1
|
Khan NS, Yoshiyasu Y, Wang BS, Khoudari A, Clerico DM, King JM, Steele TO, Dhanda AK, Takashima M, Ahmed OG. Severe epistaxis after posterior nasal nerve ablation requiring surgical intervention: A multi-center case series. Int Forum Allergy Rhinol 2024. [PMID: 38372028 DOI: 10.1002/alr.23339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
KEY POINTS Severe epistaxis occurs in 2% of PNN ablation cases, independent of method or device type. Major epistaxis requiring intervention after PNN ablation can occur on average 20 days post-procedure.
Collapse
Affiliation(s)
- Najm S Khan
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Yuki Yoshiyasu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Brian S Wang
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | | | - Jackson M King
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Aatin K Dhanda
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Masayoshi Takashima
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Omar G Ahmed
- Department of Otolaryngology-Head and Neck Surgery, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
2
|
Dennis SK, Steele TO, Gill AS, Hwang JC, Sarhadi KS, Cheema KS, Aulakh SS, Wilson MD, Strong EB. Treatment Outcomes With Conservative Management of Frontal Sinus Outflow Tract Fractures. Otolaryngol Head Neck Surg 2023; 169:1455-1461. [PMID: 37573490 PMCID: PMC10840897 DOI: 10.1002/ohn.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Historically, early surgical management of frontal sinus outflow tract (FSOT) fractures has been standard practice. There has been a paradigm shift toward nonsurgical or delayed management. Unfortunately, clinical indications and treatment outcomes for this approach are poorly understood. This study evaluates radiologic indicators, as well as sinus reaeration and complication rates for FSOT injuries treated nonsurgically. STUDY DESIGN A retrospective cohort study of FSOT injuries between 2005 and 2019. SETTING Academic, tertiary care medical center. METHODS Radiographic fracture patterns of the frontal ostia (FO) and frontal recess (FR) were recorded as either patent, disrupted, or obstructed. Sinus reaeration, surgical rescue, and complication rates were documented. Patients with follow-up imaging >42 days were included. Patients undergoing immediate surgical intervention were excluded. RESULTS One hundred patients were identified and 44 met the criteria (88 sinuses). Among nonobstructed FSOT injuries (ie, patent or disrupted), reaeration occurred in 91% of the FO and 98% of FR injuries. Two sinuses required surgical rescue including 1 Draf IIB (1%), and 1 obliteration (1%). Two sinuses had complications including 1 mucocele (1%) and 1 cerebrospinal fluid leak (1%). FO and FR fracture patterns had no identifiable correlation with long-term reaeration rates or the need for surgical intervention. CONCLUSION Among nonobstructive injuries to the FSOT, average reaeration rates in observed patients were high (91%-98%). Rescue surgery (2%) and complication rates (2%) were low, suggesting that nonsurgical management of nonobstructed FSOT is a viable strategy. No radiographic features were clearly identified to be predictive of sinus reaeration.
Collapse
Affiliation(s)
- Steven Kennedy Dennis
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Joshua C Hwang
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Kamron S Sarhadi
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Karmtej S Cheema
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Sukhkaran S Aulakh
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Machelle D Wilson
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
| |
Collapse
|
3
|
Virani FR, Wilson MD, Beliveau AM, Gill AS, Strong EB, Steele TO. The Impact of Surgical Posterior Nasal Nerve Cryoablation on Symptoms and Disease-Specific Quality of Life in Patients With Chronic Rhinitis. Ear Nose Throat J 2023; 102:654-660. [PMID: 34128402 PMCID: PMC8958794 DOI: 10.1177/01455613211018576] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Preliminary data have demonstrated long-term efficacy of posterior nasal nerve (PNN) cryoablation in reducing rhinitis symptoms for patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR). We sought to evaluate the impact of procedural cryoablation of the PNN on quality of life (QOL) in patients with AR and NAR. METHODS Adult patients undergoing PNN cryoablation for AR or NAR after appropriate medical therapy were included for analysis. Demographics, medical therapies, baseline rhinitis symptom (total nasal symptom score [TNSS]), and disease-specific QOL (mini-rhinoconjunctivitis quality of life questionnaire [mini-RQLQ]) were recorded. The Wilcoxon signed-rank test was used to test for significant changes in baseline test scores posttreatment. Absolute and relative improvement in outcomes was determined for each participant. Secondary outcomes were assessed with univariate and multivariate analyses. RESULTS Fourteen patients were enrolled with a mean follow-up of 16.5 weeks. The TNSS and mini-RQLQ scores significantly improved after PNN cryoablation (median δs [interquartile range]: -4 [3] and -1.61 [1.08], respectively; both P = .0002). The minimal clinically important difference for the TNSS and mini-RQLQ was obtained in 92.9% of patients in each category. Relative mean percentage (%) improvement after PNN cryoablation in the TNSS and mini-RQLQ was 40.7% and 40.5% (standard deviation = 24.9 and 29.5, respectively), respectively, for all patients. Patients with NAR (n = 10) reported mean improvement of 41.3% (29.1) as measured by the TNSS and 49.6% (25.9) by mini-RQLQ. Patients with AR reported mean percentage improvement in TNSS and mini-RQLQ scores of 39.5% (12.1) and 24.6% (28.5), respectively. Patients who had been prescribed a nasal anticholinergic for management prior to PNN cryoablation had statistically significantly increased improvement in mini-RQLQ scores from pre- to post-procedure (P = .0387). CONCLUSION Surgical cryoablation of the PNN significantly improves both symptoms and disease-specific QOL in majority of patients with AR and NAR.
Collapse
Affiliation(s)
- Farrukh R Virani
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, CA, USA
| | - Angela M Beliveau
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Amarbir S Gill
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - E Bradley Strong
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
| | - Toby O Steele
- UC Davis Health, Department of Otolaryngology-Head and Neck Surgery, Sacramento, CA, USA
- VA Northern California Healthcare System, Sacramento, CA, USA
| |
Collapse
|
4
|
Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
Collapse
Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Young K, Bulosan H, Kejriwal S, Liang J, Wu AW, Tang DM, Birkeland AC, Steele TO. Efficacy of Cryoablation on Chronic Rhinitis Management: A Systematic Review and Meta-Analysis. Am J Rhinol Allergy 2023:19458924231152331. [PMID: 36691694 DOI: 10.1177/19458924231152331] [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: 01/25/2023]
Abstract
BACKGROUND ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. OBJECTIVE The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). METHODS A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be -3.48 points (95% CI: -3.73 to -3.23, I2 = 0.13). and -3.50 (95% CI: -3.71 to -3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be -1.53 (95% CI: -1.74 to -1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). CONCLUSIONS The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
Collapse
Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Sameer Kejriwal
- Department of Surgery, University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, 21772University of California Davis Medical Center, Sacramento, California, USA
| |
Collapse
|
6
|
Young K, Nielsen T, Bulosan H, Thorne TJ, Ogasawara CT, Birkeland AC, Tang DM, Wu AW, Steele TO. Metastatic skull base chordoma: A systematic review. Laryngoscope Investig Otolaryngol 2022; 7:1280-1291. [PMID: 36258855 PMCID: PMC9575061 DOI: 10.1002/lio2.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Objective/Hypothesis To investigate the clinical features, management strategies and outcomes for patients with metastatic primary skull base chordomas. Study Design Systematic review. Methods A systematic search through Pubmed/Medline, Web of Science, and EBSCOhost (CINAHL) was conducted without restriction on dates. After study screening and full‐text assessment, two authors independently extracted all data using a pre‐established abstraction form. Results Forty cases were included from 38 studies. The average age (standard deviation [SD]) of the sample at presentation was 28.5 (23.3) and was equally distributed across genders. The average time (SD) between initial diagnosis to local recurrence was 40.1 (60.3) months. The average time (SD) from primary tumor detection to the diagnosis of metastatic disease was 55.2 (49.0) months. The most common subsite for metastatic spread were the lungs (32.5%). Of the 33 patients with data on outcomes, 48.5% were found to have expired by the time of publication. The median overall survival was estimated to be 84 months (95% confidence interval [CI] 62.3–105.7). Conclusions The most common subsites for metastatic spread of skull base chordoma were the lungs and bone. Overall survival for patients in the current cohort was a median of 84 months, with no significant differences noted when stratifying by the extent of surgery or the site of metastases. Level of Evidence 3a
Collapse
Affiliation(s)
- Kurtis Young
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Torbjoern Nielsen
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Hannah Bulosan
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Tyler J. Thorne
- University of Hawai'i at Mānoa John A. Burns School of Medicine Honolulu Hawaii USA
| | - Christian T. Ogasawara
- Department of Neurosurgery University of Texas Medical Branch at Galveston Galveston Texas USA
| | - Andrew C. Birkeland
- Department of Otolaryngology‐Head and Neck Surgery University of California Davis Medical Center Sacramento California USA
| | - Dennis M. Tang
- Department of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California USA
| | - Arthur W. Wu
- Department of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California USA
| | - Toby O. Steele
- Department of Otolaryngology‐Head and Neck Surgery University of California Davis Medical Center Sacramento California USA
| |
Collapse
|
7
|
Abstract
BACKGROUND Six percent of practicing otolaryngologists identified by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) are rhinologists. This is the first study to investigate both the distribution of rhinologists in the United States and the sociodemographic characteristics that may predict their practice locations. OBJECTIVE We aim to describe the geospatial distribution of the rhinology workforce and analyze sociodemographic characteristics associated with practice distribution. METHODS We conducted a cross-sectional study of 662 rhinologists queried from the 2020 American Rhinologic Society (ARS) database. Rhinologist practice addresses were compared with ZIP code tabulation area (ZCTA) sociodemographic data from the 2010 US Census Bureau and from the 2014 to 2018 American Community Surveys. Geospatial mapping and multivariate statistics were employed to visualize rhinologist practice locations and analyze which community characteristics were associated with greater densities of rhinologists in ZCTAs. RESULTS The largest and smallest densities of rhinologists were in coastal areas and in the Central and Midwestern US, respectively. Population characteristics that significantly predicted a higher number of practicing rhinologists included: greater percentage of non-citizens and greater educational attainment (p < 0.001). Population characteristics that significantly predicted a lower number of practicing rhinologists included: greater percentage of self-identified white/Caucasians, median household income, and greater percentage of population aged 65 or older (p < 0.001). CONCLUSION Disparities in healthcare access in the US is evident and applies to rhinologic subspecialty care. Through visual geospatial analysis, we demonstrate the distribution of rhinologists and the population characteristics that may be predictive of whether patients have access to rhinological care.
