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Lee JT, Abbas GM, Charous DD, Cuevas M, Göktas Ö, Loftus PA, Nachlas NE, Toskala EM, Watkins JP, Brehmer D. Two-Year Outcomes After Radiofrequency Neurolysis of Posterior Nasal Nerve in Chronic Rhinitis. Laryngoscope 2024; 134:2077-2084. [PMID: 37916848 DOI: 10.1002/lary.31120] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To assess the long-term safety and effectiveness of temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), a minimally invasive treatment for chronic rhinitis. METHODS A prospective, single-arm study of 129 patients at 16 centers (United States, Germany) was conducted. Patient-reported outcome measures were the 24-h reflective total nasal symptom score (rTNSS) and mini rhinoconjunctivitis quality of life questionnaire (MiniRQLQ). Postnasal drip and cough symptoms were assessed using a 4-point scale. RESULTS The mean pretreatment rTNSS was 7.8 (95% CI, 7.5-8.1). The significant rTNSS treatment effect at 3 months (-4.2 [95% CI, -4.6 to -3.8]; p < 0.001) was sustained through 2 years (-4.5 [95% CI, -5.0 to -3.9]; p < 0.001), a 57.7% improvement. At 2 years, the proportion of patients with a minimal clinically important difference (MCID) of ≥30% improvement in rTNSS from baseline was 80.0% (95% CI, 71.4%-86.5%). Individual postnasal drip and cough symptom scores were significantly improved from baseline through 2 years. The proportion of patients who reached the MCID for the MiniRQLQ (≥0.4-point improvement) at 2 years was 77.4% (95% CI, 68.5%-84.3%). Of 81 patients using chronic rhinitis medications at baseline, 61.7% either stopped all medication use (28.4%) or stopped or decreased (33.3%) use of ≥1 medication class at 2 years. No device/procedure-related serious adverse events were reported throughout 2 years. CONCLUSION TCRF neurolysis of the PNN resulted in sustained improvements in chronic rhinitis symptom burden and quality of life through 2 years, accompanied by a substantial decrease in medication burden. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2077-2084, 2024.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, U.S.A
| | | | - Daniel D Charous
- Arizona Desert Ear, Nose & Throat Specialists, Goodyear, Arizona, U.S.A
| | - Mandy Cuevas
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Önder Göktas
- ENT-Center, HNO-Zentrum am Kudamm, Berlin, Germany
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
| | - Nathan E Nachlas
- ENT and Allergy Associates of Florida, Boca Raton, Florida, U.S.A
| | - Elina M Toskala
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | | | - Detlef Brehmer
- Faculty of Medicine, University Witten/Herdecke, Witten, Germany
- Department of Electrical Engineering and Applied Natural Sciences, Westphalian University of Applied Sciences, Gelsenkirchen, Germany
- Department of Otorhinolaryngology, Private ENT Practice, Göttingen, Germany
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Schwartz AR, Jacobowitz O, Eisele DW, Mickelson SA, Miller MB, Oliven A, Certal V, Hopp ML, Winslow DH, Huntley TC, Nachlas NE, Pham LV, Gillespie MB, Weeks BH, Lovett EG, Shen J, Malhotra A, Maurer JT. Targeted Hypoglossal Nerve Stimulation for Patients With Obstructive Sleep Apnea: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2023; 149:512-520. [PMID: 37022679 PMCID: PMC10080405 DOI: 10.1001/jamaoto.2023.0161] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 02/03/2023] [Indexed: 04/07/2023]
Abstract
Importance Evidence is lacking from randomized clinical trials of hypoglossal nerve stimulation in obstructive sleep apnea (OSA). Objective To evaluate the safety and effectiveness of targeted hypoglossal nerve stimulation (THN) of the proximal hypoglossal nerve in patients with OSA. Design, Setting, and Participants This randomized clinical trial (THN3) was conducted at 20 centers and included 138 patients with moderate to severe OSA with an apnea-hypopnea index (AHI) of 20 to 65 events per hour and body mass index (calculated as weight in kilograms divided by height in meters squared) of 35 or less. The trial was conducted from May 2015 through June 2018. Data were analyzed from January 2022 through January 2023. Intervention Implant with THN system; randomized 2:1 to activation at month 1 (treatment) or month 4 (control). All received 11 months of THN with follow-up at months 12 and 15, respectively. Main Outcomes and Measures Primary effectiveness