Sarah K Wise

Emory University, Atlanta, Georgia, United States

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Publications (49)61.26 Total impact

  • Neurosurgery 12/2014; 10 Suppl 4:654. · 2.53 Impact Factor
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    ABSTRACT: Background Allergic fungal rhinosinusitis (AFRS) is a disease demonstrating substantial eosinophilic inflammation and characteristic radiographic bony erosion/expansion. Periostin is an extracellular matrix protein associated with eosinophil accumulation in eosinophilic esophagitis, allergic asthma mucus production, and chronic rhinosinusitis (CRS) polyp formation. Receptor activator of nuclear factor κ-B ligand (RANKL) is an osteoclast activator present in osteoporosis and periodontal disease. We sought to evaluate periostin and RANKL expression in AFRS and correlate these levels with radiographic scales of disease severity.Methods Thirty sinus tissue specimens were intraoperatively collected from 3 patient groups: AFRS; CRS without nasal polyps (CRSsNP); and controls (n = 10 per group). Specimens were analyzed by semiquantitative reverse-transcription polymerase chain reaction (sq-RT-PCR) and immunofluorescence (IF) labeling/confocal microscopy for the presence of both periostin and RANKL. Immunofluorescence staining intensity was quantified by pixel density analysis. Preoperative computed tomography (CT) scans from each patient were scored using both the Lund-Mackay and CT bone erosion scoring systems.ResultsPeriostin was significantly elevated in AFRS sinus tissue compared to CRSsNP and controls, as demonstrated by IF (p < 0.001) and PCR (p = 0.011). RANKL was not detected in sinus tissue by IF or PCR. Periostin levels positively correlated with radiographic indices of disease severity for both soft tissue and bone, using Lund-Mackay (r = 0.926 [PCR] and r = 0.581 [IF]) and CT bone erosion (r = 0.672 [PCR] and r = 0.616 [IF]) scoring systems, respectively.Conclusion Periostin is increased in AFRS tissue compared to CRSsNP and controls. Periostin levels positively correlate with radiologic disease severity scores. The increased levels of periostin in AFRS are possibly tied to its intense eosinophilic inflammatory etiology.
    International Forum of Allergy and Rhinology 07/2014; · 1.00 Impact Factor
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    ABSTRACT: Altered expression of epithelial intercellular junction proteins has been observed in sinonasal biopsies from nasal polyps and epithelial layers cultured from nasal polyp patients. These alterations comprise a "leaky" epithelial barrier phenotype. We hypothesize that T helper 2 (Th2) cytokines interleukin (IL)-4 and IL-13 modulate epithelial junction proteins, thereby contributing to the leaky epithelial barrier. Differentiated primary sinonasal epithelial layers cultured at the air-liquid interface were exposed to IL-4, IL-13, and controls for 24 hours at 37°C. Epithelial resistance measurements were taken every 4 hours during cytokine exposure. Western blot and immunofluorescence staining/confocal microscopy were used to assess changes in a panel of tight and adherens junction proteins. Western blot densitometry was quantified with image analysis. IL-4 and IL-13 exposure resulted in a mean decrease in transepithelial resistance at 24 hours to 51.6% (n = 6) and 68.6% (n = 8) of baseline, respectively. Tight junction protein junctional adhesion molecule-A (JAM-A) expression decreased 42.2% with IL-4 exposure (n = 9) and 37.5% with IL-13 exposure (n = 9). Adherens junction protein E-cadherin expression decreased 35.3% with IL-4 exposure (n = 9) and 32.9% with IL-13 exposure (n = 9). Tight junction protein claudin-2 showed more variability but had a trend toward higher expression with Th2 cytokine exposure. There were no appreciable changes in claudin-1, occludin, or zonula occludens-1 (ZO-1) with IL-4 or IL-13 exposure. Sinonasal epithelial exposure to Th2 cytokines IL-4 and IL-13 results in alterations in intercellular junction proteins, reflecting increased epithelial permeability. Such changes may explain some of the phenotypic manifestations of Th2-mediated sinonasal disease, such as edema, nasal discharge, and environmental reactivity.
