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Higgins TS, Shutt TA, Ting JY, Illing EA, Tang DM, Kosaraju N, Potts K, Cash L, Liu D, Sheeley KA, Wu AW. Development of the 12-Item Facial Complaints Evaluation Scale (FaCES-12). Ann Otol Rhinol Laryngol 2024; 133:495-502. [PMID: 38380629 PMCID: PMC11022522 DOI: 10.1177/00034894241233034] [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: 02/22/2024]
Abstract
OBJECTIVES Chronic rhinosinusitis and related rhinologic disorders are common in routine otolaryngologic practice. Common presenting symptoms include nasal obstruction, facial pain, facial pressure, headache, and a subjective feeling of the face feeling "swollen," a perceptual distortion. No validated scale exists to assess facial pain in addition to perceptual distortion or headache. The objective was to develop a novel scale for assessment of facial symptoms experienced by patients presenting for rhinologic evaluation. METHODS This was a prospective validation cross-sectional study. A patient questionnaire, the 12-item Facial Complaints Evaluation Scale (FaCES-12), was created to evaluate facial symptoms based on clinical experience and the literature, including severity and timing of facial pain, facial pressure, facial perceptual swelling, and headache. Each item was assessed utilizing an 11-point Likert scale ranging from 0 to 10 in severity. Data was collected prospectively from 210 patients in 1 private and 2 academic otolaryngologic practices from August to December 2019 along with the PROMIS Pain Intensity Scale 3a and 22-Item Sino-nasal Outcome Test. Construct validity was determined using Pearson correlation and exploratory factor analysis. Internal consistency and test-retest reliability were assessed by calculating Cronbach's alpha and assessing test-retest scores. RESULTS A new 12-item scale named FaCES-12 was developed. FaCES-12 demonstrated high reliability with a Cronbach's alpha of .94 and high test-retest reliability (r = .90). The scale revealed very strong correlation with the PROMIS Pain Intensity Scale 3a (r = .81) and moderate correlation with the Sino-nasal Outcome Test (r = .48). Exploratory factor analysis demonstrated the scale contained interrelated variables that measured unique components of facial sensations. CONCLUSION The FaCES-12 is a valid and reliable instrument for use in the evaluation of facial symptoms. Further research into the application of this scale is warranted.
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Affiliation(s)
- Thomas S. Higgins
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Travis A. Shutt
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jonathan Y. Ting
- Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elisa A. Illing
- Department of Otolaryngology—Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dennis M. Tang
- Department of Otolaryngology—Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nikitha Kosaraju
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kevin Potts
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Liz Cash
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - David Liu
- Department of Otolaryngology—Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kathleen A. Sheeley
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Arthur W. Wu
- Department of Otolaryngology—Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Wu AW, Garcia Ruiz EA, Higgins TS, Tang DM, Illing EA, Carle TR, Vasquez M, Ting JY, Sreenath SB, Halawi A, Chen PG. Sinonasal Symptom Correlation With the Postoperative Polyp Scale (POPS). Ann Otol Rhinol Laryngol 2024; 133:485-489. [PMID: 38344993 DOI: 10.1177/00034894241232475] [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: 04/17/2024]
Abstract
BACKGROUND Commonly used endoscopic nasal polyp grading scales have been shown to correlate poorly with symptom scores and quality of life metrics. The recently described Postoperative Polyp Scale (POPS) is a grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities by describing incremental recurrence in relation to the surgically opened sinus cavities. OBJECTIVE The objective of this study was to determine if the POPS correlated with sinonasal symptoms. METHODS CRSwNP patients were prospectively administered SNOT-22 questionnaires and graded according to the POPS starting at their 1-month postoperative appointments. Total POPS scores (sum of each side) and Max POPS score (larger value of left and right) were correlated with SNOT-22 total scores and subdomains using Kendall correlation testing. RESULTS A total of 127 patients were enrolled in the study. Both Total POPS or Max POPS were significantly correlated to the SNOT-22 total score (P < .001, P < .001), Rhinologic (P < .001, P < .001), Extra-Nasal Rhinologic (P < .001, P < .001), Ear/Facial (P < .001, P < .001), and Psychologic (P = .028, P = .017) subdomains. Kendall's tau indicated strong correlation (≥0.3) with Rhinologic subdomain, moderate correlation (.21-.29) with Extra-Nasal Rhinologic and Ear/Facial subdomains, and weak correlation (.1-.19) with Psychologic subdomain. CONCLUSION Previous endoscopic nasal polyp grading scales poorly correlate with symptoms and patient reported outcome measures. The new POPS moderately correlates with the total SNOT-22 score and strongly correlates with the Rhinologic subdomain, indicating that it may have good potential as a tool to evaluate postoperative CRSwNP patients.
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Affiliation(s)
- Arthur W Wu
- Snot Force Alliance, Inc., Louisville, KY, USA
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erika A Garcia Ruiz
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas S Higgins
- Snot Force Alliance, Inc., Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY, USA
| | - Dennis M Tang
- Snot Force Alliance, Inc., Louisville, KY, USA
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elisa A Illing
- Snot Force Alliance, Inc., Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Taylor R Carle
- Snot Force Alliance, Inc., Louisville, KY, USA
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Missael Vasquez
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonathan Y Ting
- Snot Force Alliance, Inc., Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Satyan B Sreenath
- Snot Force Alliance, Inc., Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Akaber Halawi
- Snot Force Alliance, Inc., Louisville, KY, USA
- Marlyand ENT Center, Lutherville, MD, USA
| | - Philip G Chen
- Snot Force Alliance, Inc., Louisville, KY, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
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Wu AW, Sharma D, Illing EA, Ting JY, Vasquez M, Rubel K, Tang DM, Higgins TS. Ostial Patency Measurements After Endoscopic Sphenoidotomies and Frontal Sinusotomies. Ann Otol Rhinol Laryngol 2023; 132:1584-1589. [PMID: 37226723 DOI: 10.1177/00034894231173483] [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: 05/26/2023]
Abstract
BACKGROUND Sphenoid and frontal sinuses have narrow ostia and are prone to stenosis. However, their relative rates of patency are not well established, and descriptive rates of sphenoid stenosis have never been reported. The objective is to measure the patency of the sphenoid and frontal sinus ostia postoperatively. METHODS A prospective multi-institutional cohort study was performed. Ostial patency was measured at surgery and 3 and 6 months postoperatively. Pertinent clinical history such as the presence of nasal polyps and prior history of ESS as well as the use of steroid eluting stents were recorded. Overall stenosis rates were calculated for both the sphenoid and frontal sinuses, and Wilcoxon-Signed Rank Test was used to compare intraoperative and postoperative ostial areas. Factorial Analysis of Variance (ANOVA) was performed to determine effects of 5 clinical factors. RESULTS Fifty patients were included. The mean sphenoid sinus ostial area decreased 42.2% in size from baseline to 3 months postoperatively (T0 55.2 ± 28.7 mm vs T3 m 31.8 ± 25.5 mm, P < .001). The mean frontal sinus ostial area decreased 39.8% in size from baseline to 3 months postoperatively (T0 33.7 ± 17.2 mm vs T3 m 19.9 ± 15.1 mm, P < .001). Neither the sphenoid nor the frontal sinus ostial patency demonstrated statistically significant change from 3 to 6 months postoperatively. CONCLUSION Both sphenoid and frontal sinus ostia routinely narrow postoperatively, predominately from baseline to 3 months. These findings can serve as a reference for both clinical outcomes and future studies of these surgeries.
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Affiliation(s)
- Arthur W Wu
- Snot Force Alliance, Louisville, KY
- Cedars-Sinai Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
| | - Dhruv Sharma
- Cedars-Sinai Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Elisa A Illing
- Cedars-Sinai Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Jonathan Y Ting
- Cedars-Sinai Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Kolin Rubel
- Cedars-Sinai Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Dennis M Tang
- Snot Force Alliance, Louisville, KY
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Thomas S Higgins
- Snot Force Alliance, Louisville, KY
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY, USA
- Kentuckiana Ear, Nose, and Throat, Louisville, KY, USA
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Wu AW, Halawi AM, Illing EA, Tang DM, Chen PG, Kuan EC, Ting JY, Norez DA, Kim SA, Sharma D, Reh DD, Rangarajan SV, Lam KK, Ow RA, Sublett JW, Higgins TS. Postoperative Polyp Scale (POPS): Development of a New Sinonasal Polyp Grading Scale. Laryngoscope 2023; 133:2885-2890. [PMID: 36866689 DOI: 10.1002/lary.30623] [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: 10/25/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Commonly used endoscopic grading scales, such as the nasal polyp scale, inadequately describe the degree of polyposis found postoperatively in the paranasal sinus cavities. The purpose of this study was to create a novel grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities, the Postoperative Polyp Scale (POPS). METHODS A modified Delphi method was utilized to establish the POPS using consensus opinion among 13 general otolaryngologists, rhinologists, and allergists. Postoperative endoscopy videos from 50 patients with chronic rhinosinusitis with nasal polyps were reviewed by 7 fellowship-trained rhinologists and scored according to the POPS. Videos were rated again 1 month later by the same reviewers, and scores were assessed for test-retest and inter-rater reliability. RESULTS Overall inter-rater reliability for the first and second reviews of the 52 videos was Kf = 0.49 (95% CI 0.42-0.57) and Kf = 0.50 (95% CI 0.42-0.57) for the POPS. Intra-rater reliability showed near-perfect test-retest reliability for the POPS with Kf = 0.80 (95% CI 0.76-0.84). CONCLUSION The POPS is an easy-to-use, reliable, and novel objective endoscopic grading scale that more accurately describes polyp recurrence in the postoperative state which will be useful in the future for measuring the efficacy of various medical and surgical interventions. LEVEL OF EVIDENCE 5 Laryngoscope, 133:2885-2890, 2023.