end points comprised AHI and oxygen desaturation index (ODI) responder rates (RRs). Treatment responses at months 4 and 12/15 were defined as a 50% or greater reduction in AHI to 20 or less per hour and an ODI decrease of 25% or greater. Coprimary end points comprised (1) month 4 AHI and ODI RR in the treatment greater than the control group and (2) month 12/15 AHI and ODI RR in the entire cohort exceeding 50%. Secondary end points included sleep apnea severity (AHI and ODI) and patient-reported outcomes (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale). Results Among 138 participants, the mean (SD) age was 56 (9) years, and 19 (13.8%) were women. Month 4 THN RRs were substantially greater in those in the treatment vs control group (AHI, 52.3% vs 19.6%; ODI, 62.5% vs 41.3%, respectively) with treatment-control standardized mean differences of 0.725 (95% CI, 0.360-1.163) and 0.434 (95% CI, 0.070-0.843) for AHI and ODI RRs, respectively. Months 12/15 RRs were 42.5% and 60.4% for AHI and ODI, respectively. Improvements in AHI, ODI, Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, and EQ-5D visual analog scale scores were all clinically meaningful (medium to large effect size). Two serious adverse events and 100 nonserious related adverse events were observed from the implant procedure or study protocol. Conclusions and Relevance This randomized clinical trial found that THN demonstrated improvements in sleep apnea, sleepiness, and quality of life in patients with OSAs over an extended AHI and body mass index range without prior knowledge of pharyngeal collapse pattern. Clinically meaningful improvements in AHI and patient-reported responses compared favorably with those of distal hypoglossal nerve stimulation trials, although clinically meaningful differences were not definitive for ODI. Trial Registration ClinicalTrials.gov Identifier: NCT02263859.
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Affiliation(s)
- Alan R Schwartz
- Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ofer Jacobowitz
- Sleep Department, ENT and Allergy Associates, New York, New York
| | - David W Eisele
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Samuel A Mickelson
- Advanced Ear Nose & Throat Associates, The Atlanta Snoring & Sleep Disorders Institute, Atlanta, Georgia
| | | | - Arie Oliven
- Department of Medicine, Bnai-Zion Medical Centre, Haifa, Israel
- Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Centre, Hospital CUF Porto & CHEDV, Porto, Portugal
- Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Martin L Hopp
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Tod C Huntley
- Center for Ear, Nose, Throat and Allergy, Carmel, Indiana
| | - Nathan E Nachlas
- Ear, Nose, Throat, and Allergy Associates of Florida, Boca Raton, Florida
| | - Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
| | - Brian H Weeks
- Department of Otolaryngology SENTA Clinic, San Diego, California
| | - Eric G Lovett
- Clinical and Medical Affairs, LivaNova PLC, Minneapolis, Minnesota
| | - John Shen
- OcTech Consulting, St Paul, Minnesota
| | - Atul Malhotra
- Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, University Hospital Mannheim, Mannheim, Germany
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Han JK, Palmer JN, Adappa ND, Nachlas NE, Chandra RK, Jacobs JB, Manes RP, McKenzie K. Image guided dilation of sinus ostium in revision sinus surgery. Am J Otolaryngol 2023; 44:103803. [PMID: 36889144 DOI: 10.1016/j.amjoto.2023.103803] [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: 08/26/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Assess if a rigid, image-guided balloon could be used effectively and safely in revision sinus surgery. MATERIALS AND METHODS A prospective, non-randomized, single-arm, multicenter study to assess the safety and device performance of the NuVent™ EM Balloon Sinus Dilation System. Adults with CRS in need of revision sinus surgery were enrolled for balloon sinus dilation of a frontal, sphenoid, or maxillary sinus. The primary device performance endpoint was the ability of the device to (1) navigate to; and (2) dilate tissue in subjects with scarred, granulated, or previously surgically-altered tissue (revision). Safety outcomes included the assessment of any operative adverse events (AEs) directly attributable to the device or for which direct cause could not be determined. A follow-up endoscopy was conducted at 14 days post-treatment for assessment of any AEs. Performance outcomes included the surgeon's ability to reach the target sinus (es) and dilate the ostia. Endoscopic photos were captured for each treated sinus pre- and post-dilation. RESULTS At 6 US clinical sites, 51 subjects were enrolled; 1 subject withdrew before treatment due to a cardiac complication from anesthesia. 