Collapse
Affiliation(s)
- Samir Hassanin
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Rijul S Kshirsagar
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Jonathan Liang
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| |
Collapse
|
8
|
Gill AS, Biggs PC, Hagwood G, Beliveau AM, Shahlaie K, Strong EB, Steele TO. Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery. Skull Base Surg 2022; 83:e401-e409. [DOI: 10.1055/s-0041-1729979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction The internet presents a rich milieu of multimedia options relating to pituitary and endoscopic skull base surgery (ESBS). Misinformation can create discordance between patient and provider expectations. The purpose of this study is to analyze the understandability and actionability of available ESBS and pituitary surgery audiovisual information on YouTube and Google.
Methods The top 50 videos generated by searching “pituitary surgery/transsphenoidal surgery” and “endoscopic skull base surgery” in both YouTube and Google were sorted by relevance. Two independent reviewers evaluated each for understandability and actionability based on the Patient Education Materials Assessment Tool for audiovisual material (PEMAT-A/V). Source, authorship, audience, and education/advertisement variables were collected. Chi-square test followed by univariate and multivariate regression analyses assessed the association between these variables and quality.
Results A total of 85 videos (52 YouTube and 33 Google) met inclusion criteria for analysis. There was no significant difference in the presence of the aforementioned variables between YouTube and Google (p < 0.05). Also, 72% of videos targeted patients and 28% targeted surgeons. Academic institutions uploaded 58% of videos. Surgeon-targeted videos were more educational (p = 0.01) and patient-targeted videos involved more advertisement (p = 0.01). Understandability and actionability scores were below the 70% threshold for both YouTube (65 ± 15, 38 ± 33, p = 0.65) and Google (66 ± 12, 38 ± 26, p = 0.94). Patient-targeted videos (p = 0.002) were more understandable, while surgeon- (p < 0.001) and education-focused videos (p < 0.001) were more actionable.
Conclusion Understandability and actionability of YouTube and Google audiovisual patient information on ESBS and pituitary surgery is poor. Consideration should be given to the formation of a standardized patient information resource.
Collapse
Affiliation(s)
- Amarbir S. Gill
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Philip C. Biggs
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Garrett Hagwood
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Angela M. Beliveau
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, California, United States
| | - E. B. Strong
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| | - Toby O. Steele
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California, United States
| |
Collapse
|
9
|
Gill AS, Hwang J, Beliveau AM, Alt JA, Strong EB, Wilson MD, Steele TO. The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis. Ann Otol Rhinol Laryngol 2022; 131:191-197. [PMID: 33978506 PMCID: PMC8935953 DOI: 10.1177/00034894211015736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). METHODS Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman's correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. RESULTS Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) (P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts (P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety (P = .728), depression (P = .624), or FCI (P = .282), but was significantly associated with hearing impairment (P < .001). CONCLUSION Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.
Collapse
Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Joshua Hwang
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Angela M Beliveau
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Edward Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Machelle D Wilson
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, CA, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
- VA Northern California Healthcare System, Sacramento, CA, USA
| |
Collapse
|
10
|
Bacorn C, Morisada MV, Dedhia RD, Steele TO, Strong EB, Lin LK. Traumatic Optic Neuropathy Management: A Survey Assessment of Current Practice Patterns. J Emerg Trauma Shock 2021; 14:136-142. [PMID: 34759631 PMCID: PMC8527061 DOI: 10.4103/jets.jets_66_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/27/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: The treatment of traumatic optic neuropathy (TON) is highly controversial with a lack of substantiated evidence to support the use of corticosteroids or surgical decompression of the optic nerve. The aim of the study was to determine if there was a general consensus in the management of TON despite controversy in the literature. Methods: An anonymous survey of members of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the North American Neuro-Ophthalmology Society regarding their practice patterns in the management of patients with TON was performed. Results: The majority of 165 respondents indicated that they treated TON with corticosteroids (60%) while a significant minority (23%) performed surgical interventions (P < 0.0001). Subgroup analysis comparing rates of treatment with steroids among oculoplastic surgeons and neuro-ophthalmologists (67% vs. 47%) was not significant (Fisher's Exact test [FET], P =0.11) while results did suggest that a higher proportion of oculoplastic surgeons (33%) than neuro-ophthalmologists (11%) recommended surgical intervention (FET, P =0.004). In cases where visual acuity exhibited a downward trend treatment with steroids was the most commonly employed management. In general, neuro-ophthalmologists trended toward observation over treatment in TON patients with stable visual acuity while oculoplastic surgeons favored treatment with corticosteroids. Conclusions: In spite of the lack of class I evidence supporting intervention of TON, the majority of respondents were inclined to offer corticosteroid treatment to patients whose visual acuity showed progressive decline following injury.
Collapse
Affiliation(s)
- Colin Bacorn
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California
| | - Megan V Morisada
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Raj D Dedhia
- Department of Otolaryngology - Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Edward Bradley Strong
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, Sacramento, California, TN, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California
| |
Collapse
|
11
|
Reddy RK, Gill AS, Hwang J, Wilson MD, Shahlaie K, Harsh GR, Strong EB, Steele TO. Surgeon education through a surgical cost feedback system reduces supply cost in endoscopic skull base surgery. J Neurosurg 2021; 136:422-430. [PMID: 34388725 DOI: 10.3171/2021.2.jns203208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A large proportion of healthcare expense is operating room (OR) costs. As a means of cost mitigation, several institutions have implemented surgeon education programs to bring awareness about supply costs. This study evaluates the impact of a surgical cost feedback system (surgical receipt) on the supply costs of endoscopic skull base surgery (ESBS) procedures. METHODS The supply costs of each ESBS surgical case were prospectively collected and analyzed before and after the implementation of a nonincentivized, automated, and itemized weekly surgical receipt system between January 2017 and December 2019. Supply cost data collected 15 months prior to intervention were compared with cost data 21 months after implementation of the surgical receipt system. Demographics, surgical details, and OR time were collected retrospectively. RESULTS Of 105 ESBS procedures analyzed, 36 preceded and 69 followed implementation of cost feedback. There were no significant differences in patient age (p = 0.064), sex (p = 0.489), surgical indication (p = 0.389), or OR anesthesia time (p = 0.51) for patients treated before and after implementation. The mean surgical supply cost decreased from $3824.41 to $3010.35 (p = 0.002) after implementation of receipt feedback. Usage of dural sealants (p = 0.043), microfibrillar collagen hemostat (p = 0.007), and oxidized regenerated cellulose hemostat (p < 0.0001) and reconstructive technique (p = 0.031) significantly affected cost. Mediation analysis confirmed that the overall cost reduction was predominantly driven by reduced use of dural sealant; this cost saving exceeded the incremental cost of greater use of packing materials such as microfibrillar collagen hemostat. CONCLUSIONS Education of surgeons regarding surgical supply costs by a surgical receipt feedback system can reduce the supply cost per case of ESBS operations.
