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Takashima M, Stolovitzky JP, Ow RA, Silvers SL, McDuffie CM, Dean M, Sedaghat AR, Tajudeen BA. Temperature-controlled radiofrequency ablation for the treatment of chronic rhinitis: Two-year outcomes from a prospective multicenter trial. Int Forum Allergy Rhinol 2024. [PMID: 38266636 DOI: 10.1002/alr.23315] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Minimally invasive temperature-controlled radiofrequency (TCRF) ablation of the posterior nasal nerve (PNN) demonstrated a significant larger treatment effect on the symptom burden of chronic rhinitis patients than a sham control (no energy delivery) at the 3-month primary endpoint of this trial. METHODS Two-year posttreatment outcomes for patients treated in a prospective, multicenter, patient-blinded randomized controlled trial were determined by combining the index active treatment-arm and index control-arm crossover patients into a single group (after the primary endpoint) to evaluate the treatment effect durability and long-term effects on concomitant chronic rhinitis medication usage. RESULTS The mean baseline reflective total nasal symptom score (rTNSS) was 8.2 (95% confidence interval [CI], 7.9-8.6; N = 104). At 2 years (N = 79), the mean change in rTNSS was -5.3 (95% CI, -5.8 to -4.8; p < 0.001; 64.6% improvement). The 2-year responder rate (≥30% improvement in rTNSS) was 87.3% (95% CI, 78.0-93.8). All four components of the rTNSS (rhinorrhea, congestion, sneezing, and nasal itching) showed significant improvement over baseline, with rhinorrhea and congestion showing the most improvement. Postnasal drip and cough symptoms were also significantly improved. At 2 years, 81.0% (95% CI, 70.6-89.0) reported a minimal clinically important difference of ≥0.4-point improvement in the mini-rhinoconjunctivitis quality of life questionnaire score. Of 56 patients using chronic rhinitis medications at baseline, 25 of 56 (44.6%) either stopped all medication use (7/56 [12.5%]) or stopped/decreased (18/56 [32.1%]) use of ≥1 medication class at 2 years. No serious adverse events related to the device/procedure were reported over 2 years. To determine the potential effect of patients who left the trial over 2 years on the responder rate, the responder statuses of the 14 patients with follow-up data who were lost to follow-up/withdrew/died were imputed by the last observation carried forward and the responder statuses of all nine patients who had an additional nasal procedure were imputed to nonresponder, resulting in a 2-year responder rate of 79.4% (95% CI, 70.3-86.8). CONCLUSION TCRF ablation of the PNN is safe and resulted in a significant and sustained reduction in chronic rhinitis symptom burden through 2 years and a substantial reduction in concomitant medication burden.
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Affiliation(s)
- Masayoshi Takashima
- The Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - J Pablo Stolovitzky
- The Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California, USA
| | | | - Chad M McDuffie
- Ear, Nose, and Throat Associates of Texas, McKinney, Texas, USA
| | - Marc Dean
- Ear & Sinus Institute, Fort Worth, Texas, USA
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech Health Science Center, Lubbock, Texas, USA
- Otorhinologic Research Institute, Dallas, Texas, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Stolovitzky JP, Ow RA, Silvers SL, Bikhazi NB, Johnson CD, Takashima M. Effect of Radiofrequency Neurolysis on the Symptoms of Chronic Rhinitis: A Randomized Controlled Trial. OTO Open 2021; 5:2473974X211041124. [PMID: 34527852 PMCID: PMC8436321 DOI: 10.1177/2473974x211041124] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the safety and efficacy of temperature-controlled radiofrequency (RF) neurolysis of the posterior nasal nerve (PNN) area for the treatment of chronic rhinitis. Study Design A multicenter, prospective, single-blinded, randomized