Frederick K Kozak

BC Children's Hospital, Vancouver, British Columbia, Canada

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Publications (44)71.41 Total impact

  • Brendan Sorichetti · John P. Moxham · Frederick K. Kozak ·

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    ABSTRACT: Records were reviewed from all infants tested for congenital cytomegalovirus infection in British Columbia, Canada from 2006 to June 2014. Fourteen of 701 infants, or approximately 4.2 per 100 000 live births, had a positive test, indicating that >90% of expected symptomatic congenital cytomegalovirus infection cases were not diagnosed using clinician-initiated testing.
    The Journal of pediatrics 11/2015; DOI:10.1016/j.jpeds.2015.10.069 · 3.79 Impact Factor
  • Alexander J Saxby · Marcela Fandino · Frederick K Kozak ·
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    ABSTRACT: No abstract is available for this article.
    ANZ Journal of Surgery 09/2015; DOI:10.1111/ans.13283 · 1.12 Impact Factor
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    ABSTRACT: To review clinical presentations and management strategies for children with plastic bronchitis. Retrospective chart review. Seven patients required rigid bronchoscopy to remove bronchial casts over a 17-year study period. Mean age at presentation was 60 months. Mean follow-up was 53 months. Co-morbidities included: congenital heart disease (n=3), chronic pulmonary disorders (n=2) and sickle cell disease (n=1). 4 patients required multiple bronchoscopies for recurrent casts. Adjunctive topical therapies were administered in all 7 patients, without complication. Rigid bronchoscopy for cast removal was performed in 2 patients who were on extra-corporal membrane oxygenation (ECMO), using special precautions to safeguard the ECMO catheters. Bronchial casts in children may present acutely or sub-acutely. Recurrent casts are unusual; however, in combination with severe cardiac disease may lead to mortality. Adjunctive topical therapies are still under investigation. Special safeguards for ECMO catheters are imperative. This case series complements and adds to the International Plastic Bronchitis Registry. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of pediatric otorhinolaryngology 07/2015; 79(10). DOI:10.1016/j.ijporl.2015.07.011 · 1.19 Impact Factor
  • Brendan Sorichetti · Brian D. Westerberg · Rusung Tan · Frederick K Kozak ·
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    ABSTRACT: Nocardia Asteroides infection in a non-immunocompromised pediatric patient is extremely rare. We present a case of ethmoid sinusitis and orbital subperiosteal abscess caused by N. asteroides with a 20 year follow up and a review of the literature. N. asteroides was grown from intraoperative cultures for mycobacteria following surgical incision and drainage of the abscess. Postoperatively, the patient received a seven month course of trimethoprim-sulfamethozaxole and had no subsequent sequelae. Nocardia infections are common in immunocompromised patients. We present what we believe to be the first case of pediatric Nocardia sinusitis with 20-year follow up. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of pediatric otorhinolaryngology 04/2015; 79(7). DOI:10.1016/j.ijporl.2015.04.022 · 1.19 Impact Factor
  • Titus S Ibekwe · Sanjiv K Bhimrao · Brian D Westerberg · Frederick K Kozak ·
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    ABSTRACT: This was a meta-analysis and systematic review to determine the global prevalence of the mitochondrially encoded 12S RNA (MT-RNR1) genetic mutation in order to assess the need for neonatal screening prior to aminoglycoside therapy. A comprehensive search of MEDLINE, EMBASE, Ovid, Database of Abstracts of Reviews of Effect, Cochrane Library, Clinical Evidence and Cochrane Central Register of Trials was performed including cross-referencing independently by 2 assessors. Selections were restricted to human studies in English. Meta-analysis was done with MetaXL 2013. Forty-five papers out of 295 met the criteria. Pooled prevalence in the general population for MT-RNR1 gene mutations (A1555G, C1494T, A7445G) was 2% (1-4%) at 99%. Routine screening for MT-RNR1 mutations in the general population prior to treatment with aminoglycosides appear desirable but poorly supported by the weak level of evidence available in the literature. Routine screening in high-risk (Chinese and Spanish) populations appear justified.
