Joseph Jacobs, M.D.

Coronary stent thrombosis in patients undergoing multidigit replantation
Jacobs J; Shah A; Zinn A; Levine J
2011 Jan;40(1):285-289, Critical care medicine
OBJECTIVE:: The development of drug-eluting stents has decreased the rate of in-stent restenosis. However, there have been reports of late stent thrombosis in patients with drug-eluting stents, especially when dual antiplatelet therapy is interrupted. The high mortality rate associated with cardiac stent thrombosis has led to recent recommendations regarding duration of antiplatelet therapy as well as timing of elective surgery in patients with both drug-eluting stents and bare metal stents. However, in patients requiring emergency operations, delaying surgery is not an option. DATA SOURCES:: In a retrospective review of 65 patients undergoing replantation from 2005 to 2010, only two patients with coronary stents presented, both with drug-eluting stents. Both of these patients developed acute in-stent thrombosis postoperatively on days 5 and 2 despite continuing dual antiplatelet therapy while undergoing multidigit replantation. CONCLUSIONS:: Several factors including large transfusion requirements and the complex pharmacogenetics of clopidogrel may have played a role. These cases bring to light the increasing number of patients with indwelling drug-eluting stents in whom the need for massive surgical or trauma type management will become more frequent
— id: 139042, year: 2011, vol: 40, page: 285, stat: Journal Article,

Measurement of mycotoxins in patients with chronic rhinosinusitis
Lieberman S.M.; Jacobs J.B.; Lebowitz R.A.; Feigenbaum B.A.
2011 ;127(2 SUPPL 1):AB123-AB123, Journal of allergy & clinical immunology
RATIONALE: Rhinosinusitis is one of the most common chronic conditions in the US. The etiology of chronic rhinosinusitis (CRS) remains unknown and controversial. Mycotoxins are toxic secondary metabolites produced by fungi including aspergillus, alternaria, and penicillium species. The presence of mycotoxins in sinonasal tissue and secretions and any possible link to CRS has not been reported. METHODS: Sinonasal tissue and mucus specimens, predominantly from the ethmoid sinuses, were collected from 18 subjects undergoing endoscopic sinus surgery for CRS. The specimens were pulverized and centrifuged, then the resultant supernatant fraction was collected. The following mycotoxins were analyzed using commercial ELISA test kits: aflatoxin, deoxynivalenol, zearalenone, ochratoxin, and fumonisin. Mycotoxin concentrations were quantified from a standard curve. All standards and samples were analyzed in duplicate. We considered a sample positive when the mean value of the sample was two standard deviations above the limit of detection for the test kit. RESULTS: Four (22%) of 18 specimens were positive for ochratoxin. All specimens were negative for aflatoxin, deoxynivalenol, zearalenone, and fumonisin. CONCLUSIONS: Ochratoxin was identified in the sinonasal tissue and/or mucus of some subjects with CRS. The clinical significance of this is not known
— id: 127252, year: 2011, vol: 127, page: AB123, stat: Journal Article,

Measurement of Mycotoxins in Patients with Chronic Rhinosinusitis
Lieberman SM; Jacobs JB; Lebowitz RA; Fitzgerald MB; Crawford J; Feigenbaum BA
2011 Aug;145(2):327-329, Otolaryngology, head & neck surgery
Mycotoxins are toxic secondary metabolites produced by a variety of fungi including Aspergillus, Alternaria, and Penicillium species. The presence of mycotoxins in sinonasal tissue and secretions and any possible link to chronic rhinosinusitis (CRS) or other diseases of the head and neck have not been reported. The authors performed an exploratory study to determine the presence and levels of mycotoxins in the sinonasal tissue and secretions of 18 subjects undergoing endoscopic sinus surgery for CRS. Using commercial enzyme-linked immunosorbent assay kits, samples were analyzed for the following mycotoxins: aflatoxin, deoxynivalenol, zearalenone, ochratoxin, and fumonisin. All specimens were negative for aflatoxin, deoxynivalenol, zearalenone, and fumonisin. Four (22%) of 18 specimens were positive for ochratoxin. The clinical significance of this finding remains to be determined
— id: 137919, year: 2011, vol: 145, page: 327, stat: Journal Article,

From virtual reality to the operating room: the endoscopic sinus surgery simulator experiment
Fried, Marvin P; Sadoughi, Babak; Gibber, Marc J; Jacobs, Joseph B; Lebowitz, Richard A; Ross, Douglas A; Bent, John P 3rd; Parikh, Sanjay R; Sasaki, Clarence T; Schaefer, Steven D
2010 Feb;142(2):202-207, Otolaryngology, head & neck surgery
OBJECTIVE: Establish the feasibility of a predictive validity study in sinus surgery simulation training and demonstrate the effectiveness of the Endoscopic Sinus Surgery Simulator (ES3) as a training device. STUDY DESIGN: Prospective, multi-institutional controlled trial. SETTING: Four tertiary academic centers with accredited otolaryngology-head and neck surgery residency programs. SUBJECTS: Twelve ES3-trained novice residents were compared with 13 control novice residents. METHODS: Subjects were assessed on the performance of basic sinus surgery tasks. Their first in vivo procedure was video recorded and submitted to a blinded panel of independent experts after the panel established a minimum inter-rater reliability of 80 percent. The recordings were reviewed by using a standardized computer-assisted method and customized metrics. Results were analyzed with the Mann-Whitney U test. Internal rater consistency was verified with Pearson moment correlation. RESULTS: Completion time was significantly shorter in the experimental group (injection P = 0.003, dissection P < 0.001), which, according to the rater panel, also demonstrated higher confidence (P = 0.009), demonstrated skill during instrument manipulation (P = 0.011), and made fewer technical mistakes during the injection task (P = 0.048) compared with the control group. The raters' post hoc internal consistency was deemed adequate (r > 0.5 between serial measurements). CONCLUSION: The validity of the ES3 as an effective surgical trainer was verified in multiple instances, including those not depending on subjective rater evaluations. The ES3 is one of the few virtual reality simulators with a comprehensive validation record. Advanced simulation technologies need more rapid implementation in otolaryngology training, as they present noteworthy potential for high-quality surgical education while meeting the necessity of patient safety
— id: 126560, year: 2010, vol: 142, page: 202, stat: Journal Article,

Three-dimensional reconstruction based on computed tomography images of the frontal sinus drainage pathway
Reitzen, S D; Wang, E Y; Butros, S R; Babb, J; Lebowitz, R A; Jacobs, J B
2010 Mar;124(3):291-296, Journal of laryngology & otology
Objective:This study aimed to investigate the utility of three-dimensional reconstructions of paranasal sinus computed tomography data in depicting the anatomy of the frontal sinus drainage pathway.Methods:Twenty-nine patients underwent imaging of the sinuses for various clinical indications. Variations in frontal sinus recess anatomy were determined from 0.75-mm thick coronal, axial and sagittal computed tomography images. Three-dimensional, reformatted images were generated from manually segmented volumes of interest. Observations were made on the variation and usefulness of these reconstructions.Results:Three-dimensional, reformatted images of segmented volumes aided delineation of the spatial relationships of the frontal sinus, frontal sinus drainage pathway, infundibular and meatal direction of drainage, agger nasi cells, ethmoid bulla cells, supraorbital cells, and suprabullar cells.Conclusion:Three-dimensional, reformatted images of frontonasal anatomy enable improved understanding of the frontal sinus drainage pathway anatomy and of the spatial relationships between ethmoid air cells in this region. Such images may provide a useful adjunct to surgical planning and education
— id: 107265, year: 2010, vol: 124, page: 291, stat: Journal Article,

Allergic fungal sinusitis with extensive bone erosion of the clivus presenting with diplopia
Reitzen, S D; Lebowitz, R A; Jacobs, J B
2009 Jul;123(7):817-819, Journal of laryngology & otology
OBJECTIVE: We report a case of allergic fungal sinusitis causing bone erosion and diplopia. CASE REPORT: A 43-year-old man presented with a four-month history of increased nasal congestion and progressive diplopia. Clinical examination revealed bilateral nasal polyposis and a right lateral gaze deficit, consistent with a VIth cranial nerve palsy. Computed tomography of the paranasal sinuses demonstrated a large sellar mass with extensive bony erosion and both supra- and infra-sellar extension. An endoscopic approach to the sphenoid sinus, clivus and posterior cranial fossa with image guidance was performed, enabling surgical treatment involving nasal polypectomy, wide marsupialisation of the sphenoid sinus and removal of the extensive allergic fungal mucin. The patient awoke from anaesthesia with complete resolution of his diplopia. CONCLUSION: Otolaryngologists should be aware that approximately 20 per cent of patients with allergic fungal sinusitis demonstrate paranasal sinus expansion and bone erosion involving surrounding anatomical structures. Such patients may have clinical findings involving the orbit and cranial vault
— id: 100473, year: 2009, vol: 123, page: 817, stat: Journal Article,