controlled trial, in which the control arm underwent a sham procedure. Setting Sixteen otolaryngology centers. Methods Patients with 24-hour reflective Total Nasal Symptom Score (rTNSS) ≥6, including moderate to severe rhinorrhea and mild to severe congestion, were randomized 2:1 to active treatment of the posterior nasal nerve area with a temperature-controlled RF device or a sham procedure, with no RF energy delivery. The stylus was applied bilaterally to nonoverlapping areas of the posterior middle meatus and posterior inferior turbinate in each nostril in the region of the PNN. The primary endpoint was responder rate at 3 months, where a response was defined as ≥30% improvement (decrease) in rTNSS from baseline. Results Patients had a mean baseline rTNSS of 8.3 (95% CI, 7.9-8.7) and 8.2 (95% CI, 7.6-8.8) (P = .797) in the active treatment (n = 77) and sham control (n = 39) arms, respectively. At 3 months, responder rate was significantly higher in the active treatment arm: 67.5% (95% CI, 55.9%-77.8%) vs 41.0% (95% CI, 25.6%-57.9%) (P = .009). The active treatment arm had a significantly greater decrease in rTNSS (mean, −3.6 [95% CI, −4.2 to −3.0] vs −2.2 [95% CI, −3.2 to −1.3]) (P = .013). Three adverse events related to the device/procedure were reported, and all resolved. Conclusion This randomized controlled trial showed temperature-controlled neurolysis of the PNN area is free from significant adverse events and superior to a sham procedure in decreasing the symptom burden of chronic rhinitis.
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Affiliation(s)
- J Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California, USA
| | | | | | | | - Masayoshi Takashima
- Department of Otolaryngology-Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
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Stolovitzky JP, Kern RC, Han JK, Forwith KD, Ow RA, Wright SK, Gould A, Matheny KE, Karanfilov B, Huang S, Stambaugh JW, Gawlicka AK. In-office Placement of Mometasone Furoate Sinus Implants for Recurrent Nasal Polyps: A Pooled Analysis. Am J Rhinol Allergy 2019; 33:545-558. [PMID: 31117809 PMCID: PMC6728749 DOI: 10.1177/1945892419850924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background A mometasone furoate (MF) sinus implant (1350 mcg) was evaluated in 2 randomized controlled trials (RCTs) in 400 adults with nasal polyps (NP) who were candidates for revision endoscopic sinus surgery (RESS). We conducted a pooled analysis to evaluate the efficacy of MF implant in specific subgroups of NP patients. Methods Pooled data from 2 RCTs for 375 patients were analyzed across prespecified subjective and objective end points through day 90. Results At day 90, patients receiving implants and MF nasal spray (MFNS) experienced significant improvements in nasal obstruction/congestion (NO/C) score ( P = .0095), bilateral polyp grade (BPG, P = .0008), and ethmoid sinus obstruction ( P < .0001) compared to control using MFNS alone. Fewer treatment than control patients remained candidates for RESS (41.0% vs 69.3%, P < .0001). All subgroups experienced significant treatment effects, except NO/C in smokers ( P = .0509) and patients without altered smell ( P = .1873). Subgroups without asthma and with only 1 prior ESS experienced largest treatment effect on NO/C, and those with recent surgery <24 months and BPG >5 showed largest effect on endoscopic end points and RESS. Control patients with ESS <24 months were at 7 times highest risk for RESS ( P < .0001). One (0.4%) patient experienced implant-related serious adverse event (epistaxis). Conclusion On pooled analysis, MF implants with MFNS showed more favorable results than MFNS alone across several subjective and objective end points at day 90 and may play an important role in management of NP patients, especially those who have allergic rhinitis, expanded polyposis, altered smell, or had most recent ESS < 24 months.