121 sinuses were treated in 50 subjects. The device performed as expected in 100 % of the 121 treated sinuses, with investigators able to navigate to the treatment area and dilate the sinus ostium without difficulty. Ten AEs were seen in 9 subjects, with 0 related to the device. CONCLUSION The targeted frontal, maxillary or sphenoid sinus ostium were safely dilated in every revision subject treated, with no AEs directly attributed to the device.
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Affiliation(s)
- Joseph K Han
- Eastern Virginia Medical School, Norfolk, VA, USA.
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Lee JT, Abbas GM, Charous DD, Cuevas PDMM, Göktas PDMÖ, Loftus PA, Nachlas NE, Toskala EM, Watkins JP, Brehmer PDMD. Clinical and Quality of Life Outcomes Following Temperature-Controlled Radiofrequency Neurolysis of the Posterior Nasal Nerve (RhinAer) for Treatment of Chronic Rhinitis. Am J Rhinol Allergy 2022; 36:747-754. [PMID: 35818709 PMCID: PMC9548948 DOI: 10.1177/19458924221109987] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/17/2022]
Abstract
Background Temperature-controlled radiofrequency (TCRF) neurolysis of the posterior
nasal nerve (PNN; RhinAer) is a minimally invasive treatment option for
patients with chronic rhinitis. Objective To determine clinical outcomes and quality of life (QoL) following TCRF
neurolysis of the PNN. Methods A prospective single-arm study of 129 patients with chronic rhinitis at 16
medical centers in the United States and Germany. Results The mean 24-h reflective total nasal symptom score (rTNSS) improved from 7.8
(95% CI, 7.5-8.1) at baseline to 3.6 (95% CI, 3.2-4.0) at 3 months and
continued to improve to 2.9 (95% CI, 2.5-3.3) at 6 months
(p < .001 comparing follow-up to baseline and
p = .002 comparing 3 and 6 months). This represents
53.8% improvement over baseline at 3 months and 62.8% improvement at 6
months. Rhinorrhea, congestion, sneezing, and itching subscores and
postnasal drip and cough scores were all significantly improved over
baseline at both timepoints. At 3 months, 76.2% (95% CI, 68.1%-82.8%) of
patients achieved a minimal clinically important difference of ≥30%
improvement in rTNSS over baseline and the percentage was higher at 6 months
(83.5% [95% CI, 75.8%-89.0%]). At 3 months, 80.3% (95% CI, 72.6%-86.3%)
reported a minimal clinically important difference of ≥0.4-point improvement
in the mini rhinoconjunctivitis quality of life questionnaire score, and the
percentage was higher at 6 months; 87.7% (95% CI, 80.7%-92.4%). There were
no serious adverse events with a relationship to the device/procedure
reported through 6 months. Conclusion In this large, multicenter study, TCRF neurolysis of the PNN was safe and
resulted in a significant reduction in rhinitis symptom burden at 3 months
that was sustained/improved through 6 months. The majority of patients
reported a clinically relevant improvement in QoL at 3 and 6 months
postprocedure.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Daniel D Charous
- Arizona Desert Ear, Nose & Throat Specialists, Goodyear, AZ, USA
| | - Pd Dr Med Mandy Cuevas
- Department of Otorhinolaryngology, University Clinic Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Elina M Toskala
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Prof Dr Med Detlef Brehmer
- Faculty of Medicine, University Witten/Herdecke, Witten, Germany.,Department of Electrical Engineering and Applied Natural Sciences, Westphalian University of Applied Sciences, Gelsenkirchen, Germany.,Department of Otorhinolaryngology, Private ENT Practice, Göttingen, Germany
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Sidle DM, Stolovitzky P, O'Malley EM, Ow RA, Nachlas NE, Silvers S. Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures. Facial Plast Surg 2021; 37:673-680. [PMID: 33853139 PMCID: PMC8492107 DOI: 10.1055/s-0041-1726464] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (
p
< 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on
www.clinicaltrials.gov
(NCT02952313 and NCT02964312).