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Affiliation(s)
- Arthur W Wu
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Akaber M Halawi
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Division of Otolaryngology-Head and Neck Surgery, University of Florida Health College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Elisa A Illing
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dennis M Tang
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Philip G Chen
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Edward C Kuan
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jonathan Y Ting
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel A Norez
- College of Medicine-Jacksonville, Center for Data Solutions, University of Florida, Gainesville, Florida, USA
| | - Stacey A Kim
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhruv Sharma
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas D Reh
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Sanjeet V Rangarajan
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, Tennessee, USA
| | - Kent K Lam
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Randall A Ow
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Sacramento Ear, Nose, and Throat, Sacramento, California, USA
| | - J Wesley Sublett
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Family Allergy & Asthma, Louisville, Kentucky, USA
| | - Thomas S Higgins
- Snot Force Alliance, Inc., Louisville, Kentucky, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky, USA
- Rhinology, Sinus & Skull Base, Kentuckiana ENT, a Division of ENT Care Centers, Louisville, Kentucky, USA
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5
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Tang DM, Goli R, Higgins TS, Ting JY, Illing EA, Wu AW. Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression. Am J Rhinol Allergy 2022; 36:835-840. [DOI: 10.1177/19458924221118139] [Citation(s) in RCA: 1] [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: 11/15/2022]
Abstract
Background and Objective This study aims to evaluate the medicolegal trends related to 2 common orbital surgeries: orbital decompression and dacryocystorhinostomy (DCR). These procedures are performed by ophthalmologists, otolaryngologists, and multidisciplinary teams of both specialists. Methods The Westlaw database was reviewed from 1980 to 2020 for medical malpractice cases involving orbital decompression and DCR surgeries. Data were compiled on plaintiff and defendant demographics, procedure performed, legal allegation, nature of injury, and verdict or settlement awards. The Ophthalmic Mutual Insurance Company was also queried for all malpractice cases pertaining to orbital decompression and DCR from 1995 to 2021. Results The Westlaw database included 60 cases (34 orbital decompression, 26 DCR); of these, 8 orbital decompression and 6 DCR cases met inclusion criteria. Of the 7 orbital decompression cases that were tried, a verdict in favor of the plaintiff occurred in 4 cases (57%). Of the 5 DCR cases that were tried, a verdict in favor of the plaintiff occurred in 2 cases (40%). A search of all claims at OMIC yielded 31 cases (15 orbital decompression, 16 DCR). 22 of 31 cases were either dismissed or resulted in no payment. The remainder was settled out of court, with only one case being tried and the verdict supporting the defendant. Conclusion Despite several thousand orbital decompressions and DCR surgeries being performed annually in the US, very few lawsuits involving these complex surgeries have gone to trial. However, of the cases that did go to trial, a relatively high proportion of verdicts for plaintiffs was observed.
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Affiliation(s)
- Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rachna Goli
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
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Nag AK, Saltagi AK, Saltagi MZ, Wu AW, Higgins TS, Knisely A, Ting JY, Illing EA. Management of Post-Infectious Anosmia and Hyposmia: A Systematic Review. Ann Otol Rhinol Laryngol 2022:34894221118186. [PMID: 35959948 DOI: 10.1177/00034894221118186] [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: 11/15/2022]
Abstract
BACKGROUND Anosmia and hyposmia significantly affect patients' quality of life and have many etiologies, including trauma, inflammatory conditions including chronic rhinosinusitis, neoplasm, and viral infections, such as rhinovirus and SARS-CoV-2. OBJECTIVE Our purpose was to establish whether a consensus exists regarding optimal management of olfactory dysfunction and to provide insight into the treatment of anosmia in the current climate of increased prevalence secondary to COVID-19. Thus, we aimed to systematically review the literature on the management of non-Chronic-rhinosinusitis- related anosmia/hyposmia. METHODS PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating management of anosmia and hyposmia written in the English language, with original data, a minimum of 3 months of follow-up except for COVID-related studies, at least 2 patients, and well-defined and measurable outcomes. RESULTS A total of 3013 unique titles were returned upon the initial search. Of these, 297 abstracts were examined, yielding 19 full texts meeting inclusion criteria (8 with level 1 evidence, 3 with level 2, 1 with level 3, and 7 with level 4). The studies included a total of 1522 subjects, with follow up ranging from 3 to 72 months, with an exception for COVID related studies. Endpoints were based on clinically significant improvements of olfactory functions as measured through validated smell tests. Treatments with the most robust data were intranasal corticosteroids and olfactory training. CONCLUSION The literature on the treatment of anosmia and hyposmia includes randomized trials showing the efficacy of a few modalities. While further research is needed to expand therapeutic options for this debilitating condition, the current literature supports the use of olfactory training and topical corticosteroids.
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Affiliation(s)
- Amit K Nag
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abdul K Saltagi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohamad Z Saltagi
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Arthur W Wu
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY, USA.,Kentuckiana Ear, Nose & Throat, Louisville, KY, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, WA, USA
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN, USA
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7
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Patel ZM, Holbrook EH, Turner JH, Adappa ND, Albers MW, Altundag A, Appenzeller S, Costanzo RM, Croy I, Davis GE, Dehgani-Mobaraki P, Doty RL, Duffy VB, Goldstein BJ, Gudis DA, Haehner A, Higgins TS, Hopkins C, Huart C, Hummel T, Jitaroon K, Kern RC, Khanwalkar AR, Kobayashi M, Kondo K, Lane AP, Lechner M, Leopold DA, Levy JM, Marmura MJ, Mclelland L, Miwa T, Moberg PJ, Mueller CA, Nigwekar SU, O'Brien EK, Paunescu TG, Pellegrino R, Philpott C, Pinto JM, Reiter ER, Roalf DR, Rowan NR, Schlosser RJ, Schwob J, Seiden AM, Smith TL, Soler ZM, Sowerby L, Tan BK, Thamboo A, Wrobel B, Yan CH. International consensus statement on allergy and rhinology: Olfaction. Int Forum Allergy Rhinol 2022; 12:327-680. [PMID: 35373533 DOI: 10.1002/alr.22929] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 11/18/2021] [Revised: 01/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). METHODS Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence-based review, or evidence-based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. RESULTS The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. CONCLUSION This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further.
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Affiliation(s)
- Zara M Patel
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric H Holbrook
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Justin H Turner
- Otolaryngology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Nithin D Adappa
- Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark W Albers
- Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aytug Altundag
- Otolaryngology, Biruni University School of Medicine, İstanbul, Turkey
| | - Simone Appenzeller
- Rheumatology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Richard M Costanzo
- Physiology and Biophysics and Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Ilona Croy
- Psychology and Psychosomatic Medicine, TU Dresden, Dresden, Germany
| | - Greg E Davis
- Otolaryngology, Proliance Surgeons, Seattle and Puyallup, Washington, USA
| | - Puya Dehgani-Mobaraki
- Associazione Naso Sano, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Richard L Doty
- Smell and Taste Center, Otolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Valerie B Duffy
- Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | | | - David A Gudis
- Otolaryngology, Columbia University Irving Medical Center, New York, USA
| | - Antje Haehner
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | - Thomas S Higgins
- Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Claire Hopkins
- Otolaryngology, Guy's and St. Thomas' Hospitals, London Bridge Hospital, London, UK
| | - Caroline Huart
- Otorhinolaryngology, Cliniques universitaires Saint-Luc, Institute of Neuroscience, Université catholgique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste, Otolaryngology, TU Dresden, Dresden, Germany
| | | | - Robert C Kern
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashoke R Khanwalkar
- Otolaryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Masayoshi Kobayashi
- Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenji Kondo
- Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Andrew P Lane
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matt Lechner
- Otolaryngology, Barts Health and University College London, London, UK
| | - Donald A Leopold
- Otolaryngology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Joshua M Levy
- Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Marmura
- Neurology Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lisha Mclelland
- Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Takaki Miwa
- Otolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Paul J Moberg
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin K O'Brien
- Otolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Teodor G Paunescu
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Carl Philpott
- Otolaryngology, University of East Anglia, Norwich, UK
| | - Jayant M Pinto
- Otolaryngology, University of Chicago, Chicago, Illinois, USA
| | - Evan R Reiter
- Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - David R Roalf
- Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas R Rowan
- Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Schlosser
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - James Schwob
- Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Allen M Seiden
- Otolaryngology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Timothy L Smith
- Otolaryngology, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Otolaryngology, Medical University of South Carolina, Mt Pleasant, South Carolina, USA
| | - Leigh Sowerby
- Otolaryngology, University of Western Ontario, London, Ontario, Canada
| | - Bruce K Tan
- Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew Thamboo
- Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bozena Wrobel
- Otolaryngology, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Carol H Yan
- Otolaryngology, School of Medicine, UCSD, La Jolla, California, USA
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8
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Lee JT, Levine CG, Overdevest JB, Higgins TS, Manes RP, Myhill JA, Soler ZM. American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery. Int Forum Allergy Rhinol 2021; 11:1296-1307. [PMID: 34251080 DOI: 10.1002/alr.22847] [Citation(s) in RCA: 2] [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] [Received: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
The goal of this American Rhinologic Society expert practice statement (EPS) is to provide clinically applicable, evidence-based recommendations regarding pain management in sinonasal surgery. This EPS was developed following the recommended methodology and approval process as previously outlined. The topics of interest included preoperative counseling, local anesthesia, use of opioids for postoperative pain, use of nonopioid medication for postoperative pain, nonsteroidal anti-inflammatory drugs and bleeding, and use of gabapentin for pain control. Following a modified Delphi approach, 6 statements were developed, 5 of which reached consensus and 1 that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.
