolutional neural network algorithm appears to successfully identify pneumatisation of the middle turbinate with high accuracy. Further studies can be pursued to test its ability in other clinically important anatomical variants in otolaryngology and rhinology.
Publisher: Stichting Nase
Date: 09-2019
DOI: 10.4193/RHIN19.269
Publisher: Elsevier BV
Date: 03-2022
Publisher: Wiley
Date: 06-11-2020
DOI: 10.1002/ALR.22476
Abstract: Nasal saline irrigation has become standard of care in various sinonasal conditions, including allergic and nonallergic rhinitis, chronic rhinosinusitis, and in the postoperative patient. Evidence regarding the mechanisms and dynamics of liquid flow through the sinonasal cavity remains limited due to inadequate experimental models (cadaveric, 3-dimensional [3D] printed, imaging of labeled dyes and radioisotopes). We aimed to develop a computational fluid dynamics (CFD) model of nasal irrigation to demonstrate sinonasal surface coverage, residence times across the mucosal surfaces, and shearing force of irrigation. A nasal cavity geometry derived from high-resolution paranasal sinus computed tomography (CT) scans of a healthy, unoperated, 25-year-old patient was created. CFD analysis was performed to assess the distribution of nasal irrigation from a tapered nozzle bottle at a forward head-tilt position of 45 degrees with a 2-second burst at 35 mL/second. The model demonstrates nasal irrigation from ipsilateral to contralateral with precise measures of velocity, pressure, wall shear stress, and mapping of surface coverage and residence times at specific locations and times. The nasal cavity experiences almost complete coverage of irrigation, while overflow from the nasal cavity facilitates moderate coverage of the ipsilateral maxillary (40%) and anterior ethmoid sinuses (30%). Negligible coverage of the sphenoid and frontal sinuses was noted. Detailed physical mechanisms of liquid irrigation injected from a commonly used squeeze bottle were shown. Ipsilateral maxillary and ethmoid sinus penetration are primarily due to overflow rather than direct jet entry, confirming the recommendation of larger volumes of irrigation to "flood" the sinus ostia.
Publisher: Cambridge University Press (CUP)
Date: 23-12-2020
DOI: 10.1017/S0022215119002536
Abstract: Deep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans. Coronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images. A total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86. Convolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.
Publisher: Elsevier BV
Date: 2020
Publisher: BMJ
Date: 05-2019
Abstract: Esthesioneuroblastoma is an uncommon tumour, and isolated primary involvement of the maxillary sinus is exceedingly rare. Esthesioneuroblastoma has infrequently been reported as a source of paraneoplastic ectopic hormone production. We report a case of isolated primary maxillary esthesioneuroblastoma, presenting as idiopathic syndrome of inappropriate antidiuretic hormone (SIADH). A 17-year-old girl presented with symptoms consistent with SIADH and no sino-nasal symptoms. MRI to exclude pituitary tumour revealed an isolated lesion of the right maxillary sinus. Biopsy demonstrated esthesioneuroblastoma. The lesion was removed endoscopically as a single en bloc specimen. Following resection, the sodium level returned to normal. This is only the third report in the literature of a primary maxillary esthesioneuroblastoma presenting as SIADH.