Collapse
Affiliation(s)
- Renuka K Reddy
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Amarbir S Gill
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Joshua Hwang
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Machelle D Wilson
- 3Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento; and
| | - Kiarash Shahlaie
- 2University of California Davis Department of Neurological Surgery, Sacramento
| | - Griffith R Harsh
- 2University of California Davis Department of Neurological Surgery, Sacramento
| | - E Bradley Strong
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento
| | - Toby O Steele
- 1University of California Davis Department of Otolaryngology-Head and Neck Surgery, Sacramento.,4VA Northern California Healthcare System, Sacramento, California
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW In the setting of the COVID-19 global pandemic, the demand for and use of telemedicine has surged in facial plastic and reconstructive surgery. This review aims to objectively review and summarize the existing evidence for the use of telemedicine within facial plastic surgery. RECENT FINDINGS Telemedicine has been successfully implemented among subsets of facial plastic surgery patients, with high patient and provider satisfaction. Although the technology to facilitate telemedicine exists and preliminary studies demonstrate promise, multiple technological, financial, and medical barriers may persist in the postpandemic era. SUMMARY Telemedicine will likely continue to grow and expand within facial plastic surgery moving forward, and we should continue to critically evaluate patient selection, access to care, and strategies for effective implementation to enhance current clinical practices.
Collapse
Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Travis T Tollefson
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, California
| | - David A Shaye
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, California
- Northern California Healthcare System, Sacramento, California, USA
| |
Collapse
|
13
|
Gill AS, Ashby S, Oakley GM, Steele TO, Menjivar D, Orlandi RR, Alt JA. Comorbidities Known to Affect Physical Function Negatively Impact Baseline Health-Related Quality-of-Life in Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2021; 36:25-32. [PMID: 33906469 DOI: 10.1177/19458924211013610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/29/2023]
Abstract
BACKGROUND Medical comorbidities are commonly encountered in chronic rhinosinusitis (CRS) and may impact both physical function and patient reported health-related quality-of-life (HRQOL). The functional comorbidity index (FCI) is designed to elucidate the role of comorbidities on functional prognosis. The objective of this study was to understand the impact of comorbidities known to impact physical function on baseline HRQOL using the FCI.Methodology: Patients meeting diagnostic criteria for CRS were prospectively enrolled in a cross-sectional study. Responses from the Sinonasal Outcomes Test-22 (SNOT-22), a measure of patient HRQOL, as well as the Lund-Kennedy and Lund-Mackay scores were recorded at enrollment. FCI was calculated retrospectively using the electronic medical record. Information was collected and compared for patients without (CRSsNP) and with nasal polyps (CRSwNP) using chi-square and t-tests. Spearman's correlations, followed by multivariate regression analysis, were used to assess the association between FCI and SNOT-22 scores. RESULTS One hundred and three patients met inclusion criteria for analysis. There were no significant differences in age, gender, and SNOT-22 scores between patients with CRSsNP and those with CRSwNP. FCI was significantly and independently associated with worse SNOT-22 scores (P = .012). FCI did not correlate with endoscopy and computed tomography scores. The mean FCI for patients with CRSsNP and CRSwNP was 2.02 and 2.24, respectively, and did not differ significantly between the two cohorts (P = .565). CONCLUSIONS Major medical comorbidities known to affect physical function are associated with worse SNOT-22 scores in patients with CRS as measured by the FCI.
Collapse
Affiliation(s)
- Amarbir S Gill
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.,Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Shaelene Ashby
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Gretchen M Oakley
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Dennis Menjivar
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Richard R Orlandi
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
14
|
Omofoye OA, Lechpammer M, Steele TO, Harsh GR. Pituitary stalk gangliogliomas: Case report and literature review. Clin Neurol Neurosurg 2020; 201:106405. [PMID: 33340839 DOI: 10.1016/j.clineuro.2020.106405] [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: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Gangliogliomas rarely occur in the sella or suprasellar region and are almost never seen in the pituitary stalk. Seven cases of gangliogliomas occurring in this region have been reported; only one case involved a tumor within the pituitary stalk. Of the six tumors external to the pituitary stalk, two occurred in the neurohypophysis, one was in the adenohypophysis, the location of one was unspecified, and two extensively invaded the optic chiasm, hypothalamus and brainstem. This is only the second reported case of a pituitary stalk ganglioglioma, and it is unique in its use of an extended endoscopic endonasal approach for biopsy. CASE REPORT A 51-year old woman presented with an eleven-month history of polydipsia and polyuria leading to the diagnosis of diabetes insipidus. Magnetic Resonance Imaging of the brain revealed contrast-enhanced thickening and anterior bowing of the hypophyseal stalk. An extended endoscopic endonasal approach permitted midline removal of the tuberculum sella, opening of underlying dura, and exposure of the pituitary stalk. A firm, white, 4 mm diameter mass, integral to the right side of the enlarged pituitary stalk was seen and biopsied. Histopathological analysis was consistent with WHO grade 1 ganglioglioma. The patient tolerated the procedure well and required no endocrinologic treatment other than desmopressin. CONCLUSION Pituitary stalk gangliogliomas are extremely rare. The diagnosis should be considered in patients with pituitary stalk enlargement. Endoscopic endonasal approach is a safe surgical approach to establish a tissue diagnosis which is essential for pathologic certainty given the wide differential diagnosis of stalk lesions.
Collapse
Affiliation(s)
- Oluwaseun A Omofoye
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
| | - Mirna Lechpammer
- Department of Pathology and Laboratory Medicine, University of California Davis Health, 4400 V Street, Sacramento, CA 95817, USA.
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, 2521 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Griffith R Harsh
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
| |
Collapse
|
15
|
Morisada MV, Hwang J, Gill AS, Wilson MD, Strong EB, Steele TO. Telemedicine, Patient Satisfaction, and Chronic Rhinosinusitis Care in the Era of COVID-19. Am J Rhinol Allergy 2020; 35:494-499. [PMID: 33115249 DOI: 10.1177/1945892420970460] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Telemedicine has become increasingly popular in the care of rhinologic patients during the COVID-19 pandemic. This change in practice patterns may place patients at risk of a perceived lower-quality exchange with their healthcare provider, which may in turn impact satisfaction. OBJECTIVE This study compares patient satisfaction scores between in-person clinic visits and telemedicine video visits in patients with chronic rhinosinusitis (CRS). METHODS Sixty-nine patients with CRS presenting to an academic rhinology clinic between March to April 2020 were retrospectively divided into video visits (VV) and clinic visits (CV) groups based on mandated state quarantine orders on March 19. Patient demographics, disease severity measures, and Patient Satisfaction Questionnaire-18 (PSQ-18) scores were collected and analyzed. Chi square test and Fisher's exact test were performed. RESULTS There were no significant differences in age (p = 0.81), gender (p = 0.55), CRS phenotype (p = 0.16), and disease severity measures (Sinonasal Outcomes Test-22 (SNOT-22) (p = 0.92); Lund-Mackay score (p = 0.96)) between the video and clinic visit groups. There were no significant differences in PSQ-18 total scores (VV PSQ-18 mean score = 78.1, CV PSQ-18 mean score = 78.4; p = 0.67) or the following subdomain scores between the two groups: general satisfaction (p = 0.73), technical quality (p = 0.62), interpersonal manner (p = 0.41), communication (p = 0.31), financial aspects (p = 0.89), time spent with doctor (p = 0.88), and accessibility and convenience (p = 0.47). CONCLUSION Patient satisfaction with telemedicine in the COVID-19 pandemic parallels that of traditional in-person visits. Video visits can serve as a viable alternative to clinic visits, while still maintaining high satisfaction.
Collapse
Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Joshua Hwang
- School of Medicine, University of California, Davis, Sacramento, California
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Machelle D Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California, Davis, Sacramento, California
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California.,VA Northern California Healthcare System, Sacramento, California
| |
Collapse
|
16
|
Hwang JC, Gill AS, Squires LD, Steele TO. Sjögren's Syndrome Sequelae: Nasal Synechiae and Nasopharyngeal Stenosis. Ear Nose Throat J 2020; 100:1095S-1097S. [PMID: 32579439 DOI: 10.1177/0145561320936965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Joshua C Hwang
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Lane D Squires
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
17
|
Gill AS, Reddy RK, Kulinich AG, Kim J, Wilson MD, Liang J, Strong EB, Steele TO. Surgeon cost feedback through a surgical receipt program reduces cost in sinonasal surgery. Int Forum Allergy Rhinol 2020; 10:1049-1056. [PMID: 32506719 DOI: 10.1002/alr.22605] [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] [Received: 03/11/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Operating room (OR) costs are a large portion of healthcare expenses. This study evaluates the impact of a surgeon-targeted surgical receipt cost feedback system on OR supply costs in sinonasal surgery and individual components contributing to procedural cost. METHODS Itemized weekly surgical receipts detailing individual case supply costs were analyzed before and after the implementation of a non-incentivized surgeon cost feedback system between January 2017 and June 2019. Supply cost data collected 15 months prior to intervention was compared to cost data 15 months after implementation of the weekly automated receipt dissemination to surgeons. Chi square test was used for categorical data and the Wilcoxon test was used to compare change in cost. Univariate and mediation analyses were performed to assess variables impacting cost. RESULTS Of 502 sinonasal procedures analyzed, 239 were before and 264 after cost feedback implementation. There were no significant differences in age/gender, or indication for surgery. The median OR supply cost decreased from $1229.64 to $1097.22 (p = 0.02) after receipt implementation. There were effects of procedure type (p = 0.02), circulating nurse specialization (p < 0.001), steroid eluting stent (p = 0.002), and sinus drill (p < 0.001) on cost. Mediation analysis confirmed full mediation by decreasing use of steroid-eluting stents. CONCLUSION Surgeon cost feedback in the form of individualized OR surgical receipts is an effective model to reduce supply cost per case in sinonasal surgery.