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Affiliation(s)
- Jivianne T Lee
- Department of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Miami, FL
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University School of Medicine, New York, NY
| | - Thomas S Higgins
- Division of Otolaryngology-Head and Neck Surgery, University of Louisville School of Medicine, Louisville, KY
| | - R Peter Manes
- Department of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT
| | - Jeffrey A Myhill
- Otolaryngology and Allergy, North East Arkansas Baptist Clinic, Jonesboro, AR
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
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9
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Saltagi AK, Saltagi MZ, Nag AK, Wu AW, Higgins TS, Knisely A, Ting JY, Illing EA. Diagnosis of Anosmia and Hyposmia: A Systematic Review. Allergy Rhinol (Providence) 2021; 12:21526567211026568. [PMID: 34285823 PMCID: PMC8264728 DOI: 10.1177/21526567211026568] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/16/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
Background Anosmia and hyposmia have many etiologies, including trauma, chronic sinusitis, neoplasms, and respiratory viral infections such as rhinovirus and SARS-CoV-2. We aimed to systematically review the literature on the diagnostic evaluation of anosmia/hyposmia. Methods PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990 using terms combined with Medical Subject Headings (MeSH). We included articles evaluating diagnostic modalities for anosmia, written in the English language, used original data, and had two or more patients. Results A total of 2065 unique titles were returned upon the initial search. Of these, 226 abstracts were examined, yielding 27 full-text articles meeting inclusion criteria (Level of evidence ranging from 1 to 4; most level 2). The studies included a total of 13,577 patients. The most utilized diagnostic tools were orthonasal smell tests (such as the Sniffin’ Sticks and the UPSIT, along with validated abridged smell tests). Though various imaging modalities (including MRI and CT) were frequently mentioned in the workup of olfactory dysfunction, routine imaging was not used to primarily diagnose smell loss. Conclusion The literature includes several studies on validity and reliability for various smell tests in diagnosing anosmia. Along with a thorough history and physical, validated orthonasal smell tests should be part of the workup of the patient with suspected olfactory dysfunction. The most widely studied modality was MRI, but criteria for the timing and sequence of imaging modalities was heterogenous.
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Affiliation(s)
- Abdul K Saltagi
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Mohamad Z Saltagi
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana
| | - Amit K Nag
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Arthur W Wu
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Division of Otolaryngology, Los Angeles, California
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose & Throat
| | - Anna Knisely
- Otolaryngology, Swedish Medical Center, Seattle, WA
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, Indiana.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana
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10
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Higgins TS, Wu AW, Ting JY. SARS-CoV-2 Nasopharyngeal Swab Testing-False-Negative Results From a Pervasive Anatomical Misconception. JAMA Otolaryngol Head Neck Surg 2021; 146:993-994. [PMID: 32940647 DOI: 10.1001/jamaoto.2020.2946] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky.,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, Kentucky
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis
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11
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Higgins TS, Wu AW, Ting JY. Overcoming Operator-Generated False-Negative Results in SARS-CoV-2 Testing-Reply. JAMA Otolaryngol Head Neck Surg 2021; 147:404-405. [PMID: 33599691 DOI: 10.1001/jamaoto.2020.5582] [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: 11/14/2022]
Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky.,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, California
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University
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12
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Saltagi MZ, Comer BT, Hughes S, Ting JY, Higgins TS. Management of Recurrent Acute Rhinosinusitis: A Systematic Review. Am J Rhinol Allergy 2021; 35:902-909. [PMID: 33622038 DOI: 10.1177/1945892421994999] [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: 11/15/2022]
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RARS is a challenging clinical problem that impacts many patients. This article seeks to systematically review the literature on RARS management. METHODS Cochrane, PubMed, EMBASE, and other databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA guidelines. Inclusion criteria included articles specifically addressing RARS management; studies with 3 or more patients; and articles in English. RESULTS A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 10 met inclusion criteria (five with level 4 evidence, four with level 3 evidence, one with level 2 evidence). The studies included a total of 890 patients (Age range 5.8 to 53.5 years), with follow up ranging from 1 to 19 months. Endpoints were primarily based on symptomatic improvement, although some articles also reported post-treatment endoscopic and radiographic findings. Management options included medical therapy (intranasal steroids, antibiotics, nasal saline irrigations, N-acetylcysteine, allergy treatment, and decongestants), balloon sinus dilation (BSD), and endoscopic sinus surgery (ESS). Surgical patients (BSD and ESS) had a trend towards greater symptom control than medically-treated patients, but meta-analysis was not possible. CONCLUSION Despite increasing interest in the treatment of RARS, there remains a lack of consensus regarding optimal management. The literature thus far, largely based on expert opinion, suggests that surgical management, either through balloon sinus dilation or endoscopic sinus surgery, may be helpful in improving symptoms and quality of life in those who do not respond to initial trials of medical management.
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Affiliation(s)
- Mohamad Z Saltagi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Department of Otolaryngology-Indiana University School of Medicine, Indianapolis, Indiana
| | - Brett T Comer
- College of Medicine, University of Kentucky, Lexington, Kentucky.,Department of Otolaryngology, University of Kentucky, Lexington, Kentucky
| | - Samuel Hughes
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Department of Otolaryngology-Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky.,Department of Otolaryngology-Kentuckiana Ear, Nose & Throat, Kentucky, Louisville, Kentucky
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13
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Maul X, Dincer BC, Wu AW, Thamboo AV, Higgins TS, Scangas GA, Oliveira K, Ho AS, Mallen-St Clair J, Walgama E. A Clinical Decision Analysis for Use of Antibiotic Prophylaxis for Nonabsorbable Nasal Packing. Otolaryngol Head Neck Surg 2021; 165:647-654. [PMID: 33588621 DOI: 10.1177/0194599820988740] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. STUDY DESIGN A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. SETTING Patients with nonabsorbable nasal packing placed. METHODS Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model. RESULTS The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective. CONCLUSIONS Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence. LEVEL OF EVIDENCE 3a.
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Affiliation(s)
- Ximena Maul
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Berkay C Dincer
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA.,School of Medicine, Hacettepe University, Ankara, Turkey
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Andrew V Thamboo
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck, University of Louisville, Louisville, Kentucky, USA
| | - George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kristin Oliveira
- Department of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allen S Ho
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Evan Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Sharma D, Campiti VJ, Ye MJ, Rubel KE, Higgins TS, Wu AW, Shipchandler TZ, Burgin SJ, Sim MW, Illing EA, Park JH, Ting JY. Aerosol generation during routine rhinologic surgeries and in-office procedures. Laryngoscope Investig Otolaryngol 2021; 6:49-57. [PMID: 33614929 PMCID: PMC7883622 DOI: 10.1002/lio2.520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Cadaveric simulations have shown endonasal drilling and cautery generate aerosols, which is a significant concern for otolaryngologists during the COVID-19 era. This study quantifies aerosol generation during routine rhinologic surgeries and in-office procedures in live patients. METHODS Aerosols ranging from 0.30 to 10.0 μm were measured in real-time using an optical particle sizer during surgeries and in-office procedures. Various mask conditions were tested during rigid nasal endoscopy (RNE) and postoperative debridement (POD). RESULTS Higher aerosol concentrations (AC) ranging from 2.69 to 10.0 μm were measured during RNE (n = 9) with no mask vs two mask conditions (P = .002 and P = .017). Mean AC (0.30-10.0 μm) were significantly higher during POD (n = 9) for no mask vs a mask covering the patient's mouth condition (mean difference = 0.16 ± 0.03 particles/cm3, 95% CI 0.10-0.22, P < .001). There were no discernible spikes in aerosol levels during endoscopic septoplasty (n = 3). Aerosol spikes were measured in two of three functional endoscopic sinus surgeries (FESS) with microdebrider. Using suction mitigation, there were no discernible spikes during powered drilling in two anterior skull base surgeries (ASBS). CONCLUSION Use of a surgical mask over the patient's mouth during in-office procedures or a mask with a slit for an endoscope during RNE significantly diminished aerosol generation. However, whether this reduction in aerosol generation is sufficient to prevent transmission of communicable diseases via aerosols was beyond the scope of this study. There were several spikes in aerosols during FESS and ASBS, though none were associated with endonasal drilling with the use of suction mitigation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Dhruv Sharma
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Michael J. Ye
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Kolin E. Rubel
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Thomas S. Higgins
- Department of Otolaryngology – Head & Neck SurgeryUniversity of LouisvilleLouisvilleKentuckyUSA
- Rhinology, Sinus & Skull BaseKentuckiana Ear, Nose, and ThroatLouisvilleKentuckyUSA
| | - Arthur W. Wu
- Department of Otolaryngology – Head & Neck SurgeryCedars SinaiLos AngelesCaliforniaUSA
| | - Taha Z. Shipchandler
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
| | - Sarah J. Burgin
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
| | - Michael W. Sim
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
| | - Elisa A. Illing
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
| | - Jae Hong Park
- School of Health SciencesPurdue UniversityWest LafayetteIndianaUSA
| | - Jonathan Y. Ting
- Department of Otolaryngology – Head & Neck SurgeryIndiana UniversityIndianapolisIndianaUSA
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15
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Hsue VB, Itamura K, Wu AW, Illing EA, Sokoloski KJ, Weaver BA, Anthony BP, Hughes N, Ting JY, Higgins TS. Topical Oral and Intranasal Antiviral Agents for Coronavirus Disease 2019 (COVID-19). Adv Exp Med Biol 2021; 1327:169-189. [PMID: 34279838 DOI: 10.1007/978-3-030-71697-4_14] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
With the largest viral loads in both symptomatic and asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) present in the oral and nasal cavities, agents that act on these two areas have the potential for large therapeutic and prophylactic benefit. A literature review was conducted to elucidate the possible agents useful in treatment of SARS-CoV-2. These agents were evaluated for their current applications, adverse reactions, their current state of study, and any future considerations in their management of coronavirus disease 2019 (COVID-2019). Our review has found that, while there are many promising agents with proven efficacy in their in-vitro efficacy against SARS-CoV-2, more clinical trials and in-vivo studies, as well as safety trials, must be conducted before these agents can be effectively implemented.
