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Sinha P, Tharakan T, Payne S, Piccirillo JF. Balloon Sinus Dilation Versus Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:578-588. [PMID: 35703383 PMCID: PMC10559877 DOI: 10.1177/00034894221104939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the efficacy of balloon sinus dilation (BSD) compared to functional endoscopic sinus surgery (FESS) or medical management for chronic rhinosinusitis (CRS). METHODS A qualified medical librarian conducted a literature search for relevant publications that evaluate efficacy of BSD. Studies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis. RESULTS From 315 abstracts reviewed, 18 studies were included in qualitative review, and 7 were included in meta-analysis. Quantitative analysis included 4 randomized clinical trials (RCTs) and 3 cohort studies comparing baseline and post-operative Sinonasal Outcome Test (SNOT)-20 scores in BSD and FESS. A meta-analysis restricted to the studies reporting SD for changes from baseline (2 RCTs, 1 cohort) showed the pooled difference in means to be 0.435, less than a clinically meaningful difference of 0.8. A separate sensitivity analysis of the studies including 4 additional studies with imputed values of SD for changes from baseline showed the pooled difference of means to be 0.237 assuming the highest level of correlation (Corr .8) between the pre- and post-intervention scores. CONCLUSIONS There is limited high-quality evidence that assesses the efficacy of BSD versus FESS in the management of CRS patients. To better inform CRS management, future studies should compare BSD with endoscopic sinus surgery, hybrid procedures, and/or medical management alone using validated objective and patient-reported outcome measures.
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Affiliation(s)
- Parul Sinha
- Washington University School of Medicine, St Louis, Missouri
| | | | - Spencer Payne
- University of Virginia Health System, Charlottesville, Virginia
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2
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Balloon sinuplasty in one-day surgery. Wideochir Inne Tech Maloinwazyjne 2021; 16:423-428. [PMID: 34136041 PMCID: PMC8193750 DOI: 10.5114/wiitm.2021.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/01/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Balloon sinus dilation is becoming an increasingly common procedure, finding a niche as an invaluable tool in endoscopic sinus surgery. Aim To assess the effectiveness of balloon sinus dilation (BSD) in 1-day surgery in patients with chronic rhinosinusitis without polyps based on our own experience. Material and methods The study group consisted of 9 patients. The Lund-Mackay scale for computed tomography of the paranasal sinuses was assessed prior to surgery. Endoscopy was performed on the basis of the Lund-Kennedy scale and patients were asked to perform the SNOT-22 survey. Two patients underwent balloon sinuplasty under general and seven under local anaesthesia. Results Twelve maxillary and eight frontal sinuses were widened (four attempts were unsuccessful). The SNOT-22 survey was assessed the day after surgery (average of 8 points) and a month after surgery (average of 15.5 points). Conclusions BSD only allows widening of the ostia of the maxillary, frontal and sphenoid sinuses. BSD offers shorter post-surgical recovery, and a more rapid return to work because of its less invasive and less traumatic nature.