Flat panel cone beam computed tomography of the sinuses
Zoumalan, Richard A; Lebowitz, Richard A; Wang, Edwin; Yung, Kathryn; Babb, James S; Jacobs, Joseph B
2009 Jun;140(6):841-844, Otolaryngology, head & neck surgery
OBJECTIVE: This study aims to compare the image quality and potential diagnostic accuracy of paranasal sinus CT scans generated by flat panel cone beam CT at three specific data acquisition times. STUDY DESIGN: Prospective, single blinded analysis. SUBJECTS AND METHODS: Eleven patients without previous radiologic evaluation were selected based on history and findings suspicious for chronic sinusitis. Each patient was scanned at three different acquisition times: 10, 20, and 40 seconds. A panel of neuroradiologists and otolaryngologists, blinded to the scan acquisition time, individually reviewed images and rated overall image quality and visualization of specific anatomic sites. Image noise values were also calculated. Techniques were compared with a Wilcoxon matched-pairs signed ranks test. RESULTS: Compared to the 10-second acquisition time, the 40- and 20-second acquisition time techniques had significantly better image quality (P < 0.05) and image noise (P < 0.05). No difference in image quality and image noise existed between the 20- and 40-second techniques. No difference in visualization of specific anatomic structures existed between any of the time techniques. CONCLUSION: The quality of flat panel CT imaging of the sinuses directly relates to scan time and thus radiation dose
— id: 99223, year: 2009, vol: 140, page: 841, stat: Journal Article,

Superior turbinate pneumatization in patients with chronic rhinosinusitis: prevalence on paranasal sinus CT
Kanowitz, Seth J; Nusbaum, Annette O; Jacobs, Joseph B; Lebowitz, Richard A
2008 Oct;87(10):578-579, Ear, nose & throat journal
With the availability of high-resolution computed tomography (CT), a great deal of attention has been paid to the anatomy of the paranasal sinuses. But while investigators have focused on the osteomeatal complex and its relation to chronic rhinosinusitis, there has been little discussion of the superior turbinate. Although a few anatomic studies have tried to quantify pneumatization of the superior turbinate, the prevalence of this finding on radiography is not well addressed in the literature. We prospectively studied 100 consecutively presenting patients who underwent coronal CT of the paranasal sinuses (200 sides) for the evaluation of symptoms of chronic rhinosinusitis at an academic tertiary referral center to determine the prevalence of pneumatization of the superior turbinate. We found evidence of pneumatization in 44 of the 200 sides, for a prevalence of 22%. In all, pneumatized superior turbinates were found in 27 patients (27%)-bilaterally in 17 (17%) and unilaterally in 10 (10%)
— id: 92166, year: 2008, vol: 87, page: 578, stat: Journal Article,

REM-associated nasal obstruction: a study with acoustic rhinometry during sleep
Morris, Luc G T; Burschtin, Omar; Setlur, Jennifer; Bommelje, Claire C; Lee, Kelvin C; Jacobs, Joseph B; Lebowitz, Richard A
2008 Nov;139(5):619-623, Otolaryngology, head & neck surgery
OBJECTIVE: Obstructive sleep apnea events are more common in REM sleep, although there is no relationship between sleep phase and pharyngeal airway status. We studied the patency of the nasal airway during REM and non-REM sleep with the use of acoustic rhinometry. METHODS: Serial acoustic rhinometric assessment of nasal cross-sectional area was performed in 10 subjects, before sleep and during REM and non-REM sleep. All measurements were standardized to a decongested baseline with mean congestion factor (MCF). RESULTS: MCF in the seated position was 10.6% (+/-3.7) and increased with supine positioning to 16.2% (+/-2.3). In REM sleep, MCF was highest, at 22.3% (+/-1.7). In non-REM sleep, MCF was lowest, at 2.3% (+/-3.1). All interstage comparisons were statistically significant on repeated measures ANOVA (P < 0.05). CONCLUSION: REM sleep is characterized by significant nasal congestion; non-REM sleep, by profound decongestion. This phenomenon may be attributable to REM-dependent variation in cerebral blood flow that affects nasal congestion via the internal carotid system. REM-induced nasal congestion, an indirect effect of augmented cerebral perfusion, may contribute to the higher frequency of obstructive events in REM sleep
— id: 102474, year: 2008, vol: 139, page: 619, stat: Journal Article,

Potential role of nasal tissue derived Alternaria-specific IgE in the pathogenesis of polyposis
Sabirov, A; Hamilton, RG; Jacobs, JB; Hillman, DE; Lebowitz, RA; Watts, JD
2008 FEB ;121(2):S266-S266, Journal of allergy & clinical immunology
— id: 87132, year: 2008, vol: 121, page: S266, stat: Journal Article,

Role of Local Immunoglobulin E Specific for Alternaria alternata in the Pathogenesis of Nasal Polyposis
Sabirov, Albert; Hamilton, Robert G; Jacobs, Joseph B; Hillman, Dean E; Lebowitz, Richard A; Watts, Joe D
2008 Jan;118(1):4-9, Laryngoscope
OBJECTIVE/HYPOTHESIS:: The role of fungal pathogens in the etiology of nasal polyposis remains unclear. The aim of this study was to determine whether there was a correlation between the presence of Alternaria-specific immunoglobulin (Ig)E antibodies, eosinophilic inflammation, and the development of nasal polyps. STUDY DESIGN:: Prospective study. METHODS:: Serum and nasal tissue homogenates from 21 patients with manifestations of chronic sinusitis with nasal polyps were compared with specimens from 13 chronic sinusitis patients without polyps and 8 healthy controls. The Phadia ImmunoCAP and enzyme-linked immunosorbent assay were used to quantify levels of total IgE and Alternaria-specific (IgE, IgG, and IgA) antibodies. Eosinophil cationic protein (ECP) and tryptase levels were measured in tissue homogenates, whereas the inflammatory response was evaluated using tissue eosinophil counts in tissue samples. RESULTS:: Serum analysis revealed no difference in the levels of total IgE and Alternaria-specific IgE, IgG, and IgA antibodies between the study groups. In contrast, the levels of Alternaria-specific IgE in tissue with polyps were significantly higher than in nonpolyp tissue. Increases in total tissue IgE paralleled increased levels of Alternaria-specific IgG and IgA antibodies in chronic sinusitis with nasal polyps as compared with control groups. A positive correlation was found between Alternaria-specific IgE and ECP in tissue. Increased mean levels of ECP corresponded to increased eosinophil counts in the group of patients with polyps. CONCLUSIONS:: Alternaria-specific IgE and eosinophilic inflammation in nasal tissue correlates with the incidence of nasal polyps irrespective of specific IgE antibodies in serum. Together, the correlation between the local immune responses and the eosinophilic inflammation in nasal polyps suggests a possible role of Alternaria in the pathogenesis of nasal polyposis
— id: 75309, year: 2008, vol: 118, page: 4, stat: Journal Article,

Construct validity of the endoscopic sinus surgery simulator: II. Assessment of discriminant validity and expert benchmarking
Fried, Marvin P; Sadoughi, Babak; Weghorst, Suzanne J; Zeltsan, Michael; Cuellar, Hernando; Uribe, Jose I; Sasaki, Clarence T; Ross, Douglas A; Jacobs, Joseph B; Lebowitz, Richard A; Satava, Richard M
2007 Apr;133(4):350-357, Archives of otolaryngology, head & neck surgery
OBJECTIVES: To establish discriminant validity of the endoscopic sinus surgery simulator (ES3) (Lockheed Martin, Akron, Ohio) between various health care provider experience levels and to define benchmarking criteria for skills assessment. DESIGN: Prospective multi-institutional comparison study. SETTING: University-based tertiary care institution. PARTICIPANTS: Ten expert otolaryngologists, 14 otolaryngology residents, and 10 medical students. INTERVENTIONS: Subjects completed the ES3's virtual reality curriculum (10 novice mode, 10 intermediate mode, and 3 advanced mode trials). Performance scores were recorded on each trial. Performance differences were analyzed using analysis of variance for repeated measures (experience level as between-subjects factor). MAIN OUTCOME MEASURES: Simulator performance scores, accuracy, time to completion, and hazard disruption. RESULTS: The novice mode accurately distinguished the 3 groups, particularly at the onset of training (mean scores: senior otolaryngologists, 66.0; residents, 42.7; students, 18.3; for the paired comparisons between groups 1 and 2 and groups 1 and 3, P = .04 and .03, respectively). Subjects were not distinguished beyond trial 5. The intermediate mode only discriminated students from other subjects (P = .008). The advanced mode did not show performance differences between groups. Scores on the novice mode predicted those on the intermediate mode, which predicted advanced mode scores (r = 0.687), but no relationship was found between novice and advanced scores. All groups performed equally well and with comparable consistency at the outset of training. Expert scores were used to define benchmark criteria of optimal performance. CONCLUSIONS: This study completes the construct validity assessment of the ES3 by demonstrating its discriminant capabilities. It establishes expert surgeon benchmark performance criteria and shows that the ES3 can train novice subjects to attain those. The refined analysis of trial performance scores could serve educational and skills assessment purposes. Current studies are evaluating the transfer of surgical skills acquired on the ES3 to the operating room (predictive validity)
— id: 126561, year: 2007, vol: 133, page: 350, stat: Journal Article,

Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: A pilot study
Morris, Luc G; Setlur, Jennifer; Burschtin, Omar E; Steward, David L; Jacobs, Joseph B; Lee, Kelvin C
2006 Mar-Apr;20(2):133-137, American journal of rhinology
BACKGROUND: Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance. METHODS: We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients. RESULTS: Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group. CONCLUSION: Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients
— id: 68713, year: 2006, vol: 20, page: 133, stat: Journal Article,

Accuracy and cost analysis of image-guided sinus surgery
Hemmerdinger, Steven A; Jacobs, Joseph B; Lebowitz, Richard A
2005 Jun;38(3):453-460, Otolaryngologic clinics of North America
— id: 56057, year: 2005, vol: 38, page: 453, stat: Journal Article,

Utility of sagittal reformatted computerized tomographic images in the evaluation of the frontal sinus outflow tract
Kanowitz, Seth J; Shatzkes, Deborah R; Pramanik, Bidyut K; Babb, James S; Jacobs, Joseph B; Lebowitz, Richard A
2005 Mar-Apr;19(2):159-165, American journal of rhinology
BACKGROUND: Anatomic and mucosal obstruction of the frontal sinus outflow tract (FSOT) can result in frontal sinusitis often associated with frontal headache. Thorough evaluation of symptomatic patients requires axial and coronal computerized tomographic (CT) scans of the paranasal sinuses (PNS). With the advent of multichannel multidetector CT scanning, the availability of high-quality sagittal images has become increasingly widespread. However, the utility of these images in the assessment of FSOT patency has not yet been established. METHODS: A retrospective review of coronal and sagittal images from 25 PNS CT scans (50 sides) were randomized, blinded, and independently evaluated by two neuroradiologists. FSOT obstruction by agger nasi cells, the ethmoid bulla, and mucosal disease was assessed. A degree of confidence was rendered for each of these findings. The results were then compared against a consensus diagnosis, which was rendered based upon simultaneous reading of the coronal and sagittal images. Generalized estimating equations were used to assess the difference between sagittal and coronal images in terms of reader confidence and diagnostic concordance with the consensus. RESULTS: Review of sagittal images had a higher degree of concordance with the consensus than did coronal images, and was highest for mucosal disease. Both readers were more confident in rendering a diagnosis based upon the sagittal images. CONCLUSION: Sagittal reformatted CT images of the PNS are helpful in the radiologic evaluation of the FSOT. Experienced neuroradiologists had a higher degree of confidence in the diagnosis of the obstruction of the FSOT using sagittal reformatted images
— id: 55966, year: 2005, vol: 19, page: 159, stat: Journal Article,

Nasal obstruction and sleep-disordered breathing: a study using acoustic rhinometry
Morris, Luc G; Burschtin, Omar; Lebowitz, Richard A; Jacobs, Joseph B; Lee, Kelvin C
2005 Jan-Feb;19(1):33-39, American journal of rhinology
BACKGROUND: The relationship between nasal airway function and sleep-disordered breathing (SDB) remains unclear. Although correction of nasal obstruction can significantly improve nighttime breathing in some patients, nasal obstruction may not play a role in all cases of SDB. An effective method of stratifying these patients is needed. Acoustic rhinometry (AR) is a reliable, noninvasive method of measuring the dimensions of the nasal airway. METHODS: In 44 patients, we performed acoustic rhinometric measurements of nasal airway cross-sectional area, followed by hospital-based polysomnography and nasal continuous positive airway pressure (nCPAP) level titration. We compared anatomic nasal obstruction to perceived nasal obstruction, as well as respiratory distress index and nCPAP titration level, using the Pearson correlation and multiple linear regression analysis within body mass index groups. RESULTS: Perceived nasal obstruction correlated significantly with objective anatomic obstruction as measured by AR (r = 0.45, p < 0.01). For certain subgroup analyses in patients with a body mass index below 25, AR measurements correlated significantly with both nCPAP titration pressure (r = 0.85, p < 0.01) and respiratory distress index (r = 0.67, p = 0,03). CONCLUSION: Nasal airway function may be a significant component of SDB in some patients, perhaps playing a larger role in patients who are not overweight. The best responders to nasal surgery for SDB may be nonoverweight patients with nasal obstruction. AR along with nasal examination may be helpful in the evaluation and treatment of the SDB patient
— id: 56058, year: 2005, vol: 19, page: 33, stat: Journal Article,

Initial report of a cranial pin system for frameless image guidance
Burstein MJ; Jacobs JB; Lebowitz RA
2004 ;15(1):71-74, Operative techniques in otolaryngology, head & neck surgery
The use of an intracoperative navigation device improves surgical accuracy, helps identify anatomic landmarks, and minimizes the risk of complications during surgery of the paranasal sinuses and skull base. Despite the benefits of image guidance, its use is limited by the headset, which precludes external surgical access. We report the successful use of a cranial pin placed into the outer table of the calvarium during surgery. This pin eliminates the need for a headset and permits unencumbered external surgical access. We describe a case that used a combined endoscopic and osteoplastic flap approach to the frontal sinus with this cranial pin system. There were no complications associated with placing the pin. The patient reported only minimal postoperative discomfort related to the temporal scalp incision. The cranial pin combines the benefits of surgical navigation with external surgical access to the paranasal sinuses and skull base. (C) 2004 Elsevier Inc. All rights reserved
— id: 46305, year: 2004, vol: 15, page: 71, stat: Journal Article,

Isolation of fungi by standard laboratory methods in patients with chronic rhinosinusitis
Lebowitz, Richard A; Waltzman, Michael N; Jacobs, Joseph B; Pearlman, Aaron; Tierno, Philip M
2002 Dec;112(12):2189-2191, Laryngoscope
OBJECTIVES/HYPOTHESIS: Allergic fungal sinusitis and the role of fungi in the pathogenesis of chronic rhinosinusitis are topics of interest and controversy in rhinology. The classification of chronic rhinosinusitis as either a bacterial infection or an allergic (eosinophilic) reaction to fungi has significant implications for treatment of this disease process. We designed a study to determine whether standard isolation techniques, as employed in a university hospital mycology laboratory, could isolate and identify fungi in the intraoperative specimens from patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. STUDY DESIGN: Forty-five random patients with a diagnosis of chronic rhinosinusitis by clinical and computed tomography criteria underwent endoscopic sinus surgery during 2001, performed by two senior surgeons (J.B.J., R.A.L.). Specimens of mucin, sinus secretions, and/or tissue were obtained intraoperatively and sent to the New York University Medical Center (New York, NY) mycology laboratory for isolation and identification of fungi. METHODS: Specimens were treated with Sputolysin and chloramphenicol; plated on Sabouraud, ChromAgar/Candida, Mycosel, and Niger seed agar plates; and incubated at 30 degrees C (or 37 degrees C) for up to 1 month. RESULTS: We were able to demonstrate the presence of fungi in 56% of intraoperative specimens obtained from patients undergoing surgery for chronic rhinosinusitis. CONCLUSIONS: Using a standard hospital mycology laboratory protocol, which is relatively inexpensive and readily available, fungus can be isolated from a majority of patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Educational statement: Discuss the possible role of fungus in chronic rhinosinusitis and evaluate the efficacy of documenting the presence of fungus in a routine fashion to encourage clinically relevant directed treatments.)
— id: 39361, year: 2002, vol: 112, page: 2189, stat: Journal Article,

Chronic sinusitis complicating sinus lift surgery
Doud Galli SK; Lebowitz RA; Giacchi RJ; Glickman R; Jacobs JB
2001 May-Jun;15(3):181-186, American journal of rhinology
Sinusitis has been reported as a complication of sinus lift surgery with antral bone augmentation. The procedure involves the creation of a submucoperiosteal pocket in the floor of the maxillary sinus for placement of a graft consisting of autogenous, allogenic, or alloplastic material. This can result in inadvertent tearing of the mucoperiosteal flap with extrusion of graft material into the antrum. Obstruction of the sinus outflow tract by mucosal edema and particulate graft material may result in sinusitis. We will discuss the clinical presentation and management of 14 cases of chronic sinusitis following sinus lift surgery with alloplastic hydroxyapatite (HA) augmentation of the maxillary antrum
— id: 21120, year: 2001, vol: 15, page: 181, stat: Journal Article,