Collapse
Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Renuka K Reddy
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Andrea G Kulinich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Joanna Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Machelle D Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA
| | - Jonathan Liang
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA.,VA Northern California Healthcare System, Sacramento, CA
| |
Collapse
|
18
|
Hsieh TY, Said M, Dedhia RD, Timbang MR, Steele TO, Strong EB. Assessment of the Learning Curve for Virtual Surgical Planning in Orbital Fractures. Craniomaxillofac Trauma Reconstr 2020; 13:186-191. [PMID: 33456685 DOI: 10.1177/1943387520923940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Virtual surgical planning (VSP) is becoming more widely used in maxillofacial reconstruction and can be surgeon-based or industry-based. Surgeon-based models require software training but allow surgeon autonomy. We evaluate the learning curve for VSP through a prospective cohort study in which planning times and accuracy of 7 otolaryngology residents with no prior VSP experience were compared to that of a proficient user after a single training protocol and 6 planning sessions for orbital fractures. The average planning time for the first session was 21 minutes 41 seconds ± 6 minutes 11 seconds with an average maximum deviation of 2.5 ± 0.8 mm in the lateral orbit and 2.3 ± 0.6 mm in the superior orbit. The average planning time for the last session was 13 minutes 5 seconds ± 10 minutes and 7 seconds with an average maximum deviation of 1.4 ± 0.5 mm in the lateral orbit and 1.3 ± 0.4 mm in the superior orbit. Novice users reduced planning time by 40% and decreased maximum deviation of plans by 44% and 43% in the lateral and superior orbits, respectively, approaching that of the proficient user. Virtual surgical planning has a quick learning curve and may be incorporated into surgical training.
Collapse
Affiliation(s)
- Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Mena Said
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - Raj D Dedhia
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Mary Roz Timbang
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Edward Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
19
|
Gill AS, Levy JM, Wilson M, Strong EB, Steele TO. Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey. Int Arch Otorhinolaryngol 2020; 25:e48-e53. [PMID: 33542751 PMCID: PMC7850893 DOI: 10.1055/s-0040-1701268] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/03/2019] [Indexed: 10/31/2022] Open
Abstract
Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice ( p = 0.05), and believe in the negative impact of MDD on postoperative outcomes ( p = 0.007), cost of care ( p = 0.04) and quality of life ( p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.
Collapse
Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Joshua M Levy
- Emory University Department of Otolaryngology - Head and Neck Surgery, Atlanta, GA
| | - Machelle Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA
| | - E Bradley Strong
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California, United States
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, California, United States.,VA Northern California Healthcare System, Sacramento, CA
| |
Collapse
|
20
|
Hwang JC, Dedhia RD, Bernard JE, Steele TO. Oncocytic Cysts of the Nasopharynx: A Case Report. Allergy Rhinol (Providence) 2020; 11:2152656720956594. [PMID: 32953230 PMCID: PMC7479853 DOI: 10.1177/2152656720956594] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nasopharyngeal oncocytic lesions are a spectrum of benign lesions that represent a reactive or hyperplastic response to chronic inflammation. Though oncocytic lesions are typically asymptomatic, unilateral, and benign, this article discusses a rare case of large, bilateral oncocytic cysts and downstream otologic sequelae with a focus on identifying and discussing similar disease processes. METHODS Case report and literature review.Case Presentation: A 67-year-old patient with 57 pack year smoking history presented for one year of left sided hearing loss and aural fullness. Clinic endoscopic exam demonstrated severe inflammatory and cystic changes lining the bilateral tori. Imaging and tissue sampling confirmed the cause was minor salivary gland cysts with papillary projections lined by oncocytic cells within bilateral tori tubarius. He was successfully treated with myringotomy with pressure equalizing tube, counseling on tobacco cessation, and surveillance with serial nasopharyngoscopy. CONCLUSIONS Chronic eustachian tube dysfunction is a possible rare presentation and sequelae of large oncocytic cysts of the nasopharynx. Oncocytic cysts should be considered on the differential diagnosis for nasopharyngeal masses causing such dysfunction.
Collapse
Affiliation(s)
- Joshua C. Hwang
- Department of Otolaryngology—Head and Neck Surgery, University of
California, Davis, Sacramento, California
| | - Raj D. Dedhia
- Department of Otolaryngology, University of Tennessee Health Science
Center, Memphis, Tennessee
- Division of Facial Plastic and Reconstructive Surgery, University of
Tennessee Health Science Center, Memphis, Tennessee
| | - Joan E. Bernard
- Department of Surgery, Veteran’s Affairs Northern California Healthcare
System, Mather, California
| | - Toby O. Steele
- Department of Otolaryngology—Head and Neck Surgery, University of
California, Davis, Sacramento, California
- Department of Surgery, Veteran’s Affairs Northern California Healthcare
System, Mather, California
| |
Collapse
|
21
|
Steele TO, Hoshal SG, Kim M, Gill AS, Wilson M, Squires LD, Bradley Strong E, Suh JD. A preliminary report on the effect of gabapentin pretreatment on periprocedural pain during in-office posterior nasal nerve cryoablation. Int Forum Allergy Rhinol 2019; 10:159-164. [PMID: 31610616 DOI: 10.1002/alr.22456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Posterior nasal nerve (PNN) cryoablation is a novel surgical technique to address allergic and nonallergic rhinitis. Periprocedural pain has been reported after PNN cryoablation and there are no standardized protocols for optimal in-office local anesthesia. This study sought to evaluate the effect of gabapentin on patient discomfort following in-office PNN cryoablation. METHODS Multi-institutional prospective analysis of patients undergoing in-office PNN cryoablation for allergic or nonallergic rhinitis between March 2018 and April 2019. Patients received local anesthesia with or without 600 mg oral gabapentin 1 hour preprocedure. Rhinitis diagnosis, demographics, and baseline disease-specific quality of life (mini-Rhinoconjunctivitis Quality of Life Questionnaire [RQLQ] and Total Nasal Symptom Score [TNSS]) were recorded. Patient discomfort was measured by the pain visual analogue scale (VAS) posttreatment and rated 0 to 10 on an ordinal scale. Fisher's exact and Wilcoxon 2-sample tests were used to evaluate differences between the 2 groups. RESULTS A total of 26 patients were enrolled (gabapentin n = 15, control = 11). Baseline TNSS scores in the gabapentin vs control group were median [25th percentile to 75th percentile]) 10 (7.5 to 11.0) and 9 (6.0 to 10.0) (p = 0.35). Baseline Mini-RQLQ scores in gabapentin vs control groups were 3.21 (2.0 to 4.0) and 2.92 (2.78 to 4.35) (p = 0.51). The median VAS pain scores at 5, 20, and 30 minutes in the gabapentin vs control group were 0.0 (0.0 to 2.0) vs 3.0 (1.0 to 4.0), 2.0 (0.0 to 3.0) vs 8.0 (6.0 to 10.0), and 1.0 (0.0 to 1.0) vs 5.0 (4.0 to 6.0) (p = 0.02, p = 0.0043, and p = 0.003, respectively). CONCLUSION Preprocedure gabapentin significantly reduces immediate and delayed postprocedural patient discomfort following PNN cryoablation.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA.,Veteran's Affairs Northern California Healthcare System, Sacramento, CA
| | - Steven G Hoshal
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Minji Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA
| | - Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Machelle Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA
| | - Lane D Squires
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA.,Veteran's Affairs Northern California Healthcare System, Sacramento, CA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
22
|
Gill AS, Said M, Tollefson TT, Strong EB, Nayak JV, Steele TO. Patient-Reported Outcome Measures and Provocative Testing in the Workup of Empty Nose Syndrome-Advances in Diagnosis: A Systematic Review. Am J Rhinol Allergy 2019; 34:134-140. [PMID: 31594386 DOI: 10.1177/1945892419880642] [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] [Indexed: 11/16/2022]
Abstract
BackgroundThe last 5 years have seen a surge of both clinical and scientific interest in empty nose syndrome (ENS). Although ENS is still considered a controversial diagnosis plagued by a lack of standardized diagnostic criteria, ENS is increasingly becoming recognized as a legitimate, physiologic disease entity. As such, it is important for clinicians to understand the most up-to-date diagnostic tools to assess ENS, confirm the diagnosis, and create a more standardized means to counsel these complex patients.ObjectiveContemporary literature review to discuss diagnostic modalities in the evaluation of ENS, in order to introduce evidence-based diagnostic criteria.MethodsA systematic review was conducted in PubMed and Embase (2013–2019) using the search term “empty nose syndrome” to identify peer-reviewed articles on the topic of ENS. Articles advancing contemporary methods of ENS diagnosis and testing were included. A quality assessment was conducted using The Rational Clinical Examination Levels of Evidence.ResultsThe novel development of the Empty Nose Syndrome 6 Questionnaire (ENS6Q) offers the clinician a validated patient-reported outcome measure to supplement history and physical examination. The in-office cotton test, performed by placing an endoscopically directed cotton plug in the site of tissue loss, may help to identify patients who may benefit from turbinate augmentation. Tools such as the sinus computed tomography scan, computational fluid dynamics, and intranasal trigeminal nerve function testing currently have insufficient evidence to support routine use in the workup of ENS. Up to 66% of ENS patients present with comorbid anxiety or depression.ConclusionThe ENS6Q and cotton test assist in creating a standardized approach to the evaluation of patients suspected of ENS. These instruments should be used as an adjunct, rather than the sole criteria, on which to ascertain the presumptive diagnosis. Patients suspected of ENS should be screened for comorbid psychological dysfunction.
