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McArdle E, Shetty S, Coutinho D, Ramadan HH, Makary CA. Correlation of patient reported outcome measures with endoscopic findings in pediatric chronic adenoiditis and chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol 2024; 179:111936. [PMID: 38583371 DOI: 10.1016/j.ijporl.2024.111936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Studies in adult chronic rhinosinusitis (CRS) showed poor correlation between patient reported outcome measures (PROMs) and objective findings. Our goal is to study the correlation between the sinus and nasal quality of life (SN-5) and the 22-items sinonasal outcome test (SNOT-22) surveys with endoscopy findings in children with chronic adenoiditis (CA) and CRS. METHODS Cross-sectional study of all pediatric patients (age 2-18) presenting for CA or CRS was performed. Patients and caregivers were asked to fill the SN-5 and SNOT-22 questionnaires at initial and follow up visits. Demographics and comorbidities were collected. Objective findings included endoscopy Modified Lund-Kennedy (MLK) scores and adenoid tissue size. RESULTS 124 children were included, with mean age of 9.9 years (SD = 4.8) and 46.8% female. 36.3% had allergic rhinitis, 23.4% had asthma, and 4% had obstructive sleep apnea. Moderate correlation was found between the rhinologic domain of SNOT-22 and MLK scores (r = 0.36, p = 0.001) and between SN5 scores and adenoid size in all patients (r = 0.39, p < 0.001). SNOT-22 scores showed moderate correlation with adenoid size (r = 0.42, p < 0.001) more specifically in CA patients (r = 0.54, p < 0.001). The correlation of SN5 and MLK scores were higher in children with allergic rhinitis or asthma. The correlation between SN5 and adenoid size was lower in children with allergic rhinitis or asthma. CONCLUSION There is discrepancy between the subjective measures and the objective findings in children with CA or CRS. The physical exam findings may not reflect the effect of CRS on the quality of life of children.
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Affiliation(s)
- Erica McArdle
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Sameer Shetty
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Dominic Coutinho
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
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Sunyecz I, Hunt C, Ramadan HH, Makary CA. Role of Sinonasal Anatomic Variants in Recurrent Acute Rhinosinusitis. Laryngoscope 2024. [PMID: 38451036 DOI: 10.1002/lary.31388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/18/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Prior studies evaluating the role of sinonasal anatomic variants with recurrent acute rhinosinusitis (RARS) are limited by inconsistent results. The goal of this study is to evaluate the association between sinonasal anatomic variants and RARS. METHODS A 1:2 retrospective case-control study was conducted using patients presenting to the rhinology clinic from August 2020 to January 2023. A total of 60 patients with RARS were compared to 120 control patients. RARS was diagnosed based on the International Consensus Statement on Allergy and Rhinology criteria of four or more independent episodes of acute rhinosinusitis per year with at least one episode documented by objective findings, with complete resolution of the infection in-between episodes. Sinonasal anatomic variants included nasal septal deviation (NSD), concha bullosa (CB), infraorbital (Haller) cells, nasal septal spur in the middle meatus, and frontal sinus cells (supra-agger, supra-agger frontal, and suprabullar frontal cells). RESULTS Age was similar in RARS and control patients (47.4 ± 16.5 vs. 49.3 ± 14.5, p = 0.432). Both the RARS group and control group were more likely to be female (78.3% vs. 77.5%, p = 0.899). There was no significant association between NSD and RARS compared to the control group (OR = 0.97, p = 0.916), and no significant association between any of the anatomic variants and RARS [infraorbital cells (OR = 0.64, p = 0.167), CB (OR = 0.84, p = 0.596), spur in the middle meatus (OR = 1.28, p = 0.514), supra-agger (OR = 0.88, p = 0.708), supra-agger frontal cells (OR = 0.97, p = 0.939), or suprabullar frontal cells (OR = 1.13, p = 0.766)]. CONCLUSION Our findings suggest no association between nasal septal deviation or any of the anatomic variants studied and RARS. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Ian Sunyecz
- Department of Otolaryngology Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Connor Hunt
- School of Medicine, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Hassan H Ramadan
- Department of Otolaryngology Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Chadi A Makary
- Department of Otolaryngology Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
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Ramadan HH. Pediatric chronic rhinosinusitis. Eur Arch Otorhinolaryngol 2024; 281:1131-1137. [PMID: 37899371 DOI: 10.1007/s00405-023-08307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE An up-to-date overview of diagnosis, differential diagnosis, comorbidities, and current medical and surgical management of pediatric chronic rhinosinusitis (PCRS). METHODS Review of current evidence-based literature on PCRS. RESULTS Diagnosis of PCRS seems to be improving based on recent evidence using nasal endoscopy as well as computed tomography scanning. Recent literature supports the fact that chronic adenoiditis can be an independent etiology of symptoms of chronic sinusitis, that are very similar to chronic adenoiditis. Allergic rhinitis and immune deficiency play important roles in the management of PCRS. Surgery for PCRS has evolved significantly in the last 15-20 years to include adenoidectomy as well as endoscopic sinus surgery. CONCLUSIONS PCRS is very common in children causing poor QOL for these children. Medical management remains the main stay of treatment with attention to management of co-morbidities that may contribute to the disease severity. Making the correct diagnosis will help with the choice of surgical intervention if medical management fails.
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Health Sciences Center, West Virginia University School of Medicine, PO Box 9200, Morgantown, WV, USA.
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Al-Asadi Z, Cui R, Lombardo D, Dewey J, Ramadan HH, Makary CA. Impact of recurrent acute rhinosinusitis on quality of life. Int Forum Allergy Rhinol 2024; 14:732-734. [PMID: 37608458 DOI: 10.1002/alr.23256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
KEY POINTS Quality of life (QoL) in patients with recurrent acute rhinosinusitis (RARS) is understudied. QoL for RARS patients is similar to chronic rhinosinusitis patients, although objective disease severity is lower. QoL of RARS patients is similarly affected during active and inactive infection.
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Affiliation(s)
- Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Dominic Lombardo
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - John Dewey
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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Reddy SG, Al-Asadi Z, Cui R, Lombardo D, Ramadan HH, Makary CA. Association of autoimmune disorders with chronic rhinosinusitis in adults. Am J Otolaryngol 2024; 45:104177. [PMID: 38113772 DOI: 10.1016/j.amjoto.2023.104177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Increasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis compared to rhinitis. GOAL To investigate the association between autoimmune disorders and rhinosinusitis. METHODS We performed a case-control study of patients referred to West Virginia University from August 2020 to October 2022 for rhinologic complaints. Rhinosinusitis patients were diagnosed with either chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). These patients were compared to non-rhinosinusitis patients. Patients' characteristics, comorbidities, and type of treatment of autoimmune disorders were reviewed. RESULTS The sample consisted of 527 rhinosinusitis [184 CRS without nasal polyps (CRSsNP), 263 CRS with nasal polyps (CRSwNP) and 80 RARS patients] patients and 564 non-rhinosinusitis patients. Patients with rhinosinusitis were more likely to be older, males, have asthma, and have current and past smoking history (all with p-value < 0.05). Autoimmune disorders, primary antibody deficiency, and immunomodulator agents were more common in rhinosinusitis patients (16.5 % vs 9.4 %, OR = 1.9, p < 0.001; 5.1 % vs 0.5 %, OR = 10.1, p < 0.001; and 3.8 % vs 1.1 %, OR = 3.7, p = 0.003 respectively). Multivariate logistic regression adjusting for confounders showed that autoimmune disorders were strongly associated with rhinosinusitis [OR = 1.6, 95 % CI = 1.10-2.48], whereas the immunomodulators did not reach statistical significance [OR = 2.4, 95 % CI = 0.87-6.47]. Subgroup analysis showed the autoimmune disorders did not significantly differ between CRS and RARS groups [OR = 1.0, 95 % CI = 0.5-2.1], or between the CRSsNP and CRSwNP groups [OR = 0.9, 95 % CI = 0.5-1.7]. CONCLUSION Autoimmune disorders are associated with rhinosinusitis, both CRS and RARS, independently of other risk factors.
