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Lehmann AE, Raquib AR, Siddiqi SH, Meier J, Durand ML, Gray ST, Holbrook EH. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: a randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol 2020; 11:1047-1055. [PMID: 33340285 DOI: 10.1002/alr.22756] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post-ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. METHODS This was a randomized, double-blind, placebo-controlled, noninferiority trial comparing amoxicillin-clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow-up, QOL was measured with 22-item Sino-Nasal Outcome Test questionnaires and Lund-Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated-measures analysis of variance and analysis of covariance and z tests for proportions. RESULTS Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT-22 scores (β = 0.18, 2-tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). CONCLUSION Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal-specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post-ESS and significantly increases the rate of diarrhea.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Aaishah R Raquib
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Josh Meier
- School of Medicine, University of Nevada, Reno, Reno, NV.,Nevada ENT and Hearing Associates, Reno, NV
| | - Marlene L Durand
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
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Maxfield AZ, Mueller SK, Raquib AR, Sedaghat AR, Bergmark RW, Metson RB, Holbrook EH, Bleier BS, Gray ST. Endoscopic management of lateral sphenoid cerebrospinal fluid leaks: Identifying a radiographic parameter for surgical planning. Laryngoscope Investig Otolaryngol 2020; 5:375-380. [PMID: 32596479 PMCID: PMC7314466 DOI: 10.1002/lio2.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/20/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Repair of cerebrospinal fluid (CSF) leaks of the lateral recess of the sphenoid (LRS) sinus can be challenging to accomplish via an endoscopic transphenoidal approach. The endoscopic transpterygoid approach can improve surgical access to the lateral recess but requires more extensive surgical dissection. We review our experience with LRS CSF leak repair via both techniques to determine whether preoperative radiologic data can help predict the most appropriate surgical approach. METHODS Electronic medical records of patients with LRS CSF leaks were retrospectively reviewed at a single tertiary referral center. Radiographic measurements from preoperative computed tomography images were reviewed. RESULTS Twenty-two LRS CSF leaks were identified. The transphenoidal and transpterygoid approach were used in 6 (27.3%) and 16 (72.7%) cases, respectively.The mean vidian canal to foramen rotundum angle of the repairs accessed transphenoidally as compared to the transptyergoid approach were not significantly different (41.93° ±10.91, 40.72° ±19.49, respectively; P = .63). However, the mean volume of the LRS accessed by the transpterygoid approach was significantly greater compared to those accessed through the transphenoidal approach (0.97 cm3 ± 0.48, 0.39 cm3 ± 0.40, respectively; P = .04). A LRS volume of 0.400 cm3 or greater predicted the use of the transpterygoid approach with 93.3% sensitivity and 60.0% specificity. CONCLUSION This study demonstrated that LRS CSF leaks that necessitated repair by the transpterygoid approach, rather than transphenoidal approach, were in the context of significantly larger lateral recess. Assessment of the LRS volume is a quantifiable parameter to aid in preoperative surgical planning. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Alice Z Maxfield
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Division of Otolaryngology-Head and Neck Surgery Brigham and Women's Hospital Boston Massachusetts USA
| | - Sarina K Mueller
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
- Department of Otolaryngology, Head and Neck Surgery University of Erlangen-Nuremberg Erlangen Germany
| | - Aaishah R Raquib
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Division of Otolaryngology-Head and Neck Surgery Brigham and Women's Hospital Boston Massachusetts USA
- Center for Surgery and Public Health Brigham and Women's Hospital Boston Massachusetts USA
- Patient Reported Outcomes, Value and Experience (PROVE) Center Brigham and Women's Hospital Boston Massachusetts USA
| | - Ralph B Metson
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
| | - Eric H Holbrook
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery Harvard Medical School Boston Massachusetts USA
- Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and Ear Boston Massachusetts USA
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Kim BJ, Irwin DJ, Song D, Daniel E, Leveque JD, Raquib AR, Pan W, Ying GS, Aleman TS, Dunaief JL, Grossman M. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology 2017; 89:1604-1611. [PMID: 28887373 DOI: 10.1212/wnl.0000000000004500] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Whereas Alzheimer disease (AD) is associated with inner retina thinning visualized by spectral-domain optical coherence tomography (SD-OCT), we sought to determine if the retina has a distinguishing biomarker for frontotemporal degeneration (FTD). METHODS Using a cross-sectional design, we examined retinal structure in 38 consecutively enrolled patients with FTD and 44 controls using a standard SD-OCT protocol. Retinal layers were segmented with the Iowa Reference Algorithm. Subgroups of highly predictive molecular pathology (tauopathy, TAR DNA-binding protein 43, unknown) were determined by clinical criteria, genetic markers, and a CSF biomarker (total tau: β-amyloid) to exclude presumed AD. We excluded eyes with poor image quality or confounding diseases. SD-OCT measures of patients (n = 46 eyes) and controls (n = 69 eyes) were compared using a generalized linear model accounting for intereye correlation, and correlations between retinal layer thicknesses and Mini-Mental State Examination (MMSE) were evaluated. RESULTS Adjusting for age, sex, and race, patients with FTD had a thinner outer retina than controls (132 vs 142 μm, p = 0.004). Patients with FTD also had a thinner outer nuclear layer (ONL) (88.5 vs 97.9 μm, p = 0.003) and ellipsoid zone (EZ) (14.5 vs 15.1 μm, p = 0.009) than controls, but had similar thicknesses for inner retinal layers. The outer retina thickness of patients correlated with MMSE (Spearman r = 0.44, p = 0.03). The highly predictive tauopathy subgroup (n = 31 eyes) also had a thinner ONL (88.7 vs 97.4 μm, p = 0.01) and EZ (14.4 vs 15.1 μm, p = 0.01) than controls. CONCLUSIONS FTD is associated with outer retina thinning, and this thinning correlates with disease severity.
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Affiliation(s)
- Benjamin J Kim
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - David J Irwin
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Delu Song
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer D Leveque
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aaishah R Raquib
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wei Pan
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tomas S Aleman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joshua L Dunaief
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Sarezky D, Raquib AR, Dunaief JL, Kim BJ. Tolerability in the elderly population of high-dose alpha lipoic acid: a potential antioxidant therapy for the eye. Clin Ophthalmol 2016; 10:1899-1903. [PMID: 27729766 PMCID: PMC5047711 DOI: 10.2147/opth.s115900] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose Alpha lipoic acid (ALA) is an antioxidant and iron-chelating supplement that has potential benefits for geographic atrophy in dry age-related macular degeneration as well as other eye diseases. The purpose of this study was to determine the tolerability of ALA in the elderly population. Patients and methods Fifteen subjects, age ≥65 years, took sequential ALA doses of 600, 800, and 1,200 mg. Each dose was taken once daily with a meal for 5 days. After each dose was taken by the subjects for 5 days, the subjects were contacted by phone, a review of systems was performed, and they were asked if they thought they could tolerate taking that dose of ALA for an extended period of time. Results The 600 mg dose was well tolerated. At the 800 mg dose, one subject had an intolerable flushing sensation. At the 1,200 mg dose, two subjects had intolerable upper gastrointestinal side effects and one subject had an intolerable flushing sensation. Subjects taking gastrointestinal prophylaxis medications had no upper gastrointestinal side effects. Conclusion High-dose ALA is not completely tolerated by the elderly. These preliminary data suggest that gastrointestinal prophylaxis may improve tolerability. (ClinicalTrials.gov, NCT02613572).
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Affiliation(s)
- Daniel Sarezky
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Aaishah R Raquib
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua L Dunaief
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin J Kim
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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