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Affiliation(s)
- Victor B Hsue
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Kyohei Itamura
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, CA, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Kevin J Sokoloski
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - Bree A Weaver
- Division of Infectious Diseases, Departments of Internal Medicine and Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Nathan Hughes
- Pharmacy Operations, Kindred Healthcare Support Center, Louisville, KY, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, USA. .,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, KY, USA.
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16
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Borrelli M, Hopp ML, Desales A, Ting JY, Illing EA, Higgins TS, Wu AW. Gender-related differences in outcomes after endoscopic sinus surgery. Int Forum Allergy Rhinol 2020; 11:949-952. [PMID: 33275321 DOI: 10.1002/alr.22749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Michela Borrelli
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Martin L Hopp
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alexis Desales
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University Health, Indianapolis, IN
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University Health, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville School of Medicine, Louisville, KY
| | - Arthur W Wu
- Cedars-Sinai Sinus Center, Los Angeles, CA.,Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
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17
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Itamura K, Tang DM, Higgins TS, Rimell FL, Illing EA, Ting JY, Lee MK, Wu A. Comparison of Patient Satisfaction Between Virtual Visits During the COVID-19 Pandemic and In-person Visits Pre-pandemic. Ann Otol Rhinol Laryngol 2020; 130:810-817. [PMID: 33251849 PMCID: PMC8174012 DOI: 10.1177/0003489420977766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the patient experience of a virtual otolaryngology clinic visit to an in-person visit, especially with its significantly increased implementation during the COVID-19 pandemic. Methods: Patient satisfaction (PS) metrics from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey were queried from March 1, 2020 to May 1, 2020 for telehealth visits and January 1, 2020 to March 1, 2020 for in-person visits. Overlapping and comparable questions were analyzed using Mann-Whitney U test, Chi-square test for independence, and Student’s t-test. Results: There were 1284 partial or complete PS surveys from in-person visits and 221 partial or complete virtual PS surveys. There were statistically significantly worse virtual visit evaluations of provider listening, conveyance of information, likelihood to recommend, and overall provider ratings compared to in-person visits. Conclusion: Telehealth has become the new norm for most healthcare providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent. Level of Evidence: 3.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis M Tang
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Louisville University, Louisville, KY, USA
| | - Franklin L Rimell
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Matthew K Lee
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arthur Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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18
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Wu AW, Ow RA, Tang DM, Mirocha J, Walgama ES, Illing EA, Hopp ML, Ting JY, Higgins TS. Effect of nasal fluticasone exhalation delivery system on Eustachian tube dysfunction. Int Forum Allergy Rhinol 2020; 11:204-206. [PMID: 33135869 DOI: 10.1002/alr.22728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - James Mirocha
- Cedars-Sinai Biostatistics and Bioinformatics Research Center, Los Angeles, CA
| | - Evan S Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University, Indianapolis, IN
| | - Martin L Hopp
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville, Louisville, KY.,Kentuckiana ENT, Louisville, KY
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19
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Borrelli M, Ting JY, Rabbani CC, Tan BK, Higgins TS, Walgama ES, Liu GC, Chen HH, Lee MK, Hopp ML, Illing EA, Mirocha J, Wu AW. Patient satisfaction survey experience among American otolaryngologists. Am J Otolaryngol 2020; 41:102656. [PMID: 32836038 DOI: 10.1016/j.amjoto.2020.102656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient Satisfaction (PS) is a commonly used metric in health care settings to assess the quality of care given by physicians. Monitoring physicians in this way may impact physician quality of life. Studies evaluating this impact are not available. This study sought to examine the physician experience of measuring PS among practicing otolaryngologists. METHODS Using an online survey platform, a 34-item survey was given to practicing otolaryngologists through email distribution. The survey included questions about physician, practice and patient demographics, as well as inquiries regarding the way in which PS was measured and how it affected physician work and personal life. Data from these questions were reviewed and analyzed. RESULTS 174 otolaryngologists responded to the survey. A majority of physicians' (55.3%) PS scores had been tracked with 89.9% reporting being tracked for a length of at least 1 year. PS scores for individual physicians were noted to be inconsistent and vary significantly between reports. Measuring patient satisfaction led to increased occupational stress, yet most physicians (63.8%) felt the monitoring did not lead to improvements in their practice. Some physicians (36.2%) reported that the collection of patient satisfaction scores had negatively influenced the way they practiced medicine, including the pressure to order superfluous tests or to prescribe unnecessary medications. CONCLUSION Overall, physicians are negatively affected by the tracking of patient satisfaction scores. Occupational stress caused by the collection of patient satisfaction scores may contribute to physician burnout.
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20
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Wu AW, Higgins TS, Ting JY, Illing EA. Use of Google Trends to investigate anosmia: power and pitfalls of infodemiology. Int Forum Allergy Rhinol 2020; 11:957-960. [PMID: 33078575 DOI: 10.1002/alr.22725] [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] [Received: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville, Louisville, KY
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, IN
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University, Indianapolis, IN
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21
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Saltagi MZ, Comer BT, Hughes S, Ting JY, Higgins TS. Diagnostic Criteria of Recurrent Acute Rhinosinusitis: A Systematic Review. Am J Rhinol Allergy 2020; 35:383-390. [PMID: 32954839 DOI: 10.1177/1945892420956871] [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: 11/15/2022]
Abstract
BACKGROUND RARS is a challenging clinical phenomenon that affects many patients, and diagnostic criteria for this condition are not fully characterized in the literature. OBJECTIVE To examine diagnostic criteria for recurrent acute rhinosinusitis (RARS). STUDY DESIGN Systematic review. METHODS Cochrane, PubMed (MEDLINE), clinicaltrials.gov, EMBASE, Google Scholar, and Web of Science databases were queried for articles related to RARS dating from 1990 to present, according to PRISMA statement guidelines. Full text articles pertinent to the diagnostic criteria of RARS were included in this review. Inclusion criteria included articles specifically addressing RARS; studies with 3 or more patients; and articles in English. RESULTS A total of 1022 titles/abstracts potentially related to RARS were identified. Of these, sixty-nine full texts were selected for review, and 22 of these ultimately met inclusion criteria. The level of evidence was generally low. Studies and guidelines have used many different definitions for RARS diagnosis over the years based on symptomatology, physical examination, nasal endoscopy, imaging, and laboratory domains. Clinically important RARS has been defined most commonly as 4 or more discrete episodes of ARS per year, but this frequency is typically based on expert opinion. Additionally, radiologic anatomic associations such as concha bullosa, accessory maxillary os, and narrowed infundibular distance may be associated with RARS. Endoscopic visualization and imaging are sometimes used to confirm the presence of sinus disease during exacerbations of RARS, but there is variability in this practice. CONCLUSION The diagnostic definition for RARS has developed over time and is currently based on low level 4 and 5 evidence. Because of the migratory definition of RARS, comparing inter-study results of RARS management remains difficult, and future studies should aim to follow current expert guidelines on diagnostic criteria of RARS.
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Affiliation(s)
- Mohamad Z Saltagi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Brett T Comer
- College of Medicine, University of Kentucky, Lexington, Kentucky.,Department of Otolaryngology, University of Kentucky, Lexington, Kentucky
| | - Samuel Hughes
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose & Throat, Louisville, Kentucky
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22
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Sharma D, Ye MJ, Campiti VJ, Rubel KE, Higgins TS, Wu AW, Shipchandler TZ, Sim MW, Burgin SJ, Illing EA, Park JH, Ting JY. Mitigation of Aerosols Generated During Rhinologic Surgery: A Pandemic-Era Cadaveric Simulation. Otolaryngol Head Neck Surg 2020; 164:433-442. [PMID: 32779974 PMCID: PMC7424621 DOI: 10.1177/0194599820951169] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE After significant restrictions initially due to the COVID-19 pandemic, otolaryngologists have begun resuming normal clinical practice. However, the risk of SARS-CoV-2 transmission to health care workers through aerosolization and airborne transmission during rhinologic surgery remains incompletely characterized. The objective of this study was to quantify the number concentrations of aerosols generated during rhinologic surgery with and without interventions involving 3 passive suction devices. STUDY DESIGN Cadaver simulation. SETTING Dedicated surgical laboratory. SUBJECTS AND METHODS In a simulation of rhinologic procedures with and without different passive suction interventions, the concentrations of generated aerosols in the particle size range of 0.30 to 10.0 µm were quantified with an optical particle sizer. RESULTS Functional endoscopic sinus surgery with and without microdebrider, high-speed powered drilling, use of an ultrasonic aspirator, and electrocautery all produced statistically significant increases in concentrations of aerosols of various sizes (P < .05). Powered drilling, ultrasonic aspirator, and electrocautery generated the highest concentration of aerosols, predominantly submicroparticles <1 µm. All interventions with a suction device were effective in reducing aerosols, though the surgical smoke evacuation system was the most effective passive suction method in 2 of the 5 surgical conditions with statistical significance (P < .05). CONCLUSION Significant aerosol concentrations were produced in the range of 0.30 to 10.0 µm during all rhinologic procedures in this cadaver simulation. Rhinologic surgery with a passive suction device results in significant mitigation of generated aerosols.