Publisher: Hindawi Limited
Date: 25-07-2019
DOI: 10.1155/2019/5247091
Abstract: Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare lesion of the nasal cavity with only 11 reported cases in the literature. COREAH is of interest as it may be easily mistaken for other diseases of the nasal cavity with higher morbidity, which require significantly different management strategies. We report, to the best of our knowledge, the oldest documented case of COREAH in the literature: an 83-year-old female who presented with headaches and was found to have a posterior nasal septal lesion. Uniquely, the patient had sequential scans performed 1 year apart demonstrating only minor interval growth. We describe our experience in managing a patient with COREAH and review the world literature, to better define aspects of the history, presentation, and investigations that may allow differentiation from more sinister disease.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 06-2020
Publisher: Taiwan Association for Aerosol Research
Date: 2021
DOI: 10.4209/AAQR.210098
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
DOI: 10.1097/SCS.0000000000005371
Abstract: Frontal sinus osteomas are benign bone-forming neoplasms. Ongoing advancements in endoscopic surgery have allowed less invasive surgical approaches to be adopted for removal. The authors systematically reviewed the literature to provide analysis and recommendations for management. One hundred ninety-three publications encompassing 1399 patients met inclusion, with mean age 42.1 ± 13.8 years and a male predominance (59.2%). Symptoms included pain (70.8%) orbital/ocular (20.7%) sinonasal (36.4%) neurologic (6.0%) other (14.5%) and asymptomatic (4.8%). Osteoma was isolated to the frontal sinus (82.9%) or extended into the ethmoid (16.6%), maxillary (0.3%), and sphenoid sinuses (0.2%). There was intracranial extension in 9.5% and intraorbital extension in 18.7%. Of those proceeding to surgery, majority (59.8%) underwent open approaches, followed by endoscopic (25.0%) and combined (11.5%). A significant ( P 0.01) increase in proportion of cases utilizing endoscopic approaches versus open/combined was observed over the period studied. Seventy-one postoperative complications were reported, in 7.5% of endoscopic cases, 27% of open, and 8.8% of combined. Complications were more likely in open/combined surgery, compared with endoscopic (22.3% versus 7.5%, P 0.001). In 181 patients, completeness of resection was reported (complete resection 87.8%) and found to be a significant predictor ( P 0.01) for disease recurrence rogression. Mean length of stay for the endoscopic group was 3.1 ± 1.3 days, compared with 7.9 ± 3.1 for open/combined ( P 0.0001). In the management of frontal sinus osteoma, indications for selecting endoscopic versus open approaches have expanded over the past 30 years, as techniques, equipment, and understanding of pathophysiology have evolved. Where endoscopic approaches are possible, they are associated with reduced morbidity and length of stay compared with open approaches.
Publisher: Elsevier BV
Date: 2016
Publisher: Wiley
Date: 23-09-2020
DOI: 10.1002/HED.26428
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.COMPBIOMED.2018.05.016
Abstract: Recent studies have demonstrated that a significant number of surgical procedures for nasal airway obstruction (NAO) have a high rate of surgical failure. In part, this problem is due to the lack of reliable objective clinical parameters to aid surgeons during preoperative planning. Modeling tools that allow virtual surgery to be performed do exist, but all require direct manipulation of computed tomography (CT) or magnetic resonance imaging (MRI) data. Specialists in Rhinology have criticized these tools for their complex user interface, and have requested more intuitive, user-friendly and powerful software to make virtual surgery more accessible and realistic. In this paper we present a new virtual surgery software tool, DigBody This new surgery module is integrated into the computational fluid dynamics (CFD) program MeComLand The effectiveness of DigBody This tool has great potential to aid surgeons in modeling potential surgical maneuvers, minimizing complications, and being confident that patients will receive optimal postoperative outcomes, validated by personalized CFD testing.
Publisher: Cambridge University Press (CUP)
Date: 05-2008
DOI: 10.1017/S0022215108002582
Abstract: We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules. Case report and literature review of pill oesophagitis. A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management. To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.
Publisher: Hindawi Limited
Date: 07-2019
DOI: 10.1155/2019/3738647
Abstract: Aim . Preoperative decongestion with Moffett’s solution is routine practice in sinonasal procedures providing an ideal operative field. Anecdotally, it is related to postoperative throat pain, yet a quantitative relationship has not been established. We compare the incidence and severity of postoperative throat pain after application of Moffett’s solution against Cophenylcaine decongestion. Methodology . A total of thirty patients from two consultants were recruited. The intervention arm (twenty) was decongested with Moffett’s solution and the control arm (ten) with Cophenylcaine. The primary outcome was self-reported postoperative throat pain as measured by visual analogue scale (VAS) at 2 hours, 4 hours, 6 hours, and next morning. Results . There was a significantly higher VAS for throat pain in patients decongested with Moffett’s solution in the early postoperative period (2 hours p=0.03, 4 hours p=0.04). Conclusion . Moffett’s solution is associated with a greater severity of transient postoperative throat pain compared to topical Cophenylcaine. We recommend further studies to identify means to minimise this side effect. Clinical Trial Registration . This paper has been registered with the Australian and New Zealand Clinical Trials Registry under the registration number: ACTRN12619000772145 .