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Affiliation(s)
- Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville, California
| | - Nathan E Nachlas
- Ear, Nose, Throat, and Allergy Associates of Florida, Boca Raton, Florida
| | - Stacey Silvers
- Madison ENT and Facial Plastic Surgery, New York, New York
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Stolovitzky P, Sidle DM, Ow RA, Nachlas NE, Most SP. In Response to Letter to the Editor Regarding: A Prospective Study for Treatment of Nasal Valve Collapse Due to Lateral Wall Insufficiency: Outcomes Using a Bioabsorbable Implant. Laryngoscope 2019; 129:E228. [PMID: 31034615 DOI: 10.1002/lary.28013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Randall A Ow
- Sacramento Ear, Nose and Throat Medical and Surgical Group, Roseville, California, U.S.A
| | - Nathan E Nachlas
- Ear, Nose and Throat Associates of South Florida, Boca Raton, Florida, U.S.A
| | - Sam P Most
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Stolovitzky P, Sidle DM, Ow RA, Nachlas NE, Most SP. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: Outcomes using a bioabsorbable implant. Laryngoscope 2018; 128:2483-2489. [PMID: 29756407 PMCID: PMC6585764 DOI: 10.1002/lary.27242] [Citation(s) in RCA: 26] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/21/2018] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine 6-month outcomes for treatment of lateral nasal wall insufficiency with a bioabsorbable implant. STUDY DESIGN Prospective, multicenter, nonrandomized, single-blinded study. METHODS One hundred and one patients with severe-to-extreme class of Nasal Obstruction Symptom Evaluation (NOSE) scores were enrolled at 14 U.S. clinics (September 2016-March 2017). Patients were treated with a bioabsorbable implant designed to support lateral wall, with or without concurrent septoplasty and/or turbinate reduction procedure(s). NOSE scores and visual analog scale (VAS) were measured at baseline and month 1, 3, and 6 postoperatively. The Lateral Wall Insufficiency (LWI) score was determined by independent physicians observing the lateral wall motion video. RESULTS Forty-three patients were treated with implant alone, whereas 58 had adjunctive procedures. Seventeen patients reported 19 adverse events, all of which resolved with no clinical sequelae. Patients showed significant reduction in NOSE scores at 1, 3, and 6 months postoperatively (79.5 ± 13.5 preoperatively, 34.6 ± 25.0 at 1 month, 32.0 ± 28.4 at 3 months, and 30.6 ± 25.8 at 6 months postoperatively; P < 0.01 for all). They also showed significant reduction in VAS scores postoperatively (71.9 ± 18.8 preoperatively, 32.7 ± 27.1 at 1 month, 30.1 ± 28.3 at 3 months, and 30.7 ± 29.6 at 6 months postoperatively; P < 0.01 for all). These results were similar in patients treated with the implant alone compared to those treated with the implant and adjunctive procedures. Consistent with patient-reported outcomes, postoperative LWI scores were demonstrably lower (1.83 ± 0.10 and 1.30 ± 0.11 pre- and postoperatively; P < 0.01). CONCLUSION Stabilization of the lateral nasal wall with a bioabsorbable implant improves patients' nasal obstructive symptoms over 6 months. LEVEL OF EVIDENCE 2b. Laryngoscope, 2483-2489, 2018.
