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Al-Salihi MM, Rahman M, Al-Jebur MS, Al-Salihi Y, Shihadeh O, Hammadi F, Ayyad A. Effect of preservation versus resection of turbinate on olfactory function in endoscopic trans-nasal trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Neurol Res 2024; 46:444-452. [PMID: 38467610 DOI: 10.1080/01616412.2024.2328493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Utilizing endoscopes in surgery offers advantages and concerns, including potential nasal function impacts. Hyposmia following Transseptal Transsphenoidal hypophysectomy ranges from 0% to 2.2%. Debates persist about managing the M.T. in endoscopic sinus surgery due to its impact on nasal function. While preservation is recommended for sinonasal health, debates continue, as certain cases require resection. Our meta-analysis aims to compare turbinate resection and preservation effects on olfactory function. METHODS We searched five electronic databases to collect all relevant studies. Records were screened for eligibility. Data were extracted from the included studies independently. Our continuous outcomes were pooled as standardized mean difference with 95% CI. Statistical analyses was done by RevMan. RESULTS Our meta-analysis included four studies involving 235 patients (81 males). Evaluating changes in olfaction scores, two one-month studies (82 patients) revealed no significant difference between preservation and resection groups (Std.MD = 0.05[-0.39, 0.50], p = 0.81). For three-month assessments (146 patients), SNOT tests indicated no significant difference (Std.MD = 0.21, 95% CI[-0.11, 0.54], p = 0.20). Two studies used other tests on 70 patients at three months, yielding no significant difference (Std.MD = 0.13, 95% CI [-0.35, 0.62], p = 0.59). Two six-month studies (72 patients) similarly found no significant difference (Std.MD = 0.09, 95% CI [-0.39, 0.56], p = 0.72). CONCLUSION Our meta-analysis involving 235 patients examined olfaction score changes over various time frames in trans-nasal trans-sphenoidal pituitary surgeries. No significant differences were observed between turbinate preservation and resection groups at one month, three months, or six months post-surgery.
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Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Mohammed Rahman
- Department of Neurosurgery, St. Marys Hospital, Decatur, IL, USA
| | | | | | - Omar Shihadeh
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Firas Hammadi
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hopsital, Doha, Qatar
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
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Ramirez-Gil LS, Ley-Tomas JJ, Hernaiz-Leonardo JC, Alobid I, Mullol J, Ceballos-Cantu JC. Effects of Endoscopic Sinus Surgery on Olfactory Function. Curr Allergy Asthma Rep 2023; 23:715-731. [PMID: 38038879 DOI: 10.1007/s11882-023-01115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW To review the effects of endoscopic sinus surgery and endonasal approaches to the skull base on olfaction. RECENT FINDINGS Advancements in endonasal endoscopic approaches to the sinuses and skull base allow for direct treatment of a variety of sinonasal and skull base diseases. However, these extended approaches will often require manipulation of normal anatomical structures and the olfactory neuroepithelium. Depending on the planned procedure and extent of disease, the prognosis of olfactory perception can vary significantly among patients. Endoscopic sinonasal surgical procedures may impact olfaction. Optimizing olfactory function requires proper surgical techniques, gentle handling of tissue, and perioperative care. Surgeons must discuss objectives and manage patient expectations. Routine olfactory assessment is crucial in surgical work-up and follow-up. Preserving anatomical structures while addressing the obstruction of the olfactory cleft helps to prevent decreased olfactory threshold. However, smell identification and discrimination do not always correlate with sinonasal anatomy.
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Affiliation(s)
- L Stefano Ramirez-Gil
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico
| | - J J Ley-Tomas
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío Villegas, CDMX, Mexico
| | - J C Hernaiz-Leonardo
- Department of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Isam Alobid
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clinic. Barcelona, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Catalonia, Spain
- Universitat de Barcelona., Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - J C Ceballos-Cantu
- Department of Otolaryngology-Head and Neck Surgery, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Vasco de Quiroga 15 Tlalpan, CDMX 14080, Mexico.
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Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is comprised of a diverse group of endotypes that cause significant morbidity for afflicted patients. While endoscopic sinus surgery helps ameliorate the disease, polyps frequently recur. Newer strategies are intended to provide access for topical steroid irrigations in attempts to improve the disease process and quality of life, and decrease overall recurrence of polyps. OBJECTIVE To review the current literature examining the latest surgical approaches for CRSwNP. METHODS Review article. RESULTS In dealing with the recalcitrant nature of CRSwNP, surgical techniques have simultaneously become more nuanced and aggressive. Bony resection in anatomically unfavorable areas such as the frontal, maxillary, and sphenoid outflow regions, replacing diseased or denuded mucosa with healthy grafts or flaps at the neo-ostia, and introducing drug-eluting biomaterials to newly opened sinus outflow tracts are highlights in the recent advancements in sinus surgery for CRSwNP. The Draf 3 or modified endoscopic Lothrop procedure has become a standard technique and demonstrated to improve quality of life and decrease polyp recurrence. A number of mucosal grafting or mucosal flap techniques have been described that cover exposed bone of the neo-ostium and evidence shows that this improves healing and diameter of the Draf 3. Partial middle turbinectomy, while controversial, appears to help decrease polyp recurrence in long-term follow-up studies. Modified endoscopic medial maxillectomy improves access to the maxillary sinus mucosa, facilitates debridement and, particularly, in the cystic fibrosis nasal polyp patient, improves overall management of the disease. Sphenoid drill-out procedure provides wider access for topical steroid irrigations and also may improve management of CRSwNP. CONCLUSION Surgical intervention remains a mainstay of therapy for CRSwNP. Newer techniques revolve around improving access for topical steroid therapy.