Publisher: Hindawi Limited
Date: 02-09-2018
DOI: 10.1155/2018/9093545
Abstract: Background . Middle turbinate (MT) lateralisation with adhesion formation (MiTLAF) is a common complication following endoscopic sinus surgery, frequently resulting in surgical failure, persistence of preoperative symptoms, and delayed secondary complications. Packing materials, splints, or spacers reduce the risk of MiTLAF but often result in postoperative nasal obstruction and discomfort, along with reduced access for irrigation. Temporary suture medialisation of the MTs reduces the risk of MiTLAF and prevents the problems encountered with packing, splints, or spacers. However, the techniques described in the literature are technically challenging and often ineffectual. Methods . We describe a method of suture placement that provides a secure temporary MT medialisation, without the technical challenges of traditional techniques, using a 4-0 Monocryl (Poliglecaprone 25, Ethicon, Somerville, NJ, USA) suture on a 19 mm precision point reverse cutting PS-2 curved needle. We review 25 consecutive patients undergoing sinonasal procedures with our new technique and assess for MiTLAF. Results . In our cohort, only one patient experienced MiTLAF which was not clinically significant. Conclusions . Our method is simple, easy to perform, and highly effective and prevents adhesion formation without the need for postoperative splints or packing.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.JOCN.2019.03.059
Abstract: Several authors have reported advantages of the purely endoscopic (PE) approach over traditional purely microscopic (PM) techniques for many sinus and anterior skull base procedures. However, in pituitary surgery, the PE approach carries a number of limitations. Experienced microscopically-trained neurosurgeons are required to master the endoscopic technique which has a steep learning curve due to its one-handed nature and optically-distorted 2-dimensional view. We describe our novel technique, the sequential endoscopic and microscopic pituitary procedure (SEMPP) which does not require microscopically-trained neurosurgeons to alter their technique. We compare SEMPP with the PE approach in terms of outcome and safety. Retrospective chart review of consecutive SEMPP cases performed at our institution between January 2010 and December 2013 was conducted. Operative time, gross total resection rate, resolution of endocrine and visual dysfunction, hospital length of stay, cerebrospinal fluid (CSF) leak rate and revision rates were recorded. 32 patients were identified (50% female, mean age 53.0 years), and 33 SEMPP cases. Mean operating time was 132 min (range 90-200). 69% of patients experienced gross total resection. Most patients (81.3%) with preoperative visual deficit either experienced complete resolution or improved symptoms. The remainder experienced no change in vision. 12.5% (n = 4) of patients experienced intraoperative CSF leaks. All were repaired intraoperatively or with conservative management. Two patients (6.3%) experienced epistaxis managed with conservative measures. The SEMPP technique demonstrates comparable outcomes, complication rates and operative time to PE and PM techniques described in the literature.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Cambridge University Press (CUP)
Date: 18-02-2019
DOI: 10.1017/S0022215119000252
Abstract: Chronic maxillary atelectasis is a rare and underdiagnosed condition in which there is a persistent and progressive decrease in maxillary sinus volume secondary to inward bowing of the antral walls. Chronic maxillary atelectasis is typically unilateral. Simultaneous bilateral chronic maxillary atelectasis is extremely uncommon. A retrospective review was performed of patient data collected by the senior clinician over a three-year period (2015–2018). A comprehensive literature search was conducted to locate all documented cases of chronic maxillary atelectasis in English-language literature. Abstracts and full-text articles were reviewed. Three patients presented with sinonasal symptoms. Imaging findings were consistent with bilateral chronic maxillary atelectasis. The literature review revealed at least nine other cases of bilateral chronic maxillary atelectasis. Management is typically via endoscopic middle meatus antrostomy. Chronic maxillary atelectasis was initially defined as a unilateral disorder, but this description has been challenged by reports of bilateral cases. Further investigation is required to determine the aetiology and pathophysiology of the disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-12-2021
Publisher: SAGE Publications
Date: 13-11-2022
DOI: 10.1177/19458924221137982
Abstract: Nasal adhesions (NAs) are a known complication of nasal airway surgery. Even minor NAs can lead to significant postoperative nasal airway obstruction (NAO). Division of such NAs often provides much greater relief than anticipated. We examine the impact of NAs at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD) and multiple test subjects. CT scans of healthy adult subjects were used to construct three-dimensional nasal airway computational models. A single virtual 2.5 mm diameter NA was placed at one of five sites commonly seen following NAO surgery within each nasal cavity bilaterally, resulting in 10 NA models and 1 NA-free control for each subject. CFD analysis was performed on each NA model and compared with the subject's NA-free control model. 4 subjects were recruited to create 44 computational models. The NAs caused the airflow streamlines to separate, leading to a statistically significant increase in mucosal temperature immediately downstream to the NAs (wake region). Changes in the mucosal temperature in the wake region of the NAs were most prominent in anteriorly located NAs with a mean increase of 1.62 °C for the anterior inferior turbinate NAs ( NAs result in marked disruption to airflow patterns and reduced mucosal cooling on critical surfaces, particularly in the wake region. Reduced wake region mucosal cooling may be a contributing factor to the exaggerated perception of nasal obstruction experienced by patients with NAs.