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Martinez-Paredes JF, Karatayli-Ozgursoy S, Gonzalez V, Olomu O, Donaldson AM. Effect of Partial Uncinectomy After Balloon Sinuplasty on Maxillary Sinus Irrigant Penetration: A Cadaveric Study. OTO Open 2021; 5:2473974X21989583. [PMID: 33598598 PMCID: PMC7863165 DOI: 10.1177/2473974x21989583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/23/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The uncinate process may play a role in the amount of irrigation penetrance. In this cadaver study, we aimed to investigate if the addition of partial uncinectomy provides better maxillary sinus irrigation penetrance than balloon sinuplasty (BSP) alone. Study Design Cadaveric study. Setting Simulation laboratory at the Mayo Clinic in Florida. Methods Five fresh-frozen human cadaveric heads (10 sides) were used to assess maxillary sinus irrigation penetration after 3 interventions performed sequentially: irrigation penetrance with no intervention, irrigation after BSP, and irrigation after BSP and partial removal of the uncinate. Penetrance was recorded with intrasinus endoscopy and scored by 4 blinded observers using a scale from 0 (no irrigation) to 5 (fully irrigated). The diameter of the maxillary ostium was measured before and after BSP. Internal consistency was evaluated with Cronbach’s alpha. Results Mean ostium size increased from 4.1 to 6.8 mm after BSP (P = .013). Cronbach’s alpha was 0.93. The median scores of irrigation penetration after no intervention, BSP, and BSP and partial uncinectomy were 2.5, 3, and 4, respectively. We found a significantly higher penetrance following partial uncinectomy plus BSP versus BSP alone (P = .008). Both interventions had a statistically significant difference in irrigation penetrance as compared with no intervention (P = .0001). Conclusion Maxillary sinus irrigation penetration increased from baseline after BSP. The addition of a partial uncinectomy to the balloon dilation of the maxillary sinus was associated with a statistically significant increase in irrigation penetrance scores as compared with BSP alone.
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Affiliation(s)
- Jhon F Martinez-Paredes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Selmin Karatayli-Ozgursoy
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Valeria Gonzalez
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Osarenoma Olomu
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Angela M Donaldson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
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4
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Mirza AA, Shawli HY, Alandejani TA, Aljuaid SM, Alreefi M, Basonbul RA, Alhomaiani SK, Althobaity BA, Alhumaidi DA, Zawawi F. Efficacy and safety of paranasal sinus balloon catheter dilation in pediatric chronic rhinosinusitis: a systematic review. J Otolaryngol Head Neck Surg 2020; 49:69. [PMID: 32993786 PMCID: PMC7523047 DOI: 10.1186/s40463-020-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Chronic rhinosinusitis (CRS) negatively affects quality of life (QoL), and balloon catheter sinuplasty (BCS) has shown good outcomes in adult patients. However, there has not been much research on the effects of BCS on pediatric patients. The objective of this review is to systematically assess the literature for studies demonstrating the effectiveness and safety of BCS in pediatric CRS patients. Data sources PubMed, Embase and Cochrane Library. Study selection We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations (PRISMA) to conduct our study. Observational- and interventional-based studies reporting efficacy and/or side effects of BCS among pediatric populations were included. Efficacy was evaluated by clinically reliable measures including Sino-Nasal 5 (SN-5) QoL scale. Antibiotic usage and revision surgery were also evaluated. Data extraction Articles were screened, and data were obtained. Study design, sample size and demographics, treated sinuses, criteria of inclusion, adjunct procedure(s), follow-up time, and outcomes measured were reported. Main findings Out of 112 articles identified, 10 articles were included: two interventional controlled trials and eight observational studies. All studies evaluating QoL by SN-5 showed a remarkable reduction in SN-5 score postoperatively. Improvement in the computed tomography (CT) and endoscopic findings for up to 1 year after operation was reported. Furthermore, the majority of patinets treated with BCS did not recieve any course of sinusitis-indicated antibiotics during long-term follow-up, and they had low surgical revision rates. Minor side effects were reported, most commonly synechia. Conclusion Available evidence suggests that BCS is safe and effective for the treatment of CRS in pediatric patients. Future randomized controlled studies with large sample size are warranted. Such studies can further determine the efficacy of BCS in managing children with CRS.
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Affiliation(s)
- Ahmad A Mirza
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, P.O Box 80205, Jeddah, 21589, Saudi Arabia. .,Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Hatim Y Shawli
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Talal A Alandejani
- Department of Surgery-Division of Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Surgery-Division of Otolaryngology, Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Sattam M Aljuaid
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Mahmoud Alreefi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, P.O Box 80205, Jeddah, 21589, Saudi Arabia
| | - Razan A Basonbul
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, P.O Box 80205, Jeddah, 21589, Saudi Arabia
| | | | | | | | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Thong G, Dombrowski ND, Kawai K, Cunningham MJ, Adil EA. Balloon Sinuplasty Utilization in the Pediatric Population: A National Database Perspective. Otolaryngol Head Neck Surg 2019; 161:683-687. [PMID: 31184274 DOI: 10.1177/0194599819849918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. STUDY DESIGN Retrospective review. SETTING National pediatric database. SUBJECTS AND METHODS All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. RESULTS A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. CONCLUSION Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.