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Affiliation(s)
| | - Robert C Kern
- 2 Department of Otolaryngology - Head and Neck Surgery at Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Joseph K Han
- 3 Divisions of Rhinology and Endoscopic Sinus - Skull Base Surgery and Allergy, Eastern Virginia Medical School, Norfolk, Virginia
| | | | | | | | - Andrew Gould
- 4 Advanced ENT and Allergy, Louisville, Kentucky
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Sikand A, Ehmer DR, Stolovitzky JP, McDuffie CM, Mehendale N, Albritton FD. In-office balloon sinus dilation versus medical therapy for recurrent acute rhinosinusitis: a randomized, placebo-controlled study. Int Forum Allergy Rhinol 2018; 9:140-148. [PMID: 30452127 DOI: 10.1002/alr.22248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/29/2018] [Revised: 09/24/2018] [Accepted: 10/17/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND A limited number of studies have demonstrated symptomatic improvement for recurrent acute rhinosinusitis (RARS) patients after endoscopic sinus surgery. In this randomized, controlled study we evaluated 24-week outcomes for balloon sinus dilation (BSD) performed in-office (IO) with medical management (MM) as compared with MM only for RARS patients. METHODS Adults diagnosed with RARS were randomized to groups with BSD plus MM (n = 29) or MM alone (n = 30). Patients who received MM alone also received a sham BSD-IO procedure to blind them to group assignment. Patients were followed to 48 weeks posttreatment. The primary outcome was the difference between arms in change in Chronic Sinusitis Survey (CSS) score from baseline to 24 weeks. Secondary endpoints included comparisons of Rhinosinusitis Disability Index (RSDI) score, medication usage, medical care visits, and sinus infections. RESULTS Change in patient-reported quality of life (QOL), as measured by the CSS total score from baseline to 24 weeks, was significantly greater in the BSD plus MM group compared with the MM-only group (37.3 ± 24.4 [n = 26] vs 21.8 ± 29.0 [n = 27]; p = 0.0424). CONCLUSION BSD plus MM proved superior to MM alone in enhancing QOL for RARS patients. BSD plus MM should be considered as a viable treatment option for properly diagnosed RARS patients.
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Affiliation(s)
- Ashley Sikand
- Ear, Nose & Throat Consultants of Nevada, Henderson, NV
| | | | | | | | | | - Ford D Albritton
- The Sinus & Respiratory Disease Center at the Texas Institute, Dallas, TX
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Singh A, Luong AU, Fong KJ, Ow RA, Han JK, Gerencer R, Stolovitzky JP, Stambaugh JW, Raman A. Bioabsorbable steroid-releasing implants in the frontal sinus ostia: a pooled analysis. Int Forum Allergy Rhinol 2018; 9:131-139. [PMID: 30431709 PMCID: PMC6587788 DOI: 10.1002/alr.22238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/02/2018] [Accepted: 09/13/2018] [Indexed: 11/08/2022]
Abstract
Background Bioabsorbable steroid‐releasing implants (mometasone furoate, 370 μg) are effective for improving postsurgical outcomes in the frontal sinus ostia (FSO). In this study we evaluated the effect of these implants on frontal outcomes in various patient subgroups with chronic rhinosinusitis (CRS) using pooled data from 2 randomized, controlled trials (RCTs). Methods A total of 160 subjects were enrolled in 2 RCTs. After surgery, subjects were randomized to receive an implant in 1 FSO with the contralateral side as control. Data through day 90 from the 2 studies were pooled and subgroup analyses were performed. Results At day 30, relative to controls, steroid‐releasing implants significantly reduced the need for postoperative interventions by 46.8% (95% confidence interval [CI], −60.7 to −27.9), for surgical interventions by 51.2% (95% CI, −68.2 to −25.2), and for oral steroid interventions by 37.2% (95% CI, −54.6 to −13.1) in the pooled data set. At day 90, statistically significant reductions (p < 0.05) in the need for postoperative interventions (relative reduction [RR], 30.2%), restenosis/occlusion rate (RR, 31.7%), and inflammation score (absolute difference, −6.0), and increase in estimated FSO diameter (absolute difference, 1 mm), favoring the treated side, were observed. Subgroup analyses of the pooled data showed statistically significant improvements (p < 0.05) at day 90 in restenosis/occlusion rate, and estimated FSO diameter, favoring the treated side across subgroups, with no statistically significant subgroup‐by‐treatment interactions. Conclusion Bioabsorbable steroid‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO.