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Affiliation(s)
- Sairisheel Gabbi Reddy
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Dominic Lombardo
- School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
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Kais A, Orabi N, Cui R, Ramadan HH. Predictors of Success of Adenoidectomy in the Treatment of Pediatric Chronic Rhinosinusitis. Ear Nose Throat J 2024:1455613241232879. [PMID: 38400707 DOI: 10.1177/01455613241232879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Objectives: There is consensus for adenoidectomy as treatment of chronic rhinosinusitis (CRS) in children younger than 6 years but less consensus for those aged 6 years and older. The present clinical research study investigated predictors of adenoidectomy success for pediatric CRS. Methods: A retrospective chart review was conducted for 107 children who presented to an otolaryngology clinic and had an adenoidectomy for CRS after failure of maximal medical therapy. Results: The majority of sample was male (N = 63; 58.9%) with mean age of 4.88 (SD = 2.54) and mean Lund-Mackay score of 7.76 (SD = 3.87). Patients who had success with adenoidectomy were older on average [mean (M) = 5.46; SD = 2.83] than patients who failed the procedure (M = 4.36; SD = 2.40; F = 4.06, P = .047). This equated to 67.9% of children aged 6 years and older and 39.2% of children younger than 6 years succeeding with the surgery. Conclusions: Adenoidectomy is a good first-line surgery for children aged 12 years and younger, especially in the 6 to 12 years group which had a high rate of success with 68% experiencing remission of symptoms after surgery.
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Affiliation(s)
- Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Norman Orabi
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Behnke J, Dundervill C, Al-Asadi Z, Shahid M, Ramadan HH, Makary CA. Gender Differences in Adults With Chronic Rhinosinusitis: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38317564 DOI: 10.1002/ohn.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/25/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Gender differences in chronic rhinosinusitis (CRS) have been demonstrated in many studies over the last 15 years. The purpose of this scoping review is to investigate the current knowledge on gender differences in CRS and to analyze the gaps in the literature. DATA SOURCES A systematic search of PubMed, Cochrane Library, and Embase databases was performed. REVIEW METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies that evaluated gender differences in CRS were included in the review. RESULTS Of the 523 abstracts reviewed, a total of 23 studies met the criteria for inclusion. Articles consisted of retrospective and prospective cohort studies. They were divided into 3 categories based on whether they evaluated gender differences in (1) presentation and baseline quality of life, (2) pathophysiology, and/or (3) outcomes of treatment. Eleven studies addressed differences in presentation, 5 addressed differences in pathophysiology, and 10 dealt with differences in outcomes after surgical or medical management. Most of the studies showed worse baseline QoL secondary to CRS in women, with outcome of treatment being similar in both genders. CONCLUSION The experience of CRS appears to vary between genders, with women experiencing a greater subjective burden of disease than men, though with similar outcomes after treatment. Further research is indicated, particularly involving the pathophysiology of CRS, to fully understand the underlying causes of these discrepancies.
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Affiliation(s)
- John Behnke
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
| | - Caroline Dundervill
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Michel Shahid
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, Virginia University, USA
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Dundervill C, Al-Asadi Z, Behnke J, Tumlin P, Chaiban R, Ramadan HH, Makary CA. Gender Differences in Quality of Life of Adolescent Patients With Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2024; 133:169-173. [PMID: 37608693 DOI: 10.1177/00034894231195662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To identify the differences in the impact of chronic rhinosinusitis (CRS) between female and male adolescent patients at presentation. STUDY DESIGN Cross sectional study. METHODS Adolescent patients, age 12 to 18 years old, presenting to our Otolaryngology clinic between August 2020 and April 2023 for CRS were asked to fill both the SNOT-22 and the SN5 forms. Female and male cohorts were compared regarding their demographics, comorbidities, subjective and objective disease measurements, and choice of treatment. RESULTS Sixty-six patients were included, 30 female and 36 male patients. There were no differences in age, allergic rhinitis, asthma, obstructive sleep apnea, presence of nasal septal deviation, and objective disease severity (P > .05 for all). At presentation, mean overall SNOT-22, ear/facial, sleep, and psychological domains were all higher in female patients (43vs 30.9, P = .02; 9.1vs 6, P = .03; 11.8vs 8.3, P = .07; 14.1vs 8.8, P = .02 respectively). SN5 scores and overall QoL visual analog scale were similar in females and males. CONCLUSION Female patients with CRS show higher subjective disease burden. Incorporating data on gender-specific differences may be important to personalize treatment decision making.
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Affiliation(s)
| | - Zayd Al-Asadi
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - John Behnke
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Parker Tumlin
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Rafka Chaiban
- Department of Pediatrics, West Virginia University Medicine, Morgantown WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
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Kais A, McArdle E, Chaiban R, Cui R, Makary CA, Ramadan HH. Role of Acute Rhinosinusitis in Periorbital Infections in Children. Int J Pediatr Otorhinolaryngol 2024; 176:111813. [PMID: 38043186 DOI: 10.1016/j.ijporl.2023.111813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Periorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children. STUDY DESIGN Retrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS. SETTING Patients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022. METHODS Patients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients' characteristics, treatment, hospital length of stay, and readmission were collected. RESULTS The sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups. CONCLUSION Children presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections.
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Affiliation(s)
- Amani Kais
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Erica McArdle
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Rafka Chaiban
- West Virginia University School of medicine, Department of Pediatrics, P.O. Box 9100, Morgantown, WV, 26506-9600, USA
| | - Ruifeng Cui
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Chadi A Makary
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA.
| | - Hassan H Ramadan
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
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Behnke J, Asadi ZA, Lombardo D, Cui R, Ramadan HH, Makary CA. Risk Factors associated with Recurrent Acute Rhinosinusitis. Int Forum Allergy Rhinol 2024; 14:141-143. [PMID: 37365859 DOI: 10.1002/alr.23224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
KEY POINTS Few studies have evaluated the association of recurrent acute rhinosinusitis (RARS) with other comorbidities. Allergic rhinitis, asthma, primary antibody deficiency, and autoimmune disorders are associated with RARS. Evaluation for these comorbidities should be considered when treating patients with RARS.
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Affiliation(s)
- John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Zayd Al Asadi
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dominic Lombardo
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Ruifeng Cui
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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Tumlin P, Assi S, Armeni M, Ramadan HH, Reyes C, Makary CA. Outcome of Endoscopic Repair of Nasal Septal Perforation. Ann Otol Rhinol Laryngol 2023; 132:1617-1620. [PMID: 37246364 DOI: 10.1177/00034894231176610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. METHODS A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. RESULTS Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). CONCLUSION The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.