    International Forum of Allergy and Rhinology 02/2014; · 1.00 Impact Factor
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    ABSTRACT: BACKGROUND: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. METHODS: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery-otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. RESULTS: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. CONCLUSION: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.
    American Journal of Rhinology and Allergy 05/2013; 27(3):202-205.
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    ABSTRACT: BACKGROUND: Epithelial permeability is highly dependent upon the integrity of tight junctions, which are cell-cell adhesion complexes located at the apical aspect of the lateral membrane of polarized epithelial cells. We hypothesize that sinonasal epithelial exposure to Der p 1 house dust mite antigen decreases expression of tight junction proteins (TJPs), representing a potential mechanism for increased permeability and presentation of antigens across the sinonasal epithelial layer. METHODS: Confluent cultured primary human sinonasal epithelial cells were exposed to recombinant Der p 1 antigen vs control, and transepithelial resistance measurements were performed over 24 hours. Antibody staining for a panel of TJPs was examined with immunofluorescence/confocal microscopy and Western blotting. Tissue for these experiments was obtained from 4 patients total. RESULTS: Der p 1 exposed sinonasal cells showed a marked decrease in transepithelial resistance when compared to control cells. In addition, results of Western immunoblot and immunofluorescent labeling demonstrated decreased expression of TJPs claudin-1 and junction adhesion molecule-A (JAM-A) in Der p 1-exposed cultured sinonasal cells vs controls. CONCLUSION: Der p 1 antigen exposure decreases sinonasal epithelium TJP expression, most notably seen in JAM-A and claudin-1 in these preliminary experiments. This decreased TJP expression likely contributes to increased epithelial permeability and represents a potential mechanism for transepithelial antigen exposure in allergic rhinitis.
    International Forum of Allergy and Rhinology 04/2013; · 1.00 Impact Factor
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    ABSTRACT: BACKGROUND: Prolonged healing and persistent inflammation following surgery for rhinosinusitis impacts patient satisfaction and healthcare resources. Cytokines interleukin (IL)-4, IL-5, and IL-13 are important mediators in T-helper 2 (Th2) inflammatory rhinosinusitis. Decreased wound healing has been demonstrated with Th2 cytokine exposure, but this has not been extensively studied in sinonasal epithelium. We hypothesized that in vitro exposure of primary sinonasal epithelial cell cultures to Th2 inflammatory cytokine IL-4 and IL-13 would impair wound resealing and decrease expression of annexin A2 at the wound edge. METHODS: Following 24-hour exposure to IL-4, IL-5, or IL-13 vs controls, sterile linear mechanical wounds were created in primary sinonasal epithelial cultures (n = 12 wounds per condition). Wounds were followed for 36 hours or until complete closure, and residual wound areas were calculated by image analysis. Group differences in annexin A2 were assessed by immunofluorescence labeling, confocal microscopy, and Western blots. RESULTS: Significant wound closure differences were identified across cytokine exposure groups (p < 0.001). Mean percentage wound closure at the completion of the 36-hour time course was 98.41% ± 3.43% for control wounds vs 85.02% ± 18.46% for IL-4 exposed wounds. IL-13 did not significantly impair sinonasal epithelial wound resealing in vitro. Annexin A2 protein levels were decreased in IL-4 treated wounds when compared to control wounds (p < 0.01). CONCLUSION: Th2 cytokine IL-4 decreases sinonasal epithelial wound closure in vitro. Annexin A2 is also diminished with IL-4 exposure. This supports the hypothesis that IL-4 exposure impairs sinonasal epithelial wound healing and may contribute to prolonged healing in Th2 inflammatory rhinosinusitis.
    International Forum of Allergy and Rhinology 03/2013; · 1.00 Impact Factor
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    ABSTRACT: PURPOSE OF REVIEW: Sublingual immunotherapy (SLIT) has been shown to be a new and promising treatment for people with various allergic syndromes. Several studies have examined its efficacy. However, significantly fewer investigations have explored its specific impact on the patient's quality of life (QOL). RECENT FINDINGS: SLIT has an excellent safety profile, superior in many ways to subcutaneous immunotherapy (SCIT). Additionally, SLIT significantly decreases the use of allergy medications, as well as decreasing the money spent on allergy symptom control. Finally, SLIT has been shown to improve the patient's QOL when compared to placebo or even second-generation antihistamines. SUMMARY: Increasing data support the use of SLIT as a well tolerated, cost-effective, and time-efficient modality for the treatment of multiple allergic syndromes. However, additional studies are needed, particularly QOL studies which compare SLIT to the FDA-approved SCIT.