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Affiliation(s)
- Ameet Singh
- Division of Otolaryngology, George Washington University Medical Center, Washington, DC
| | - Amber U Luong
- Department of Otorhinolaryngology Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | | | | | - Joseph K Han
- Divisions of Rhinology and Endoscopic Sinus-Skull Base Surgery and Allergy, Eastern Virginia Medical School, Norfolk, VA
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Stolovitzky JP, Mehendale N, Matheny KE, Brown WJ, Rieder AA, Liepert DR, Tseng E, Gould A. Medical Therapy Versus Balloon Sinus Dilation in Adults With Chronic Rhinosinusitis (MERLOT): 12-Month Follow-up. Am J Rhinol Allergy 2018; 32:294-302. [PMID: 29781286 DOI: 10.1177/1945892418773623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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
Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians' and patients' discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.
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Affiliation(s)
- J Pablo Stolovitzky
- 1 Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Douglas R Liepert
- 6 Allied Physicians of Michiana-Otolaryngology Associates, South Bend, Indiana
| | | | - Andrew Gould
- 7 Advanced ENT and Allergy, Louisville, Kentucky
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Kern RC, Stolovitzky JP, Silvers SL, Singh A, Lee JT, Yen DM, Iloreta AMC, Langford FPJ, Karanfilov B, Matheny KE, Stambaugh JW, Gawlicka AK. A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps. Int Forum Allergy Rhinol 2018; 8:471-481. [PMID: 29350840 PMCID: PMC5900893 DOI: 10.1002/alr.22084] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
Abstract
Background Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid‐eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days. Methods A randomized, sham‐controlled, double‐blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in‐office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co‐primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review. Results Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant‐related serious adverse event (epistaxis). Conclusion Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.
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Affiliation(s)
| | | | | | - Ameet Singh
- George Washington Medical Faculty Associates, Washington, DC
| | - Jivianne T Lee
- Orange County Sinus Institute, Southern California Permanente Medical Group, Irvine, CA.,Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Luong A, Ow RA, Singh A, Weiss RL, Han JK, Gerencer R, Stolovitzky JP, Stambaugh JW, Raman A. Safety and Effectiveness of a Bioabsorbable Steroid-Releasing Implant for the Paranasal Sinus Ostia: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2017; 144:28-35. [PMID: 29098299 DOI: 10.1001/jamaoto.2017.1859] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Suboptimal outcomes of endoscopic sinus surgery (ESS) are often associated with restenosis and inflammation of frontal sinus ostia. Steroid-releasing sinus implants have been shown to maintain sinus patency by minimizing inflammation and scar tissue formation. An hourglass-shaped, bioabsorbable, steroid-releasing implant was developed to provide mechanical support and optimize drug delivery to paranasal sinus ostia. Objective To assess the safety and efficacy of the hourglass-shaped, bioabsorbable, steroid-releasing sinus implant in improving postoperative outcomes when placed in the frontal sinus ostia (FSO) following ESS in patients with chronic rhinosinusitis (CRS). Design, Setting, and Participants In a prospective, multicenter, randomized clinical trial using an intrapatient control design (ESS followed by implant placement within 1 FSO vs ESS alone on the contralateral side) 80 adult patients, with a mean (SD) age of 49.5 (13.4) years and consisting of 53 (66%) men and 27 (34%) women, were enrolled and underwent bilateral frontal sinusotomies with 1 frontal sinus randomized to receive a steroid-releasing implant. The study was carried out in 12 US centers between July 2015 and March 2016. Interventions A bioabsorbable steroid-releasing implant with hourglass shape containing 370 µg of mometasone furoate. All patients received standardized postoperative care. Main Outcomes and Measures The need for postoperative interventions, medical and surgical, in the FSO at day 30, as determined based on review of video endoscopic findings by an independent blinded surgeon. Also, endoscopic grading by the independent reviewer and clinical investigators at day 30 and day 90 and computed tomographic scan at day 90. Results The mean (SD) age of patients was 49.5 (13.4) years, 53 (66%) were men. Implants were successfully placed in all 80 randomized treatment sinuses. At day 30, steroid-releasing implants significantly reduced the need for postoperative interventions to 11.5% compared with 32.8% by surgery alone (mean difference, -21.3%; 95% CI, -35.1% to -7.6%), as assessed by the independent reviewer. Real-time endoscopic assessment by clinical investigators at day 30 demonstrated significant reduction in need for postoperative intervention (mean difference, -17.3%; 95% CI, -27.9% to -6.7%), significant reduction in inflammation score (mean difference, -12.3 mm; 95% CI, -18.3 to -6.4 mm), and significant reduction in rate of frontal restenosis or occlusion (mean difference, -22.7%; 95% CI, -33.5% to -11.9%) on treated compared with control sides. The results favoring the treatment sides were sustained through day 90: reduced need for postoperative interventions (mean difference, -11.7%; 95% CI, -21.0% to -2.4%) and reduction in restenosis and/or occlusion of the frontal ostium (mean difference, -17.4%; 95% CI, -28.6% to -6.1%). No implant-related adverse events were observed. Conclusions and Relevance The hourglass-shaped steroid-releasing sinus implant was safe and more effective in maintaining FSO patency and improving surgical outcomes compared with surgery alone in the setting where no other immediate postoperative corticosteroids were administered. Trial Registration ClinicalTrials.gov identifier: NCT02266810.