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Affiliation(s)
- Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Michael J Ye
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | | | - Kolin E Rubel
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA.,School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky, USA.,Rhinology, Sinus, and Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, Kentucky, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, California, USA
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Michael W Sim
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Sarah J Burgin
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Jae Hong Park
- School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
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Higgins TS, Wu AW, Illing EA, Sokoloski KJ, Weaver BA, Anthony BP, Hughes N, Ting JY. Intranasal Antiviral Drug Delivery and Coronavirus Disease 2019 (COVID-19): A State of the Art Review. Otolaryngol Head Neck Surg 2020; 163:682-694. [PMID: 32660339 DOI: 10.1177/0194599820933170] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 12/11/2022]
Abstract
OBJECTIVE To provide a state of the art review of intranasal antiviral drug delivery and to discuss current applications, adverse reactions, and future considerations in the management of coronavirus disease 2019 (COVID-19). DATA SOURCES PubMed, Embase, and Clinicaltrials.gov search engines. REVIEW METHODS A structured search of the current literature was performed of dates up to and including April 2020. Search terms were queried as related to topics of antiviral agents and intranasal applications. A series of video conferences was convened among experts in otolaryngology, infectious diseases, public health, pharmacology, and virology to review the literature and discuss relevant findings. CONCLUSIONS Intranasal drug delivery for antiviral agents has been studied for many years. Several agents have broad-spectrum antiviral activity, but they still require human safety and efficacy trials prior to implementation. Intranasal drug delivery has potential relevance for future clinical trials in the settings of disease spread prevention and treatment of SARS-CoV-2 and other viral diseases. IMPLICATIONS FOR PRACTICE Intranasal drug delivery represents an important area of research for COVID-19 and other viral diseases. The consideration of any potential adverse reactions is paramount.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communica-tive Disorders, University of Louisville, Louisville, Kentucky, USA.,Rhinology, Sinus, and Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, Kentucky, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai, Los Angeles, California, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kevin J Sokoloski
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, USA.,Center for Predictive Medicine and Emerging Infectious Diseases, University of Louisville, Louisville Kentucky, USA
| | - Bree A Weaver
- Division of Infectious Diseases, Departments of Internal Medicine and Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Nathan Hughes
- Pharmacy Operations, Kindred Healthcare Support Center, Louisville, Kentucky, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
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24
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Itamura K, Rimell FL, Illing EA, Higgins TS, Ting JY, Lee MK, Wu AW. Assessment of Patient Experiences in Otolaryngology Virtual Visits During the COVID-19 Pandemic. OTO Open 2020; 4:2473974X20933573. [PMID: 32551407 PMCID: PMC7281887 DOI: 10.1177/2473974x20933573] [Citation(s) in RCA: 24] [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] [Received: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
This study evaluates the patient experience during virtual otolaryngology clinic
visits implemented during the coronavirus disease 2019 (COVID-19) pandemic.
Patient satisfaction surveys were queried from January 1, 2020, to May 1, 2020,
for both telehealth and in-person visits. A descriptive analysis of the question
responses was performed. There were 195 virtual and 4013 in-person visits with
surveys completed in this time period. Ratings related to provider-patient
communication were poor for virtual visits. Telehealth has become the new norm
for most health care providers in the United States. This study demonstrates
some of the initial shortcomings of telehealth in an otolaryngology practice and
identifies challenges with interpersonal communication that may need to be
addressed as telehealth becomes increasingly prevalent.
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Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Franklin L Rimell
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Louisville University, Louisville, Kentucky, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Matthew K Lee
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Arthur W Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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25
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Higgins TS, Wu AW, Sharma D, Illing EA, Rubel K, Ting JY. Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study. JMIR Public Health Surveill 2020; 6:e19702. [PMID: 32401211 PMCID: PMC7244220 DOI: 10.2196/19702] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. OBJECTIVE The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. METHODS An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. RESULTS Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. CONCLUSIONS This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, United States.,Rhinology, Sinus & Skull Base, Kentuckiana Ear Nose Throat, Louisville, KY, United States
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, CA, United States
| | - Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Elisa A Illing
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Kolin Rubel
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, United States
| | -
- Snot Force, KY, United States
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26
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Sharma D, Rubel KE, Ye MJ, Shipchandler TZ, Wu AW, Higgins TS, Burgin SJ, Ting JY, Illing EA. Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163:145-150. [PMID: 32423283 PMCID: PMC7240308 DOI: 10.1177/0194599820929274] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures. Study Design Cadaver simulation series. Setting Dedicated surgical laboratory. Subjects and Methods After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition. Results There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm). Conclusion Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.
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Affiliation(s)
- Dhruv Sharma
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kolin E Rubel
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Michael J Ye
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head & Neck Surgery, Cedars Sinai, Los Angeles, California, USA
| | - Thomas S Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, Kentucky, USA.,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, Kentucky, USA
| | - Sarah J Burgin
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Jonathan Y Ting
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Elisa A Illing
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana, USA
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27
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Scangas GA, Wu AW, Ting JY, Metson R, Walgama E, Shrime MG, Higgins TS. Cost Utility Analysis of Dupilumab Versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2020; 131:E26-E33. [PMID: 32243622 DOI: 10.1002/lary.28648] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically-refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost-effectiveness of dupilumab versus ESS for patients with CRSwNP. STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS-24 and SINUS-52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT-22 instrument in both cohorts. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed. RESULTS The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One-way sensitivity analyses showed ESS to be cost-effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855. CONCLUSIONS The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost-effective manner. LEVEL OF EVIDENCE 2C Laryngoscope, 131:E26-E33, 2021.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Center for Global Surgery Evaluation, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, Kentucky, U.S.A
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28
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Wu AW, Walgama ES, Higgins TS, Borrelli M, Vardanyan N, Hopp S, Shamsian A, Hopp ML. Eustachian Tube Quality of Life and Severity of Disease in Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2020; 34:532-536. [PMID: 32188265 DOI: 10.1177/1945892420912366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has long been a suspected risk factor for Eustachian tube dysfunction (ETD). However, there have been few studies quantifying the presence of ETD in CRS patients. We sought to determine the prevalence of ETD symptoms in patients undergoing functional endoscopic sinus surgery (FESS) for CRS using the validated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate the ETDQ-7 scores with scores of CRS symptom severity based on the 22-item Sino-Nasal Outcome Test (SNOT-22). METHODS Patients for FESS were preoperatively administered both the ETDQ-7 and the SNOT-22 validated quality of life instruments. Pearson and Spearman correlation coefficients were calculated. Changes in ETDQ-7 were measured at 3 months and differences were compared via paired t test. RESULTS A total of 82 patients completed the surveys. Thirty-nine (47.6%) patients had ETDQ-7 score ≥14.5, signifying clinically significant ETD symptoms. The mean ETDQ-7 score of the study population was 15.8 ± 8.8, and the mean SNOT-22 score was 37.5 ± 19.7. The Pearson and Spearman correlation coefficients between ETDQ-7 and the total SNOT-22 score were 0.52 (P > .0001) and 0.51 (P < .0001), respectively. There was significant improvement in ETDQ-7 scores postoperatively. CONCLUSION While the association between ETD and CRS has long been known, this is one of the few prospective patient studies evaluating otologic symptoms in a CRS population. We found that a significant percentage of CRS patients suffer from ETD symptoms based on patient-reported subjective outcome measures. This study demonstrates that otologic symptoms increase with CRS severity and improve after FESS.
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Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Evan S Walgama
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, & Throat, Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Michela Borrelli
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Narine Vardanyan
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Stephanie Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Arash Shamsian
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Martin L Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
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29
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Wu AW, Gettelfinger JD, Ting JY, Mort C, Higgins TS. Alternative therapies for sinusitis and rhinitis: a systematic review utilizing a modified Delphi method. Int Forum Allergy Rhinol 2020; 10:496-504. [DOI: 10.1002/alr.22488] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Arthur W. Wu
- Division of Otolaryngology–Head and Neck SurgeryCedars‐Sinai Medical Center Los Angeles CA
| | - John D. Gettelfinger
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of Medicine Indianapolis IN
| | - Jonathan Y. Ting
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of Medicine Indianapolis IN
| | | | - Thomas S. Higgins
- Rhinology, Sinus and Skull BaseKentuckiana Ear, Nose, & Throat Louisville KY
- Department of Otolaryngology–Head & Neck SurgeryUniversity of Louisville Louisville KY
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30
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Sharma D, Sandelski MM, Ting J, Higgins TS. Correlations in Trends of Sinusitis-Related Online Google Search Queries in the United States. Am J Rhinol Allergy 2020; 34:482-486. [PMID: 32064888 DOI: 10.1177/1945892420905761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Online search query trends have been shown to correlate with real-life epidemiologic phenomena. OBJECTIVE The aim of this study was to analyze correlations in trends in Google online search volumes of sinusitis-related terms, including symptomatology and similar disease states. METHODS Terms clinically associated with "sinusitis" were determined by consensus. Terms of symptomatology were derived from the validated 22-item sinonasal outcome test (SNOT-22) as well as terminology encountered with the authors' clinical experience. Terms of disease states that could overlap in symptomatology with sinusitis were then chosen. Google Trends, an online tool for extracting relative frequencies from a public database of search queries, was used to query normalized monthly volumes in the United States from January 2004 to September 2017 of searches related to the topics decided upon by consensus. Bivariate Pearson correlation was used to compare the search queries. RESULTS Online search volumes of "sinusitis" have a distinct seasonal variation, with consistent annual peaks and troughs. In terms of symptomatology, "postnasal drip," "nasal congestion," "cough," "rhinorrhea," and "sore throat" most highly correlated with "sinusitis" search volumes with statistical significance. "sinusitis" search query volume had a higher positive correlation with "common cold" and "acute sinusitis" than "chronic sinusitis" with regard to disease states. CONCLUSIONS Trends in Google online search volumes over time of "sinusitis" symptomatology mimic real-world clinical phenomena and provide insight into the issues affecting the general population.