Publisher: AME Publishing Company
Date: 02-2020
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/S0022215120000675
Abstract: The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width ( r = 0.35, p = 0.04). The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
Publisher: BMJ
Date: 29-04-2015
Publisher: SAGE Publications
Date: 06-2023
DOI: 10.1177/00034894221095899
Abstract: Convolutional neural networks (CNNs) represent a state-of-the-art methodological technique in AI and deep learning, and were specifically created for image classification and computer vision tasks. CNNs have been applied in radiology in a number of different disciplines, mostly outside otolaryngology, potentially due to a lack of familiarity with this technology within the otolaryngology community. CNNs have the potential to revolutionize clinical practice by reducing the time required to perform manual tasks. This literature search aims to present a comprehensive systematic review of the published literature with regard to CNNs and their utility to date in ENT radiology. Data were extracted from a variety of databases including PubMED, Proquest, MEDLINE Open Knowledge Maps, and Gale OneFile Computer Science. Medical subject headings (MeSH) terms and keywords were used to extract related literature from each databases inception to October 2020. Inclusion criteria were studies where CNNs were used as the main intervention and CNNs focusing on radiology relevant to ENT. Titles and abstracts were reviewed followed by the contents. Once the final list of articles was obtained, their reference lists were also searched to identify further articles. Thirty articles were identified for inclusion in this study. Studies utilizing CNNs in most ENT subspecialties were identified. Studies utilized CNNs for a number of tasks including identification of structures, presence of pathology, and segmentation of tumors for radiotherapy planning. All studies reported a high degree of accuracy of CNNs in performing the chosen task. This study provides a better understanding of CNN methodology used in ENT radiology demonstrating a myriad of potential uses for this exciting technology including nodule and tumor identification, identification of anatomical variation, and segmentation of tumors. It is anticipated that this field will continue to evolve and these technologies and methodologies will become more entrenched in our everyday practice.
Publisher: AVES YAYINCILIK A.Ş.
Date: 06-05-2020
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/S0022215120000717
Abstract: To explore the feasibility of constructing a proof-of-concept artificial intelligence algorithm to detect tympanic membrane perforations, for future application in under-resourced rural settings. A retrospective review was conducted of otoscopic images analysed using transfer learning with Google's Inception-V3 convolutional neural network architecture. The ‘gold standard’ ‘ground truth’ was defined by otolaryngologists. Perforation size was categorised as less than one-third (small), one-third to two-thirds (medium), or more than two-thirds (large) of the total tympanic membrane diameter. A total of 233 tympanic membrane images were used (183 for training, 50 for testing). The algorithm correctly identified intact and perforated tympanic membranes (overall accuracy = 76.0 per cent, 95 per cent confidence interval = 62.1–86.0 per cent) the area under the curve was 0.867 (95 per cent confidence interval = 0.771–0.963). A proof-of-concept image-classification artificial intelligence algorithm can be used to detect tympanic membrane perforations and, with further development, may prove to be a valuable tool for ear disease screening. Future endeavours are warranted to develop a point-of-care tool for healthcare workers in areas distant from otolaryngology.