Histopathologic evaluation of the ethmoid bone in chronic sinusitis
Giacchi RJ; Lebowitz RA; Yee HT; Light JP; Jacobs JB
2001 May-Jun;15(3):193-197, American journal of rhinology
Chronic rhinosinusitis (CRS) is defined as a condition lasting for a period greater than 12 weeks, and manifested by an inflammatory response involving the mucous membranes of the nasal cavity and paranasal sinuses, fluids within these cavities, and/or the underlying bone. The mucosal changes that occur in CRS have been well described, and include edema, decreased number of ciliated cells, and goblet cell hyperplasia. However, the changes that may occur in the underlying ethmoid bone have only recently been investigated. We evaluated decalcified ethmoid bone specimens from 20 patients undergoing endoscopic sinus surgery for CRS. Our analysis revealed histopathologic changes consistent with varying grades of bone remodeling. Polarized light microscopy demonstrated changes in the extracellular matrix, such as bone resorption and neoosteogenesis. Preoperative clinical data and CT staging were recorded on all patients and correlated with the histopathologic findings. These findings suggest that CRS may be associated with osteitis of the underlying ethmoid bone
— id: 21119, year: 2001, vol: 15, page: 193, stat: Journal Article,

Asymmetry of the ethmoid roof: analysis using coronal computed tomography
Lebowitz, R A; Terk, A; Jacobs, J B; Holliday, R A
2001 Dec;111(12):2122-2124, Laryngoscope
OBJECTIVES/HYPOTHESIS: To determine the incidence and degree of asymmetry in the height and contour of the ethmoid roof. STUDY DESIGN: Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans. METHODS: Retrospective review of 200 consecutive direct coronal sinus CT scans done at New York University Medical Center from July 25, 2000 to October 11, 2000. The height and contour of the fovea ethmoidalis were examined for symmetry between the right and left sides. When an asymmetry in the height of the fovea ethmoidalis existed, this difference was quantified. RESULTS: In 19 scans (9.5%), there was an asymmetry between the height of the fovea ethmoidalis on the right and left sides. Of these 19, 12 (63.2%) were lower on the right side, whereas 7 (36.8%) were lower on the left. Ninety-six patients (48.0%) demonstrated a contour asymmetry with 'flattening' of the ethmoid roof on one side, 46 on the right and 50 on the left. One patient demonstrated both height and contour asymmetry. The fovea ethmoidalis on the remaining 86 scans (43.0%) was symmetric. CONCLUSIONS: In a patient population with sinus and nasal symptoms, the height and contour of the right and left fovea ethmoidalis were symmetric in less than 50% of individuals. The asymmetry was most often the result of a difference in contour with flattening of the fovea on one side. This underscores the importance of careful preoperative and intraoperative review of paranasal sinus CT scans in patients undergoing endoscopic sinus surgery
— id: 111707, year: 2001, vol: 111, page: 2122, stat: Journal Article,

Middle turbinate resection: issues and controversies [In Process Citation]
Giacchi RJ; Lebowitz RA; Jacobs JB
2000 May-Jun;14(3):193-197, American journal of rhinology
Diversity of opinion continues to exist among otolaryngologists regarding the potential benefits of preservation or resection of the middle turbinate during endoscopic ethmoidectomy. Rhinologists in favor of middle turbinate preservation cite the potential loss of olfactory function as well as diminished humidification and filtration of inspired air following its resection. In addition, the middle turbinate remnant could lateralize, causing frontal recess obstruction and frontal sinusitis. In general, it is accepted that a diseased or flail middle turbinate should be resected during ethmoidectomy to create a marsupialized surgical bed. However, in the case of a structurally sound middle turbinate, indications for resection vary significantly. We are reporting on 100 primary endoscopic ethmoidectomies for chronic rhinosinusitis followed for at least 2 years. Of these 100 sides, 50 included conservative partial middle turbinectomy and 50 were performed with middle turbinate preservation. The postoperative clinical and endoscopic findings revealed no difference in the incidence of frontal sinusitis or frontal recess stenosis between groups. We compared additional data and present our technique of conservative middle turbinate resection, which preserves a portion of this structure as an important anatomic landmark
— id: 11607, year: 2000, vol: 14, page: 193, stat: Journal Article,

Mucosal leishmaniasis presenting as sinusitis and optic neuropathy
Huna-Baron R; Warren FA; Miller W; Jacobs J; Green J; Kupersmith MJ
2000 Jun;118(6):852-854, Archives of ophthalmology
— id: 65682, year: 2000, vol: 118, page: 852, stat: Journal Article,

Preoperative sagittal CT evaluation of the frontal recess
Jacobs JB; Lebowitz RA; Sorin A; Hariri S; Holliday R
2000 Jan-Feb;14(1):33-37, American journal of rhinology
Endoscopic surgical approaches for chronic frontal sinusitis require the reestablishment of adequate frontal sinus ventilation and drainage for relief of symptoms. After the resection of anterior ethmoid mucosal disease and cellular structure, the anterior to posterior depth of the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla (frontal sinus ostium) often represents a critical margin for functional success. However, little information concerning this dimension is available. Depending on intraoperative surgical judgment of this distance, extended endoscopic surgical procedures involving additional bone resection may be indicated. These approaches may be hazardous due to the proximity of the cranial cavity and orbit. In addition, secondary stenosis can result from the subsequent inflammatory response. Improved CT imaging, high resolution sagittal reformatting, and computer workstations provide the ability to obtain direct preoperative measurements of the frontal recess. We used a paramedian sagittal section and recorded the maximal anterior to posterior depth from the nasofrontal beak to the base of skull at the insertion of the ethmoidal bulla in 20 patients, 31 sides, undergoing primary endoscopic frontoethmoidectomy. In addition, we found a positive correlation between this distance and agger nasi air cell size measured in the same 31 sides
— id: 11808, year: 2000, vol: 14, page: 33, stat: Journal Article,

The bacteriology of chronic rhinosinusitis: results using a novel culture device
Liu ES; Lebowitz RA; Jacobs JB; Tierno PM
2000 Mar-Apr;14(2):101-105, American journal of rhinology
The bacteriology of chronic rhinosinusitis is an area of great interest among rhinologists. Numerous studies have reported culture results implicating a variety of aerobic and anaerobic organisms in the etiology of this disease process. Sampling is generally accomplished through the nasal cavity, creating the potential for contamination with resident nasal flora. In some reports, strict anaerobic techniques have not been used, possibly accounting for the failure to recover these fastidious organisms. In an attempt to clarify the microbiology of chronic rhinosinusitis, we used a novel culture and transport system in 50 patients undergoing endoscopic sinus surgery. The Accu-CulShure (MLA Systems, Pleasantville, NY, USA) is a self-contained polyethylene culture swab and transport device, capable of collecting a representative sample from the sinus without contamination, and preserving the quality of the material during transport. Our aerobic and anaerobic culture results, as well as pertinent patient data, are presented. The Accu-CulShure device may permit standardization of culture techniques for future studies, and allow for more accurate determination of the microbiology of chronic rhinosinusitis
— id: 11722, year: 2000, vol: 14, page: 101, stat: Journal Article,

Primary amyloidosis presenting as a nasopharyngeal mass
Lim JS; Lebowitz RA; Jacobs JB
1999 May-Jun;13(3):209-212, American journal of rhinology
Amyloid is defined as a pathologic proteinaceous substance which, when deposited between the cells of tissues and organs, leads to various clinical conditions. Immunohistochemistry has allowed for better classification and understanding of the pathophysiology of amyloidosis. In the upper aerodigestive tract, amyloidosis is a rare condition occurring most frequently in the larynx. We present the case of a 42-year-old woman with complete nasal obstruction due to primary nasopharyngeal amyloidosis. This represents the first reported case of primary nasopharyngeal amyloidosis containing both the lambda and kappa immunoglobulin light chains. The clinical and radiologic findings, as well as the management of primary amyloidosis of the upper aerodigestive tract, will be discussed. A review of the literature pertaining to nasal and nasopharyngeal amyloidosis will be presented
— id: 11998, year: 1999, vol: 13, page: 209, stat: Journal Article,