Collapse
Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California
| | - Mena Said
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California.,Department of Surgery, VA Northern California Healthcare System, Sacramento, California
| |
Collapse
|
23
|
Hsieh TY, Cervenka B, Steele TO. Validation of Haptic Properties of Materials for Endoscopic Sinus and Skull Base Surgery Simulation-Reply. JAMA Otolaryngol Head Neck Surg 2019; 144:1185-1186. [PMID: 30193287 DOI: 10.1001/jamaoto.2018.1811] [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)
- Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento.,Veterans Affairs Northern California Healthcare System, Sacramento, California
| |
Collapse
|
24
|
Kinzinger M, Steele TO, Chin O, Strong EB. Degree of Frontal Bone Exposure via Upper Blepharoplasty Incision: Considerations for Frontal Sinus Fracture. Otolaryngol Head Neck Surg 2019; 160:468-471. [PMID: 30667301 DOI: 10.1177/0194599818825456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The upper eyelid blepharoplasty incision affords direct access to the frontal bone for skull base surgery and trauma reconstruction with a well-hidden scar. The goal of this study is to quantify frontal bone exposure that can be achieved with an upper eyelid blepharoplasty incision. DESIGN Anatomic study with human cadaver heads. SETTING UC Davis Medical Center. SUBJECTS/METHODS Fourteen human cadaver heads were used to perform 26 upper blepharoplasty approaches. Exposure was measured with virtual planning software to create virtual reference points at the midline of the superior orbital rim. Surgical navigation was used with a 3-dimensionally printed drill model to measure the maximum exposure achievable relative to the virtual reference point at 5 standardized angles. RESULTS Mean ± SD exposures at medial 60°, medial 30°, 0°, lateral 30°, and lateral 60° were 16.1 ± 1.3 mm, 17.8 ± 1.3, 18.3 ± 1.4, 19.3 ± 1.9, and 20.9 ± 1.9, respectively. Significant differences were detected between exposures at 60° laterally and 60° medially and between exposures 60° laterally and 30° medially ( P < .05). CONCLUSIONS The upper eyelid blepharoplasty incision provides direct surgical access to the inferior frontal bone. Access was greatest with far lateral extension (mean, 20.9 mm) and most limited with far medial extension (mean, 16.1 mm). Treatment of injuries above this level could be achieved with additional percutaneous incisions for screw placement.
Collapse
Affiliation(s)
- Michael Kinzinger
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Toby O Steele
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA.,2 Department of Surgery, VA Northern California Healthcare System, Sacramento, California, USA
| | - Oliver Chin
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Edward B Strong
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| |
Collapse
|
25
|
Dedhia RD, Hsieh TY, Rubalcava Y, Lee P, Shen P, Steele TO, Strong EB. Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium. Ann Otol Rhinol Laryngol 2018; 128:215-219. [PMID: 30501407 DOI: 10.1177/0003489418816725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
IMPORTANCE Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility. OBJECTIVE To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection. DESIGN, SETTING, AND PARTICIPANTS Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. MAIN OUTCOMES AND MEASURES The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery. RESULTS Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states (P = .75) and between primary and revision cases (P = .13). CONCLUSIONS AND RELEVANCE The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.
Collapse
Affiliation(s)
- Raj D Dedhia
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Yecenia Rubalcava
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Paul Lee
- Department of Radiology, Kaiser Permanente, Sacramento, CA, USA
| | - Peter Shen
- Department of Radiology, Kaiser Permanente, Sacramento, CA, USA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
- Department of Surgery, Veteran's Affairs Northern California Healthcare System, Sacramento, CA, USA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
26
|
Abstract
INTRODUCTION: Sinonasal hemangioma is a rare benign tumor of vascular endothelial cells. The pathogenesis is closely linked to abnormalities in the vascular endothelial growth factor signaling pathway. Multiple treatment modalities are available, though wide local excision remains the preferred treatment. Bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, has known efficacy against hemangiomas, though there are no cases of sinonasal hemangiomas managed with bevacizumab. METHODS: Case report. RESULTS: The authors review the case of a 67-year-old man with a left-sided nasal hemangioma originating from the nasal septum. He presented with progressive left nasal obstruction and recurrent epistaxis. At the time of his presentation, the lesion had recurred after 1 excision/polypectomy at an outside institution. He then underwent revision surgery via wide local excision and septoplasty. After tumor recurrence following the revision surgery, the hemangioma was noted to recur on 1 year postoperative surveillance nasal endoscopy. In-office intralesional injection of 50 mg bevacizumab was then performed under endoscopic visualization. No improvement in the tumor size was noted at 2 months after injection, with the tumor measuring 1.5 cm. At the 10-month surveillance clinical visit following injection, the tumor had dramatically involuted to 3 mm in greatest dimension. The patient reported complete resolution of his primary symptoms of epistaxis and nasal obstruction. CONCLUSIONS: This report demonstrates the first reported successful treatment of a sinonasal hemangioma with intralesional bevacizumab. Intralesional bevacizumab confers an additional option for adjuvant treatment of sinonasal hemangiomas. Further evaluation of intralesional bevacizumab in the treatment of these tumors is warranted.
Collapse
Affiliation(s)
- Michael R Kinzinger
- 1 Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - E Bradley Strong
- 1 Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
| | - Joan Bernard
- 2 Veterans Affairs Northern California Healthcare System, Sacramento, CA, USA
| | - Toby O Steele
- 1 Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA.,2 Veterans Affairs Northern California Healthcare System, Sacramento, CA, USA
| |
Collapse
|
27
|
Abstract
OBJECTIVE Despite advances in technology and instrumentation, access to the lateral frontal sinus remains a challenge for surgeons. We sought to quantify the reach and applicability of the upper blepharoplasty approach (UBA) to the frontal sinus. METHODS Twelve cadaveric specimens were obtained for anatomic research and frontal sinuses divided into 3 zones. Zone 1 was defined as medial to the supraorbital neurovascular bundle (SON). The remaining orbit was then bisected to define zone 2 (centrally) and zone 3 (laterally). Twenty-four UBAs were performed followed by 12 modified endoscopic Lothrop procedures (MELP). The ability to instrument each wall of the frontal sinus was recorded for the MELP, UBA, and combined approach. RESULTS The UBA provided excellent access to the lateral frontal sinus in zones 2 and 3 (89% and 100%). The MELP provided poorer access in zone 3 (67%) but improved access in zone 1 (83%-100%). Access for zone 1 through the UBA was limited. The combined approach yielded 100% access to each frontal sinus boundary. CONCLUSION The MELP in combination with the UBA/lateral trephination provides excellent access to each frontal sinus boundary. The UBA provides excellent access to the lateral frontal sinus but is limited medially by the SON.