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Affiliation(s)
- Parker Tumlin
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Sahar Assi
- American University of Beirut, Beirut, Lebanon
| | - Mark Armeni
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Camilo Reyes
- Department of Otolaryngology, Augusta University, Augusta, GA, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
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Makary CA, Bonnici M, Jones G, Sullivan P, Stokes C, Ramadan HH. Long-term Follow-up of Pediatric Chronic Rhinosinusitis After Surgical Treatment. Ann Otol Rhinol Laryngol 2023; 132:1400-1403. [PMID: 36951071 DOI: 10.1177/00034894231161417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To study the long-term outcomes of pediatric chronic rhinosinusitis (CRS) after surgical treatment. METHODS Cross-sectional survey of patients who were treated surgically for CRS as children more than 10 years ago. Survey included SNOT-22 questionnaire, additional functional endoscopic sinus surgery (FESS) since last treatment, status of allergic rhinitis and asthma, and availability of any CT scan sinus/face for review. RESULTS About 332 patients were contacted by phone or email. Seventy-three patients filled the survey (22.5% response rate). Current age was 26 years (±+/-4.7, 15.3-37.8 years). Age at initial treatment was 6.8 years (+/-3.1, 1.7-14.7 years). Fifty-two patients (71.2%) had FESS and adenoidectomy, and 21 patients (28.8%) had adenoidectomy only. Follow-up since surgical treatment was 19.3 years (+/-4.1). SNOT-22 score was 34.5 (+/-22.2). None of the patients had any additional FESS for the duration of the follow-up, and only 3 patients had septoplasty and inferior turbinoplasty as adults. Twenty-four patients had CT scan sinuses/face available for review. Scans were obtained at an average of 14 years after surgical intervention (+/-5.2). CT LM score was 0.9 (+/-1.9), compared to 9.3 at time of their surgery (+/-5.9) (P < .0001). Currently 45.8% and 36.9% of patients have asthma and AR, compared to 35.6% and 40.6% respectively as kids (P = .897 and P = .167). CONCLUSION Children who had surgery for CRS do not seem to have CRS as adults. However, patients continue to have active allergic rhinitis that may affect their quality of life.
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Affiliation(s)
- Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | | | - Garrett Jones
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - Patrick Sullivan
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Cara Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
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Kais A, Sinan M, Crawford A, Rose AS, Gudis DA, Ramadan HH, Makary CA. Improvement in Quality of Life after Septoplasty in Children: a Systematic Review. Int Forum Allergy Rhinol 2023; 13:2076-2081. [PMID: 37057507 DOI: 10.1002/alr.23169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/19/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/15/2023]
Abstract
KEY POINTS Septoplasty for nasal obstruction in the pediatric population shows positive outcomes in objective and subjective post-operative measurements. Septoplasty in children results in disease-related improvement in quality of life. Higher level studies are needed to confirm these results.
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Affiliation(s)
- Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Moaz Sinan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Anna Crawford
- Health Sciences Library, West Virginia University, Morgantown, West Virginia, USA
| | - Austin S Rose
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Colombia University School of Medicine, New York, New York, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
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Bonnici M, Orabi NA, Gannon M, Williams N, Stokes CM, Ramadan HH, Turner MT, Makary CA. Complications and Outcomes of Endovascular Embolization for Intractable Epistaxis: A Systematic Review and Meta-analysis. Ann Otol Rhinol Laryngol 2023; 132:1233-1248. [PMID: 36582148 DOI: 10.1177/00034894221143187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. METHODS This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. RESULTS Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. CONCLUSIONS Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications.
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Affiliation(s)
| | - Norman A Orabi
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Michael Gannon
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Nathan Williams
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Cara M Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Meghan T Turner
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Kais A, Chaiban R, Makary CA, Ramadan HH. Corrigendum to "Seasonal variations, acute rhinosinusitis and orbital infections in children" [Am J Otolaryngology Volume 44, Issue 4, July-August 2023, 103918]. Am J Otolaryngol 2023; 45:104032. [PMID: 37717399 DOI: 10.1016/j.amjoto.2023.104032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Rafka Chaiban
- Division of General Pediatrics, Department of Pediatrics, West Virginia University, Morgantown, WV, United States of America
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
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16
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Orabi NA, Behnke J, Reyes C, Ramadan HH, Makary CA. Effect of absorbable nasal packing saturated with ciprofloxacin and dexamethasone following endoscopic sinus surgery: A prospective cohort study. Int Forum Allergy Rhinol 2023; 13:1801-1804. [PMID: 36413477 DOI: 10.1002/alr.23114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 08/24/2023]
Affiliation(s)
- Norman A Orabi
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - John Behnke
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Camilo Reyes
- Department of Otolaryngology, Medical College of, Georgia at Augusta University, Augusta, GA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
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17
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Kais A, Chaiban R, Makary AC, Ramadan HH. Seasonal variations, acute rhinosinusitis and orbital infections in children. Am J Otolaryngol 2023; 44:103918. [PMID: 37178538 DOI: 10.1016/j.amjoto.2023.103918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Orbital infections in children are commonly secondary to acute bacterial rhinosinusitis (ABRS). It is unclear whether seasonal variations can predispose to these complications mirroring acute rhinosinusitis incidence. OBJECTIVE To determine the incidence of ABRS as a cause of orbital infections and whether seasonality is a risk factor. METHODS A retrospective review of all children who presented to West Virginia University children's hospital between 2012 and 2022 were reviewed. All children with CT evidence of orbital infection were included. Date of occurrence, age, gender, and presence of sinusitis were reviewed. Children with orbital infection secondary to tumors, trauma, or surgery were excluded. RESULTS 118 patients were identified with mean age of 7.3 years with 65 (55.1 %) males. 66 (55.9 %) children had concomitant sinusitis on CT scan, and the distribution of orbital complications per season showed 37 (31.4 %) cases occurred in the winter season, followed by 42 (35.6 %) cases in spring, 24 (20.3 %) cases in summer, and 15 (12.7 %) in fall. Children with orbital infections during winter & spring had sinusitis in 62 % of children vs. 33 % in other seasons (P = 0.02). Preseptal cellulitis was present in 79 (67 %) children, 39 (33 %) children with orbital cellulitis, and 40 (33.9 %) children with abscesses. 77.6 % children were treated with IV antibiotics and 94 % with oral antibiotics, and 14 (11.9 %) with systemic steroids. Only 18 (15.3 %) children required surgery. CONCLUSIONS There seems to be a seasonal predisposition for orbital complications mainly in the winter and spring seasons. Rhinosinusitis was present in 55.6 % of children presenting with orbital infections. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- A Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - R Chaiban
- Division of General Pediatrics, Department of Pediatrics, West Virginia University, Morgantown, WV, United States of America
| | - A C Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America
| | - H H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, United States of America.