Initial report on postoperative healing after endoscopic sinus surgery with the microdebrider
Bernstein JM; Lebowitz RA; Jacobs JB
1998 Jun;118(6):800-803, Otolaryngology, head & neck surgery
Synechiae formation is a frequent occurrence after endoscopic sinus surgery and may cause symptomatic sinus outflow tract obstruction. Various means are used to reduce the incidence of synechiae formation. These include meticulous operative technique, partial middle turbinate resection, middle meatus spacers or stents, and postoperative debridement. The microdebrider is a powered rotary shaving device that precisely resects tissue, minimizing inadvertent mucosal trauma and stripping. We present 40 cases of endoscopic sinus surgery performed with the microdebrider. Patients had at least a 5-month follow-up and demonstrated rapid mucosal healing, minimal crust formation, and a low incidence of synechiae formation. These initial data suggest that the microdebrider may be advantageous in surgery for chronic sinusitis
— id: 12109, year: 1998, vol: 118, page: 800, stat: Journal Article,

Precisely defining high-risk operable head and neck tumors based on RTOG :85-03 and :88-24: targets for postoperative radiochemotherapy?
Cooper JS; Pajak TF; Forastiere A; Jacobs J; Fu KK; Ang KK; Laramore GE; Al-Sarraf M
1998 Oct;20(7):588-594, Head & neck
BACKGROUND: Local-regional recurrence of disease remains the major obstacle to cure of advanced head and neck cancers. METHODS: This investigation reviewed data derived from Radiation Therapy Oncology Group (RTOG) protocols :85-03 and :88-24 to identify characteristics of tumors that predicted local-regional recurrence of disease following surgery and postoperative radiotherapy (RT). RESULTS: The presence of tumor in two or more lymph nodes, and/or extracapsular spread of nodal disease, and/or microscopic-size tumor involvement of the surgical margins of resection imparts a high risk of local-regional (L-R) relapse. Our data also support the hypothesis that, following surgery, the concurrent addition of chemotherapy (CT) to RT may increase the likelihood of L-R control of disease for patients who have these high-risk characteristics. CONCLUSION: A prospective trial of surgery followed by concurrent RT and CT is warranted for patients who have high-risk characteristics found at surgery
— id: 8023, year: 1998, vol: 20, page: 588, stat: Journal Article,

Conservative approach to inflammatory nasofrontal duct disease
Jacobs JB; Lebowitz RA; Lagmay VM; Damiano A
1998 Aug;107(8):658-661, Annals of otology rhinology & laryngology
Endoscopic data reveal that mucosal disease frequently recurs following the surgical treatment of chronic diffuse hyperplastic frontal sinus and nasofrontal duct disease. However, this group of patients often remains asymptomatic. We present 40 patients who underwent endoscopic sinus surgery with a 4-year mean follow-up. Postoperative endoscopy revealed mucosal disease within the frontal recess in 39 of the 40 (97.5%) patients; however, only 3 of the 40 (7.5%) were symptomatic. Of these 3 patients, 1 underwent revision surgery. Historical information demonstrates the potential for significant nasofrontal duct stenosis associated with such revision surgery. On the basis of our initial results, endoscopic observation and medical therapy seem to be successful in controlling the symptoms associated with this disease process
— id: 7618, year: 1998, vol: 107, page: 658, stat: Journal Article,

Antral augmentation, osseointegration, and sinusitis: the otolaryngologist's perspective
Zimbler MS; Lebowitz RA; Glickman R; Brecht LE; Jacobs JB
1998 Sep-Oct;12(5):311-316, American journal of rhinology
Osseointegrated dental implants are a widely used method of replacing lost or missing teeth. Resorption of the alveolar ridge of the edentulous posterior maxilla may necessitate augmentation before osseointegration to provide adequate bone for implant fixation. This can be accomplished through an intraoral approach to the maxillary sinus, with elevation of the mucosa of the sinus floor creating a pocket for graft placement. Disruption of the intact sinus mucosa may result in sinusitis, graft infection, or extrusion with secondary formation of an oroantral communication. To treat these patients effectively, the otolaryngologist must be aware of the techniques of sinus augmentation and osseointegration as well as the etiology of associated complications. We will discuss the management of four patients with significant sinus complications, and evaluate the otolaryngologist's role in the preoperative and postoperative care of these patients
— id: 7872, year: 1998, vol: 12, page: 311, stat: Journal Article,

An analysis of sites of disease in revision endoscopic sinus surgery
Chu CT; Lebowitz RA; Jacobs JB
1997 Jul-Aug;11(4):287-291, American journal of rhinology
Revision endoscopic sinus surgery is performed when symptoms associated with sinusitis persist after sinus surgery and despite continued medical therapy. The causes of treatment failure are varied and may include systemic, mucosal, and anatomic factors associated with persistent inflammatory disease. The purpose of this retrospective review was to define the sites of recurrent or persistent sinonasal disease in patients undergoing revision endoscopic sinus surgery. This data was based on our preoperative CT scan and nasal endoscopy, as well as intraoperative findings. This study includes an evaluation of the most recent sinus surgery in a group of 153 patients and 265 operated sides. The frequency and distribution of regional anatomic sites of disease is presented and discussed
— id: 7130, year: 1997, vol: 11, page: 287, stat: Journal Article,

100 years of frontal sinus surgery
Jacobs JB
1997 Nov;107(11 Pt 2):1-36, Laryngoscope
The surgical treatment of chronic inflammatory frontal sinus disease over the past century has varied between intranasal and external procedures. There has been constant modification of these techniques; however, a single approach that will lead to relief of symptoms, eradication of disease with preservation of function, and a minimum of deformity has not yet been attained. The functional theory of sinus disease, the evolution of endoscopic techniques, and data provided by the computed tomography scan have renewed our interest in the anatomy of the lateral nasal wall and endonasal surgery. Extensive literature exists concerning the results of ethmoid, maxillary, and sphenoid endoscopic surgery. However, detailed information is not available on the treatment of inflammatory frontal sinusitis. The author presents the results of a retrospective analysis of a series of 101 patients with inflammatory frontal sinusitis who underwent endoscopic surgery that included the frontoethmoid complex. Results for improvement of symptoms as well as endoscopic findings are presented. Relief of symptoms was significant but did not correlate with postoperative endoscopic findings in patients with hyperplastic and polypoid sinusitis. Patients with anterior ethmoid cell encroachment on the frontal sinus outflow tract had a positive correlation between improvement of symptoms and postoperative endoscopic findings. Frontal recess stenosis was associated with a poor outcome. Anatomic obstruction of the frontonasal duct is most consistent with the functional theory of sinusitis
— id: 7172, year: 1997, vol: 107, page: 1, stat: Journal Article,

Aspirin reduces the incidence of second eye NAION: a retrospective study
Kupersmith MJ; Frohman L; Sanderson M; Jacobs J; Hirschfeld J; Ku C; Warren FA
1997 Dec;17(4):250-253, Journal of neuroophthalmology
The objective of this study was to determine if aspirin reduces the incidence of second eye involvement after nonarteritic anterior ischemic optic neuropathy (NAION) in one eye. Records were reviewed of 131 patients who sustained unilateral NAION. Of these, the 33 patients who sustained second eye NAION were compared to those followed for a minimum of 2 years without sustaining a second eye NAION (67). Thirty-one of the 131 patients were excluded because of inadequate follow-up. Except for diabetes (relative risk [RR] 1.43, p = 0.05), the incidence of second eye NAION was independent of gender, age, cup/disk, hypertension, anemia, and migraine. The degree of visual acuity or field dysfunction in the first eye correlated poorly with the acuity (r = 0.28) and field (r = 0.33) loss in the second eye. Aspirin (65-1,300 mg) taken two or more times per week decreased the incidence (17.5% vs. 53.5%) and relative risk (RR = 0.44, p = 0.0002) of second eye AION regardless of the usual risk factors. Even after eliminating those patients who had bilateral disease when first referred, ASA still reduced the incidence of second eye involvement (35% vs. 13%, RR = 0.74, p = 0.01). Aspirin may be an effective means of reducing second eye NAION
— id: 65687, year: 1997, vol: 17, page: 250, stat: Journal Article,

Role of the agger nasi cell in chronic frontal sinusitis
Brunner E; Jacobs JB; Shpizner BA; Lebowitz RA; Holliday RA
1996 Sep;105(9):694-700, Annals of otology rhinology & laryngology
Agger nasi cells contribute to nasofrontal duct (NFD) obstruction and chronic frontal sinus disease. To investigate this relationship, we conducted a review of the surgical outcome and computed tomographic imaging in 26 patients with chronic frontal sinusitis. Coronal and sagittal images were used to delineate the anatomic variability and mucosal disease in the NFD and frontal sinus region. Data from coronal and sagittal images were compared. The results were also correlated with the outcome of frontal sinus surgery in patients with a clinical history of chronic frontal sinus disease. Our data suggest that agger nasi cell pneumatization with narrowing of the frontal sinus outflow tract is a significant cause of persistent frontoethmoid pain and chronic frontal sinusitis. Sagittal reformatted images are more capable than coronal images of demonstrating agger nasi cell encroachment on the NFD, as well as NFD mucosal disease. Endoscopic frontal sinusotomy is an effective treatment for chronic frontal sinus disease
— id: 6985, year: 1996, vol: 105, page: 694, stat: Journal Article,