Collapse
Affiliation(s)
- Toby O Steele
- 1 Department of Otolaryngology-Head and Neck Surgery. University of California Davis, Sacramento, California, USA
- 2 Veterans Affairs Northern California Healthcare System, Sacramento, California, USA
| | - Oliver Y Chin
- 1 Department of Otolaryngology-Head and Neck Surgery. University of California Davis, Sacramento, California, USA
| | - Michael R Kinzinger
- 1 Department of Otolaryngology-Head and Neck Surgery. University of California Davis, Sacramento, California, USA
| | - E Bradley Strong
- 1 Department of Otolaryngology-Head and Neck Surgery. University of California Davis, Sacramento, California, USA
| |
Collapse
|
28
|
Abstract
BACKGROUND Lymphomas of the sinonasal tract are a rare and heterogeneous subset of solid sinonasal neoplasms. OBJECTIVE To characterize, in this case series, presenting symptoms, treatment modalities, and outcomes for patients with sinonasal lymphoma within a single institution. METHODS Retrospective patient data were collected from an academic, oncologic center and entered into a repository designed to capture outcomes for sinonasal malignancies. Patient demographics, presenting symptoms, imaging findings, treatment modalities, and health status were retrospectively extrapolated and evaluated by using Kaplan-Meier estimations for survival probability. RESULTS Patients with sinonasal lymphoma with a mean follow-up of 50 months were identified (n = 18). Histologic diagnosis included the following: diffuse large B-cell lymphoma (n = 9), natural killer/T-cell lymphoma (n = 5), follicular lymphoma (n = 1), T-cell lymphoma (n = 1), and lymphoma-not otherwise specified (n = 2). The most frequent presenting symptoms were nasal obstruction (78%), facial pain (72%), facial swelling (50%), and nasal discharge (44%). Treatment before lymphoma diagnosis included antibiotics (83%), oral steroids (22%), decongestants (22%), and topical steroids (11%). Treatment regimens after diagnosis included both chemotherapy (94%) and chemoradiotherapy (56%). Survival rates by lymphoma subtype were 56% for B-cell lymphoma and 40% for natural killer/T-cell lymphoma. Overall, 2- and 5-year survival rates were 67% and 50%, respectively. The combination of chemotherapy and radiation resulted in significantly higher survival rates (p ≤ 0.001) than chemotherapy alone. CONCLUSION Sinonasal lymphomas are characterized by meager survival rates, which differ by histopathologic subtype. The diagnosis of sinonasal lymphoma is challenging because symptoms frequently parallel those of chronic rhinosinusitis. Increased awareness of these rare malignancies may improve detection and more timely treatment. Clinical trial registration NCT01332136.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | | | | | | | | |
Collapse
|
29
|
Abstract
IMPORTANCE A case of nasal septal perforation secondary to systemic bevacizumab therapy for ovarian cancer is reported. Bevacizumab is a vascular endothelial growth factor A (VEGF-A) inhibitor that is becoming more widely utilized in the oncologic community. There is only one prior report of septal perforation secondary to bevacizumab in the Otolaryngology specific literature. The purpose of this report is: 1) to raise awareness and discuss the literature surrounding the sinonasal complications of bevacizumab and 2) provide workup and treatment recommendations based on the sum of the available literature. OBSERVATIONS We review the clinical record of a 59year old patient who presented with an anterior septal perforation while taking bevacizumab therapy for ovarian cancer. She had mild symptoms. Her oncologist held bevacizumab and topical moisture therapy was started. After several weeks, the perforation remained stable and bevacizumab was restarted for her ovarian cancer. CONCLUSION AND RELEVANCE Bevacizumab is associated with both septal perforation and more widespread sinonasal toxicity. These lesions tend to produce only mild symptoms and can usually be managed conservatively. The decision to hold bevacizumab therapy should be made in conjunction with the patient and medical oncologist. Otolaryngologists should be aware of the toxicity from this increasingly common oncologic therapy.
Collapse
|
30
|
Steele TO, Mace JC, Dedhia R, Rudmik L, Smith TL, Alt JA. Health utility values for patients with recurrent acute rhinosinusitis undergoing endoscopic sinus surgery: a nested case control study. Int Forum Allergy Rhinol 2016; 6:1182-1187. [PMID: 27309906 DOI: 10.1002/alr.21809] [Citation(s) in RCA: 9] [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: 03/29/2016] [Revised: 05/12/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health utility scores quantify an individual's valuation of particular health states and are vital components of health economic studies and cost-effectiveness research. We sought to characterize health utility values for patients with recurrent acute rhinosinusitis (RARS) both before and after endoscopic sinus surgery (ESS), as well as compare health utility to chronic rhinosinusitis without nasal polyposis (CRSsNP). METHODS Patients with RARS (n = 20) and CRSsNP (n = 20) undergoing ESS were enrolled as part of a longitudinal, observational, prospective cohort. Case patients diagnosed with RARS were age- and gender-matched to controls with CRSsNP using a nested case-control design at a 1:1 ratio. Health utility was measured using the Medical Outcomes Study Short Form-6D (SF-6D) survey. RESULTS Patients with RARS were followed for an average of 14.0 ± 6.1 (mean ± standard deviation) months compared to an average of 14.4 ± 5.3 months for CRSsNP controls (p = 0.779). Mean preoperative SF-6D health utility scores were statistically comparable between RARS (0.71 ± 0.14) and CRSsNP (0.66 ± 0.12; p = 0.341). Both patients with RARS and CRSsNP reported significant postoperative improvement in SF-6D scores from 0.71 ± 0.14 to 0.79 ± 0.13 (p = 0.031) and from 0.66 ± 0.12 to 0.77 ± 0.13 (p = 0.004), respectively. No difference in last postoperative SF-6D scores were found between RARS and CRSsNP (p = 0.583) or in the average magnitude of postoperative improvement (0.08 ± 0.16 vs 0.11 ± 0.13; p = 0.620). CONCLUSION Patients with RARS and CRSsNP report significant impairment in health utility as measured by the SF-6D. ESS significantly improves health utility in patients with RARS and CRSsNP to near normative values. These data will help inform future economic analysis and cost-effectiveness research.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Raj Dedhia
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR.
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| |
Collapse
|
31
|
Abstract
OBJECTIVE To evaluate the ultrasonic bone aspirator versus traditional powered drill technique for use in endoscopic dacryocystorhinostomy. STUDY DESIGN Retrospective chart review. SETTING Academic institution. SUBJECTS AND METHODS A retrospective chart review of all patients undergoing endoscopic dacryocystorhinostomy from June 2010 through May 2014 was performed. Data were collected from 63 eyes of 63 patients. Recorded data points include: age, gender, etiology of epiphora, procedure type, success rate, need for septoplasty, and length of follow-up. Surgical failure was defined as no improvement in epiphora, postoperative dacryocystitis, or inability to irrigate the lacrimal system post-operatively. RESULTS Sixty three consecutive patients underwent endonasal endoscopic dacryocystorhinostomy. Twenty nine patients underwent powered microdrill DCR (pDCR); 34 patients underwent ultrasonic bone aspirator DCR (uDCR). There was no statistically significant difference between groups in terms of age or gender. The success rates were: pDCR 86.2% and uDCR 94.1% (p=0.4). Concurrent septoplasty was performed in 48% of pDCR patients and 21% of uDCR patients (p=0.03) There was no significant difference in surgical success when septoplasty was controlled for (p=0.39). CONCLUSION Ultrasonic bone aspirator dacryocystorhinostomy has a similar success rate to traditional powered microdrill dacryocystorhinostomy.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA.
| | - Machelle Wilson
- Department of Public Health Sciences/Biostatistics, Clinical and Translational Science Center, University of California Davis, Sacramento, CA
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| |
Collapse
|
32
|
Levy JM, Mace JC, DeConde AS, Steele TO, Smith TL. Improvements in psychological dysfunction after endoscopic sinus surgery for patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:906-13. [PMID: 27080574 DOI: 10.1002/alr.21776] [Citation(s) in RCA: 26] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychological dysfunction is highly prevalent among patients with chronic rhinosinusitis (CRS). Previous study has identified various measures of anxiety and depression as predictors of quality-of-life outcomes following endoscopic sinus surgery (ESS). Psychological dysfunction scores, as measured by the 22-item Sino-Nasal Outcome Test (SNOT-22), have been found to influence treatment decision making in CRS. This study aims to further elucidate improvement in discrete psychological symptoms following ESS for CRS. METHODS Adult patients with medically recalcitrant CRS electing to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort. Psychological-related symptom severity and postoperative outcomes were assessed using psychological domain items of the SNOT-22, including subgroup analysis of patients with and without comorbid depression. RESULTS A total of 374 participants met inclusion criteria and were followed postoperatively for a mean ± standard deviation (SD) of 14.6 ± 5.0 months. Total mean psychological domain scores improved from 15.9 ± 8.2 to 8.5 ± 8.4 (p < 0.001). Significant relative mean improvements were reported in "waking up tired" (23%; p < 0.001), "fatigue" (25%; p < 0.001), "reduced productivity" (28%; p < 0.001), "reduced concentration" (27%; p < 0.001), " frustrated/restless/irritable" (27%; p < 0.001), "sad" (15%; p < 0.001), and "embarrassed" (8%; p < 0.001) scores. A total of 64% to 66% of participants reported improvement in "reduced productivity," "waking up tired," "fatigue," and "frustrated/restless/irritable," compared to 46% and 38% reporting improvement in "sad" and "embarrassed," respectively. CONCLUSION Patients with CRS report significant improvement in common mental health-related symptoms following ESS. Despite these improvements, some degree of persistent postoperative psychological dysfunction was reported. Further study is necessary to determine which factors are associated with persistent psychological dysfunction after ESS in order to optimize treatment outcomes.