    African Journal of Paediatric Surgery 04/2015; 12(2):105-13. DOI:10.4103/0189-6725.160342
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    ABSTRACT: Tracheal-bronchus is an aberrant bronchus arising from the lateral tracheal wall, superior to the carina. A "False-carina" can be classified as a sub-type. This clinical entity will be defined and the clinical presentation, diagnosis and management of five patients with variations of the anatomical definition of a False-carina, identified at our institution, will be reviewed. Congenital bronchial abnormalities, including False-carina, have important implications in the overall management of the airway. Management can range from expectant in asymptomatic patients to surgical intervention in cases of recurrent respiratory infections. Awareness and understanding of this clinical entity allows for timely investigation, diagnosis and appropriate intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Pediatric Otorhinolaryngology 01/2015; 79(4). DOI:10.1016/j.ijporl.2015.01.023 · 1.19 Impact Factor
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    ABSTRACT: Abstract Objective Establishing the prevalence of semicircular canal dehiscence in a pediatric population using temporal bone CT imaging. Study design Retrospective analysis of all temporal bone CT scans during a 5-year period (2007–2012). Methods CT scan images were reformatted in the plane of the canals and assessed by two independent reviewers with a third to resolve disagreement. Detailed chart review was performed for those found to have dehiscence. Superior and posterior canals were classified as “dehiscent”, “possibly dehiscent”, “thin” or “normal” for each case. Results 649 temporal bones were assessed from 334 children (under 18 years of age). The prevalence rate of superior canal dehiscence (SCD) was 1.7% (3.3% of individuals). Posterior canal dehiscence (PCD) was present in 1.2% (2.1% of individuals). There were no cases of bilateral SCD, and one case of bilateral PCD. Age under 3 years was associated with a higher prevalence of thinning but not dehiscence. Congenital inner ear malformation was not related to a higher probability of dehiscence. The superior petrosal sinus was associated with the SCD in three cases (27.3%). Retrospective chart review highlighted possible vestibular symptoms in 3/11 patients with SCD (27.3%). Conclusions This forms the largest pediatric study of canal dehiscence to date. This study's prevalence rate is significantly lower than previous reports. The identified association with overlying venous structures may reflect the etiological process involved. The occurrence in children supports the hypothesis of a congenital predisposition for development of canal dehiscence syndrome. Keywords: Superior semicircular canal dehiscence, Posterior semicircular canal dehiscence, Semicircular canal dehiscence syndrome, Pediatric population, Computed tomography
    International Journal of Pediatric Otorhinolaryngology 01/2015; 79(3). DOI:10.1016/j.ijporl.2015.01.001 · 1.19 Impact Factor
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    Lauren N Ogilvie · Julie Pauwels · Neil K Chadha · Frederick K Kozak ·
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    ABSTRACT: Background To determine the rate of publication in a peer-reviewed journal for all oral presentations made at the Canadian Society for Otolaryngology- Head and Neck Surgery¿s Annual Meetings from 2006¿2010.Methods All abstracts were searched by keywords and authors¿ names in Medline via PubMed and Google Scholar. Authors of presented abstracts not found to be published were contacted directly for further information.Results50.5% of presented abstracts (n¿=¿198) were subsequently published with an average time to publication of 21 months. For those abstracts found not to be published 74.6% (n¿=¿167) of authors responded with further information about their research, 66% (n¿=¿89) of abstracts with author response that were not published were never submitted for publication. Authors¿ main reasons for not publishing were that the research was still in process (34%, n¿=¿21) or that a resident or fellow working on the project ¿had moved on¿ (26%, n¿=¿16).Conclusion The publication rate for the Canadian Society for Otolaryngology- Head and Neck Surgery¿s Annual Meetings from 2006¿2010 is within the range reported by other conferences and specifically other Canadian conferences in different specialties; however, roughly half of presentations went on to be published. The main barrier to publication was bringing projects to the submission stage and not rejection by journals. Resources such as more time for research or personnel to coordinate projects may result in a greater rate of project completion.
    Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 12/2014; 43(1):51. DOI:10.1186/s40463-014-0051-5 · 0.89 Impact Factor
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    ABSTRACT: Importance Because tonsillar enlargement can have substantial ill health effects in children, reliable monitoring and documentation of tonsil size is necessary in clinical settings. Tonsil grading scales potentially allow clinicians to precisely record and communicate changes in tonsil size, but their reliability in a clinical setting has not been studied. Objective To assess the interobserver and intraobserver reliability of the Brodsky and Friedman tonsil size grading scales and a novel 3-grade scale.Design, Setting, and Participants Cross-sectional study between June 2012 and August 2013 at a tertiary pediatric otolaryngology outpatient clinic at British Columbia Children's Hospital. We recruited 116 children, aged 3 to 14 years, with no major craniofacial abnormalities. For each child, 2 separate tonsil assessments (with at least a 5-minute interval in between) were conducted by 4 independent observers: 2 staff pediatric otolaryngologists, 1 otolaryngology trainee (fellow or resident), and 1 medical student. Each observer assessed and graded tonsil sizes using 3 different scales.Main Outcomes and Measures Interobserver and intraobserver reliabilities were assessed by deriving the intraclass correlation coefficients (ICCs) and Pearson correlation coefficients, respectively. To discount for any asymmetric scores, all data analysis was conducted on the left tonsil measurement only.Results Mean interobserver reliability was highest for the Brodsky grading scale (ICC, 0.721; Cronbach α, 0.911), followed by the Friedman grading scale (ICC, 0.647; Cronbach α, 0.879) and the 3-grade scale (ICC, 0.599; Cronbach α, 0.857). The mean intraobserver reliabilities for the Brodsky, Friedman, and modified 3-grade scales were 0.954, 0.932, and 0.927, respectively.Conclusions and Relevance The Brodsky grading scale offered the highest interobserver and intraobserver reliability when compared with the Friedman and novel 3-grade scales. The results of this study would support the uniform use of the Brodsky scale for future clinical and research work.
    JAMA Otolaryngology - Head and Neck Surgery 10/2014; 140(11). DOI:10.1001/jamaoto.2014.2338 · 1.79 Impact Factor
  • Anat Zaidman-Zait · Deirdre Curle · Janet R Jamieson · Ruth Chia · Frederick K Kozak ·
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    ABSTRACT: Although increasing numbers of children with additional disabilities are receiving cochlear implants (CIs), little is known about family perspectives of the benefits and challenges of cochlear implantation in this pediatric population. This study examines perceptions among parents of deaf children with additional disabilities regarding satisfaction with service provision, benefits, and challenges of the CI process. This was a mixed-methods study, which included a survey and interviews. Twenty-three families of deaf children with additional disabilities participated in this study, and 17 of these parents participated in in-depth interviews regarding their child's experience with the CI, including benefits and challenges. Interviews were analyzed through inductive thematic analysis. Parent-perceived benefits of cochlear implantation included children's improved sound awareness, communication skills, and greater well-being, compared to preimplantation status. However, the majority of families felt that they and their children were not receiving enough services. Major challenges included managing funding; coping with limited availability of specialized services, particularly in rural areas; and continuing concerns about the child's communication, social skills, and academic performance. Results suggest that children with additional disabilities benefit from CIs, but they and their families also face unique challenges that professionals should consider when working with families.
    Journal of Deaf Studies and Deaf Education 09/2014; 20(1). DOI:10.1093/deafed/enu030 · 1.02 Impact Factor
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    ABSTRACT: Objective To describe three cases of newborn acute respiratory distress caused by a nasopharyngeal choristoma. The cases presented include the radiological, surgical, histological and historical perspective of this entity. Methods Retrospective chart review of three cases and review of the literature. Results Three cases of nasopharyngeal choristoma are reported each presenting with neonatal respiratory distress during the first day of life. All cases were assessed initially with cross-sectional imaging (CT or MRI) and subsequently confirmed on nasopharyngoscopy/laryngoscopy and surgically removed. Conclusions Nasopharyngeal choristoma is a rare congenital nasopharyngeal mass which may present with rapid onset of acute upper airway obstruction by virtue of its relative size and anatomic position.