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Affiliation(s)
- Amber Luong
- Department of Otolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston
| | | | - Ameet Singh
- Department of Surgery and Neurosurgery, George Washington Medical Faculty Associates, Washington, DC
| | - Robert L Weiss
- The Connecticut Center for Advanced ENT Care, Norwalk, Connecticut
| | - Joseph K Han
- Divisions of Rhinology and Endoscopic Sinus-Skull Base Surgery and Allergy, Eastern Virginia Medical School, Norfolk
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Forwith KD, Han JK, Stolovitzky JP, Yen DM, Chandra RK, Karanfilov B, Matheny KE, Stambaugh JW, Gawlicka AK. RESOLVE: bioabsorbable steroid-eluting sinus implants for in-office treatment of recurrent sinonasal polyposis after sinus surgery: 6-month outcomes from a randomized, controlled, blinded study. Int Forum Allergy Rhinol 2016; 6:573-81. [PMID: 26992115 DOI: 10.1002/alr.21741] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 08/27/2015] [Revised: 12/09/2015] [Accepted: 01/05/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients with recurrent sinonasal polyposis after endoscopic sinus surgery (ESS) have limited treatment options. Safety and efficacy were previously reported for a bioabsorbable sinus implant that elutes mometasone furoate for 3 months. Here we summarize longer-term outcomes. METHODS A randomized, controlled, blinded study with 100 chronic rhinosinusitis with nasal polyps (CRSwNP) patients who failed medical treatment and were considered candidates for revision ESS. Treated patients (n = 57) underwent in-office implant placement. Control patients (n = 43) underwent a sham procedure. Endoscopic grading at 3 months by clinicians was corroborated by an independent review of randomized videoendoscopies by a panel of 3 sinus surgeons. Six-month follow-up included endoscopic grading and patient-reported outcomes. RESULTS At 6 months, treated patients experienced significant improvement in Nasal Obstruction Symptom Evaluation (NOSE) score (p = 0.021) and >2-fold improvement in mean nasal obstruction/congestion score (-1.06 ± 1.4 vs -0.44 ± 1.4; p = 0.124). Endoscopically, treated patients experienced significant reduction in ethmoid sinus obstruction (p < 0.001) and bilateral polyp grade (p = 0.018) compared to controls. Panel review confirmed a significant reduction in ethmoid sinus obstruction (p = 0.010) and 2-fold improvement in bilateral polyp grade (p = 0.099), which reached statistical significance (p = 0.049) in a subset of 67 patients with baseline polyp burden ≥2 bilaterally. At 6 months, control patients were at 3.6 times higher risk of remaining indicated for ESS than treated patients. CONCLUSION The symptomatic and endoscopic improvements observed confirm the efficacy of the steroid-eluting implant for in-office treatment of CRSwNP after ESS. These longer-term 6-month study results demonstrate that the steroid-eluting implant represents a durable, safe, and effective treatment strategy for this patient population.