Collapse
Affiliation(s)
- Joshua M Levy
- 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
| | - Jess C Mace
- 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
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - 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.
| |
Collapse
|
33
|
Alt JA, DeConde AS, Mace JC, Steele TO, Orlandi RR, Smith TL. Quality of Life in Patients With Chronic Rhinosinusitis and Sleep Dysfunction Undergoing Endoscopic Sinus Surgery: A Pilot Investigation of Comorbid Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2016; 141:873-81. [PMID: 26356240 DOI: 10.1001/jamaoto.2015.1673] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patients with chronic rhinosinusitis (CRS) have reduced sleep quality linked to their overall well-being and disease-specific quality of life (QOL). Other primary sleep disorders also affect QOL. OBJECTIVE To determine the impact of comorbid obstructive sleep apnea (OSA) on CRS disease-specific QOL and sleep dysfunction in patients with CRS following functional endoscopic sinus surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective multisite cohort study conducted between October 2011 and November 2014 at academic, tertiary referral centers with a population-based sample of 405 adults. INTERVENTION Functional endoscopic sinus surgery for medically refractory symptoms of CRS. MAIN OUTCOMES AND MEASURES Primary outcome measures consisted of preoperative and postoperative scores operationalized by the Rhinosinusitis Disability Index (RSDI) survey, the 22-item Sinonasal Outcome Test (SNOT-22), and the Pittsburgh Sleep Quality Index (PSQI). Obstructive sleep apnea was the primary, independent risk factor. RESULTS Of 405 participants, 60 (15%) had comorbid OSA. A total of 285 (70%) participants provided preoperative and postoperative survey responses, with a mean (SD) of 13.7 (5.3) months of follow-up. Significant postoperative improvement (P < .05) was reported across all mean disease-specific QOL measures for both participants with and without comorbid OSA. Participants without OSA reported significant greater improvement in unadjusted mean (SD) RSDI global scores (−25.0 [23.3] vs. −16.5 [22.1]; P = .03), RSDI physical (−10.7 [9.2] vs. −7.3 [9.1]; P = .03) and functional (−8.4 [8.7] vs. −5.1 [7.5]; P = .03) subdomain scores, and SNOT-22 rhinologic symptom domain scores (−9.1 [7.7] vs. −5.7 [6.9]; P = .008). Participants without OSA also reported greater improvements on mean (SD) PSQI global (−1.9 [4.0] vs. −0.5 [3.7]; P = .03), sleep quality (−0.4 [0.8] vs. −0.03 [0.7]; P = .02), and sleep disturbance (−0.4 [0.7] vs. −0.1 [0.7]; P = .03) scores. The majority of these associations were found to be durable after adjustment for alternate independent cofactors using stepwise linear regression modeling. CONCLUSIONS AND RELEVANCE Patients with CRS and comorbid OSA have poor QOL with substantial disease-specific QOL improvements following surgery. Patients who present with CRS should be assessed for primary sleep disorders and, if identified, should be treated concurrently for both CRS and OSA to improve sleep dysfunction to optimize surgical outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01332136.
Collapse
|
34
|
Steele TO, Rudmik L, Mace JC, DeConde AS, Alt JA, Smith TL. Patient-centered decision making: the role of the baseline SNOT-22 in predicting outcomes for medical management of chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:590-6. [PMID: 26852743 DOI: 10.1002/alr.21721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/09/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND For patients with chronic rhinosinusitis (CRS), the decision to elect continued medical management vs surgery is complex and involves tradeoffs between benefits, risks, and overall effectiveness of each therapy. The purpose of this study is to investigate whether baseline disease-specific quality of life (QOL) can assist in predicting outcomes in patients with refractory CRS who elect continued medical management. METHODS CRS patients electing medical management were enrolled in a prospective, multi-institutional cohort study. Patients were stratified into pretreatment 22-item Sino-Nasal Outcome Test (SNOT-22) subgroups based on 10-point score increments (eg, 10 to 19, 20 to 29, 30 to 39, etc.) to capture potential outcome differences by baseline SNOT-22 disease burden. The proportion of patients achieving minimal clinically important difference (MCID≥9 points) and relative improvement (%) for each score category were calculated. RESULTS Seventy-five CRS patients with a mean ± standard deviation pretreatment SNOT-22 score of 45.2 ± 16.6 were followed for a mean of 14.9 months. The majority of participants electing medical therapy failed to improve 1 MCID (57%) with a mean relative score improvement of 16%. Overall, 37% of patients maintained baseline SNOT-22 QOL status, whereas 20% of patients deteriorated >1 MCID. When treatment crossover patients (to endoscopic sinus surgery [ESS]) were included (n = 117), approximately 1 in 4 (27%) patients achieved an MCID. CONCLUSION Results from this study suggest that the majority of CRS patients electing ongoing medical management with low baseline disease-specific QOL impairment maintain stable QOL with continued medical management. Furthermore, of CRS patients electing ongoing medical therapy, approximately 1 in 4 patients achieved MCID, whereas 1 in 5 experienced deterioration by >1 MCID.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Luke Rudmik
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jess C Mace
- 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
| | - Adam S DeConde
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - 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
| |
Collapse
|
35
|
Steele TO, Detwiller KY, Mace JC, Strong EB, Smith TL, Alt JA. Productivity outcomes following endoscopic sinus surgery for recurrent acute rhinosinusitis. Laryngoscope 2016; 126:1046-53. [PMID: 26749066 DOI: 10.1002/lary.25705] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS We sought to evaluate preoperative and postoperative productivity losses and quality of life (QOL) impairment reported by patients with recurrent acute rhinosinusitis (RARS) as compared to patients with chronic rhinosinusitis without nasal polyposis (CRSsNP). STUDY DESIGN Prospective, multi-institutional, nested case-control. METHODS Participants with RARS (n = 20) and CRSsNP (n = 20) undergoing endoscopic sinus surgery (ESS) were enrolled as part of a prospective cohort study. For comparison, participants diagnosed with RARS cases were age/gender-matched to control participants diagnosed with CRSsNP using a 1:1 ratio. RESULTS RARS and CRSsNP participants were followed for ∼14 months postoperatively. Productivity losses were reported as the number of days missed from normal productive activities out of the previous 90 days. RARS participants reported similar baseline productivity losses (12.6 ± 27.1 [standard deviation]) as participants with CRSsNP (11.7 ± 20.9; P = .314). Postoperatively, improvement in productivity losses was similar between RARS participants and CRSsNP controls (-6.7 ± 20.0 vs. -9.8 ± 19.1; P = .253). Preoperative and postoperative disease-specific QOL measures (Sino-Nasal Outcomes Test-22 and Rhinosinusitis Disability Index) were similar between the two groups. RARS participants reported a significant decrease in days of previous antibiotic (P = .009) and nasal decongestant (P = .004) use following ESS, whereas participants with CRSsNP reported a significant decrease in antibiotic (P = .002) and oral corticosteroid use (P = .002). CONCLUSIONS RARS patients report baseline productivity losses and disease-specific QOL impairment to levels that parallel those with CRSsNP. Patients with RARS report improvement in QOL following ESS in all disease-specific QOL measures and in several medication measures. Productivity losses and postoperative improvements are similar between patients with RARS and CRSsNP. LEVEL OF EVIDENCE 3b Laryngoscope, 126:1046-1053, 2016.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Kara Y Detwiller
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Jess C Mace
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - E Bradley Strong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Timothy L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Jeremiah A Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| |
Collapse
|
36
|
El Rassi E, Mace JC, Steele TO, Alt JA, Smith TL. Improvements in sleep-related symptoms after endoscopic sinus surgery in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 6:414-22. [PMID: 26678684 DOI: 10.1002/alr.21682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sleep impairment is highly prevalent in patients with chronic rhinosinusitis (CRS). Although endoscopic sinus surgery (ESS) has been shown to improve overall patient-reported sleep quality, the postoperative impact on individual sleep symptoms remains unclear. METHODS Patients with medically-recalcitrant CRS who elected to undergo ESS were prospectively enrolled into a multi-institutional, observational cohort study. Sleep-related symptom severity and treatment outcomes were assessed using the sleep domain questions within the 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS A total of 334 participants met criteria and were followed postoperatively for an average of 14.5 ± 4.9 months (mean ± standard deviation [SD]). Mean SNOT-22 sleep domain scores improved from 13.7 ± 6.8 to 7.7 ± 6.6 (p < 0.001). Significant mean relative improvements were reported for "difficulty falling asleep" (45%; p < 0.001), "waking up at night" (40%; p < 0.001), "lack of a good night's sleep" (43%; p < 0.001), "waking up tired" (40%; p < 0.001), and "fatigue" (42%; p < 0.001) scores. A total of 66% of study participants reported postoperative improvement in "lack of a good night's sleep," "waking up tired," and "fatigue"; 62% reported improvement in "waking up at night"; and 58% reported improvement in "difficulty falling asleep." CONCLUSION Patients with CRS report significant and sustained improvements following ESS in common sleep-related symptoms as assessed by the SNOT-22 sleep domain. Despite these significant improvements, some degree of persistent postoperative sleep impairment was reported. Further study is necessary to determine what factors are associated with continued sleep dysfunction after sinus surgery.