    International Journal of Pediatric Otorhinolaryngology Extra 09/2014; 9(3). DOI:10.1016/j.pedex.2014.03.003
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    ABSTRACT: Cranial fasciitis is a fibroblastic lesion found in the cranium of children three weeks to six years of age. It most commonly manifests as a solitary, rapid growing mass on the scalp with frequent involvement of underlying bone and occasional intracranial expansion. Patients with cranial fasciitis may present with a wide range of associated symptoms. Otologic symptoms such as otalgia, otorrhea, hearing loss and middle ear effusion are not frequently encountered. We present a case of cranial fasciitis with intracranial involvement and associated otologic symptoms in a four year old boy with subsequent follow up 14 years later.
    American Journal of Otolaryngology 09/2014; 35(5). DOI:10.1016/j.amjoto.2014.06.004 · 0.98 Impact Factor
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    ABSTRACT: Objective: Ingestion of foreign bodies in the pediatric population is common and in the majority of cases involves spontaneous passage through the esophagus; however, they can become lodged in spaces of anatomical narrowing. Sharp foreign bodies are of particular concern due to a higher chance of perforation and other complications. The goal of this case report is to describe the safe removal of a chicken wishbone and 3 alternate options in the event that the initial choice was unsuccessful. Methods: We report the case of a 2-year-old boy who presented to our pediatric tertiary center after unsuccessful endoscopic removal of a chicken wishbone from the esophagus. Results: Radiologically, the wishbone was oriented with the tines pointing up. Endoscopic examination revealed the tips of both tines to be embedded deeply into the lateral walls of the esophageal mucosa. Esophagoscopy and protecting the sharp points of the wishbone were used to successfully extract the intact wishbone. Conclusion: Previous techniques have involved cutting the bone; however, in this case, tension was so high that it was felt that cutting the bone would result in perforation. Proper management of such cases requires planning and often multiple strategies.
    The Annals of otology, rhinology, and laryngology 07/2014; 124(1). DOI:10.1177/0003489414541422 · 1.09 Impact Factor
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    ABSTRACT: Background Pediatric tracheostomy has undergone notable changes in frequency and indication over the past 30 years. This study investigates pediatric tracheostomy at British Columbia Children's Hospital (BCCH) over a 30-year period. Methods A retrospective chart review of tracheostomy cases at BCCH from 1982 to 2011 was conducted. Charts were reviewed for demographics, date of tracheostomy, indication, complications, mortality and date of decannulation. Data from three 10-year time periods were compared using Fisher's Exact test to examine changes over time. Results 251 procedures (154 males) performed on 231 patients were reviewed. Mean age at tracheostomy was 3.74 years with 48% of procedures undertaken before the age of one year. Frequency of procedure by year has generally declined into the early 2000's. Upper airway obstruction was the most common indication accounting for 33% of procedures. The rate of complication across the entire cohort was 22% with 63% of patients being decannulated. Tracheostomy related mortality occurred in 2.0% of cases reviewed. Conclusions Changes occurred in primary indications with infections indicating less procedures and neurological impairments indicating more procedures over time. Complications increased and the decannulation rate decreased over this 30-year review. Pediatric tracheostomy is considered a safe and effective procedure at BCCH.
    Journal of Pediatric Surgery 07/2014; 49(11). DOI:10.1016/j.jpedsurg.2014.04.014 · 1.39 Impact Factor
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    ABSTRACT: To systematically review the literature describing the relationship between autism spectrum disorder (ASD) and peripheral hearing loss including literature recommendations for audiological assessment and auditory habilitation in cases where peripheral hearing loss and ASD coexist. Published studies indexed in MEDLINE (1948-2011). The search strategy identified 595 potential studies. After a review of the titles, 115 abstracts were reviewed and 39 articles were retrieved and assessed independently by at least two authors for possible inclusion. 22 articles pertained to children with ASD and peripheral hearing loss, hearing assessment in children with ASD, audiological habilitation for children with ASD or hyper-responsiveness in children with ASD. 17 further studies were garnered from the reference section of the 22 papers. Controversy exists in the literature regarding prevalence of hearing impairment among individuals with ASD. In cases where ASD and hearing impairment co-exist, diagnosis of one condition often leads to a delay in diagnosing the other. Audiological assessment can be difficult in children with ASD and test-retest reliability of behavioural thresholds can be poor. In cases where hearing impairment exists and hearing aids or cochlear implantation are recommended, devices are often fit with special considerations for the child with ASD. Hyper-responsiveness to auditory stimuli may be displayed by individuals with ASD. Evidence or the suspicion of hyper-responsiveness may be taken into consideration when fitting amplification and planning behavioural intervention. Prevalence rates of hearing impairment among individuals with ASD continue to be debated. At present there is no conclusive evidence that children with ASD are at increased risk of peripheral hearing loss. A complete audiological assessment is recommended in all cases where ASD is suspected so as not to delay the diagnosis of hearing impairment in the event that hearing loss and ASD co-exist. Objective assessment measures should be used to confirm behavioural testing in order to ensure reliability of audiological test results. Fitting of hearing aids or cochlear implantation are not contraindicated when hearing loss is present in children with ASD; however, success with these devices can be variable.