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Affiliation(s)
- T Graham Norwood
- Department of Otolaryngology/Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica W Grayson
- Department of Otolaryngology/Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bradford A Woodworth
- Department of Otolaryngology/Head & Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Hsu PY, Hsieh LC, Wang YH, Chen SJ, Chan YK, Shen KH, Wang YP. Olfactory Outcomes After Middle Turbinate Resection in Endoscopic Transsphenoidal Surgery: A Prospective Randomized Study. Otolaryngol Head Neck Surg 2022; 167:964-970. [PMID: 35316101 DOI: 10.1177/01945998221086202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Endoscopic endonasal transsphenoidal surgery is safe and effective for sellar and parasellar tumor removal. Partial middle turbinate (MT) resection is sometimes performed to optimize the surgical field and facilitate postoperative care. Disturbances in olfaction are concerning because of the lack of randomized studies in this field. STUDY DESIGN Prospective randomized trial. SETTING Single academic medical center. METHODS We resected the lower halves of bilateral MTs in the resected group and laterally fractured bilateral MTs in the preserved group. Olfactory outcomes and sinonasal conditions were assessed by using the validated Taiwan Smell Identification Test and Lund-Kennedy Endoscopy Score, respectively. Forty-nine patients were enrolled in the final analysis, of whom 23 underwent partial MT resection. RESULTS The average Taiwan Smell Identification Test result was 36.9 one month after surgery, with a significant change of -4.4 ± 3.1 (mean ± SD; P < .01) from baseline. The impact was not significant at 3 months (-2.1 ± 2.6, P = .13) or 6 months (0.3 ± 2.0, P = .79). Between the MT resection and preservation groups, there were no significant differences at postoperative 1 month (P = .60), 3 months (P = .86), and 6 months (P > .99). Lund-Kennedy Endoscopy Score was still higher at 3 months (P = .006) after surgery but returned to the preoperative level at 6 months (P = .63). CONCLUSIONS Endoscopic endonasal transsphenoidal surgery may affect olfaction at 1 month after surgery, and olfactory function is expected to return after 3 months. Partial MT resection did not result in additional olfactory loss. It is safe to perform partial MT resection during surgery without compromising the olfactory outcomes.
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Affiliation(s)
- Pei-Yuan Hsu
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
| | - Yu-Hsuan Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Shiu-Jau Chen
- School of Medicine, Mackay Medical College, New Taipei City.,Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Yun-Kai Chan
- Department of Neurosurgery, Mackay Memorial Hospital, Taipei
| | - Kuang-Hsuan Shen
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Ying-Piao Wang
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei.,School of Medicine, Mackay Medical College, New Taipei City.,Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City
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Cherian LM, Bright RR, Varghese L, Rupa V, Kurien R. Characteristics of Chronic Rhinosinusitis with Nasal Polyps Based on Allergic Mucin and Fungal Elements in Patients Undergoing Revision Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:108-115. [PMID: 35070932 PMCID: PMC8743328 DOI: 10.1007/s12070-021-02834-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/21/2021] [Indexed: 11/24/2022] Open
Abstract
This study sought to document the features in chronic rhinosinusitis with nasal polyp (CRSwNP) patients undergoing revision endoscopic sinus surgery (RESS), based on presence or absence of allergic mucin (AM) and fungal elements (F). A retrospective chart review of RESS cases collected Lund Mackay score (LMS), endoscopic, microbiological, histopathological, surgical and follow-up data of these patients. Patients were categorised into AM + F +, AM + F-, AM-F + and AM-F- subgroups based on the presence or absence of AM and F. The total serum IgE was significantly higher (p > 0.001) in the AM + F + subgroup. Other factors analysed including LMS, duration from previous surgery, comorbidities, degree of inflammation and disease recurrence showed no specific predilection among subgroups. Patients with a retained middle turbinate showed lesser (p = 0.04) recurrence on follow-up. Subgroups of recurrent CRSwNP showed similar characteristics and had further disease recurrence which was independent of allergic mucin and fungal elements. The presence of an intact healthy middle turbinate could reduce early disease recurrence following RESS.