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Affiliation(s)
- Dhruv Sharma
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Bloomington, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Morgan M Sandelski
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Bloomington, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky.,Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, and Throat, Louisville, Kentucky
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Wu AW, Walgama ES, Genç E, Ting JY, Illing EA, Shipchandler TZ, Higgins TS. Multicenter study on the effect of nonsteroidal anti-inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery. Int Forum Allergy Rhinol 2019; 10:489-495. [PMID: 31834679 DOI: 10.1002/alr.22506] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/16/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The taboo of avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) after functional endoscopic sinus surgery (FESS) has been waning. The impetus to reduce opioid prescriptions in view of the opioid epidemic led the authors to change their practices to include NSAIDs after sinus surgery. This study's aim was to analyze the differences between patients before and after we began recommending NSAIDs after FESS. METHODS A prospective cohort study was performed on patients undergoing FESS or other endoscopic nasal surgeries at 3 institutions, by 5 rhinologists and 1 facial plastic surgeon. Before introducing NSAIDs, all patients were given a prescription for hydrocodone-acetaminophen 5/325 mg and also recommended preferentially to use acetaminophen 325 mg. After the addition of NSAIDs, ibuprofen 200 mg and acetaminophen 325 mg were recommended preferentially, using the narcotic as a rescue medication. Patients kept a pain diary and medication log, and gave a visual analog scale (VAS) score for overall pain. Demographics, surgical variables, and comorbidities were also analyzed. RESULTS One hundred sixty-six total patients were recruited and had data that could be analyzed (65 without NSAIDs, 101 with NSAIDs). Overall, mean pain VAS score was 3.12 ± 1.95 for the non-NSAID group and 2.33 ± 2.30 for the NSAID group (p value = 0.006). The day with the highest mean pain was the first postoperative day. The mean number of total opioid pills taken was 6.94 ± 6.85 without NSAIDs vs 3.77 ± 4.56 with NSAIDs (p = 0.018). Age and gender were found to be the only consistently significant patient variables to affect pain. There were no bleeding complications. CONCLUSION NSAID use was introduced into the practices of 5 practicing rhinologists and 1 facial plastic surgeon. No bleeding complications were seen. Both pain and overall opioid usage were reduced significantly.
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Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery Cedars-Sinai Medical Center, Los Angeles, CA
| | - Evan S Walgama
- Division of Otolaryngology-Head & Neck Surgery Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ege Genç
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Jonathan Y Ting
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Elisa A Illing
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Taha Z Shipchandler
- Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, IN
| | - Thomas S Higgins
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, & Throat, Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, KY
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Higgins TS, Cappello ZJ, Wu AW, Ting JY, Sindwani R. Predictors of eustachian tube dysfunction improvement and normalization after endoscopic sinus surgery. Laryngoscope 2019; 130:E721-E726. [PMID: 31747061 DOI: 10.1002/lary.28416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/23/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Studies have demonstrated improvement in Eustachian tube dysfunction (ETD) symptomatology after functional endoscopic sinus surgery (FESS); however, factors associated with ETD symptom alteration have not been elucidated. This study evaluated factors associated with improvement and normalization of ETD symptoms after FESS. METHODS A case-control study was performed of FESS patients who had clinically significant ETD symptoms based on the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7 ≥ 2.1) without middle ear effusion (MEE) preoperatively. Study patients were identified as those with a normalized ETDQ-7 at 2 months postoperatively. Controls were patients whose ETDQ-7 did not normalize at 2 months. Demographics, surgery characteristics, chronic rhinosinusitis phenotype, Lund-Mackay score, temporomandibular joint dysfunction (TMJD), preoperative ETDQ-7 and SNOT-22 scores, and tympanograms were analyzed. Univariate and multivariate analyses were performed comparing study cases and controls. RESULTS Data were collected on 165 patients, with 46% patients having clinically significant preoperative ETD and 60 patients meeting final study inclusion/exclusion criteria. FESS was associated with both SNOT-22 and ETDQ-7 improvement (P < 0.001). Nasal polyposis was associated with a higher probability of ETDQ-7 normalization (OR 4.429, P = 0.035). Factors associated with failure of ETDQ-7 normalization included TMJD (OR 0.086, P < 0.001, 95% CI 0.019-0.391) and high preoperative ETDQ-7 (OR 0.140, P = 0.006, 95% CI 0.032-0.613). CONCLUSION In patients with clinically significant ETD symptoms without MEE, FESS was associated with ETDQ-7 improvement. Nasal polyposis was associated with an increased probability of normalization of ETD symptoms postoperatively, whereas TMJD had a negative association. LEVEL OF EVIDENCE 3b Laryngoscope, 2019.
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Affiliation(s)
- Thomas S Higgins
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, Kentucky, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky, U.S.A
| | - Zachary J Cappello
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky, U.S.A.,Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Arthur W Wu
- Department of Otolaryngology-Head & Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Raj Sindwani
- Section of Rhinology, Sinus and Skull Base Surgery, Head & Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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Alwani MM, Svenstrup TJ, Bandali EH, Sharma D, Higgins TS, Wu AW, Shipchandler TZ, Illing EA, Ting JY. Validity testing of a three‐dimensionally printed endoscopic sinonasal surgery simulator. Laryngoscope 2019; 130:2748-2753. [DOI: 10.1002/lary.28356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Mohamedkazim M. Alwani
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Thomas J. Svenstrup
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Elhaam H. Bandali
- Department of Epidemiology Indiana University‐Purdue University Indianapolis Indiana U.S.A
| | - Dhruv Sharma
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Thomas S. Higgins
- Department of Otolaryngology‐Head and Neck Surgery University of Louisville Louisville Kentucky U.S.A
| | - Arthur W. Wu
- Division of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center, Los Angeles Los Angeles California U.S.A
| | - Taha Z. Shipchandler
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Elisa A. Illing
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
| | - Jonathan Y. Ting
- Department of Otolaryngology–Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A
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Higgins TS, Öcal B, Adams R, Wu AW. "In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps". Ann Otol Rhinol Laryngol 2019; 129:280-286. [PMID: 31690091 DOI: 10.1177/0003489419887195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2022]
Abstract
OBJECTIVE Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. METHODS A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. RESULTS Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. CONCLUSION In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. LEVELS OF EVIDENCE IV.
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Affiliation(s)
- Thomas S Higgins
- Rhinology, Sinus and Skull Base, Director of Research, Kentuckiana Ear, Nose & Throat, PSC, Clinical Assistant Professor, Otolaryngology, University of Louisville, Louisville, KY, USA
| | - Bülent Öcal
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Division of Otolaryngology, Ankara, Turkey
| | - Ridwan Adams
- Medical Student, Faculty of Clinical Sciences, University of Lagos, Akoka Yaba, Nigeria
| | - Arthur W Wu
- Associate Professor Otolaryngology, Cedars-Sinai, Medical Center, Los Angeles, CA, USA
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Newman AC, Omrani K, Higgins TS, Ting JY, Walgama ES, Wu AW. The prevalence of eustachian tube dysfunction symptoms in temporomandibular joint disorder patients. Laryngoscope 2019; 130:E233-E236. [PMID: 31265138 DOI: 10.1002/lary.28162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS Ear fullness and pressure is a common complaint seen in otolaryngology clinics and frequently is attributed to eustachian tube dysfunction (ETD). In addition to traditional tympanometry and physical examination, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) has recently been used to aid in the diagnosis of ETD and to assess its severity. Temporomandibular joint disorder (TMJD) is a common condition that causes similar symptoms to ETD and has been recognized as a potential confounding condition in patients presenting with ETD symptoms. We sought to determine the cross-sectional prevalence of ETD symptoms in patients with TMJD using the ETDQ-7. STUDY DESIGN Prospective cross-sectional analysis. METHODS An analysis was performed of ETDQ-7 scores in patients diagnosed with TMJD. RESULTS A total of 21 patients with confirmed TMJD completed the ETDQ-7 at routine consult or follow-up for their TMJD. The mean ± standard deviation ETDQ-7 score for the cohort was 24.5 ± 12.5. Two-thirds of patients had an ETDQ-7 score of >14.5, which has been used in the literature to denote clinically significant ETD. No single question was scored significantly higher than the others. CONCLUSIONS Symptoms of ETD are highly prevalent among patients with TMJD determined by patient-reported outcome measures. It is not clear if these symptoms reflect true derangement of eustachian tube function in these patients or whether there is only clinical similarity between ETD and TMJD. However, future research efforts may resolve this dilemma. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E233-E236, 2020.