Publisher: Springer Science and Business Media LLC
Date: 02-09-2022
DOI: 10.1007/S11095-022-03375-Y
Abstract: Nasal saline irrigation is highly recommended in patients following functional endoscopic sinus surgery (FESS) to aid the postoperative recovery. Post-FESS patients have significantly altered anatomy leading to markedly different flow dynamics from those found in pre-op or non-diseased airways, resulting in unknown flow dynamics. This work investigated how the liquid stream disperses through altered nasal cavities following surgery using Computational Fluid Dynamics (CFD). A realistic squeeze profile was determined from physical experiments with a 27-year-old male using a squeeze bottle with load sensors. The administration technique involved a head tilt of 45-degrees forward to represent a head position over a sink. After the irrigation event that lasted 4.5 s, the simulation continued for an additional 1.5 s, with the head orientation returning to an upright position. The results demonstrated that a large maxillary sinus ostium on the right side allows saline penetration into this sinus. The increased volume of saline entering the maxillary sinus limits the saline volume available to the rest of the sinonasal cavity and reduces the surface coverage of the other paranasal sinuses. The average wall shear stress was higher on the right side than on the other side for two patients. The results also revealed that head position alters the sinuses’ saline residual, especially the frontal sinuses. While greater access to sinuses is achieved through FESS surgery, patients without a nasal septum limits posterior sinus penetration due to the liquid crossing over to the contralateral cavity and exiting the nasal cavity early.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.RESP.2021.103769
Abstract: Middle turbinate resection significantly alters the anatomy and redistributes the inhaled air. The superior half of the main nasal cavity is opened up, increasing accessibility to the region. This is expected to increase inhalation dosimetry to the region during exposure to airborne particles. This study investigated the influence of middle turbinate resection on the deposition of inhaled pollutants that cover spherical and non-spherical particles (e.g. pollen). A computational model of the nasal cavity from CT scans, and its corresponding post-operative model with virtual surgery performed was created. Two constant flow rates of 5 L/min, and 15 L/min were simulated under a laminar flow field. Inhaled particles including pollen (non-spherical), and a spherical particle with reference density of 1000 kg/m
Publisher: AMPCo
Date: 03-12-2018
DOI: 10.5694/MJA18.00365
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 04-2010
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 09-03-2019
DOI: 10.1002/HED.25724
Abstract: This meta-analysis describes the validity of narrow band imaging (NBI) in the assessment of suspicious oral lesions. Medline, EMBASE, and Scopus were searched for trial studies comparing NBI with conventional modalities in the oral cavity (OC) and oropharynx (OP) for the detection of dysplastic and malignant change. Seven studies were found, and generally supported the utility of NBI in different clinical settings, although there were exceptions. Pooled data from 4 studies of NBI validity demonstrated high summary specificity and sensitivity for a wide range of suspicious lesions of the OC or OP (75.7% with 95% CI 65.1%-83.9%, and 91.5% with 95% CI 81.8%-96.3%, respectively). Summary positive likelihood ratio (LR+) was 8.91 (95% CI 4.1-19.6) and 0.27 (95% CI 0.18-0.39), respectively. NBI is a promising diagnostic and surveillance tool for suspicious lesions in the OC or OP however, higher powered studies will define precise NBI criterion and clinical recommendations.
Publisher: Wiley
Date: 03-08-2022
DOI: 10.1002/LARY.30327
Abstract: Recent evidence suggests that detection of nasal mucosal temperature, rather than direct airflow detection, is the primary determinant of subjective nasal patency. This study examines the role of nasal mucosal temperature in the perception of nasal patency using in vivo and computational fluid dynamics (CFD) measurements. Healthy adult participants completed Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS) questionnaires. A temperature probe measured nasal mucosal temperature at the vestibule, inferior turbinate, middle turbinate, and nasopharynx bilaterally. Participants underwent a CT scan, used to create a 3D nasal anatomy model to perform CFD analysis of nasal mucosal and inspired air temperature and heat flux along with mucosal surface area where heat flux W/m 2 (SAHF50). Eleven participants with a median age of 27 (IQR 24 48) were recruited. Probe‐measured temperature values correlated strongly with CFD‐derived values ( r = 0.87, p 0.05). Correlations were seen anteriorly in the vestibule and inferior turbinate regions between nasal mucosal temperature and unilateral VAS ( r = 0.42–0.46 p 0.05), between SAHF50 and unilateral VAS ( r = −0.31 to −0.36 p 0.05) and between nasal mucosal temperature and SAHF50 ( r = −0.37 to −0.41 p 0.05). Subjects with high patency (VAS ≤10) had increased heat flux anteriorly compared with lower patency subjects (VAS p 0.05). Lower nasal mucosal temperature and higher heat flux within the anterior nasal cavity correlates with a perception of improved unilateral nasal patency in healthy in iduals. 4 Laryngoscope , 133:1328–1335, 2023