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Affiliation(s)
- Gerard Thong
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eelam A Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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6
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Sayal NR, Keider E, Korkigian S. Visualized ethmoid roof cerebrospinal fluid leak during frontal balloon sinuplasty. EAR, NOSE & THROAT JOURNAL 2018; 97:E34-E38. [PMID: 30138524 DOI: 10.1177/014556131809700807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Balloon sinus dilation (BSD) is generally accepted as a safe alternative to traditional sinus surgery. It is a unique technique designed to potentially minimize complications associated with traditional functional endoscopic sinus surgery (FESS). We present a case in which a 65-year-old man experienced a cerebrospinal fluid (CSF) leak in the ethmoid roof that was visualized instantly after balloon dilation in a revision sinus surgery. In this case report, we discuss the causes of CSF leaks and explain in detail the immediate endoscopic repair with a collagen matrix. Also, literature is reviewed on the safety of BSD versus traditional FESS. Postoperatively, the patient has been without CSF leak and remains symptom free. CSF leak is a rare but major complication during both FESS and BSD. As BSD use increases, its complication profile will become clearer when used alone, in conjunction with FESS, and/or during revision surgery. Although BSD is considered a benign procedure, one should be cautious when using it in revision sinus surgery.
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Affiliation(s)
- Navdeep R Sayal
- Department of Otolaryngology, Beaumont Hospital Farmington Hills, 28050 Grand River Ave, Farmington Hills, MI 48336, USA.
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7
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Chaaban MR, Rana N, Baillargeon J, Baillargeon G, Resto V, Kuo YF. Outcomes and Complications of Balloon and Conventional Functional Endoscopic Sinus Surgery. Am J Rhinol Allergy 2018; 32:388-396. [DOI: 10.1177/1945892418782248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Since the Food and Drug Administration approval of balloon sinuplasty (BSP) in 2005, no nationally representative population-based studies have examined the outcomes and adverse events of BSP. Objective To assess the rates of complications and revision surgery in patients who received BSP, functional endoscopic sinus surgery (FESS), or a hybrid procedure. Methods Using one of the nation’s largest commercial insurance databases, we conducted a retrospective cohort study of pediatric and adult patients diagnosed with chronic rhinosinusitis between 2011 and 2014 who underwent BSP, conventional FESS, or a hybrid procedure. The primary outcomes were surgical complication and revision rates within 6 months of initial surgery. Results A total of 16,040 patients who underwent sinus surgery were included. Overall, 2,851 patients underwent BSP, 11,955 underwent conventional FESS, and 1 234 underwent a hybrid procedure. BSP surgery was more likely to have been performed in an office setting (86.53%) compared to FESS (0.74%). The complication rate was 5.26% for BSP and 7.35% for conventional FESS. Revision rates were 7.89% for BSP, 16.85% for FESS, and 15.15% for a hybrid procedure. Conclusion Despite the low overall risk, major complications occur with BSP including cerebrospinal fluid leak, pneumocephalus, orbital complications, and severe bleeding. Otolaryngologists should discuss these risks with their patients. Prospective studies are still needed to compare outcomes of BSP with those of FESS.
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Affiliation(s)
- Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Nikunj Rana
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Jacques Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Gwen Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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8
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Stolovitzky JP, Mehendale N, Matheny KE, Brown WJ, Rieder AA, Liepert DR, Tseng E, Gould A. Medical Therapy Versus Balloon Sinus Dilation in Adults With Chronic Rhinosinusitis (MERLOT): 12-Month Follow-up. Am J Rhinol Allergy 2018; 32:294-302. [PMID: 29781286 DOI: 10.1177/1945892418773623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians' and patients' discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.