Anosmia and chronic sinus disease
Downey LL; Jacobs JB; Lebowitz RA
1996 Jul;115(1):24-28, Otolaryngology, head & neck surgery
Chronic sinus disease associated with progressive mucosal disease is often a cause for anosmia. Despite aggressive allergic, medical, and surgical intervention, long-term relief of anosmia has been difficult to document. Fifty patients sought treatment for subjective anosmia and symptoms of progressive sinusitis and underwent endoscopic sinus surgery. After surgery 52% maintained significant improvement in smell by subjective measures that correlated with objective olfactory University of Pennsylvania Small Identification test ('UPSIT') results. Of the remaining patients, some had intermittent improvement, but most remained hyposmic or anosmic despite clinically well-healed ethmoid surgical beds. Of the preoperative and postoperative historical, clinical, and radiological data analyzed, severity of the presenting sinus disease (defined as stage II In the Kennedy staging criteria or disease extending beyond the ethmoids on preoperative computed tomography scan) and persistent mucosal disease in the surgical bed are associated with persistent anosmia (p = 0.005)
— id: 12589, year: 1996, vol: 115, page: 24, stat: Journal Article,

Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer
Fu, K K; Cooper, J S; Marcial, V A; Laramore, G E; Pajak, T F; Jacobs, J; Al-Sarraf, M; Forastiere, A A; Cox, J D
1996 Jun 1;35(3):425-438, International journal of radiation oncology biology physics
During the past 25 years, the Radiation Therapy Oncology Group (RTOG) has played a major role in head and neck cancer clinical research. The major research themes for recent and currently active trials have been: (a) combined modality therapy, (b) altered fractionation radiotherapy, (c) hypoxic cell sensitizers, (d) organ preservation, (e) chemoprevention, and (f) clinical/laboratory correlations. For advanced operable disease, the RTOG showed improved local-regional control with postoperative radiotherapy as compared to preoperative radiotherapy for carcinoma of the supraglottic larynx and hypopharynx. This established the use of surgery followed by postoperative radiotherapy as the standard treatment in subsequent RTOG and Intergroup trials for operable disease. For advanced inoperable disease, the RTOG demonstrated the feasibility of testing altered fractionation radiotherapy in a multiinstitutional clinical trials setting. A Phase III trial comparing hyperfractionation and accelerated fractionation to conventional fractionation is now in progress. Phase I/II combined modality studies established the efficacy of concurrent high-dose cisplatin and radiotherapy in the treatment of advanced disease and provided the basis for further testing in Phase III trials for nasopharyngeal carcinoma, larynx preservation, and high-risk advanced operable disease. Analysis of the extensive RTOG Head and Neck Cancer database established the incidence of second malignancies and their adverse impact on patients whose initial tumors were cured by radiotherapy, and provided the basis for chemoprevention trials. Recursive partitioning analysis identified 6 distinct prognostically homogeneous patient groups based on pretreatment tumor or patient characteristics and/or treatment variables. Retrospective analysis identified tumor p105 antigen density as an independent prognostic indicator in patients irradiated for head and neck cancer. Future trials will continue to focus on the reduction of morbidity and mortality, and improvement of the quality of life of head and neck cancer patients through innovative radiotherapy delivery, multimodality approaches, use of chemical and biological modifiers, and other novel therapies, identification of clinical and biological prognostic indicators, and prevention or diminution of acute morbidity and late complications of the disease and its treatment
— id: 141383, year: 1996, vol: 35, page: 425, stat: Journal Article,

Intracranial inverting papilloma
Miller PJ; Jacobs J; Roland JT Jr; Cooper J; Mizrachi HH
1996 Sep-Oct;18(5):450-453, Head & neck
BACKGROUND: Inverting papillomas usually originate from the lateral wall of the nose and sporadically from the ethmoid, maxillary, sphenoid, or frontal sinuses. Intracranial extension and dural penetration is rare and often associated with recurrent disease that has degenerated into squamous cell carcinoma. A case of inverting papilloma with dural penetration in the absence of malignant degeneration has prompted an investigation into the incidence and treatment of dural invasion by benign inverting papilloma. METHODS: A literature search revealed 1468 cases of inverting papilloma. A detailed analysis was performed to obtain data on the incidence of intracranial invasion. RESULTS: Of the 1468 cases, 5 were noted to be associated with intracranial extension without histologic evidence of malignancy (0.34%). Treatment consisted of surgery alone in 3, radiotherapy in 1, and combined therapy in the last patient. Dural invasion was documented histopathologically in one case. CONCLUSION: Intracranial extension and dural penetration of benign inverting papilloma is extremely rare, and a uniform treatment plan has not been established. Further investigation is necessary in the pathophysiology and management of intracranial inverting papilloma
— id: 12554, year: 1996, vol: 18, page: 450, stat: Journal Article,

Safe and effective infundibulotomy technique
Lebowitz RA; Jacobs JB; Tavin ME
1995 Sep;113(3):266-270, Otolaryngology, head & neck surgery
The ostiomeatal complex has been identified as an important anatomic region in the pathogenesis of sinusitis. Functional endoscopic techniques rely on removal of mucosal disease from this site to improve drainage and aeration. Structural variations and the use of a sharp blade to create the infundibulotomy can result in inadvertent injury to the orbit. To avoid orbital penetration we perform the infundibulotomy with a curved, blunt dental elevator and displace the uncinate with its medial and lateral mucosa toward the middle turbinate. This stretches the infundibulum to reveal the maxillary ostium at its depth. The remaining mucosal attachments of the uncinate process are then incised under direct vision, and the complex is resected, creating an initial wide antrostomy. This technique has avoided orbital penetration in 700 cases in patients with early or late stages of mucosal disease
— id: 6838, year: 1995, vol: 113, page: 266, stat: Journal Article,

ALLERGIC MUCIN SINUSITIS WITHOUT FUNGUS
MARCELLI, A; LEBOWITZ, R; MIZRACHI, H; JACOBS, J; FEINER, H
1995 JAN ;72(1):A103-A103, Laboratory investigation
— id: 87431, year: 1995, vol: 72, page: A103, stat: Journal Article,

ASPIRIN REDUCES ANTERIOR ISCHEMIC OPTIC NEUROPATHY (AION) IN THE 2ND EYE
SANDERSON, M; KUPERSMITH, M; FROHMAN, L; JACOBS, J; HIRSCHFELD, J; KU, C; WARREN, F
1995 MAR 15 ;36(4):S196-S196, Investigative ophthalmology & visual science. IOVS
— id: 87331, year: 1995, vol: 36, page: S196, stat: Journal Article,

Metastatic basal cell carcinoma of the head and neck
Tavin E; Persky MS; Jacobs J
1995 Aug;105(8 Pt 1):814-817, Laryngoscope
Metastases are occasionally associated with cutaneous squamous cell carcinoma but only rarely with basal cell carcinoma. There are approximately 200 cases of metastases from basal cell carcinoma reported in the world literature. We describe 6 additional cases. All of our patients demonstrated recurrence at the primary site before they developed their metastases. Metastases presented in subcutaneous tissue, cervical lymph nodes, bone, and lung between 1.5 and 14 years after initial treatment of the primary lesion. The long interval seen in these patients between the initial treatment of the primary and the development of metastases underscores the need for long-term follow-up in what is often thought to be a nonaggressive, nonmetastasizing malignancy
— id: 6870, year: 1995, vol: 105, page: 814, stat: Journal Article,

Comparison of functional endoscopic sinus surgery under local and general anesthesia
Gittelman PD; Jacobs JB; Skorina J
1993 Apr;102(4 Pt 1):289-293, Annals of otology rhinology & laryngology
We present a retrospective comparison of intravenous sedation and general anesthesia techniques employed at New York University-Bellevue Medical Center for functional endoscopic sinus surgery. Some authors have stressed the use of local anesthesia with intravenous sedation in order to avoid complications and reduce blood loss. We have reviewed 232 patients who underwent 401 consecutive ethmoidectomies and maxillary antrostomies. Local anesthesia, employed in 64% of patients, carried an estimated blood loss of 23 mL per side. General anesthesia was associated with an average blood loss of 58 mL per side. The rate of operative complications for local anesthesia was 8.7% per patient, with a 1.6% rate of major complications per side. General anesthesia carried an overall complication rate of 2.4% per patient, with no major complications. General anesthesia is a relatively safe and viable option for endoscopic sinus surgery that in selected cases may be preferable to local anesthesia
— id: 13202, year: 1993, vol: 102, page: 289, stat: Journal Article,