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.IJPORL.2018.08.010
Abstract: Coins are the commonest foreign body ingested in paediatric populations. Although most ingested coins are either spontaneously passed or retrieved with medical intervention without serious consequence, there is potential for serious morbidity and mortality related to paediatric coin ingestion. We performed a 10-year retrospective review of Australian denomination coin ingestion at a tertiary paediatric hospital in Sydney, Australia. We attempted to determine whether a relationship exists between coin size, patient age, coin ingestion and spontaneous passage. Hospital records of all children presenting in a 10-year period to a paediatric tertiary care centre for coin ingestion were reviewed. Demographic information, coin denomination, previous history, symptoms, investigations, management, outcome and complications were recorded. 241 cases were identified. The majority (55%) of cases occurred in children ≤3 years of age (range 7 months-11 years, mean 3.39 years). The most common location where coins were identified was in the proximal third of the oesophagus or at the cricopharyngeus (65%). Spontaneous passage occurred in 84 cases (34.9%) while 167 cases (69.3%) required intervention. Children ≤3 years were more likely to ingest small coins ( 3 years were more likely to ingest larger coins (22-26 mm) (OR: 2.17 1.39-4.35). Coin size, coin weight and age of the child appear to be predictors for both likelihood of ingestion and spontaneous passage in paediatric coin ingestion cases. A child with minimal symptoms, witnessed ingestion and radiographic identification of the coin in the lower oesophagus or more distal can often be safety observed for up to 24 h in anticipation of spontaneous passage.
Publisher: SAGE Publications
Date: 02-02-2020
Abstract: Topical nasal decongestant sprays are used commonly in routine otolaryngology practice to reduce the symptoms of nasal airway obstruction (NAO) through vasoconstriction, thereby reducing the bulk of vasoerectile tissue and increasing nasal airflow. Such tissue is found predominantly on the lateral wall of the nose within the inferior turbinates (ITs), but recent evidence suggests that it may also be found medially within the nasal septal swell body (SSB). To determine whether isolated topical decongestion of the medial nasal wall, targeting the SSB, is as effective as isolated decongestion of the lateral nasal wall, targeting the IT, in maximizing nasal patency. A double-blinded, randomized controlled, crossover study was performed investigating the effect of decongestion of the lateral nasal wall or septum in isolation on nasal airflow. Isolated decongestion was performed by placing a cottonoid, soaked in oxymetazoline and attached to a silastic sheet, into the nasal cavity randomly facing either the septum or lateral nasal wall, bilaterally. Anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow (PNIF), and subjective patient-reported outcomes (Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation (NOSE) scores) were recorded at baseline and postdecongestion. Decongestion of the alternate site was then performed at a later date. A total of 20 healthy volunteers (30% females, mean age 26.6 ± 3.8 years) were recruited. Improvements in nasal obstruction and SNOT-22 scores were found following decongestion of the septum compared with baseline (mean difference: 0.82, t = 2.32, P = .04 mean difference: 3.30, t = 2.50, P = .04, respectively). Improvements in mean inspiratory flow, minimal cross-sectional area, volume, and PNIF were also demonstrated. This study suggests that the SSB contains erectile tissue that responds to topical decongestant therapy in a similar manner to IT tissue. The SSB may represent a novel target in surgery for NAO.
Publisher: Public Library of Science (PLoS)
Date: 28-01-2021
DOI: 10.1371/JOURNAL.PONE.0246007
Abstract: Evaluation of nasal spray drug absorption has been challenging because deposited particles are consistently transported away by mucociliary clearance during diffusing through the mucus layer. This study developed a novel approach combining Computational Fluid Dynamics (CFD) techniques with a 1-D mucus diffusion model to better predict nasal spray drug absorption. This integrated CFD-diffusion approach comprised a preliminary simulation of nasal airflow, spray particle injection, followed by analysis of mucociliary clearance and drug solute diffusion through the mucus layer. The spray particle deposition distribution was validated experimentally and numerically, and the mucus velocity field was validated by comparing with previous studies. Total and regional drug absorption for solute radius in the range of 1 − 110 nm were investigated. The total drug absorption contributed by the spray particle deposition was calculated. The absorption contribution from particles that deposited on the anterior region was found to increase significantly as the solute radius became larger (diffusion became slower). This was because the particles were consistently moved out of the anterior region, and the delayed absorption ensured more solute to be absorbed by the posterior regions covered with respiratory epithelium. Future improvements in the spray drug absorption model were discussed. The results of this study are aimed at working towards a CFD-based integrated model for evaluating nasal spray bioequivalence.