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Affiliation(s)
- Pablo Stolovitzky
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Douglas M Sidle
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Randall A Ow
- Sacramento Ear Nose and Throat Medical and Surgical Group, Roseville
| | - Nathan E Nachlas
- Ear, Nose and Throat Associates of South Florida, Boca Raton, Florida
| | - Sam P Most
- Division of Facial Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Poe D, Anand V, Dean M, Roberts WH, Stolovitzky JP, Hoffmann K, Nachlas NE, Light JP, Widick MH, Sugrue JP, Elliott CL, Rosenberg SI, Guillory P, Brown N, Syms CA, Hilton CW, McElveen JT, Singh A, Weiss RL, Arriaga MA, Leopold JP. Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial. Laryngoscope 2017; 128:1200-1206. [PMID: 28940574 DOI: 10.1002/lary.26827] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [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: 05/15/2017] [Revised: 06/21/2017] [Accepted: 07/05/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess balloon dilation of the Eustachian tube with Eustachian tube balloon catheter in conjunction with medical management as treatment for Eustachian tube dilatory dysfunction. STUDY DESIGN In this prospective, multicenter, randomized, controlled trial, we assigned, in a 2:1 ratio, patients age 22 years and older with Eustachian tube dilatory dysfunction refractory to medical therapy to undergo balloon dilation of the Eustachian tube with balloon catheter in conjunction with medical management or medical management alone. METHODS The primary endpoint was normalization of tympanogram at 6 weeks. Additional endpoints were normalization of Eustachian Tube Dysfunction Questionaire-7 symptom scores, positive Valsalva maneuver, mucosal inflammation, and safety. RESULTS Primary efficacy results demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone. Tympanogram normalization at 6-week follow-up was observed in 51.8% (72/139) of investigational patients versus 13.9% (10/72) of controls (P < .0001). Tympanogram normalization in the treatment group was 62.2% after 24 weeks. Normalization of Eustachian Tube Dysfunction Questionaire-7 Symptom scores at 6-week follow-up was observed in 56.2% (77/137) of investigational patients versus 8.5% (6/71) controls (P < .001). The investigational group also demonstrated substantial improvement in both mucosal inflammation and Valsalva maneuver at 6-week follow-up compared to controls. No device- or procedure-related serious adverse events were reported for those who underwent balloon dilation of the Eustachian tube. CONCLUSIONS This study demonstrated superiority of balloon dilation of the Eustachian tube with balloon catheter + medical management compared to medical management alone to treat Eustachian tube dilatory dysfunction in adults. LEVEL OF EVIDENCE 1b. Laryngoscope, 128:1200-1206, 2018.