    International journal of pediatric otorhinolaryngology 11/2013; 78(1). DOI:10.1016/j.ijporl.2013.10.063 · 1.19 Impact Factor
  • Neil K Chadha · Gilbert O A Lam · Jeffrey P Ludemann · Frederick K Kozak ·
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    ABSTRACT: IMPORTANCE To our knowledge, the present study is the first double-blind, randomized, placebo-controlled trial in children to compare nasal preparation sprays administered before flexible nasendoscopy with placebo. OBJECTIVE To compare the degree of pain experienced by children undergoing flexible nasendoscopy after 1 of 3 intranasal sprays: placebo, decongestant with topical local anesthetic (TLA), or decongestant without TLA. DESIGN, SETTING, AND PARTICIPANTS A randomized placebo-controlled trial with blinding of participants, caregivers, observers, and otolaryngologists was conducted in a tertiary pediatric otolaryngology ambulatory clinic. Participants included a consecutive sample of children aged 3 to 12 years requiring flexible nasendoscopy. Exclusion criteria included concomitant respiratory tract infection, known allergy to a trial agent, or previous flexible nasendoscopy. One hundred fifty-one children were assessed for eligibility; 24 eligible children refused participation and 69 were included and block-randomized. All completed the study, and there were no adverse events. INTERVENTIONS Nasal spray administration of placebo (normal saline); xylometazoline hydrochloride, 0.05% (decongestant); or lidocaine hydrochloride, 1%, with xylometazoline hydrochloride, 0.05% (TLA with decongestant) was performed 10 minutes before flexible nasendoscopy. MAIN OUTCOMES AND MEASURES Primary outcome measure was the child-reported Wong-Baker Faces Pain (WBFP) scale. Secondary outcomes included the caregiver-proxy WBFP scale; the Face, Legs, Activity, Cry, and Consolability (FLACC) scale; and the physician-reported Difficulty of Procedure Visual Analog Scale (DPVAS). RESULTS Twenty-three children were recruited in each of the intervention arms. Baseline characteristics were comparable between groups. The mean child-rated WBFP scale scores were 2.4, 1.8, and 2.2 for the placebo, decongestant, and TLA with decongestant groups, respectively (P = .45). Although the finding was statistically nonsignificant, decongestant had the lowest mean caregiver-proxy WBFP scale score, lowest observer-rated FLACC scale score, and highest physician-rated DPVAS score. Subgroup analysis did not demonstrate any correlation between the outcomes and age or sex. CONCLUSIONS AND RELEVANCE This study revealed no statistically significant difference in the discomfort experienced by children undergoing flexible nasendoscopy after placebo, decongestant, or TLA with decongestant. Decongestant was associated with the least discomfort (on child, caregiver, and observer-rated pain scale scores) and the lowest rating for difficulty of procedure. With these findings, the study suggests that there is no significant benefit of topical decongestant with or without TLA compared with placebo in reducing pain associated with pediatric flexible nasendoscopy. TRIAL REGISTRATION Identifier: NCT01351298.