    Current opinion in otolaryngology & head and neck surgery 02/2013;
  • Kara K Prickett, Sarah K Wise
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    ABSTRACT: Successful endoscopic repair of the skull base may be performed with a variety of grafting materials. Graft materials discussed in this chapter are broadly categorized as autologous tissue, acellular human dermis, engineered collagen products, rigid support materials and tissue glues. Autologous tissues continue to be widely used due to their safety, availability, and low cost. Engineered collagen products and acellular dermis are favored in revision cases and larger repairs. The need for rigid support continues to be an area of controversy as pedicled grafts are increasingly used for larger defects. Tissue glues and sealants, however, are used by many authors. The components of, and evidence for, commonly used sealants are detailed. Relatively little high-quality, comparative evidence exists to guide decision making when selecting graft materials, but where available, this evidence is cited. If surgeon experience and patient characteristics are carefully considered, excellent results can be expected with most materials.
    Advances in Oto-Rhino-Laryngology 01/2013; 74:24-32.
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    ABSTRACT: OBJECTIVE To ascertain the effect of endoscopic sinus surgery (ESS) on lung function, intravenous (IV) antibiotic use, and hospitalization in adults with cystic fibrosis (CF). DESIGN Retrospective analysis. SETTINGS Tertiary care center. PATIENTS Fifteen adults with a diagnosis of CF undergoing ESS between March 1, 2006, and June 31, 2008. MAIN OUTCOME MEASURES Twelve-month preoperative and 12-month postoperative pulmonary function testing (forced vital capacity [FVC] and forced expired volume in 1 second [FEV1]), number of IV antibiotic courses, total number of days of intravenous antibiotic use, and number of inpatient hospital days (IHDs) were assessed. RESULTS Twenty-two adults with CF underwent ESS; 15 patients had adequate data for evaluation. No significant differences were found between mean preoperative and postoperative FEV1 (61.3% vs 59.5%; P = .41) or FVC (76.4% vs 76.1%; P = .97) or between best preoperative and postoperative FEV1 (67.4% vs 67.0%; P = .95) or FVC (84.2% vs 83.0%; P = .86) (paired samples t test). The number of IV antibiotic courses and the total number of days of IV antibiotic use did not differ between the preoperative and postoperative periods (Wilcoxon signed rank test P = .61 and P = .10, respectively). However, the number of IHDs was significantly lower in the 1-year postoperative period (36.7 days) vs the 1-year preoperative period (59.1 days) (Wilcoxon signed rank test, z = -2.20, P = .03). CONCLUSIONS This preliminary study of ESS in adult CF patients indicates significant reduction in the number of IHDs in the postoperative period. However, there is no evidence that ESS improved lung function or the need for IV antibiotics.
    Archives of otolaryngology--head & neck surgery 12/2012; 138(12):1167-70. · 1.92 Impact Factor
  • Sarah K Wise, Rodney J Schlosser
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    ABSTRACT: In this article, the authors review the current evidence regarding the public health and economic impact of allergic rhinitis. Diagnostic methods for allergic disease are discussed as well as certain nuances of allergy skin testing protocols. In addition, the evidence supporting sublingual immunotherapy (SLIT) for allergic rhinitis is reviewed, with subsequent attention to certain subgroups, such as adults and children, seasonal versus perennial allergens, and SLIT efficacy for individual antigens. The authors consider the evidence supporting appropriate SLIT dosing as well as the existing data on SLIT safety.