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Orabi NA, Assi S, Tumlin P, Bulbul MG, Ramadan HH, Makary CA. Clinical characteristics of patients with pain-related temporomandibular disorders presenting as chronic rhinosinusitis. Int Forum Allergy Rhinol 2023; 13:273-276. [PMID: 36059195 DOI: 10.1002/alr.23080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Norman A Orabi
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Sahar Assi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Parker Tumlin
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Mustafa G Bulbul
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Hassan H Ramadan
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Chadi A Makary
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
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Behnke J, Dundervill C, Bulbu M, Armeni M, Ramadan HH, Makary CA. Using the sino-nasal outcome test (SNOT-22) to study outcome of treatment of nasal obstruction. Am J Otolaryngol 2023; 44:103879. [PMID: 37004319 DOI: 10.1016/j.amjoto.2023.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE To validate the sino-nasal outcome test (SNOT-22) as an outcome measure for nasal obstruction, and to determine if it correlates with the nasal obstruction and septoplasty effectiveness (NOSE) scale. STUDY DESIGN Prospective cohort study. METHODS All patients presenting to our otolaryngology clinic for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy between August 2020 and June 2022 were asked to fill both the SNOT-22 and the NOSE questionnaires. Demographics and comorbidities were reviewed. Patients with chronic rhinosinusitis (CRS) were excluded. SNOT-22 total and subdomain scores were then compared to NOSE scores. RESULTS 126 patients completed both surveys. Average age was 42.6 years (range 13.8-78.3 years), and 40.5 % were female. 35 patients had septoplasty and inferior turbinoplasty (IT), 34 had functional septorhinoplasty and IT, 6 patients had IT, 7 had nasal septal perforation repair and 44 patients had medical treatment. Overall, SNOT-22 and NOSE scores correlated well preoperatively and postoperatively (r = 0.54, p < 0.0001; r = 0.68, p < 0.0001 respectively). The rhinologic and sleep SNOT-22 subdomains scores had the strongest correlation to NOSE score (r = 0.56, p < 0.0001; r = 0.64, p < 0.0001 respectively). Both NOSE and SNOT-22 scores showed improvement postoperatively [NOSE: 67.4 vs 25.1 (p < 0.0001) at 3 months, 69.5 vs 34 (p < 0.0001) at 6 months; SNOT-22: 37.1 vs 25.2 (p = 0.002) at 3 months, 38.1 vs 22.6 (p = 0.002) at 6 months]. No significant improvement in NOSE or SNOT scores was seen in the medical treatment group. CONCLUSION SNOT-22 instrument can be used to study the outcome of treatment for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy. LEVEL OF EVIDENCE: 4
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Bulbul MG, Jones G, Shaikh N, Assi S, E Bailey C, Ramadan HH, Makary CA. Is there an association between chronic rhinosinusitis and statins? A single institution study. Int Forum Allergy Rhinol 2023; 13:184-187. [PMID: 35980343 DOI: 10.1002/alr.23075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Garrett Jones
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Noah Shaikh
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sahar Assi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Christopher E Bailey
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Chadi A Makary
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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21
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Orabi NA, Makary CA, Ramadan HH. The use of SN-5 to differentiate chronic rhinosinusitis and chronic adenoiditis in children. Int J Pediatr Otorhinolaryngol 2022; 161:111269. [PMID: 35987130 DOI: 10.1016/j.ijporl.2022.111269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic adenoiditis (CA) and chronic rhinosinusitis (CRS) present with similar symptoms, but an accurate diagnosis is critical for optimal treatment. We aim to differentiate CRS and CA based on sinonasal symptoms using the Sinus and Nasal Quality of Life Survey (SN-5) in children. METHODS This is a retrospective cohort study. Children (age 12 and younger) presenting with chronic sinonasal symptoms were divided into 2 groups based on CT scan sinus findings: CA group included patients with CT Lund-Mackay (LM) score <5 and CRS group included patients with CT LM score of 5 and more. SN-5 scores for each group were then compared, and both groups were compared to a control group. Other demographic data were also collected and analyzed. RESULTS There were 27 patients in the CA group, 42 patients in CRS group and 38 patients in the control group. Mean SN-5 scores were 2.03±0.71 for the control group, 3.49±1.00 for the CA group, and 4.53±0.77 for the CRS group (p < 0.0001); Statistical significance persisted when CA and CRS were compared in subset analysis (p < 0.0001). CT LM score was 2.70±2.07 for the CA group and 9.94±3.46 for the CRS group (p < 0.0001). Rates of asthma, allergic rhinitis, and smoke exposure differed between the three groups (p < 0.01), but they were not statistically different when CA and CRS were compared in subset analysis. CONCLUSION Children with CRS have higher SN-5 score than children with CA. SN-5 score can be used to help otolaryngologists differentiate between these two clinical entities.
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Affiliation(s)
- Norman A Orabi
- West Virginia University School of Medicine, Department of Otolaryngology- Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Chadi A Makary
- West Virginia University School of Medicine, Department of Otolaryngology- Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Hassan H Ramadan
- West Virginia University School of Medicine, Department of Otolaryngology- Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA.
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22
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Makary CA, Tumlin P, Asad F, Wasef K, Ramadan HH. Quality of Life Measurement for Adolescent Patients with Sinonasal Symptoms. Laryngoscope 2022; 133:1052-1058. [PMID: 35638256 DOI: 10.1002/lary.30232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/26/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To validate each of the sino-nasal outcome test (SNOT-22) and the sinus and nasal quality of life (SN5) surveys for the adolescent population defined as 12 to 18 years old, and to determine if they correlate in regard to reports of sinonasal symptoms and quality of life. STUDY DESIGN Cross-sectional study. METHODS Adolescent patients, age 12 to 18 years old, presenting to our otolaryngology clinic between August 2020 and June 2021 were asked to fill both the SNOT-22 and the SN5 forms. Demographics and comorbidities were reviewed. Patients recruited were then divided into a sinonasal cohort (those with chronic sinonasal symptoms) and a control cohort (those who did not have any sinonasal disorders at time of visit). RESULTS One hundred fifteen patients completed both surveys, 80 patients in the sinonasal cohort and 35 patients in the control cohort. Average age was 14.9 years, and 49.6% were female. Mean SNOT-22 and SN5 scores were significantly higher in the sinonasal cohort as compared with the control cohort which confirmed validity of both surveys for the adolescents. Good test-retest reliability for both surveys was obtained (r = 0.76 for SNOT-22, and r = 0.64 for SN5). SNOT-22 and SN5 scores correlated well in both the sinonasal cohort (r = 0.63, p < 0.0001) and the control cohort (r = 0.61, p = 0.0003). Both surveys strongly predicted chronic sinonasal disorders with an odds ratio of 2.5 for SNOT-22 and 2.2 for SN5. CONCLUSION Both instruments can be used to study the outcome of treatment for sinonasal disorders in adolescent patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Parker Tumlin
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Fatima Asad
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Kareem Wasef
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
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Abstract
Rhinosinusitis is a common diagnosis encountered by providers of all disciplines. Pediatric acute and chronic rhinosinusitis account for up to 2% of the total annual visits to the outpatient clinics and emergency departments. Once correct diagnosis is made, appropriate treatment measures can be initiated. It is important to recognize rhinosinusitis in children due to the potential serious complications and the impact it may have on quality of life of those children. Medical management is the mainstay of treatment, and, fortunately, it is successful in most of those children. When medical management fails, or a complication occurs, surgery may be required.
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
| | - Rafka Chaiban
- Department of Pediatrics, West Virginia University, Uniontown, PA, USA
| | - Chadi Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
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Ramadan HH, Bulbul MG, Asad F, Wasef K, Makary CA. Complications of primary pediatric endoscopic sinus surgery for chronic rhinosinusitis: A 25‐year single surgeon experience. Laryngoscope Investig Otolaryngol 2022; 7:658-661. [PMID: 35734063 PMCID: PMC9194991 DOI: 10.1002/lio2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS). Methods Case series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention. Results A total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Conclusions Complications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury. Level of evidence: 4.