    JAMA Otolaryngology - Head and Neck Surgery 10/2013; 139(12). DOI:10.1001/jamaoto.2013.5297 · 1.79 Impact Factor
  • Marcela Fandiño · Frederick K Kozak · Cindy Verchere · Andrew Campbell ·
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    ABSTRACT: Congenital tracheal stenosis (CTS) is a life-threatening condition that is associated with significant morbidity and mortality particularly when symptomatic presentation occurs in the newborn period. The most challenging form of CTS is long segment congenital tracheal stenosis (LSCTS) with compromise of the carina and main stem bronchi. We report the case of a newborn with severe distal tracheal stenosis with carinal and main stem bronchial involvement who was managed successfully with a modified slide and autologous rib graft tracheoplasty. The patient was discharged from hospital without ventilator support or oxygen requirement at 2 months of age. The details of this case and the description of the surgical procedure are presented and the related literature is reviewed.
    International journal of pediatric otorhinolaryngology 09/2013; 77(12). DOI:10.1016/j.ijporl.2013.09.002 · 1.19 Impact Factor
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    ABSTRACT: Individuals with X-linked lymphoproliferative disease (XLP) lack invariant natural killer T (iNKT) cells and are exquisitely susceptible to Epstein-Barr virus (EBV) infection. To determine whether iNKT cells recognize or regulate EBV, resting B cells were infected with EBV in the presence or absence of iNKT cells. The depletion of iNKT cells was found to increase both viral titers and the frequency of EBV-infected B cells. However, EBV-infected B cells rapidly lost expression of the iNKT cell receptor ligand CD1d, abrogating iNKT cell recognition. To determine whether induced CD1d expression could restore iNKT recognition in EBV-infected cells, lymphoblastoid cell lines (LCL) were treated with AM580, a synthetic retinoic acid receptor-α (RARα) agonist that upregulates CD1d expression via the nuclear protein, lymphoid enhancer-binding factor-1 (LEF-1). AM580 significantly reduced LEF-1 association at the CD1d promoter region, induced CD1d expression on LCL and restored iNKT recognition of LCL. CD1d-expressing LCL elicited IFN-γ secretion and cytotoxicity by iNKT cells even in the absence of exogenous antigen suggesting that an endogenous iNKT antigen is expressed during EBV infection. These data indicate that iNKT cells may be important for early, innate control of B cell infection by EBV and that downregulation of CD1d may allow EBV to circumvent iNKT-mediated immune recognition.
    Blood 08/2013; 122(15). DOI:10.1182/blood-2013-01-480665 · 10.45 Impact Factor
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    ABSTRACT: Objective To systematically review the literature and appraise the evidence reporting the effects of women's health, including pregnancy, postpartum, menstruation, oral contraception, menopause, and hormone replacement therapy, on common rhinological pathologies and nasal physiology.Data SourcesSystematic search strategy using MEDLINE (1966-2012) and EMBASE (1980-2012) databases.Review Methods Title review, abstract screening, and then full paper analysis were undertaken by 2 authors independently. Level of evidence was graded according to the Oxford Centre of Evidence Based Medicine 2011 criteria and risk of bias assessment using the Jadad scale for randomized controlled trials and Newcastle-Ottawa Scale for cohort and case-controlled studies.ResultsOver the 46 years analyzed, the search strategy produced 2904 titles. In total, 314 abstracts were screened, from which 192 full-text articles were evaluated, and 145 research papers met all the criteria for inclusion in the study. Overall, the available evidence was of low quality. Seventy percent of studies (102 of 145) were case reports or case series from which only limited conclusions can be drawn. Only 3% of the included papers (4 of 145) were randomized controlled studies. The remaining data were mainly of a prospective cohort design. Study heterogeneity in design and measured outcomes resulted in data synthesis being limited to a descriptive/exploratory review. Study findings are presented by women's health category and then by rhinological manifestation with important clinical correlations highlighted.Conclusion Physiological and hormonal changes occurring as a normal part of women's health have an important influence on rhinological function and disease.
    Otolaryngology Head and Neck Surgery 02/2013; 148(5). DOI:10.1177/0194599813477837 · 2.02 Impact Factor

Publication Stats

323 Citations
71.41 Total Impact Points


  • 2009-2015
    • BC Children's Hospital
      Vancouver, British Columbia, Canada
  • 2004-2015
    • University of British Columbia - Vancouver
      • • Faculty of Medicine
      • • Department of Pathology and Laboratory Medicine
      • • Department of Surgery
      Vancouver, British Columbia, Canada