    Otolaryngologic Clinics of North America 10/2012; 45(5):1045-54. · 1.46 Impact Factor
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    ABSTRACT: BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammatory upper-airway disease with numerous etiologies. Patients with a characteristic subtype of CRS, allergic fungal rhinosinusitis (AFRS), display increased expression of T helper 2 (Th2) cytokines and antigen-specific immunoglobulin E (IgE). Various sinonasal inflammatory conditions are associated with alterations in epithelial barrier function. The aim of this study was to compare epithelial permeability and intercellular junctional protein expression among cultured primary sinonasal cells from AFRS patients vs noninflammatory controls. METHODS: Epithelial cells isolated from paranasal sinus mucosa of AFRS and noninflammatory control patients were grown to confluence on permeable supports and transitioned to air-liquid interface (ALI). Transepithelial resistance (TER) was measured with a horizontal Ussing chamber to characterize the functional permeability of each cell type. After TER recordings were complete, a panel of intercellular junctional proteins was assessed by Western blot and immunofluorescence labeling followed by confocal microscopy. RESULTS: After 12 samples were measured from each group, we observed a 41% mean decrease in TER in AFRS cells (296 ± 89 ohms × cm(2) ) compared to control (503 ± 134 ohms × cm(2) , p = 0.006). TER deficits observed in AFRS were associated with decreased expression of the tight junction proteins occludin and junctional adhesion molecule-A (JAM-A), and increased expression of a leaky tight junction protein claudin-2. CONCLUSION: Cultured sinonasal epithelium from AFRS patients displayed increased epithelial permeability and altered expression of intercellular junctional proteins. Given that these cells were not incubated with inflammatory cytokines in vitro, the cultured AFRS epithelial alterations may represent a retained modification in protein expression from the in vivo phenotype. © 2012 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 08/2012; · 1.00 Impact Factor
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    ABSTRACT: Analyses of office-based procedures in laryngology and otology have shown them to be safe and satisfying for patients, with substantial savings of time and money for patients and physicians. The objectives of this study were to compare the billable charges and reimbursement for rhinologic procedures performed in the office with charges for procedures performed in an ambulatory surgery center operating room (OR). A retrospective, matched-pair cost analysis was performed. Patients who underwent office-based procedures between 2006 and 2011 were matched by Current Procedural Terminology® (CPT) code with patients who underwent similar procedures in the OR. Twenty-nine matched pairs were included. Charges for surgery, anesthesia, and facility usage were analyzed. Because surgery charges may be influenced by contracts with insurance providers, both the total billed charges and total allowed charges were analyzed using paired t tests. When a single office-based procedure was compared with multiple procedures performed during the same operation in the OR, anesthesia and facility charges were scaled to allow for more accurate comparison. Mean total charges for office-based procedures were significantly less than for OR procedures ($2,737.17 vs $7,329.69, p < 0.001). Mean allowed charges for office-based procedures were significantly less than for OR procedures ($762.08 vs $5,835.09, p < 0.001). Mean scaled charges for office-based procedures were also significantly less than mean scaled charges for OR procedures ($762.08 vs $4,089.33, p < 0.001). Office procedures were reimbursed at similar or higher rates than were OR procedures. In appropriate patients, performing simple rhinologic procedures in the office rather than in the OR offers significant cost savings without impacting physician reimbursement.
    International Forum of Allergy and Rhinology 01/2012; 2(3):207-11. · 1.00 Impact Factor
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    ABSTRACT: The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.
    American Journal of Rhinology 01/2012; 22(6):635-41. · 1.36 Impact Factor
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    ABSTRACT: Traditionally, endoscopic transsphenoidal pituitary surgery is performed using 2-dimensional (2D) endoscopes, which lack depth of field and contribute to image distortion. Recently, a new generation of 3D endoscopes has been introduced for improved endoscopic depth perception. Little data exist comparing surgical outcomes with 2D vs 3D endoscopic systems. This study examines perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopes. The objective of this work was to determine the differences in perioperative and postoperative factors in patients undergoing pituitary surgery using 2D vs 3D endoscopy. Retrospective chart review at a tertiary academic referral center. Statistical comparison was undertaken for perioperative (estimated blood loss, operative time) and postoperative factors (length of stay, complications, and readmission rate). A total of 58 patients underwent endoscopic pituitary surgery during the 24-month study period (22 functional, 36 nonfunctional lesions). The 2D endoscopic system was used for pituitary tumor resection in 32 patients (55%), and the 3D endoscopic system in 26 patients (45%). No significant difference existed between 2D and 3D endoscopic systems for operative time (p = 0.275) or estimated blood loss (p = 0.312). Additionally, no difference was found between groups for cerebrospinal fluid (CSF) leak rate (p = 0.581), postoperative endocrine complications (p = 0.081), length of hospital stay (p = 0.934), or hospital readmission rate (p = 1.0). 3D endoscopy affords the surgeon improved depth of field and stereoscopic vision. Our data demonstrate that 3D endoscopy does not result in significantly different perioperative or postoperative outcomes vs 2D endoscopic surgery.