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Affiliation(s)
- Hassan H. Ramadan
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
| | - Mustafa G. Bulbul
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
| | - Fatima Asad
- School of Medicine, West Virginia University Morgantown West Virginia USA
| | - Kareem Wasef
- School of Medicine, West Virginia University Morgantown West Virginia USA
| | - Chadi A. Makary
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
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Roberts C, Castaño J, Ozolek J, Smith MC, Kiefer A, Ramadan HH, Makary CA. Endoscopic-Assisted Resection of a Novel Nasopharyngeal Hairy Polyp and Odontoma in an Infant. Ear Nose Throat J 2021:1455613211065516. [PMID: 34894791 DOI: 10.1177/01455613211065516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christopher Roberts
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - Johnathan Castaño
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - John Ozolek
- Department of Pathology, 5631West Virginia University, Morgantown, WV, USA
| | - Mark Cody Smith
- Department of Pediatrics, 5631West Virginia University, Morgantown, WV, USA
| | - Autumn Kiefer
- Department of Pediatrics, 5631West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
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Behnke J, Jimenez-Herrera P, Peppers B, Ramadan HH, Makary CA. Outcome of immunoglobulin replacement therapy in children with rhinosinusitis. Int Forum Allergy Rhinol 2021; 12:795-797. [PMID: 34699128 DOI: 10.1002/alr.22921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/05/2022]
Affiliation(s)
- John Behnke
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | | | - Brian Peppers
- Department of Pediatrics, Allergy and Immunology, West Virginia University, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
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Makary CA, Behnke J, Peppers B, Ramadan HH. Outcome of Immunoglobulin Replacement Therapy in Adults With Rhinosinusitis. Laryngoscope 2021; 132:732-736. [PMID: 34146351 DOI: 10.1002/lary.29694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the outcome of immunoglobulin (IG) replacement therapy in adults with rhinosinusitis and primary humoral immunodeficiency disorders (PID). STUDY DESIGN Retrospective cohort study. METHODS Retrospective chart review of adult (18 years and older) patients who were diagnosed with PID and had the diagnosis of recurrent acute rhinosinusitis (RARS) and chronic rhinosinusitis (CRS) and who are on IG replacement therapy. Demographic data, associated conditions, and duration of treatment were reviewed. Number of yearly sinus infections, sinus CT Lund-Mackay (LM) score, and need for functional endoscopic sinus surgery (FESS) were reviewed before and after starting IG therapy. RESULTS Fifty-eight patients were included. Average age was 52 years (18-79 years). About 74% were female. Thirty patients (51.7%) had common variable immunodeficiency (CVID), 18 (31.1%) had hypogammaglobulinemia, and 10 (17.2%) had specific antibody deficiency (SAD). About 79% of patients had allergic rhinitis and 74% had asthma. Pretreatment LM score was 7.6 (±2.2, range of 0-24) compared to posttreatment score of 3.5 (±1.3, range of 0-16) (P = .01). Eleven patients (19%) had FESS pretreatment compared to only two patients (3.4%) requiring ESS after starting treatment on IG therapy (P = .004). Prior to starting IG therapy, five patients (8.6%) had more than 10 sinus infections per year, 33 patients (56.9%) had 5 to 10 infections, and 20 patients (34.5%) had 1 to 5 infections per year. After starting on IG, 34 patients (58.6%) had no infections reported anymore (P < .001), and 24 patients (41.4%) had only 1 to 5 infections reported per year CONCLUSION: IG therapy is a promising treatment option for recurrent rhinosinusitis in patients with PID. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Chadi A Makary
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, U.S.A
| | - John Behnke
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Brian Peppers
- Department of Pediatrics, Allergy and Immunology, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, U.S.A
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Makary CA, Zalzal HG, Ramadan J, Ramadan HH. Endoscopic endonasal CSF rhinorrhea repair in children: Systematic review with meta-analysis. Int J Pediatr Otorhinolaryngol 2020; 134:110044. [PMID: 32320837 DOI: 10.1016/j.ijporl.2020.110044] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Cerebrospinal fluid (CSF) rhinorrhea in children is relatively uncommon. Endoscopic repair techniques in adults have become first line for nasal-based CSF leaks, and this meta-analysis looks at the success rates of CSF leak cessation following endoscopic repair in children. METHODS Three researchers extracted information involving patient population, surgical technique, outcomes of interest, and study design. A computerized search of MEDLINE, EMBASE and the Cochrane library (January 1990-September 2019) looked for several papers on the subject of CSF leak repair in children using endoscopic technique. RESULTS A total of 15 studies met inclusion criteria. Endoscopic repair of CSF rhinorrhea in children shows a pooled weighted success rate of 94% after first attempt. The most common etiology was traumatic followed by congenital. Iatrogenic defects secondary to tumor resection are becoming more common. The high success rate was irrespective of the techniques using. CONCLUSION Endoscopic repair techniques have a highly successful closure rate for children presenting with CSF rhinorrhea.
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Affiliation(s)
- Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Habib G Zalzal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jad Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
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Purnell PR, Addicks BL, Zalzal HG, Shapiro S, Wen S, Ramadan HH, Setola V, Siderovski DP. Single Nucleotide Polymorphisms in Chemosensory Pathway Genes GNB3, TAS2R19, and TAS2R38 Are Associated with Chronic Rhinosinusitis. Int Arch Allergy Immunol 2019; 180:72-78. [PMID: 31137020 DOI: 10.1159/000499875] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/16/2019] [Accepted: 03/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a multifaceted disease with a significant genetic component. The importance of taste receptor signaling has recently been highlighted in CRS; single nucleotide polymorphisms (SNPs) of bitter tastant-responsive G-protein-coupled receptors have been linked with CRS and with altered innate immune responses to multiple bacterially derived signals. OBJECTIVE To determine in CRS the frequency of six SNPs in genes with known bitter tastant signaling function. METHODS Genomic DNA was isolated from 74 CRS volunteers in West Virginia, and allele frequency was determined and compared with demographically matched data from the 1,000 Genomes database. RESULTS For two SNPs in a gene recently associated with bitterant signaling regulation, RGS21, there were no associations with CRS (although the frequency of the minor allele of RGS21, rs7528947, was seen to increase with increasing Lund-Mackay CT staging score). Two TAS2R bitter taste receptor gene variants (TAS2R19 rs10772420 and TAS2R38 rs713598), identified in prior CRS genetics studies, were found to have similar associations in this study. CONCLUSION Unique to our study is the establishment of an association between CRS in this patient population and GNB3 SNP rs5443, a variation in an established G protein component downstream of bitterant receptor signal transduction.
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Affiliation(s)
- Phillip R Purnell
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Benjamin L Addicks
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Habib G Zalzal
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Scott Shapiro
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Vincent Setola
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Department of Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - David P Siderovski
- Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, West Virginia, USA,
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Zalzal HG, Makary CA, Ramadan HH. Long-Term Effectiveness of Balloon Catheter Sinuplasty in Pediatric Chronic Maxillary Sinusitis. Ear Nose Throat J 2019; 98:207-211. [PMID: 30943802 DOI: 10.1177/0145561319840126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of our study was to assess the long-term effectiveness of balloon catheter sinuplasty in the treatment of pediatric chronic maxillary sinusitis following failed first-line medical and surgical management with adenoidectomy. Pediatric patients younger than 12 years were reviewed for having failed previous adenoidectomy and undergone a balloon catheter sinuplasty between August 2006 and March 2011 for chronic rhinosinusitis. Demographic data and clinical characteristics were recorded in patients who met inclusion criteria. Outcomes were assessed by need for functional endoscopic sinus surgery and persistence of chronic infection within at least 5 years of follow-up. Failure was defined by any child who was rediagnosed with chronic sinus disease after balloon catheter sinuplasty or who required endoscopic sinus surgery within 5 years. Sixty-two children were reviewed, with 38 patients meeting inclusion criteria (prior adenoidectomy, a preoperative Lund-Mackay score of ≥5, and balloon catheter sinuplasty). The mean age (standard deviation) was 6.76 (2.27) years with an age range of 2 to 11 years. Eight children (21.1%, P < .01) continued to have chronic sinus complaints following balloon procedure, with 5 (13.1%) individuals requiring eventual endoscopic surgery within 5 years. Age, asthma, allergy, and gender did not have any statistically significant impact on outcome. Balloon catheter sinuplasty is an effective long-term alternative for the treatment of chronic rhinosinusitis in pediatric patients, hoping to avoid further infections and eventual endoscopic surgery.