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Affiliation(s)
- Alan C Newman
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Katayoun Omrani
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus and Skull Base, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose, and Throat, University of Louisville, Louisville, Kentucky.,and Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Evan S Walgama
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Arthur W Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
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Mattos JL, Soler ZM, Rudmik L, Manes PR, Higgins TS, Lee J, Schneider J, Setzen M, Parasher AK, Smith TL, Stokken JK. A framework for quality measurement in the presurgical care of chronic rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2018; 8:1380-1388. [DOI: 10.1002/alr.22154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/23/2018] [Accepted: 05/14/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Jose L. Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; University of Virginia; Charlottesville VA
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary AB Canada
| | - Peter R. Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; Yale School of Medicine; New Haven CT
| | - Thomas S. Higgins
- Department of Otolaryngology-Head and Neck Surgery; University of Louisville; Louisville KY
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California; Los Angeles David Geffen School of Medicine; Los Angeles CA
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis MO
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell University, College of Medicine; New York NY
| | - Arjun K. Parasher
- Department of Otolaryngology-Head and Neck Surgery; University of South Florida; Tampa FL
| | - Timothy L. Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery; Oregon Health and Science University; Portland OR
| | - Janalee K. Stokken
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic, Rochester; MN
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Roxbury CR, Smith DF, Higgins TS, Lee SE, Gallia GL, Ishii M, Lane AP, Reh DD. Complete surgical resection and short-term survival in acute invasive fungal rhinosinusitis. Am J Rhinol Allergy 2018; 31:109-116. [PMID: 28452707 DOI: 10.2500/ajra.2017.31.4420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute invasive fungal rhinosinusitis (AIFR) is a fulminant fungal infection seen in patients who are immunocompromised. Due to its rarity, there is little evidence regarding the appropriate antifungal treatment regimen, especially the degree of surgical intervention. OBJECTIVE To assess factors that impact short-term survival in AIFR as defined by survival to hospital discharge and to develop a staging system to predict survival and complete surgical resection. METHODS Fifty-four patients with histopathologically diagnosed AIFR who met inclusion criteria were identified between 1984 and 2014. Patient characteristics, disease extent, treatment modality, and short-term survival data were collected. Univariate analysis was performed to assess for factors associated with survival and increased likelihood of surgical resection. RESULTS Of 52 patients with adequate documentation, 36 (69.2%) survived their hospital stay. Complete surgical resection was the only factor associated with improved survival (survival, 95.5%; p < 0.01). A surgical staging system was proposed to guide probability of complete resection and overall prognosis, with stage I disease limited to the nasal cavity, stage II involving the paranasal sinuses, stage III involving the orbit, and stage IV with skull base or intracranial extension. The χ2 analyses showed a decreased likelihood of complete surgical resection with stage III or IV disease compared with stage I (resection, 90.9%) (stage III resection, 37.5% [p = 0.01]; stage IV resection, 16.7% [p = 0.002]). There was a decreased likelihood of survival associated with increasing disease stage compared with stage I (survival, 100%) (stage II survival, 60% [p = 0.009]; stage III survival, 62.5% [p = 0.02]; stage IV survival, 54.6%, [p = 0.006]). CONCLUSION Although further studies are needed to define specific treatment protocols, analysis of these data indicated that endoscopic sinus surgery with the goal of complete surgical resection may provide the best survival outcomes in select patients when complete surgical resection can be performed. Our staging system represents the first attempt to predict surgical success and prognosis in patients with AIFR.
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Affiliation(s)
- Christopher R Roxbury
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Saltagi MZ, Rabbani CC, Ting JY, Higgins TS. Management of long-lasting phantosmia: a systematic review. Int Forum Allergy Rhinol 2018; 8:790-796. [PMID: 29485754 DOI: 10.1002/alr.22108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 11/01/2017] [Revised: 01/23/2018] [Accepted: 02/06/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Interest in the pathophysiology and management of phantom smells has increased rapidly over the last decade. A PubMed search for the term "phantosmia" demonstrated a near-doubling of articles published on phantosmia within the past 7 years. We aimed to systematically review the literature on the management of phantosmia. METHODS The PubMed, EMBASE, and Cochrane databases were searched for articles published since January 1990, using terms combined with pertinent Boolean search operators. We included articles evaluating management of phantosmia written in the English language, with original data and a minimum of 6 months of follow-up, on at least 2 patients and with well-defined and measurable outcomes. RESULTS A total of 2151 unique titles were returned upon the initial search. Of these, 146 abstracts were examined, yielding 7 articles meeting the inclusion criteria. All articles were predominantly level 4 evidence. One prospective level 3 study was included. The studies included a total of 96 patients, with follow-up ranging from 6 months to 11 years. Endpoints were primarily based on subjective patient responses. Management options included observation and medical and surgical therapy. Olfactory mucosa excision was the only surgical intervention studied, with short-term symptomatic improvement in 10 of 11 patients. Forty-one patients were treated medically, which included antipsychotic, antimigraine, and antiseizure medications, transcranial stimulation, and topical cocaine application. CONCLUSION Despite increasing interest in the treatment of phantosmia and reports of successful therapies, there remains a paucity of data and lack of consensus regarding optimal management of this difficult condition.
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Affiliation(s)
| | - Cyrus C Rabbani
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN
| | - Jonathan Y Ting
- Indiana University School of Medicine, Indianapolis, IN.,Department of Otolaryngology-Head and Neck Surgery, Indiana University Health, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY.,Kentuckiana Ear, Nose & Throat, Louisville, KY
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Rudmik L, Mattos JL, Stokken JK, Soler ZM, Manes RP, Higgins TS, Setzen M, Lee J, Schneider J. Rhinology-specific priority setting for quality improvement: a modified Delphi study from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2017; 7:937-944. [PMID: 28799731 DOI: 10.1002/alr.21998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/07/2017] [Accepted: 07/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Improving the quality of healthcare is a complex and resource intensive process. To optimize the allocation of scarce resources, quality improvement (QI) should focus on high-value diseases that will produce the largest improvement in health system performance. Given the breadth and multidisciplinary nature of sinonasal disease management, the purpose of this study was to transparently develop a prioritized list of sinonasal diseases for QI from the perspective of the specialty of rhinology and the American Rhinologic Society (ARS). METHODS The RAND modified Delphi methodology was used to rank the priority of nine sinonasal disease categories from 1 (lowest priority) to 9 (highest priority). Two rounds of ranking along with a teleconference meeting was performed by a panel of 9 experts from the ARS Quality Improvement Committee. RESULTS The final QI-prioritized list of sinonasal diseases are as follows: chronic rhinosinusitis (CRS) (mean score = 8.9), recurrent acute rhinosinusitis (RARS) (mean score = 7.9), sinonasal neoplasms (mean score = 7.0), anatomic nasal obstruction (mean score = 5.9), refractory epistaxis (mean score = 5.2), complicated acute rhinosinusitis (mean score = 5.2), chronic nonallergic rhinitis (mean score = 4.4), orbital disease (mean score = 4.3), uncomplicated acute rhinosinusitis (mean score = 4.1), and allergy/allergic rhinitis (mean score = 3.7). CONCLUSION The three most important disease categories for QI from the perspective of the specialty of rhinology were CRS, RARS, and sinonasal neoplasms. Future studies need to define and validate quality metrics for each of these important disease categories in order to facilitate appropriate measurement and improvement initiatives.
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Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jose L Mattos
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia School of Medicine, Charlotteville, VA
| | - Janalee K Stokken
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - Zachary M Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - R Peter Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, KY
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO
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40
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Rudmik L, Mattos J, Schneider J, Manes PR, Stokken JK, Lee J, Higgins TS, Schlosser RJ, Reh DD, Setzen M, Soler ZM. Quality measurement for rhinosinusitis: a review from the Quality Improvement Committee of the American Rhinologic Society. Int Forum Allergy Rhinol 2017; 7:853-860. [DOI: 10.1002/alr.21983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Calgary; Calgary AB Canada
| | - Jose Mattos
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - John Schneider
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis MO
| | - Peter R. Manes
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; Yale School of Medicine; New Haven CT
| | - Janalee K. Stokken
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester MN
| | - Jivianne Lee
- Department of Otolaryngology-Head and Neck Surgery University of California; Los Angeles David Geffen School of Medicine; Los Angeles CA
| | - Thomas S. Higgins
- Department of Otolaryngology-Head and Neck Surgery; University of Louisville; Louisville KY
| | - Rodney J. Schlosser
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
| | - Douglas D. Reh
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore MD
| | - Michael Setzen
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell University; College of Medicine; New York NY
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston SC
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Abstract
Surgery for chronic rhinosinusitis is an effective complement to a well-designed medical regimen. Functional endoscopic sinus surgery is among the most common surgeries performed for sinonasal disease refractory to maximal medical therapy. Nasal surgery techniques, such as septoplasty and inferior turbinate surgery, may assist in both relieving the symptom of nasal obstruction and providing access for sinus surgery. Although rare, open sinus techniques are occasionally required.