RHINOMANOMETRIC AND CLINICAL-EVALUATION OF TRIAMCINOLONE ACETONIDE AND BECLOMETHASONE DIPROPIONATE IN RHINITIS
LEBOWITZ, RA; JACOBS, JB
1993 MAY-JUN ;7(3):121-124, American journal of rhinology
A prospective randomized study comparing the effectiveness of triamcinolone acetonide and beclomethasone dipropionate nasal sprays in the treatment of allergic or vasomotor rhinitis was conducted at New York University Medical Center Both medications were used at their recommended dosages. Fifty patients were evaluated during a 2-month treatment period. Nasal airflow and resistance were quantified by anterior active rhinomanometry using the Rhinotest microprocessor rhinomanometer. The patients' subjective complaints were graded on a standard questionnaire. Both steroid inhalants were highly effective in relieving local symptomatology and the subjective improvement in nasal obstruction correlated with rhinomanometric assessment of the nasal airway. Triamcinolone acetonide used once daily represents an alternative to the twice daily beclomethasone dipropionate nasal steroid spray currently available for the treatment of rhinitis
— id: 54112, year: 1993, vol: 7, page: 121, stat: Journal Article,

MINIPLATE FIXATION OF ZYGOMATIC FRACTURES - REPLY
JACOBS, JB
1992 SEP-OCT ;14(5):420-420, Head & neck
— id: 51913, year: 1992, vol: 14, page: 420, stat: Journal Article,

SINUS DISEASE IN THE IMMUNOCOMPROMISED HOST
KOHAN, D; SKORINA, JMG; JACOBS, JB; LEBOWITZ, A; ROTHSTEIN, SG
1992 MAY-JUN ;6(3):115-118, American journal of rhinology
Sinusitis in the immunocompromised person can be a fulminant or even fatal illness. Aggressive treatment with intravenous antibiotics and surgery is often warranted. We report 13 cases of sinusitis in immunocompromised patients who, having failed medical treatment, required surgical management of their sinus disease. Among the patients whose sinuses were cultured intraoperatively, 63% grew Staphylococcus aureus. Most of the patients showed improvement in their infections, and none had complications of surgery
— id: 51883, year: 1992, vol: 6, page: 115, stat: Journal Article,

Streptococcal gangrene of the head and neck: a case report and review of the literature [see comments]
Miles LT; Jacobs JB; Gittelman PD; Lebowitz AS
1992 Mar-Apr;14(2):143-147, Head & neck
Necrotizing bacterial infections that occur in the head and neck are exceedingly rare and are often associated with a group A beta-hemolytic streptococcus (Streptococcus pyogenes). The disease is associated with soft tissue necrosis and vascular thrombosis. There appears to be an increasing incidence of hyperaggressive beta hemolytic streptococcal infections associated with high mortality rates. We report the survival of an otherwise healthy patient who developed a flu-like illness followed by a rapidly progressive toxic systemic illness associated with subtotal facial soft tissue necrosis down to bone. The recent literature related to this necrotizing bacterial infection is reviewed. Otolaryngologists must be aware of this entity since survival depends upon aggressive early wound management and high-dose intravenous antibiotics
— id: 13663, year: 1992, vol: 14, page: 143, stat: Journal Article,

Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host
Tyson JC; Gittelman PD; Jacobs JB; Holliday R; Press R
1992 Jul;107(1):115-119, Otolaryngology, head & neck surgery
— id: 13536, year: 1992, vol: 107, page: 115, stat: Journal Article,

Miniplate fixation of zygomatic fractures [see comments]
Berman PD; Jacobs JB
1991 Sep-Oct;13(5):424-426, Head & neck
The availability and application of miniplate systems for the repair of displaced zygomatic fractures may effect commonly accepted guidelines for fixation of these injuries. A retrospective review of 20 patients at New York University-Bellevue Medical Center was conducted to further delineate issues concerning surgical repair and fixation. Our experience with one- and two-point fixation is evaluated and guidelines are presented
— id: 13907, year: 1991, vol: 13, page: 424, stat: Journal Article,

Staphylococcus aureus nasal carriage in patients with rhinosinusitis
Gittelman PD; Jacobs JB; Lebowitz AS; Tierno PM Jr
1991 Jul;101(7 Pt 1):733-737, Laryngoscope
Toxic shock syndrome has been associated with rhinologic surgery and medical devices, and it has been linked to a circulating exotoxin of a toxogenic strain of Staphylococcus aureus. One hundred forty patients with rhinosinusitis were studied. Nasal cultures were obtained. The microbiological characteristics are described. The carrier rate for Staphylococcus aureus was 35%. Thirty percent of patients selected for surgery were Staphylococcus aureus carriers. Toxin-capable isolates were identified in 40% of those tested. Users of cocaine, topical decongestants, and steroid sprays had a statistically higher rate of Staphylococcus aureus carriage compared to nonusers. It is hoped that by identifying the population at risk and defining the factors associated with the development of toxic shock syndrome, a cogent policy of prevention can be established
— id: 13967, year: 1991, vol: 101, page: 733, stat: Journal Article,

Giant keratoacanthoma: an atypical presentation
Edelman BA; Jacobs JB; Rotterdam H; Auerbach R
1990 Sep;103(3):472-475, Otolaryngology, head & neck surgery
— id: 38361, year: 1990, vol: 103, page: 472, stat: Journal Article,

Destructive cemento-ossifying fibroma of the maxilla
Jacobs JB; Berg HM
1990 Dec;69(12):805-808, Ear, nose & throat journal
— id: 14270, year: 1990, vol: 69, page: 805, stat: Journal Article,

EVALUATION OF THE POLICY OF EMPIRIC TREATMENT OF SUSPECTED TOXOPLASMA ENCEPHALITIS IN PATIENTS WITH THE ACQUIRED IMMUNODEFICIENCY SYNDROME
Cohn, JA; Mcmeeking, A; Cohen, W; Jacobs, J; Holzman, RS
1989 May;86(5):521-527, American journal of medicine
— id: 31774, year: 1989, vol: 86, page: 521, stat: Journal Article,

Evaluation of the frontonasal duct in frontal sinus fractures
Heller EM; Jacobs JB; Holliday RA
1989 Jan-Feb;11(1):46-50, Head & neck
Successful management of frontal sinus fractures depends on correct identification of structural pathology, which may lead to inflammatory complications. Obstruction of the frontonasal duct is a significant factor predisposing to such complications and its evaluation is thus critical in the management of these fractures. Specific radiographic CT criteria and an intraoperative dye irrigation test are presented to determine the likelihood of frontonasal duct injury. Eighteen cases of frontal sinus fractures are reviewed, which have been treated based on these principles. A scheme is presented outlining the management of frontal sinus trauma using these methods
— id: 10799, year: 1989, vol: 11, page: 46, stat: Journal Article,

Rhinomanometric evaluation of two nasal steroid sprays in rhinitis
Kohan D; Jacobs JB; Nass RL; Gonzalez S
1989 Oct;101(4):429-433, Otolaryngology, head & neck surgery
A prospective, randomized study comparing the effectiveness of two nasal steroid sprays, flunisolide and beclomethasone dipropionate, in the treatment of nasal obstruction associated with allergic or vasomotor rhinitis has been conducted at New York University Medical Center-Bellevue Hospital. All patients underwent routine history and physical examinations and a modified radioallergosorbent test. Paranasal sinus films were used to exclude patients with sinusitis. The Rhinotest microprocessor rhinomanometer was used to quantify pretreatment and posttreatment total nasal air flow and resistance during a period of 2 months. These findings were assessed in conjunction with the patients' subjective complaints. Results demonstrated that anterior rhinomanometric assessment of the nasal airway during inhalant therapy correlated well with the patients' own subjective impressions of nasal air flow. Both steroid inhalants were effective; however, flunisolide provided for earlier and more substantial symptomatic relief. Beclomethasone dipropionate had milder side effects
— id: 10487, year: 1989, vol: 101, page: 429, stat: Journal Article,

The use of Gore-Tex implants in nasal augmentation operations
Rothstein, S G; Jacobs, J B
1989 Sep;:40, 42, 44-5, Ear, nose & throat journal
— id: 106394, year: 1989, vol: , page: 40, 42, 44, stat: Journal Article,