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Affiliation(s)
- Habib G Zalzal
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Chadi A Makary
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Hassan H Ramadan
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
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Purnell PR, Ramadan JH, Ramadan HH. Can Symptoms Differentiate Between Chronic Adenoiditis and Chronic Rhinosinusitis in Pediatric Patients. Ear Nose Throat J 2019; 98:279-282. [PMID: 30939913 DOI: 10.1177/0145561319840133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis (P = .017). Symptoms including cough (P = .022), rhinorrhea (P = .27), and facial pressure (P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores >5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained.
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Affiliation(s)
- Phillip R Purnell
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Jad H Ramadan
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Hassan H Ramadan
- 1 Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
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Makary CA, Limjuco A, Nguyen J, Ramadan HH. Combined Lid Crease and Endoscopic Approach to Lateral Frontal Sinus Disease With Orbital Extension. Ann Otol Rhinol Laryngol 2018; 127:637-642. [PMID: 29972305 DOI: 10.1177/0003489418784967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Functional endoscopic sinus surgery for frontal sinus disease has obviated the need for external approaches. Special circumstances such as acute infection with orbital involvement or significant lateral sinus disease frequently require adjunct access. We describe the clinical outcomes of a combined upper eyelid crease and endoscopic approach for lateral frontal sinus disease with orbital extension. METHODS A retrospective case series of 7 patients who underwent a combined lid crease approach for frontal sinus disease with orbital extension between April 2012 and October 2016 was performed. All patients had the presence of lateral frontal sinus disease as well as orbital extension as seen on a preoperative computed tomography (CT) scan. Patient demographics, indications for surgery, and perioperative findings were examined. RESULTS Six of the 7 patients were male. Mean age was 61 years, and the indication for surgery was primarily drainage of mucopyocele and inverting papilloma (IP) in 1 patient. The frontal sinus and orbit were successfully accessed, and the respective pathology was addressed in both locations. No intraoperative or postoperative complications were encountered. There was no postoperative or cosmetic complications. CONCLUSION The combined lid crease and endoscopic approach is a safe and effective technique for accessing the lateral frontal sinus and orbit.
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Affiliation(s)
- Chadi A Makary
- 1 WVU medicine Ear, Nose and Throat, West Virginia University, Martinsburg, West Virginia, USA
| | - Alex Limjuco
- 2 Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - John Nguyen
- 3 Department of Oculoplastic surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Hassan H Ramadan
- 2 Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
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Zalzal HG, Makary CA, Evans R, Giardina S, Underwood T, Rowlands A, Ramadan HH. Using Clinical Indicators to Reduce Perianesthesia Recovery Time Following Outpatient Tonsillectomy. Ann Otol Rhinol Laryngol 2018; 127:620-624. [PMID: 29925253 DOI: 10.1177/0003489418783226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine whether we could reduce the time that patients undergoing tonsillectomy are observed postoperatively without decreasing the quality of care, which would eliminate the unnecessary use of resources to monitor those patients. Study Design: Prospective cohort. Methods: Patients undergoing tonsillectomy were recruited for the study prior to their operation. Each patient was then monitored in perianesthesia recovery until clinical indicators for discharge readiness were met (baseline respiratory function, afebrile, ambulation per age, adequate consciousness, absence of nausea/vomiting, adequate pain control, no active bleeding, fluid toleration). Patients were then contacted by phone approximately 24 to 72 hours after discharge to determine if they experienced any postoperative complications. Data analyzed included general demographics and surgical case information such as surgical duration, medications, and timeframes during recovery. Results: Data from 93 patients (age range, 3-34 years) were analyzed. Clinical indicators were met in a mean time of 253.36 (SD ± 79.0) minutes, an average of 93.2 (SD ± 63.4) minutes sooner than average total post-anesthesia recovery time (346.63 minutes). Eight patients experienced minor complications overall (3 in perianesthesia recovery, 5 at home). Conclusion: This study demonstrates that using clinical indicators as discharge criteria is both safe and efficient, with a low rate of postoperative complications.
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Affiliation(s)
- Habib G. Zalzal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Chadi A. Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Raquel Evans
- Department of Nursing, WVU Medicine, Morgantown, West Virginia, USA
| | - Stacy Giardina
- Department of Nursing, WVU Medicine, Morgantown, West Virginia, USA
| | - Tracy Underwood
- Department of Nursing, WVU Medicine, Morgantown, West Virginia, USA
| | - Aletha Rowlands
- Department of Nursing, WVU Medicine, Morgantown, West Virginia, USA
| | - Hassan H. Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Abstract
PURPOSE OF REVIEW Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments. RECENT FINDINGS Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable. More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.
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Affiliation(s)
- Chadi A Makary
- WVU Medicine Ear Nose and Throat Associates, West Virginia University Medicine, 200 Foundation Way Suite 3200, Martinsburg, WV, 25401, USA.
| | - Hassan H Ramadan
- Department of Otolaryngology, West Virginia University Medicine, Morgantown, WV, USA
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Abstract
Fulminant invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting the immunocompromised host. Although frequently fatal, prognosis is related directly to early recognition and aggressive treatment. Various reports advocate computed tomography (CT) scanning as the study of choice in evaluating suspected invasive fungal disease, reserving magnetic resonance imaging (MRI) for select cases. Others report lack of correlation between CT and surgical or pathological findings. Our aim was to investigate the usefulness of CT and MR in the diagnosis of invasive fungal rhinosinusitis. We retrospectively reviewed four cases of biopsyproven invasive disease. Correlations between radiographic, endoscopic, and surgical findings were investigated. Rhizopus species were detected in three cases and mixed Mucor and Aspergillus species in another. Superimposed bacterial sinusitis was confirmed in all cases. CT findings were nonspecific, revealing pansinusitis; no bone destruction or intracranial extension was noted. Mild orbital cellulitis was noted in one case. Anterior rhinoscopy revealed nonviable tissue in two patients. Nasal endoscopy later confirmed tissue ischemia in a third patient, whereas a final patient had normal findings on both exams. Nonspecific findings resulted in delay of diagnosis by 48–72 hours in two patients with presumed bacterial sinusitis. MR revealed intracranial extension in two patients and better represented intraoperative findings. In conclusion, CT findings in invasive fungal rhinosinusitis may be nonspecific and underestimate extent of disease. A high index of suspicion and early endoscopic examination with biopsy are mandatory for evaluation. MRI may better represent disease progression and should be considered early.
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Affiliation(s)
- R. Charles Howells
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
| | - Hassan H. Ramadan
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
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Ramadan HH, Meek RB, Dawson GS, Spirou GA, Cuff CF, Berrebi AS. Histologic and Immunologic Observations of Viral-Induced Rhinosinusitis in the Mouse. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240201600111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Viral upper respiratory infection is one of the most common diagnoses made in primary care offices. Although symptoms resolve within 1 week for many patients, a percentage develops rhinosinusitis, and many of these patients are treated with antibiotics. We have developed a model of viral rhinosinusitis using intranasal inoculation of reovirus into mice that were then killed on postinoculation days 2, 4, 7, 10, 14, or 21 and heads were embedded in paraffin for histological and immunohistochemical analyses. Reovirus-like immunoreactivity was noted in the septa and paranasal sinus mucosa in mice as early as day 2, with peak intensity seen on day 4, and scant staining seen on day 7. Complete absence of viral staining was seen by day 10, which corresponded with increased intracellular adhesion molecule 1 immunostaining in the nose. By day 10, a large mucosal influx of B cells was observed, with a moderate influx of macrophages and smaller influx of T cells. By day 14, there was a peak in the number of B cells with a corresponding, but less pronounced peak in T cells, while macrophages began to decline at this point. By day 21, the panel of immune markers returned to near normal levels. The results of this study suggest that the immune system continues to produce a response as long as 2 weeks after clearance of viral antigens. One proposed mechanism for this phenomenon is that local factors such as cytokines are released continually after infection, even in the absence of persistent viruses or bacteria.