Publisher: Wiley
Date: 31-03-2022
DOI: 10.1111/ALL.15289
Publisher: Wiley
Date: 26-06-2020
DOI: 10.1002/LIO2.414
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.RESP.2021.103719
Abstract: Nasal adhesions are a known postoperative complication following surgical procedures for nasal airway obstruction (NAO) and are a common cause of surgical failure, with patients often reporting significant NAO, despite relatively minor adhesion size. Division of such nasal adhesions often provides much greater relief than anticipated, based on the minimal reduction in cross-sectional area associated with the adhesion. The available literature regarding nasal adhesions provides little evidence examining their quantitative and qualitative effects on nasal airflow using objective measures. This study examined the impact of nasal adhesions at various anatomical sites on nasal airflow and mucosal cooling using computational fluid dynamics (CFD). A high-resolution CT scan of the paranasal sinuses of a 25-year-old, healthy female patient was segmented to create a three-dimensional nasal airway model. Virtual nasal adhesions of 2.5 mm diameter were added to various locations within the nasal cavity, representing common sites seen following NAO surgery. A series of models with single adhesions were created. CFD analysis was performed on each model and compared with a baseline no-adhesion model, comparing airflow and heat and mass transfer. The nasal adhesions resulted in no significant change in bulk airflow patterns through the nasal cavity. However, significant changes were observed in local airflow and mucosal cooling around and immediately downstream to the nasal adhesions. These were most evident with anterior nasal adhesions at the internal valve and anterior inferior turbinate. Postoperative nasal adhesions create local airflow disruption, resulting in reduced local mucosal cooling on critical surfaces, explaining the exaggerated perception of nasal obstruction. In particular, anteriorly located adhesions created greater disruption to local airflow and mucosal cooling, explaining their associated greater subjective sensation of obstruction.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.JHIN.2022.05.015
Abstract: Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques. To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing. Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038 or an AccuFit 9000 PRO fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Healthcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover. Thirty subjects were assessed of these, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects, the median best-achieved fit factor was 200 (interquartile range 178-200). None of the subjects had an adverse reaction to the under-mask beard cover. The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair who cannot shave.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.COMPBIOMED.2019.103505
Abstract: The use of computational fluid dynamics (CFD) to model and predict surgical outcomes in the nasal cavity is becoming increasingly popular. Despite a number of well-known nasal segmentation methods being available, there is currently a lack of an automated, CFD targeted segmentation framework to reliably compute accurate patient-specific nasal models. This paper demonstrates the potential of a robust nasal cavity segmentation framework to automatically segment and produce nasal models for CFD. The framework was evaluated on a clinical dataset of 30 head Computer Tomography (CT) scans, and the outputs of the segmented nasal models were further compared with ground truth models in CFD simulations on pressure drop and particle deposition efficiency. The developed framework achieved a segmentation accuracy of 90.9 DSC, and an average distance error of 0.3 mm. Preliminary CFD simulations revealed similar outcomes between using ground truth and segmented models. Additional analysis still needs to be conducted to verify the accuracy of using segmented models for CFD purposes.
Publisher: AME Publishing Company
Date: 2021
DOI: 10.21037/AJO-20-63
Publisher: Wiley
Date: 08-2011
DOI: 10.1177/0194599811416318A238
Abstract: Study the ex vivo allergen‐specific cytokine responses of cells derived from human nasal polyps. We hypothesized that nasal‐polyp derived human respiratory cells from atopic in iduals would respond with reduced IL10 compared with cells from nonatopics. Thirty‐one nonsmoking adults with nasal polyposis requiring surgery were recruited. Atopic status was determined by skin prick tests. Polyps were harvested during routine surgery. After digestion with collagenase, cell suspensions were incubated with positive and negative allergen (cat, grass, or HDM) for 6 days. Cytokine detection was by cytometric bead array. IL‐10 was induced in nasal polyp cell suspensions derived from both atopics and nonatopics with the addition of allergen in a dose‐response fashion. Our results indicate that IL‐10 producing T cells regulate Th2 cytokine production in nasal‐polyp derived human airway cells.
No related grants have been discovered for Narinder Pal Singh.