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Affiliation(s)
| | - Joseph K Han
- Divisions of Rhinology and Endoscopic Sinus-Skull Base Surgery and Allergy, Eastern Virginia Medical School, Norfolk, VA
| | | | - David M Yen
- Bethlehem Ear, Nose and Throat Associates, Bethlehem, PA
| | - Rakesh K Chandra
- Rhinology, Sinus and Skull Base Surgery, Department of Otolaryngology, Vanderbilt University, Nashville, TN
| | - Boris Karanfilov
- Department of Otolaryngology, Ohio State University, Ohio Sinus Institute, Dublin, OH
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Stolovitzky JP, Hwang PH, Nussenbaum BA, Wilkinson EP. Hot Topics for the General Otolaryngologists. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a27] [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: This miniseminar is designed to update general otolaryngologists on cutting-edge advances. Dr Nussenbaum will present on human papillomavirus (HPV)–related oropharyngeal cancer, now widely accepted to be a distinct disease. With the increasing incidence of HPV, otolaryngologists need to be familiar with underlying principles that direct comprehensive evaluation and management. Dr Hwang will review the evidence for various methods of drug delivery in treating chronic rhinosinusitis and how the efficacy of topical medical therapy directly relates to the modality of delivery. Dr Wilkinson will give a comprehensive overview of the critical considerations in assessment, diagnosis, and treatment of sudden sensorineural hearing loss. Educational Objectives: (1) List current recommendations for diagnosis and management of sudden sensorineural hearing loss. (2) Incorporate into practice with up-to-date clinically relevant information about screening, prevention, diagnosis, and management of HPV-related oropharyngeal cancer. (3) Consider the range of options for topical drug delivery to the paranasal sinuses and the evidence substantiating their use.
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Stolovitzky JP, Kennedy DW, Poe DS, Friedman M. Hot Topics for the General Otolaryngologists. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813493390a24] [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: This miniseminar is designed to update general otolaryngologists on cutting edge advances in our specialty by a panel of experts. Dr. David Kennedy will highlight the key principles of endoscopic resection of tumors of the skull base and the importance of preoperative planning of the skull base closure. Dr. Dennis Poe will present recent developments in diagnostic methods, medical treatment, and updates in research on surgical therapy for chronic Eustachian tube dysfunction. Dr. Michael Friedman will review new noninvasive and multilevel minimally invasive treatment options including transoral robotic surgery for the treatment of snoring and obstructive sleep apnea (OSA). Educational Objectives: 1) Improve knowledge of the surgical principles of skull base tumor surgery. 2) Understand the mechanisms of Eustachian tube pathophysiology and be able to diagnose disorders. 3) Describe noninvasive and multilevel minimally invasive treatment options for OSA that should be incorporated in a general otolaryngology practice.
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Randolph GW, Kennedy DW, Lee KJ, Myers EN, Saunders J, Snyderman NL, Stolovitzky JP, Fagan J, Izundegui JF, Fraysse BG, Muhlfay G, Tan K. Global Health 2012: Our Academy around the World. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812449008a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stolovitzky JP, Maves MD, Koopmann CF, Watts J. BOG Miniseminar: Otolaryngology Managed Care Symposium. Otolaryngol Head Neck Surg 2004. [DOI: 10.1016/j.otohns.2004.06.102] [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: 10/26/2022]
Affiliation(s)
| | | | | | - John Watts
- Atlanta GA; Chicago IL; Ann Arbor MI; Atlanta GA
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Stolovitzky JP, Todd NW, Cotton RT, Campbell WG. Autoimmune hypothesis of acquired subglottic stenosis: lack of support at time of surgical repair in children. Int J Pediatr Otorhinolaryngol 1997; 38:255-61. [PMID: 9051430 DOI: 10.1016/s0165-5876(96)01452-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Numerous mechanisms have been suggested for the development of subglottic stenosis. This study sought serum antibody and cricoid cartilage immunohistologic evidence of an autoimmune process. The autoimmune hypothesis is that subglottic inflammation may extend into the cricoid cartilage, degrade the extracellular matrix and expose normally-sequestered type II collagen to the afferent arm of the immune system. The resultant anti-collagen antibodies are hypothesized to contribute to further injury and scarring. Specimens were obtained from 10 patients. Immunofluorescent stains for antibodies in histologic specimens, and serum antibodies to type II and type IX collagen were sought. No evidence for an autoimmune process was found in these specimens with the techniques used. The negative findings may be attributable to the autoimmune process being inactive at the mature stage of the disease in the patients studied.