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Affiliation(s)
- Hassan H. Ramadan
- Departments of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert B. Meek
- Departments of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - G. Stephen Dawson
- Departments of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - George A. Spirou
- Departments of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
- Departments of Sensory Neuroscience Research Center, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Christopher F. Cuff
- Departments of Microbiology, Immunology, and cell Biology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Albert S. Berrebi
- Departments of Otolaryngology–Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
- Departments of Sensory Neuroscience Research Center, West Virginia University School of Medicine, Morgantown, West Virginia
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Abstract
Background With the baby boomers getting older, endoscopic sinus surgery (ESS) is being performed more on elderly people than before. We compared patients undergoing ESS who were >65 years of age with those <65 years. Materials and Methods We reviewed our database of cases who had ESS between 1992 and 2002. Demographics and patient characteristics and complications encountered intraoperatively and immediately postoperatively were reviewed. Results Forty-six (8.1%) patients were older than 65 years of age compared with 522 patients who were 18–64 years old. The older group had a 24% revision rate compared with 34% in the younger group. Complication rates were 21.7% for the elderly compared with 12.8% for the younger group. There was a significantly higher complication rate in the older group of people who were having revision ESS. Conclusion The elderly people who were having revision surgery had a higher risk for complications compared with those having primary surgery or those <65 years old.
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Affiliation(s)
- Hassan H. Ramadan
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
| | - Ray Vanmetre
- Department of Otolaryngology, Head and Neck Surgery, West Virginia University, Morgantown, West Virginia
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. 过敏和鼻科学国际共识声明 : 鼻窦炎. Int Forum Allergy Rhinol 2017. [DOI: 10.1002/alr.21695_c] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND AND HYPOTHESIS Biofilms have been implicated in several head and neck infectious processes such as the following: dental and periodontal disease, otitis media, tympanostomy tube otorrhea, and chronic tonsillitis. We believe that biofilms also are associated with chronic rhinosinusitis. No information is known regarding the presence of biofilms in chronic rhinosinusitis. STUDY DESIGN AND SETTING With institutional review board approval, tissue was obtained from consenting chronic rhinosinusitis patients who were undergoing functional endoscopic sinus surgery. Specimens were taken bilaterally from the ethmoid and maxillary sinuses. Inclusion criteria consisted of a positive diagnosis with pathologic tissue confirmation of chronic inflammation. Diagnosis was based on patient history, physical exam, and coronal sinus CT findings. Once collected, the specimens were labeled and fixed in formalin. The specimens were subsequently dehydrated, with successive immersions in increasing concentrations of diluted ethanol. The specimens were allowed to air dry and then were affixed to aluminum stubs with colloidal carbon. The sample surface was coated with a gold and palladium layer. The specimens were examined under an electron microscope. Areas of interest were photographed. RESULTS Specimens from 5 patients were examined. All revealed bacterial biofilms. Invariably, biofilms were seen in the ethmoid, as well as in other samples. Denudation of ciliated and goblet cells was noted in all specimens. Biofilms resembled that of Staphylococcus species. Unidentified biofilms were also seen. CONCLUSIONS This is the first documentation of biofilms in association with chronic rhinosinusitis. Further investigation is warranted, especially with control research subjects.
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA.
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Cross JL, Ramadan HH, Thomas JG. The Impact of a Cation Channel Blocker (Furosemide) on Pseudomonas aeruginosa PA01 Biofilm Architecture. Otolaryngol Head Neck Surg 2016; 137:21-6. [PMID: 17599559 DOI: 10.1016/j.otohns.2007.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 02/14/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To determine if furosemide could have a role in inhibition of biofilm formation. STUDY DESIGN: A prospective study of 72-hour biofilms grown in the Calgary Biofilm Device (CBD) treated with furosemide and controls. METHODS: Bacteria were treated with furosemide and controls to determine its antiplanktonic properties. PA01 biofilms were treated with serial 2-fold dilutions of furosemide and controls over a 48-hour period at pH concentrations of 7.0, 8.0, and 9.0. RESULTS: Furosemide had no effect on planktonic PA01. It had minimal effect at pH below 8.0. A pH of 8.0 and 9.0 reduced biofilms 25%. Furosemide 10 mg/mL reduced biofilms 50% at pH 8.0 and 9.0. It inhibited biofilms to <30% at concentrations of 0.6 to 0.16 mg/mL at pH 8.0 and <10% at concentrations of 1.25 to 0.3 mg/mL at pH 9.0. CONCLUSION: Furosemide was found to be nonantiplanktonic, but does appear to destabilize preformed PA01 biofilms at pH-dependent concentrations.
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Affiliation(s)
- Jenny L Cross
- Department of Otolaryngology Head-Neck Surgery, West Virginia University, Morgantown, WV 26506-9200, USA
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Castaño JE, Freiser ME, Ramadan HH. Complications Following Inpatient Extracapsular Tonsillectomy in Children 36 Months and Younger. JAMA Otolaryngol Head Neck Surg 2016; 142:270-3. [PMID: 26847141 DOI: 10.1001/jamaoto.2015.3562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Monika E. Freiser
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM, Batra PS, Bernal-Sprekelsen M, Bhattacharyya N, Chandra RK, Chiu A, Citardi MJ, Cohen NA, DelGaudio J, Desrosiers M, Dhong HJ, Douglas R, Ferguson B, Fokkens WJ, Georgalas C, Goldberg A, Gosepath J, Hamilos DL, Han JK, Harvey R, Hellings P, Hopkins C, Jankowski R, Javer AR, Kern R, Kountakis S, Kowalski ML, Lane A, Lanza DC, Lebowitz R, Lee HM, Lin SY, Lund V, Luong A, Mann W, Marple BF, McMains KC, Metson R, Naclerio R, Nayak JV, Otori N, Palmer JN, Parikh SR, Passali D, Peters A, Piccirillo J, Poetker DM, Psaltis AJ, Ramadan HH, Ramakrishnan VR, Riechelmann H, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Senior BA, Sindwani R, Stankiewicz JA, Stewart M, Tan BK, Toskala E, Voegels R, Wang DY, Weitzel EK, Wise S, Woodworth BA, Wormald PJ, Wright ED, Zhou B, Kennedy DW. International Consensus Statement on Allergy and Rhinology: Rhinosinusitis. Int Forum Allergy Rhinol 2016; 6 Suppl 1:S22-209. [DOI: 10.1002/alr.21695] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023]
Affiliation(s)
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- Royal National Throat Nose and Ear Hospital; London UK
| | - Amber Luong
- University of Texas Medical School at Houston
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Ramadan HH, Makary CA. Can computed tomography score predict outcome of adenoidectomy for chronic rhinosinusitis in children. Am J Rhinol Allergy 2015; 28:e80-2. [PMID: 24717893 DOI: 10.2500/ajra.2014.28.4004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic adenoiditis (CA) and chronic rhinosinusitis (CRS) in children are difficult to distinguish based on symptoms alone. A computed tomography (CT) scan is one way to distinguish between the two entities. The purpose of this study was to determine whether CT scores can predict outcome of adenoidectomy. METHODS A retrospective review was performed over a 10-year period. All children who failed medical treatment had a CT scan and an adenoidectomy, which were reviewed. Children who had a CT score of ≥5 were included in the CA with concurrent CRS group, whereas those who had a CT score of <5 were included in the CA without CRS group. RESULTS Two hundred thirty-three children met the aforementioned criteria. Mean age was 5.5 years and mean CT score was 6.4. The CRS group had a success rate of 43%, whereas the CA group had a 65% success rate (p = 0.0017). Those children who were asthmatic and had CRS had a success rate of 28% compared with 53% for those who had CA (p = 0.022). CONCLUSION Making the diagnosis of CRS in children seems to be critical in determining whether, initially, an adenoidectomy alone is an appropriate treatment, specifically for those who have asthma.