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Affiliation(s)
| | | | - Lalee Varghese
- Department of ENT, Christian Medical College, Vellore, India
| | - V. Rupa
- Department of ENT, Christian Medical College, Vellore, India
| | - Regi Kurien
- Department of ENT, Christian Medical College, Vellore, India
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Karadaghy OA, Peterson AM, Fox M, White J, Bhalla V, Beahm D, Villwock J, Chiu AG. Creation of aNovel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg 2021; 167:611-619. [PMID: 34699279 PMCID: PMC10174269 DOI: 10.1177/01945998211053530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS). (2) Create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. DATA SOURCES Ovid MEDLINE, Embase and Medline via Embase.com, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. REVIEW METHODS Systematic search was performed using a combination of standardized terms and keywords. Studies were included if they investigated anatomic contributions to persistent CRS requiring RESS or the relationship between anatomic landmarks and surgical morbidity. Identified studies were screened by title/abstract, followed by full-text review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly followed. RESULTS In total, 599 articles met screening criteria, 89 were eligible for full-text review, and 27 studies were included in the final review. The identified anatomic sites of interests are broad; the most frequently cited anatomic region was retained anterior ethmoid cells (22/27 studies), followed by posterior ethmoid cells (14/27 studies). Using the consolidated information, a clinical acronym, REVISIONS, was created: Residual uncinate, Ethmoid cells (agger, Haller, supraorbital), Vessels (anterior and posterior ethmoid), Infundibulum, Septal deviation, I (eye) compartment, Onodi cell, Natural os, and Skull base slope and integrity. CONCLUSIONS The REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.
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Affiliation(s)
- Omar A Karadaghy
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew M Peterson
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Meha Fox
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jacob White
- A. R. Dykes Library, Research & Learning, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Vidur Bhalla
- Department of Surgery, St Luke's Hospital, Kansas City, Missouri, USA
| | - David Beahm
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Middle turbinate handling during ESS. Our experience. Am J Otolaryngol 2021; 42:102980. [PMID: 33621766 DOI: 10.1016/j.amjoto.2021.102980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/14/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The treatment of middle turbinate (MT) during endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) remains a controversial issue. Several authors recommended preservation of MT to avoid complications, but MT resection is sometimes necessary. In the last years, our group has applied an original surgical technique to preserve MT, stabilize its head and ensure patency of the ostiomeatal complex (OMC) in ESS. We herein described this approach to the MT and reported its preliminary results in terms of post-operative endoscopic features and complications. METHODS The study retrospectively considered 34 consecutive adult patients suffering from CRS and treated with primary or revision ESS. Medialization of the MT and its stabilization to achieve post-operative patency of the OMC was obtained by means of: (i) creation of a surgically controlled synechia between the MT head and nasal septum; (ii) positioning of a silicone plate in the OMC. The silicone splints kept the MT head in an obliged position to contact the septum. RESULTS At 12-month follow-up control, we found: (i) stabilized MT medialization in all treated cases, (ii) only one case of lateral synechia without recurrent CRS, and (iii) a polypoid recurrence rate of 13%. CONCLUSIONS The MT handling technique during ESS herein preliminarily described seems to be an effective approach to medialize and stabilize the MT. This technique could be particularly appropriate for unstable MT after removing massive inflammatory lesions of the mucosa.
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Clinical characteristics in unilateral vestibular atelectasis. J Neurol 2020; 268:689-700. [PMID: 32909094 DOI: 10.1007/s00415-020-10220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Unilateral vestibular atelectasis (UVA), an entity first described by Merchant and Schuknecht in 1988, has rarely been reported in vivo as of yet. We specify here the clinical characteristics of 22 patients diagnosed with UVA. MATERIALS AND METHODS Patients with a radiological diagnosis of UVA who underwent delayed inner ear MRI were included between April 2017 and January 2020. Full clinical testing including ocular infrared video-oculography, oVEMPs, cVEMPs, vHIT, bithermal caloric testing and auditory testing was performed. RESULTS There were 13 men and 9 women, of mean age 58.6 ± 13.7 years. Onset was more frequently sudden (73%) than insidious (27%) though both clinical presentations were reported, and positional vertigo was described in 41% of cases. There were only two (9%) patients reporting Tullio's phenomenon. Vestibular testing showed that in 90% of cases, there was utricular dysfunction on oVEMP, while in 77% of cases, saccular function was preserved on cVEMP. vHIT showed high-velocity canal function impairment in all 22 patients: 8 patients (36%) had one impaired canal, 5 (23%) had two and 9 (41%) had all three canals affected. Caloric tests found complete unilateral areflexia, in 65% of tested cases, and partial deficiency in 35% of cases. Nine patients (40%) displayed asymmetrical hearing. CONCLUSION We described in this study the various clinical presentations of a disease rarely reported in vivo, UVA. Initial clinical presentation can appear similar to an acute vestibular deficit, a recurrent positional vertigo, or fluctuating dizziness.
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