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Affiliation(s)
- Dennis Poe
- Boston Children's Hospital, Boston, Massachusetts
| | - Vijay Anand
- Weill Cornell Medical College, Department of Otolaryngology and Head and Neck Surgery, New York, New York
| | | | - William H Roberts
- Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, North Carolina
| | | | - Karen Hoffmann
- Piedmont Ear, Nose and Throat and Related Allergy, Atlanta, Georgia
| | | | - Joshua P Light
- ENT Associates of South Florida, P.A., Boynton Beach, Florida
| | - Mark H Widick
- ENT Associates of South Florida, Boca Raton, Florida
| | - John P Sugrue
- ENT and Allergy Associates, LLP Department of Otolaryngology, Port Jefferson, New York
| | - C Layton Elliott
- Witham Health Services/Memorial Hospital ENT Department, Lebanon, Indiana
| | | | | | - Neil Brown
- Meriter/UnityPoint Heathcare, Madison, Wisconsin
| | - Charles A Syms
- University of Texas Health, San Antonio, Department of Otolaryngology, San Antonio, Texas
| | - Christopher W Hilton
- HealthPartners Medical Group, Department of Otolaryngology Head and Neck Surgery, St. Paul, Minnesota
| | - John T McElveen
- Carolina Ear and Hearing Clinic, P.C., Department of Otology/ Neurotology, Raleigh, North Carolina
| | - Ameet Singh
- George Washington University Medical Center, Division of Otolaryngology, Department of Surgery, Washington, DC
| | | | - Moises A Arriaga
- Louisiana State University, School of Medicine, Department of Otolaryngology and Neurosurgery, New Orleans, Louisiana
| | - John P Leopold
- Depuy Synthes, Johnson & Johnson Medical Devices Companies, Raynham, Massachusetts, U.S.A
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9
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Nachlas NE, Papel ID, Steiner A. Functional and cosmetic surgery of nose and ear deformities in children and adolescents. Md Med J 1990; 39:655-9. [PMID: 2398783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Congenital and traumatic disorders of the nose and ear in children and adolescents must be dealt with on an individual basis. The indications for surgical correction must be guided by functional, psychologic, and aesthetic considerations.
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Affiliation(s)
- N E Nachlas
- Dept. of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions
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10
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McAfee PC, Bohlman HH, Riley LH, Robinson RA, Southwick WO, Nachlas NE. The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg Am 1987; 69:1371-83. [PMID: 2450093] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since 1959, we have used a superior extension of the anterior approach to the cervical spine of Robinson and Smith in a consecutive series of seventeen patients. This approach provided anterior access to the neural elements from the clivus to the body of the third cervical vertebra, without the need for posterior dissection of the carotid sheath or entrance into the hypopharynx or oral cavity. It also provided adequate exposure for the insertion of iliac or fibular strut grafts, which was necessary in thirteen patients. The approach gave excellent exposure for anterior intralesional excision of a tumor in ten patients, marginal excision of an osteochondroma, two corpectomies of the second cervical vertebra combined with removal of the odontoid process, corpectomy of the second cervical vertebra for the treatment of fixed atlanto-axial subluxation, removal of a bullet anterior to the clivus, reduction of a dislocation of the second on the third cervical vertebra secondary to an unstable fracture of the pedicles of the second cervical vertebra, and anterior débridement for treatment of pyogenic vertebral osteomyelitis. In contrast to the reported results of transmucosal approaches to the atlas and axis, there were no infections or iatrogenic neurological deficits of the spine in the present series. Twelve patients who were followed for two years or more had a solid anterior fusion and no subsequent loss of cervical stability. Pain in the neck was relieved in all of the patients who had had a pathological or traumatic fracture.
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Affiliation(s)
- P C McAfee
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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Nachlas NE, McAfee PC, Johns ME. Anterior extraoral approach to the atlas and axis. Laryngoscope 1987; 97:814-9. [PMID: 3298901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A transcervical extraoral approach was utilized to achieve exposure to the upper cervical spine in five patients, four of whom required bone graft placement. Excellent exposure was achieved in all patients, and the postoperative course was uncomplicated. The anterior extraoral approach is a reliable technique in treatment of pathology of the atlas and axis.
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Mattox DE, Nachlas NE. Book Review: Comprehensive Manuals of Surgical Specialties. Otolaryngol Head Neck Surg 1986. [DOI: 10.1177/019459988609400427] [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: 11/15/2022]
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Mattox DE, Nachlas NE. Book Review: Head and Neck Cancer. Otolaryngol Head Neck Surg 1986. [DOI: 10.1177/019459988609400426] [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]
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Nachlas NE, Trail M, Duncan D. Sacculotomy in the treatment of Meniere's disease. Md State Med J 1969; 18:53-6. [PMID: 5824129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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