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown West Virginia, USA
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Lam HP, Ramadan HH. Role of Polysomnography in Children When Clinical Indicators of Sleep-Disordered Breathing Are Met. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Sleep-disordered breathing (SDB) affects approximately 12% of children, ranging from snoring to obstructive sleep apnea (OSA). Polysomnography (PSG) is the gold standard for diagnosing SDB and has been increasingly obtained in children. Some feel PSG is underutilized given recent clinical guidelines; however, others believe that if the clinical indicators for OSA are present, a PSG is unnecessary. The purpose of this study was to determine the effectiveness of clinical indicators in predicting PSG results in children. Methods: A retrospective review of PSG on children between 2 and 18 years old ordered by an otolaryngologist at West Virginia University between January 2011 and November 2013. Recorded variables included: age, sex, symptoms of gasping, snoring, restlessness, body mass index, previous adenoidectomy, tonsil size, and apnea-hypopnea index (AHI). Statistical analysis was used to compare positive PSG with clinical indicators. Results: Ninety-five patients were reviewed with 73 meeting inclusion criteria. Age range was 2 to 17 years (mean, 5.3 years) and mean AHI was 3.26. Gasping showed a statistical significant correlation with positive PSG (61.9% positive, P < .05). Overweight/obese patients with gasping had a 73.3% positive PSG. Snoring and restlessness did not have a statistically significant correlation with positive PSG; however, restlessness was approaching clinical significance. One patient (25%) without gasping and restlessness combined had positive PSG. Gasping had a statically significant higher mean AHI of 4.3 compared to 2.2 without symptoms of gasping. Neither snoring nor restlessness showed statistically significant higher AHI. Conclusions: Gasping is an effective clinical indicator in predicting positive PSG and diagnosing OSA in children.
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Makary CA, Ramadan HH. The role of sinus surgery in children. Laryngoscope 2013; 123:1348-52. [PMID: 23361382 DOI: 10.1002/lary.23961] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/28/2012] [Accepted: 12/06/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Chadi A. Makary
- Department of Otolaryngology; West Virginia University School of Medicine; Morgantown; West Virginia; U.S.A
| | - Hassan H. Ramadan
- Department of Otolaryngology; West Virginia University School of Medicine; Morgantown; West Virginia; U.S.A
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Ramadan HH, Bueller H, Hester ST, Terrell AM. Sinus Balloon Catheter Dilation After Adenoidectomy Failure for Children With Chronic Rhinosinusitis. ACTA ACUST UNITED AC 2012; 138:635-7. [DOI: 10.1001/archoto.2012.1070] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
We conducted a study to determine if coating a suction cautery tip with an antistick phospholipid solution would decrease the amount of time required to complete primary pediatric adenoidectomies. The aim of the study was focused on two main criteria: the amount of surgical time required to complete each procedure and the number of times an operation had to be interrupted because the suction cautery tip needed to be cleaned (each interruption was called a "handback"). We obtained data prospectively during 61 pediatric adenoidectomies performed at our institution from February through June 2009. These patients were randomized to undergo surgery either with (n = 31) or without (n = 30) the use of the antistick phospholipid solution (Electro Lube; Mectra Labs; Bloomfield, Ind.). The overall mean amount of time needed to complete an adenoidectomy was 6 minutes and 39 seconds (6:39); use of the antistick solution shortened the amount of surgical time by 1:45-a decrease of 23.2% (p = 0.0360). Likewise, surgeries performed with Electro Lube required an average of 3.0 fewer handbacks for cleaning during the operation (p < 0.0001). The benefits of the antistick solution were even more pronounced in patients with larger adenoids than in those with smaller adenoids.
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Affiliation(s)
- Jeffrey C Baker
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Room 2222 Health Sciences Center South, Morgantown, WV 26506, USA
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Affiliation(s)
- Hassan H Ramadan
- Department of Otolaryngology–Head and Neck Surgery, West Virginia University, Morgantown, USA.
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Anfuso AJ, Ramadan HH. Antrochoanal Polyp Originating from Inferior Turbinate. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Present a case of an unusual presentation of an antral choanal polyp that originates from the left inferior turbinate and does not extend into the maxillary sinus. Literature review shows only 3 prior cases where an antrochoanal polyp originated from the inferior turbinate. Method: This is a case presentation of an 81-year-old woman who presented with a left sided nasal mass. Her workup included CT scan and MRI of the sinuses. The nasal mass was removed endoscopically and was sent for review by our pathologists. Results: In this elderly female, physical examination showed a dark nasal mass filling the entire nasal cavity. CT and MRI showed a left-sided nasal soft tissue mass with lateral displacement of the medial wall of the left maxillary antrum. The preoperative diagnosis included inverted papilloma, benign nasal polyp, and squamous cell carcinoma. The patient was taken to the operating room where it was found that the mass originated from inferior turbinate and spanned its entire length. It was removed from this attachment and delivered nasally using endoscopic sinus instruments. Surprisingly, pathology revealed antrochoanal polyp. Conclusion: Classically, an antrochoanal polyp originates within the maxillary antrum. We present this case to illustrate that the antrochoanal polyp can originate from the inferior turbinate and should be considered in a patient with a unilateral nasal mass distinct from the maxillary sinus.
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Rimell FL, Ramadan HH, Manning SC, Shah UK. Pediatric Sinusitis: Drugs and Devices. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415818a71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Program Description: Pediatric sinusitis is a major source of patient referrals for the otolaryngologist. The issue of diagnosis and treatment differs from the adult with regard to pathophysiology, management, and patient cooperation. This seminar will focus on the current state of drugs and devices used to diagnose and treat pediatric sinusitis. The seminar will begin with the use of devices in children to diagnose chronic rhinosinusitis or differentiate rhinitis from sinusitis. Discussion will include the use of pediatric office endoscopy, endoscopic-guided cultures, CT scanning, pH probe testing and other devices. We will also discuss how they should be used in the office on children. The seminar will then progress to the use of drugs and devices in the management and treatment of pediatric sinusitis. This discussion will include adenoidectomy and associated devices, culture techniques, balloon sinus surgery, and associated minimally invasive devices as well as traditional endoscopic surgical techniques. Further discussion will focus on various endoscopic surgical drugs and devices applied to the pediatric patient both intraoperative and postoperative. Drugs discussed for the treatment and management of pediatric sinusitis will include intravenous antibiotics, topical aerosol therapy, mucolytic agents, steroids, and intranasal packing and stents. Presentations will also occur on the pediatric patient with special issues and sinusitis such as immunologic deficiencies and cystic fibrosis. This will be a presentation based on the current literature, extensive clinical experience and case studies. Panel discussions and opinion by pediatric otolaryngologist with extensive experience will be a major part of this seminar. Educational Objectives: 1) Discuss and present drugs and medical devices currently used to diagnose and treat pediatric sinusitis. 2) Present current medical devices and techniques used to treat pediatric sinusitis in the operative setting. 3) Present current drugs and devices used to manage children with sinusitis and related medical disorders.
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