Toxic shock syndrome in nasal surgery: a physiochemical and microbiologic evaluation of Merocel and NuGauze nasal packing
Breda SD; Jacobs JB; Lebowitz AS; Tierno PM Jr
1987 Dec;97(12):1388-1391, Laryngoscope
A prospective comparison of the microbiologic safety of Merocel versus NuGauze nasal packing in 119 surgical patients is presented. Presurgical and postsurgical nasal cultures were obtained, analyzed, and compared. The importance of a preoperative nasal culture isolate of Toxic Shock Syndrome Toxin Number 1 (TSST-1) producing Staphylococcus aureus in predicting postoperative toxigenic S. aureus isolation and Toxic Shock Syndrome symptomatology is demonstrated. An in vitro comparison of the ability of NuGauze and Merocel to amplify TSST-1 production was performed
— id: 11300, year: 1987, vol: 97, page: 1388, stat: Journal Article,

Carotid sinus hypersensitivity secondary to parapharyngeal space carcinoma
Rothstein, S G; Jacobs, J B; Reede, D L
1987 Jul-Aug;9(6):332-335, Head & neck surgery
Carotid sinus hypersensitivity secondary to the presence of head and neck carcinoma has been recently reviewed in the otolaryngologic literature. We present a case of carotid sinus hypersensitivity coupled with glossopharyngeal neuralgia due to tonsillar carcinoma invading the parapharyngeal space. Medical management with atropine, carbamazepine, and transvenous pacing was only moderately successful in controlling the symptomatology. Surgery appeared to offer a more permanent solution to the problem
— id: 106395, year: 1987, vol: 9, page: 332, stat: Journal Article,

Correlation of fine needle aspiration biopsy and CT scanning of parotid masses
Berg, H M; Jacobs, J B; Kaufman, D; Reede, D L
1986 Dec;96(12):1357-1362, Laryngoscope
Preoperative evaluation of parotid tumors still poses difficult problems for the head and neck surgeon. The complex anatomy of the parotid space leads to difficulty in localizing these tumors. In addition, physical examination will rarely determine whether a parotid lesion is benign or malignant. High resolution CT scanning with contrast and fine needle aspiration can provide enough preoperative information to enable the surgeon to counsel his patient concerning possible risks and the extent of surgery that may be indicated. We are able to determine tumor location, multiple or bilateral masses, associated adenopathy, and often specific tumor histology. Forty-two parotid aspirates and 26 CT scans were reviewed and correlated with their postoperative pathology specimen. Parotid aspiration cytology was found to be a highly accurate and safe procedure for preoperative determination of parotid pathology. However, the CT scan was specific only in defining the anatomic localization and extent of a parotid mass
— id: 145529, year: 1986, vol: 96, page: 1357, stat: Journal Article,

Oncocytic adenoma of the parotid gland with psammoma bodies
Feiner, H D; Goldstein, S; Ittman, M; Pelton, K; Jacobs, J
1986 Jul;110(7):640-644, Archives of pathology & laboratory medicine
An unusual slow-growing tumor was found in the superficial lobe of the right parotid gland. It was multilobulated and encapsulated and consisted of sheets of epithelial oncocytes and minor foci of myoepithelium and ducts. Psammoma bodies were abundant. An antibody directed against keratin protein was localized in all tumor cells and in ductal but not acinar elements of adjacent parotid tissue. Ultrastructurally, the neoplastic cells proved to be ductal epithelial and myoepithelial oncocytes
— id: 129343, year: 1986, vol: 110, page: 640, stat: Journal Article,

The modified rhytidectomy incision as an approach to buccal space masses
Myssiorek, D; Jacobs, J B
1986 Oct;65(10):463-467, Ear, nose & throat journal
— id: 73772, year: 1986, vol: 65, page: 463, stat: Journal Article,

Cricopharyngeal myotomy: a review of surgical results in patients with cricopharyngeal achalasia of neurogenic origin
Berg, H M; Jacobs, J B; Persky, M S; Cohen, N L
1985 Nov;95(11):1337-1340, Laryngoscope
Cricopharyngeal myotomy is an effective procedure for the treatment of swallowing disorders due to dysfunction of the upper esophageal sphincter and pharyngeal musculature. Eight patients with documented pharyngeal and sphincteric dysfunction have undergone myotomies with significant improvement in swallowing associated with restoration of oral feeding without aspiration in 5, while 3 patients have not improved. The preoperative work-up and evaluation is discussed as well as criteria that may identify those patients most likely to benefit from this treatment
— id: 145531, year: 1985, vol: 95, page: 1337, stat: Journal Article,

Restoration of speech discrimination following suboccipital, transmeatal excision of extracanalicular acoustic neuroma
Cohen, N L; Ransohoff, J; Jacobs, J
1985 Feb;93(1):126-131, Otolaryngology, head & neck surgery
— id: 67637, year: 1985, vol: 93, page: 126, stat: Journal Article,

Trousseau's syndrome in the head and neck
Liu, P G; Jacobs, J B; Reede, D
1985 Sep-Oct;6(5):405-408, American journal of otolaryngology
Thromboses in Trousseau's syndrome are typically confined to the vascular system of the extremities and viscera. The authors report a case of sequential bilateral internal and external jugular-vein thromboses secondary to this paraneoplastic hypercoagulable state. The etiologies of commonly encountered head and neck venous thromboses are infection, trauma, and obstruction. This article purports that head and neck venous thromboses without a proximal inflammatory or mechanical cause may be the initial manifestation of an occult malignancy. Upon establishing the presence of a hypercoagulable state, further evaluation may lead to the early diagnosis of such an occult malignancy
— id: 145530, year: 1985, vol: 6, page: 405, stat: Journal Article,

Congenital facial hemihypertrophy: report of a case with airway compromise
Sculerati, N; Jacobs, J B
1985 Nov-Dec;8(2):124-128, Head & neck surgery
Facial hemihypertrophy, first described by Beck in 1836, aroused some interest in the early part of this century among European and American clinicians. However, a search of the otolaryngologic literature failed to reveal hemihypertrophy of the head and neck area as a well-recognized entity. We recently encountered a case of hemifacial hypertrophy in a 2-year-old. The child presented with airway compromise and swallowing difficulty. The treatment of this child and a review of associated head and neck findings are discussed
— id: 145533, year: 1985, vol: 8, page: 124, stat: Journal Article,

Chondrosarcoma of the nasal septum: a case report
Beneck, D; Seidman, I; Jacobs, J
1984 Dec;7(2):162-167, Head & neck surgery
Chondrosarcoma arising in the nasal septum has been previously described only 11 times. In this report, another case occurring in an 89-year-old man is discussed. The rarity of such a tumor arising in previously normal cartilage is emphasized. Prognostic factors and surgical treatment are discussed
— id: 145534, year: 1984, vol: 7, page: 162, stat: Journal Article,

Pneumatic dilatation as the primary treatment for achalasia
Jacobs, J B; Cohen, N L; Mattel, S
1983 Jul-Aug;92(4 Pt 1):353-356, Annals of otology rhinology & laryngology
Pneumatic dilatation under fluoroscopic control has proven highly successful in the treatment of achalasia. This procedure involves minimal morbidity, local anesthesia is employed, and hospitalization is brief, usually only two days. Surgical myotomy of the lower esophageal sphincter, the Heller procedure, requires a thoracotomy under general anesthesia with its attendant morbidity and at least ten days of hospitalization. In addition, there is a significant incidence of postoperative gastric reflux. We have employed pneumatic dilatation as the sole primary treatment for 30 patients over the last 10 years. The results have been highly successful with marked relief of symptoms and weight gain. Pneumatic dilatation is an effective treatment for achalasia and is recommended as the initial procedure of choice
— id: 145535, year: 1983, vol: 92, page: 353, stat: Journal Article,

Traumatic pneumocephalus
Jacobs, J B; Persky, M S
1980 Mar;90(3):515-521, Laryngoscope
— id: 145532, year: 1980, vol: 90, page: 515, stat: Journal Article,

Treatment of radiation-induced alopecia
Jacobs, J B; Monell, C
1979 Nov-Dec;2(2):154-159, Head & neck surgery
Radiotherapy is frequently employed in the management of head and neck neoplasia, either as an adjunct to surgery or as the sole treatment modality. Consequently, radiation alopecia--a well-known complication of high-dosage radiotherapy--is seen often. Longer patient survival, especially with earlier discovery of the malignancy and more refined treatment regimens, will provide the surgeon with the opportunity to treat radiation alopecia by means of the punch graft technique of hair transplantation. The technique is substantially similar to that employed in treating male pattern baldness, although the approach to the recipient and donor areas must be modified. A successful case report is documented and a modified approach is highlighted
— id: 145536, year: 1979, vol: 2, page: 154, stat: Journal Article,