    International Forum of Allergy and Rhinology 01/2012; 2(1):2-8. · 1.00 Impact Factor
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    Sarah K Wise, Rodney J Schlosser
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    ABSTRACT: Increasing interest in sublingual immunotherapy (SLIT) among practitioners and patients has resulted in numerous publications and clinical trials in recent years. With the clinical growth of SLIT, discussions of its efficacy, safety, and immunologic effects have intensified, as have comparisons to subcutaneous immunotherapy (SCIT). In the United States, SCIT has been the traditional form of immunotherapy for inhalant allergy and is the only immunotherapy method approved by the U.S. Food and Drug Administration at this time. The similarities and differences between SLIT and SCIT are often discussed, yet clinical studies directly comparing these immunotherapy methods are scarce. A literature review of specific issues and controversies between SLIT and SCIT for allergic rhinitis was conducted. Safety, efficacy, and immunologic effects of these two immunotherapy techniques are reviewed. Unanswered questions relating to SLIT are examined.
    American Journal of Rhinology and Allergy 01/2012; 26(1):18-22.
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    ABSTRACT: Sublingual immunotherapy (SLIT) permits rapid antigen escalation with an improved safety profile over that of subcutaneous immunotherapy. Outcomes for SLIT in terms of the timing of clinical improvement were investigated in a retrospective review of patients undergoing SLIT who completed quality of life (QOL) and medication-use questionnaires at baseline and immediately after antigen escalation was performed. A subset of patients (n = 24) also completed maintenance-phase questionnaires. Paired post-escalation data (mean 5.5 weeks; N = 38) demonstrated improvement (p< 0.05) in overall QOL scores and in 6 of 14 symptom domains. Maintenance phase data (n = 24) revealed significant improvements in total QOL scores and in 5 symptom domains. A significant reduction in nasal steroid use was also demonstrated during the maintenance phase of treatment (p < 0.05). Significant improvement is seen immediately post-escalation in SLIT patients. This improved QOL appears to be maintained, and perhaps even increases, during the maintenance phase, with decreased nasal steroid use.
    Ear, nose, & throat journal 09/2011; 90(9):E16-22. · 1.03 Impact Factor
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    ABSTRACT: To compare the postoperative healing profiles of graft materials used for endoscopic repair of cerebrospinal fluid (CSF) leak. Retrospective cohort study with 1 to 21 months of follow-up. Tertiary referral, academic medical center. Consecutive sample of patients undergoing endoscopic repair of CSF leak from March 2007 through May 2009. Endoscopic repair of CSF leak with acellular dermis, collagen matrix, or sinonasal mucosal grafts. Graft success, time to full graft mucosalization, and duration of graft or donor site crusting were assessed during the postoperative period. Forty repairs were performed on 37 patients: 17 with mucosal grafts, 10 with acellular dermis, and 13 with collagen matrix grafts. The mean follow-up time was 5.3 months (range, 0.5-21.0 months). Two patients had partial graft loss; none had a recurrence of CSF leak. There was a significant difference in time to mucosalization with acellular dermis (11.7 weeks) when compared with collagen matrices (6.6 weeks) or mucosa (4.9 weeks) (P < .001). Graft crusting was more prolonged with acellular dermis (9.4 weeks) than with collagen matrices (5.1 weeks) (P = .04). No patients with mucosal grafts had graft crusting. Donor site crusting was present only in the mucosal group, with an average duration of 6.5 weeks (range, 1.0-20.0 weeks). Mucosal grafts, acellular dermis, and collagen matrices have similar success rates in endoscopic repair of CSF leak. Acellular dermis grafts have longer time to mucosalization and more weeks of crusting than mucosal or collagen matrix grafts.