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Affiliation(s)
- J Pablo Stolovitzky
- 1 Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Douglas R Liepert
- 6 Allied Physicians of Michiana-Otolaryngology Associates, South Bend, Indiana
| | | | - Andrew Gould
- 7 Advanced ENT and Allergy, Louisville, Kentucky
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9
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Arianpour K, Nguyen B, Yuhan B, Svider PF, Eloy JA, Folbe AJ. Opioid Prescription Among Sinus Surgeons. Am J Rhinol Allergy 2018; 32:323-329. [PMID: 29781284 DOI: 10.1177/1945892418773578] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Misuse and diversion of opioids have contributed to the U.S. opioid crisis, making an understanding of specialty-specific and procedure-specific trends essential. Objective The objective of this analysis was to evaluate nationwide trends in opioid prescribing patterns among sinus surgeons performing functional endoscopic sinus surgery and maxillary sinus balloon dilation, specifically examining factors associated with variations. Methods High-volume sinus surgeons were identified through the Centers for Medicare and Medicaid Services database and cross-referenced against prescriptions to Medicare Part D beneficiaries during 2013 through 2015. Number of opioid prescriptions, prescription lengths, and demographic information were obtained. Results This cohort of 570 surgeons wrote 21,042 opioid prescriptions (5.4 days per prescription) in 2015, with 80.3% and 54.7% writing >10 and >25 prescriptions, respectively. Surgeons writing a greater amount of prescriptions wrote lengthier courses throughout all 3 years ( P = .01, P = .002, P = .003). Female otolaryngologists wrote lengthier prescriptions (6.2 vs 5.3 days, P = .01). Early career otolaryngologists (≤10 years) offered fewer prescriptions compared to those who had greater experience (31.1 vs 39.3, P = .02). Moreover, 73.6% of fellowship-trained otolaryngologists offered >10 prescriptions versus 82.7% of nonfellowship-trained otolaryngologists ( P = .02). Practitioners in the South on average prescribed the greatest amount of opioids ( P < .05). Conclusion A majority of sinus surgeons prescribe ≥25 opioid prescriptions annually, with otolaryngologists who write a greater amount of prescriptions writing lengthier courses. As the mean opioid prescription length is 5.4 days, recent legislation limiting opioid prescriptions to 5 days may only have a modest impact for preventing the diversion of perioperative opioid prescriptions. These data suggest further standardized guidelines may be beneficial in elucidating the appropriate indications for the prescription of opioids among sinus surgeons.
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Affiliation(s)
- Khashayar Arianpour
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Brandon Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Brian Yuhan
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.,2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan
| | - Peter F Svider
- 1 Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jean Anderson Eloy
- 3 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.,5 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,6 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Adam J Folbe
- 2 Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan.,7 Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
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Piccirillo JF, Payne SC, Rosenfeld RM, Baroody FM, Batra PS, DelGaudio JM, Edelstein DR, Lane AP, Luong AU, Manes RP, McCoul ED, Platt MP, Reh DD, Corrigan MD. Clinical Consensus Statement: Balloon Dilation of the Sinuses. Otolaryngol Head Neck Surg 2018; 158:203-214. [DOI: 10.1177/0194599817750086] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices. Conclusion Expert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described.
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Affiliation(s)
- Jay F. Piccirillo
- Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Spencer C. Payne
- University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | - Pete S. Batra
- Rush University Medical Center, Chicago, Illinois, USA
| | | | - David R. Edelstein
- New York Head and Neck Institute at the Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - Andrew P. Lane
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amber U. Luong
- McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
| | - R. Peter Manes
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Maureen D. Corrigan
- American Academy of Otolaryngology—Head and Neck Surgery Founda-tion, Alexandria, Virginia, USA
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