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Higgins TS, Lane AP. What is the best imaging modality to investigate olfactory dysfunction in the setting of normal endoscopy? Laryngoscope 2013; 124:4-5. [PMID: 24115075 DOI: 10.1002/lary.23892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/02/2012] [Accepted: 10/24/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas S Higgins
- Kentuckiana Ear, Nose, and Throat, PSC, University of Louisville, Louisville, Kentucky; Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky
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Rawlings BA, Higgins TS, Han JK. Bacterial pathogens in the nasopharynx, nasal cavity, and osteomeatal complex during wellness and viral infection. Am J Rhinol Allergy 2013; 27:39-42. [PMID: 23406599 DOI: 10.2500/ajra.2013.27.3835] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Viral sinusitis can precede acute bacterial sinusitis, but the influence of viral infection on bacterial colonization is unclear. The objective of this study was to evaluate the presence of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the osteomeatal complex (OMC), nasal cavity, and nasopharynx in adults during wellness and viral upper respiratory illness (URI). METHODS Subjects were recruited for the study during wellness and at the time of acute viral rhinosinusitis. Swab cultures were obtained from the OMC, nasal cavity, and the nasopharynx. Swab eluates were inoculated on selective agars to detect S. pneumoniae, H. influenzae, and M. catarrhalis. RESULTS The study included 237 subjects, 100 adults with URI and 137 well adults. Positive culture results were found for any site in 70% (n = 70) of ill subjects and 64% (n = 88) of well subjects (p = 0.393). Of the 91 OMC cultures, positive cultures were over five times more likely to be found in ill subjects than in well subjects (31% versus 8%; p = 0.010). The nasal cavity cultures were positively statistically significant more often in ill subjects versus well subjects (39% versus 25%; p = 0.022). The overall nasopharyngeal cultures did not show a statistically significant difference (65% versus 60%; odds ratio, 1.2; p = 0.461). S. pneumoniae was positively cultured in at least one site in 15% of ill subjects and 31% of well subjects (p = 0.006). H. influenzae was positively cultured in at least one site in 45% of ill subjects and 31% of well subjects (p = 0.027). M. catarrhalis was positively cultured in at least one site in 42% of ill subjects and 27% of well subjects (p = 0.018). CONCLUSION This study defines the carriage rates of the three most common bacterial pathogens for acute sinusitis in the nasopharynx, nasal cavity, and OMC during illness and in the healthy state.
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Affiliation(s)
- Brad A Rawlings
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
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Liang J, Higgins TS, Ishman SL, Boss EF, Benke JR, Lin SY. Surgical management of chronic rhinosinusitis in cystic fibrosis: a systematic review. Int Forum Allergy Rhinol 2013; 3:814-22. [PMID: 23839953 DOI: 10.1002/alr.21190] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 03/11/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The objective of this work was to systematically review literature on the effectiveness of surgical management for chronic rhinosinusitis (CRS) in cystic fibrosis (CF) patients. METHODS We performed a literature search encompassing the last 25 years in PubMed, Embase, and Cochrane CENTRAL. Inclusion criteria included English language papers containing original data, more than 6 subjects, and measurable clinical outcomes. Data was systematically collected on study design, patient demographics, clinical characteristics and outcomes, and level-of-evidence. Two investigators independently reviewed all manuscripts. A quality assessment of the included studies was performed. RESULTS The initial search yielded 416 abstracts, of which 24 articles met inclusion criteria, detailing 680 adult and pediatric CF patients who underwent surgical therapy. Surgical treatment included primarily endoscopic sinus surgery (ESS) (22/24). Outcome measures included sinonasal symptoms (14/24), endoscopic findings (8/24), pulmonary function testing (8/24), recurrence or revision surgery (5/24), hospitalization (4/24), need for antibiotic therapy (2/24), radiographic findings (2/24), and pulmonary exacerbations (1/24). The level-of-evidence was predominantly Level 4 (21/24); there were no Level 1 evidence studies. Most studies found improvement in symptom measures and endoscopic findings but no improvement in lower airway function after surgical therapy. Postoperative measures of the other outcomes were inconclusive or inconsistent. CONCLUSION For adult and pediatric CF sinusitis, ESS yielded clinical improvement as measured primarily by sinonasal symptoms and endoscopic findings. It is unclear if surgical intervention modifies lower airway disease. Future prospective studies with predetermined, objective, and validated outcome measures are needed to determine the effectiveness of surgical intervention for CF-related CRS. Overall evidence Grade B/C.
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Affiliation(s)
- Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD
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Affiliation(s)
- Swapna K. Chandran
- Department of Otolaryngology Head and Neck Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Gallia GL, Reh DD, Lane AP, Higgins TS, Koch W, Ishii M. Endoscopic resection of esthesioneuroblastoma. J Clin Neurosci 2012; 19:1478-82. [PMID: 22995757 DOI: 10.1016/j.jocn.2012.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 03/05/2012] [Accepted: 03/10/2012] [Indexed: 11/19/2022]
Abstract
Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.
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Affiliation(s)
- Gary L Gallia
- Department of Neurosurgery, Phipps Building, Room 101, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Reh DD, Higgins TS, Smith TL. Impact of tobacco smoke on chronic rhinosinusitis: a review of the literature. Int Forum Allergy Rhinol 2012; 2:362-9. [PMID: 22696460 DOI: 10.1002/alr.21054] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/05/2012] [Accepted: 04/17/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Environmental factors such as inhaled pollutants like cigarette smoke may play a significant role in diseases of the upper airway including chronic rhinosinusitis (CRS). The objectives of this review are to summarize prior studies that describe the correlation between active smoking and secondhand smoke (SHS) on CRS. We also review the pathophysiologic effects of cigarette smoke on sinonasal mucosa and discuss its impact on surgical outcomes of endoscopic sinus surgery (ESS). METHODS A literature search was conducted of the PubMed database using the terms "sinusitis" or "rhinosinusitis" and "smoking." Additional search terms of "nasal epithelial" and "smoke" were used to find articles that discussed pathophysiologic effects of tobacco smoke, whereas "secondhand smoke" was added to identify articles analyzing the correlation of SHS and CRS. Finally "endoscopic sinus surgery" and "outcomes" were linked to "smoking" to find articles that analyzed the impact of smoking on surgical results. RESULTS We identified 204 articles in the initial search. An additional 72 articles were reviewed for their relevance to the pathophysiologic effects of tobacco smoke while 31 articles were analyzed to determine the correlation of SHS and CRS. Twenty-nine articles were reviewed to analyze the impact of smoking on surgical results. CONCLUSION There is clear evidence in the literature that cigarette smoke, either through active smoking or passive exposure to SHS, contributes to CRS. Recent prospective studies suggest that active smoking is not a contraindication to ESS, whereas the impact of smoking volume and long-term smoking after ESS has not been sufficiently evaluated.
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Affiliation(s)
- Douglas D Reh
- Johns Hopkins Sinus Center, Johns Hopkins Medicine, Baltimore, MD, USA
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Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1:255-61. [PMID: 22287429 DOI: 10.1002/alr.20051] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/23/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled-data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies. METHODS A search was conducted of MEDLINE (1966-2008), EMBASE (1980-2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases and supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, sinonasal malignancy characteristics, survival outcomes, and recurrence. Kaplan-Meier survival and locoregional control rates were calculated and compared using the log-rank test. RESULTS Of the 2314 citations reviewed, the search yielded 15 case series with individual data on 226 patients. The most common malignancies were esthesioneuroblastoma (47%), adenocarcinoma (24%), and undifferentiated carcinoma (22%). The overall 5-year survival rate for the sample was 56.5% (standard error [SE] ± 3.8). Because of the paucity of data with endoscopic resection of high-stage malignancies, the outcome results were highly variable and no useful comparison could be made. Among low-stage malignancies (T1-2 or Kadish A-B), the endoscopic and open approaches demonstrated no statistically significant difference in outcome results. The 5-year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs 76.8% (SE ± 8.3) for open approaches (p = 0.351); disease-specific survival was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251). CONCLUSION Transnasal endoscopic resection appears to be a reasonable alternative to craniofacial resection in the management of low-stage sinonasal malignancies.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Endoscopic Sinus, and Skull Base Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: A meta-analysis. Laryngoscope 2011; 121:1009-17. [DOI: 10.1002/lary.21578] [Citation(s) in RCA: 183] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Higgins TS, Hwang PH, Kingdom TT, Orlandi RR, Stammberger H, Han JK. Systematic review of topical vasoconstrictors in endoscopic sinus surgery. Laryngoscope 2011; 121:422-32. [PMID: 21271600 DOI: 10.1002/lary.21286] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 06/18/2010] [Accepted: 06/22/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study is to systematically review the literature and examine the safety for the use of topical vasoconstrictors in endoscopic sinus surgery. STUDY DESIGN Systematic review clinical trials. METHOD A systematic literature search was performed in MEDLINE, EMBASE, The Cochrane Library, and National Guideline Clearinghouse, and references in the selected articles. RESULTS The search criteria captured 42 manuscripts with relevant titles. A systematic review on the topical use of phenylephrine was found; however, no other systematic review, meta-analyses, or clinical guidelines were identified. Six randomized clinical trials or comparative studies, as well as multiple case reports and review articles were also identified. The literature supports the safety of oxymetazoline and epinephrine when used judiciously in carefully selected patients undergoing endoscopic sinonasal surgery; however, topical phenylephrine is not recommended because of its risk profile. CONCLUSION In sinus or nasal surgery, topical vasoconstrictors should be used in a manner that minimizes the risk of cardiovascular morbidity.
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Affiliation(s)
- Thomas S Higgins
- Department of Otolaryngology and Head and Neck Surgery, Eastern Virginia Medical School, Norfok, Virginia 23507, USA
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