    Archives of otolaryngology--head & neck surgery 02/2011; 137(5):457-61. · 1.92 Impact Factor
  • Elizabeth K Hoddeson, Sarah K Wise
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    ABSTRACT: A multitude of potential etiologies exist for rhinitis and rhinosinusitis. These sinonasal disorders are heterogeneous entities that are best understood by evaluating the causative factors in each individual patient. More precise diagnosis permits accurate and effective treatment. The association of allergy with sinonasal symptoms has been described for decades; however, the specific relationship between allergy, rhinitis, and rhinosinusitis is complex. Considering allergy in terms of a systemic atopic disorder, along with a local inflammatory process mediated by IgE production in sinonasal tissues, is helpful in unveiling the complex connection between allergy, rhinitis, and rhinosinusitis. This article reviews recent literature regarding local IgE and sinonasal inflammatory conditions.
    Current Allergy and Asthma Reports 02/2011; 11(3):230-5. · 2.75 Impact Factor
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    ABSTRACT: To explore alterations in expression of tight junction proteins (TJPs) in nasal polyposis and in respiratory epithelium under inflammatory conditions. Our hypothesis is that exposure of nasal and respiratory epithelium to inflammatory cytokines results in the altered expression of specific TJPs. Human sinonasal mucosa (3 nasal polyp specimens and 3 nonpolypoid controls) were stained with immunofluorescent markers specific for TJPs claudin-1 and occludin and examined with confocal scanning laser microscopy. A complementary in vitro experiment involving exposure of cultured human bronchial epithelium to interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α) was also performed. Alterations in claudin-1 and occludin were localized by immunofluorescence labeling and confocal microscopy and quantified by western blotting. Nasal polyp epithelium from human tissue specimens had reduced claudin-1 expression along the basal aspect of the mucosal layer, whereas occludin expression was reduced in the apical and basal epithelial zones. In vitro experiments demonstrated stable or increased TJP expression after 24 hours of cytokine exposure (43% increase for claudin-1, 9% increase for occludin). However, a reduction in TJP expression was observed after 72 hours of cytokine exposure (18% reduction for claudin-1, and 43% reduction for occludin). Nasal polyposis is associated with epithelial TJP alterations. Further, the expression of TJPs in a model of inflamed respiratory mucosa is reduced in a similar fashion. Research on the histopathology of other epithelial inflammatory disorders suggests TJP alterations contribute to a self-perpetuating inflammatory state. Findings of this preliminary study support a similar process in nasal polyposis.
    International Forum of Allergy and Rhinology 01/2011; 1(1):50-4. · 1.00 Impact Factor
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    ABSTRACT: Traditional descriptions of type I hypersensitivity and its manifestations center on systemic immunoglobulin E (IgE)-mediated reactions to inciting antigens. Hence, many current diagnostic and therapeutic measures are based on systemic skin testing for allergy, systemic pharmacotherapy, and immunotherapy. Recent developments in rhinology and pulmonology, particularly in defining the phenomenon of local IgE production in various airway inflammatory conditions, have an impact on both medical and surgical diagnosis and management of these conditions. This review includes a discussion of allergy as a systemic disease, current systemic diagnostic and management strategies for allergy, and local IgE presence and synthesis in the upper and lower airways.
    Otolaryngologic Clinics of North America 06/2010; 43(3):503-20, viii. · 1.46 Impact Factor

Publication Stats

304 Citations
61.26 Total Impact Points


  • 2009–2014
    • Emory University
      • Department of Otolaryngology - Head & Neck Surgery
      Atlanta, Georgia, United States
  • 2012
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 2007–2012
    • Medical University of South Carolina
      • • Department of Otolaryngology-Head and Neck Surgery
      • • Department of Neurosciences (College of Medicine)
      Charleston, SC, United States
  • 2010
    • South Infirmary Victoria University Hospital
      Corcaigh, Munster, Ireland
  • 2006
    • Emory Hospitals
      Atlanta, Georgia, United States