Current Research

Microarray analysis of sinus samples from patients with and without chronic rhinosinusitis.

Acute rhinosinusitis is a common, infectious, debilitating disease and the responsible bacteria have been well described. However, the pathophysiology of chronic rhinosinusitis (CRS) remains enigmatic. Multiple factors, including allergy, inflammation, physical obstruction of outflow tracts, and various microorganisms have been implicated. The microbiology of CRS continues to be debated, and prior studies have been limited by sampling technique, culture methods, and the inherent heterogeneity of the disease.

 Sleep apnea is a common disorder that affects more than 12 million Americans. People with sleep apnea experience transient cessation of respiration during their sleep, with each interval lasting for 10 seconds or more. While a range of non-surgical treatments is available, including medications, behavioral changes, continuous positive airway pressure, or mouthpiece, many have opted surgery as a solution. Currently, the decision on the type of surgery suitable for a patient is determined through medical history and physical examinations, X-rays, endoscopic examinations and other resources while a patient is awake.

The purpose of this study is to determine whether a propofol-induced sleep endoscopy can improve our understanding on the patterns of blockage of breathing during sleep. As the patient sleeps, we are able to witness their typical breathing patterns exhibited at night. Our goal is to observe the throat to see how and where the airway is blocked and to determine if this technique provides important, unique information.

 PCR Analysis of Nasal Polyps for Fungal DNA

 Nasal polyps are soft growths projecting from the mucous membrane of the sinuses and are often caused by chronic sinus disease. Inflammation of the sinuses causes blood vessels to be more permeable to water, allowing for fluid retention and through time, polyp formation. Nasal polyps are the result of chronic inflammation, which maybe set up by allergies, molds, fungus and/or bacterial or viral infections.

This study aims to find out if any specific type of fungus or mold is correlated with chronic sinus disease. Patients enrolled in the study will have their nose swabbed with a cytology brush and will be asked to bring in their vacuum bag to be swabbed as well. The specimens collected will be sent to Stephen Vesper, PhD, of US Environmental Protection Agency Office of Research and Development, in Cincinnati, Ohio, for analysis. We hope that this study will add new insight about chronic sinus disease and the different types of fungus and mold found in the human nose.

Posterior glottic stenosis represents a challenging clinical condition for which numerous procedures are available to improve airway obstruction. The endoscopic postcricoid advancement flap has been described as useful adjunct for treatment of posterior glottic stenosis, employing an endoscopic method for placing vascularized tissue in the posterior glottis to prevent scar re-formation. The procedure minimizes trauma through use of an endoscopic approach rather than a midline thyrotomy and can be performed with available microlaryngeal equipment by surgeons familiar with laryngeal microsurgery. A review of the application of this technique is being performed to better identify patients with posterior glottic stenosis who are appropriate candidates for the procedure.

Uvulopalatopharyngoplasty (UPPP) Resource Utilization Study

UPPP is often one of the first steps recommended to adult patients seeking a surgical approach to ameliorating obstructive sleep apnea. The perioperative mortality and serious morbidity rates are very low for this operation. Some authors have suggested that overnight hospitalization following uvulopalatopharyngoplasty is unnecessary. This recommendation principally takes into account complications rates and not patient comfort and levels of pain in the postoperative period. While outcomes following UPPP at our institution have similarly low morbidity and mortality, paralleling the outcomes reported in the literature, patients undergoing UPPP appear to require a high level of care, utilize inpatient services extensively and that overnight hospitalization may be appropriate on this basis. This report provides a quantifiable retrospective review utilizing prospectively collected data of our experience with the hospital admission of these patients with attention to utilization of hospital resources and patient comfort. This study will investigate the resource utilization of patients undergoing UPPP and assess appropriateness of hospital care in the postoperative period.

Intraoral versus Extraoral Repair of Mandible Fractures

Mandible fractures are the second most common facial fracture. The aim of treatments of mandible fractures by transoral or extraoral approach is rapid healing by optimized reduction and fixation in order to restore function and appearance with minimal disability and complications. Extraoral approach to mandible fractures of the posterior mandibular body, angle and ramus improves visualization of the fracture site and thus improves reduction or repair resulting in improved overall outcome, and fewer complications. On occasion, cases that are begun with the intraoral approach are converted to the extraoral approach for improved visualization, and thus actually increase overall operative time. Our study was a retrospective chart review of 100 patients with isolated mandible fractures treated at a level one trauma center, the San Francisco General Hospital, from January 2000 to January 2004. Cases were evaluated for cause, age, gender, dentition, site, extent of fractures, surgical approach, postoperative complication, timing to repair, operative time, and postoperative occlusion. By comparing the two main approaches to the mandible (transoral and extraoral) for their advantages and disadvantages, we plan to recommend a reasonable treatment algorithm for mandible fracture repair.

The interest in providing more effective surgical treatments for obstructive sleep apnea has resulted in a wave of innovative and pioneering work. An obstacle to their implementation is the difficulty in interpreting some of the outcomes studies, which are often retrospective and contain numerous confounding factors. The aim of the present study is to develop a cadaver model to help provide the rationale for these novel sleep apnea procedures. Acoustic pharyngometry, a research instrument that converts acoustic signal data to distance-area curves, and pressure-flow measurements are performed to demonstrate changes in cross-sectional area and compliance of the pharynx.