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Affiliation(s)
- J P Stolovitzky
- Division of Otolaryngology, Emory University School of Medicine, Atlanta, GA 30322, USA
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Abstract
Giant cell lesions of the maxilla and paranasal sinuses represent a rare, locally aggressive disorder which present as a soft tissue mass with distinct histologic and clinical features. There is considerable controversy on the therapeutic modalities, the prediction of clinical behavior based on histologic features, and whether these growths are reactive or neoplastic in nature. We present our clinical experience with four of these lesions. Follow-up ranged from 3 to 11 years. Our results and the rationale for aggressive surgical treatment will be discussed. We hypothesize that giant cell "granuloma" of the maxilla and paranasal sinuses and giant cell tumor of other bones represent a continuum of a single disease process, which may have an aggressive clinical behavior. This paper, with a literature review, will address the treatment controversy and advocate surgical resection for all giant cell lesions.
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Affiliation(s)
- J P Stolovitzky
- Division of Otolaryngology, Emory University, Atlanta, Georgia
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Abstract
We examined 187 males to evaluate the hypothesis that short-headed persons more often have otitis media than long-headed persons. The subjects were seen as part of routine health screening before attending recreational summer camp. The photographic appearance of each tympanic membrane was judged on two separate occasions by an otolaryngologist who categorized them as "normal", "abnormal", or "cannot determine". The repeatability of the categorizations was fair: kappa = 0.44. Only the tympanic membranes categorized identically twice were used for data analysis. The left-right symmetry of the tympanic membrane categorizations was fair: correlation coefficient phi = 0.42. Subjects categorized as having bilaterally normal tympanic membranes were considered to have not had previous otitis media (N = 95). In contrast, subjects categorized as having at least one abnormal tympanic membrane were considered to have had previous otitis media (N = 13). Head length and width, measured by calipers, and the cephalic index (width divided by length) x 100 were determined for each person. On the average, the cephalic index of the normal subjects was lower than that for the subjects with otitis media (t = 3.06, p less than 0.005). These data support the suggestions of Pautow (1925) and Worley et al. (1987): dolichocephalic persons have otitis media less often than do brachycephalic persons. Though this association is not useful in clinical care of the individual patient, it may be considered a weak external manifestation of the different cranial base and eustachian tube anatomy found in persons with otitis media.
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Affiliation(s)
- J P Stolovitzky
- Division of Otolaryngology, Emory University School of Medicine, Atlanta, GA 30322
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Abstract
Acquired subglottic stenosis is a devastating additional burden for nearly 4% of premature infants receiving neonatal intensive care. The duration of endotracheal intubation is considered the most important etiologic factor. Surprisingly, most premature infants do not acquire subglottic stenosis. Infants with similar clinical characteristics and care have varying laryngeal outcomes. We hypothesized an autoimmune mechanism to type-II collagen to explain the varying laryngeal outcomes of these infants. A retrospective study of premature infants of comparable birth weight, gestational age, and duration of endotracheal intubation was conducted. The eight control children, who did not manifest symptoms of airway obstruction, had longer durations of intubation than did the infants who developed subglottic stenosis. Three of five affected infants had serum antibodies to type-II collagen, in contrast to none of the control infants (P = .035). This finding warrants additional study, and might lead to new diagnostic and therapeutic measures for these patients.
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Affiliation(s)
- J P Stolovitzky
- Section of Otolaryngology, Emory University School of Medicine, Atlanta, GA
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