Collapse
Affiliation(s)
- Edward El Rassi
- 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
| | - Jess C Mace
- 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
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Jeremiah A Alt
- Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT
| | - 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
| |
Collapse
|
37
|
El Rassi E, Mace JC, Steele TO, Alt JA, Soler ZM, Fu R, Smith TL. Sensitivity analysis and diagnostic accuracy of the Brief Smell Identification Test in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 6:287-92. [PMID: 26625169 DOI: 10.1002/alr.21670] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 06/25/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Brief Smell Identification Test (BSIT) is an abbreviated version of the Smell Identification Test (SIT) used to assess olfactory function. Although the BSIT can be efficiently administered in under 5 minutes, the accuracy of the BSIT in relation to the SIT in patients with chronic rhinosinusitis (CRS) is unknown. METHODS Patients with CRS were recruited as part of an ongoing multi-institutional observational cohort study. A total of 183 participants provided both BSIT and SIT olfactory function scores during initial enrollment. Linear associations between BSIT and SIT scores were evaluated using Pearson's correlation coefficients (rp ). The sensitivity, specificity, and accuracy of BSIT scores were determined using SIT scores as the "gold standard." RESULTS A strong bivariate linear association was found between BSIT and SIT scores (rp = 0.893; p < 0.001) for all participants. A significantly lower proportion of patients were identified as having abnormal olfaction using the BSIT compared to the SIT (47% vs 68%, respectively; p < 0.001). Using the currently defined score of ≤8 as a cut-point for abnormal olfactory function, the BSIT demonstrated a sensitivity of 63% and specificity of 88% with an overall accuracy of 71%. Increasing the cut-point to ≤9 resulted in an increased sensitivity of 86%, a specificity of 76%, and an improved overall accuracy of 83%. CONCLUSION In patients with CRS, BSIT scores strongly correlate with SIT scores; however, the BSIT underestimates olfactory dysfunction as defined by the suggested cut-point of ≤8. Increasing the cut-point to ≤9 increased the sensitivity and accuracy of the BSIT.
Collapse
Affiliation(s)
- Edward El Rassi
- 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
| | - Jess C Mace
- 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
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology & Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Rongwei Fu
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
| | - 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
| |
Collapse
|
38
|
Orb Q, Mace JC, DeConde AS, Steele TO, Cox ST, Smith TL, Alt JA. Patients electing medical vs surgical treatment: emotional domain of the Rhinosinusitis Disability Index associates with treatment selection. Int Forum Allergy Rhinol 2015; 6:315-21. [PMID: 26536520 DOI: 10.1002/alr.21656] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/10/2015] [Accepted: 08/28/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Rhinosinusitis Disability Index (RSDI) consists of multiple subdomains shown to be useful in studying chronic rhinosinusitis (CRS). The objective of this study was to determine if RSDI subdomain scores are associated with selection of treatment modality (endoscopic sinus surgery [ESS] or continued medical management [CMM]) in subjects with CRS. METHODS Patients with CRS were prospectively enrolled into a multi-institutional cohort study. Following an initial period of medical management, patients elected to undergo treatment with either ESS or CMM. Baseline RSDI total and subdomain scores were compared between patients electing different treatment modalities. RESULTS A total of 684 subjects were enrolled with 122 (17.8%) electing CMM and 562 (82.2%) electing ESS. When compared to patients undergoing CMM, patients electing ESS exhibited significantly higher mean baseline RSDI total scores (mean ± standard deviation [SD]: 48.1 ± 24.9 vs 40.1 ± 24.1; p = 0.001) and subdomain scores (emotional: 13.2 ± 9.1 vs 10.4 ± 8.3; p = 0.001; functional: 15.3 ± 8.9 vs 12.6 ± 8.4; p = 0.002; and physical: 19.6 ± 9.3 vs 17.1 ± 9.6; p = 0.007). Emotional subdomain scores were found to be the most associated with choice of treatment modality. CONCLUSION Patients with CRS electing ESS had worse baseline RSDI total and subdomain scores compared to those electing CMM. Although both rhinologic and nonrhinologic symptoms contributed to the selection of treatment modality, emotional symptoms appeared to exhibit the greatest influence on patient-centered treatment decisions.
Collapse
Affiliation(s)
- Quinn Orb
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Toby O Steele
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA
| | - Steve T Cox
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, TN
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Skull Base Surgery, Oregon Health Science Center, Portland, OR
| | - Jeremiah A Alt
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
39
|
Steele TO, Mace JC, DeConde AS, Xiao CC, Storck KA, Gudis DA, Schlosser RJ, Soler ZM, Smith TL. Does comorbid obesity impact quality of life outcomes in patients undergoing endoscopic sinus surgery? Int Forum Allergy Rhinol 2015. [PMID: 26201473 DOI: 10.1002/alr.21599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). METHODS Adult patients with medically refractory CRS (n = 241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5 to 24.9, overweight: 25.0 to 29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI] and the 22-item Sino-Nasal Outcome Test [SNOT-22]) were evaluated compared across BMI groups and obesity subclasses. RESULTS The prevalence of comorbid obesity was 41% (n = 99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p ≤ 0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p ≥ 0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs 55%, respectively) and SNOT-22 total score (29% and 40% vs 48%, respectively). CONCLUSION Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.
Collapse
Affiliation(s)
- Toby O Steele
- 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
| | - Jess C Mace
- 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
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Christopher C Xiao
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Kristina A Storck
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Sinus Surgery, Medical University of South Carolina, Charleston, SC
| | - 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
| |
Collapse
|
40
|
Luk LJ, Steele TO, Mace JC, Soler ZM, Rudmik L, Smith TL. Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study. Int Forum Allergy Rhinol 2015; 5:1018-27. [PMID: 26140502 DOI: 10.1002/alr.21588] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/08/2015] [Accepted: 06/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND A health utility value represents an individual's preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). METHODS The Medical Outcomes Study Short Form-6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA). RESULTS Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ(2) = 6.91; p = 0.009) and surgical intervention (χ(2) = 8.11; p = 0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (mean ± standard deviation; 0.76 ± 0.12 vs 0.70 ± 0.15; p = 0.023). Significant improvement in health utility was reported in the ESS cohort (F(2) = 37.69; p < 0.001), whereas values remained stable, without significant improvement, in both the medical therapy cohort (F(2) = 0.03; p = 0.967) and treatment crossover cohort (F(2) = 2.36; p = 0.115). CONCLUSION Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS show significant improvement in health utility, whereas those electing continued medical management demonstrate stable health utility over 12 months.
Collapse
Affiliation(s)
- Lauren J Luk
- 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
| | - Toby O Steele
- 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
| | - Jess C Mace
- 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
| | - 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, Alberta, Canada
| | - 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
| |
Collapse
|
41
|
Steele TO, Mace JC, Smith TL. Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery? Int Forum Allergy Rhinol 2015; 5:829-38. [PMID: 25908106 DOI: 10.1002/alr.21543] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Approximately 25% of patients with chronic rhinosinusitis (CRS) have comorbid anxiety and both conditions independently decrease quality of life (QOL). QOL outcomes for CRS and depression have garnered the majority of research attention, but efforts to better understand the impact of anxiety disorders on QOL are increasing. We evaluated the role of comorbid anxiety in patients with CRS undergoing endoscopic sinus surgery (ESS). METHODS Adult patients (n = 148) with CRS with and without comorbid anxiety were prospectively enrolled into a treatment outcomes investigation. History of comorbid anxiety was retrospectively identified (n = 30; 20%) and preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI], and 22-item Sino-Nasal Outcome Test [SNOT-22]) scores were compared to patients without comorbid anxiety. RESULTS Compared to patients without anxiety, patients with anxiety were found to be younger (p = 0.02) and have a higher prevalence of female gender (p = 0.05), diabetes mellitus (p < 0.001), depression (p < 0.001), and tobacco use (p = 0.03). Participants with comorbid anxiety reported significantly worse preoperative psychological dysfunction as measured by SNOT-22 subdomain scores (p = 0.02), as well as worse preoperative functional (p = 0.04) and emotional (p = 0.001) impairment as evaluated by RSDI subdomain scores. After adjustment for other cofactors, patients with anxiety improved significantly less on SNOT-22 total scores compared to participants without anxiety after ESS (p = 0.02). CONCLUSION Anxiety occurs with higher prevalence in patients with CRS and the presence of comorbid anxiety is associated with worse preoperative QOL and reduced QOL improvement following ESS. These findings warrant improvement in screening, diagnosis, and treatment for patients with CRS and comorbid anxiety.
Collapse
Affiliation(s)
- Toby O Steele
- 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
| | - Jess C Mace
- 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
| | - 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
| |
Collapse
|
42
|
Squires LD, Steele TO, Biron VL, Luu QK, Farwell DG, Bewley AF. Factors Affecting the Likelihood of Undergoing Transoral Robotic Surgery for Head and Neck Cancer. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541629a84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Evaluate whether patient demographics and hospital characteristics are associated with a patient’s likelihood of undergoing transoral robotic surgery (TORS) for head and neck cancer. Methods: A cross-sectional analysis of 13,193 patients who were admitted to US hospitals in 2009 and 2011 with a primary diagnosis of head and neck cancer was performed using data from the Nationwide Inpatient Sample. A multinomial logistic regression model was used to calculate the likelihood of undergoing TORS based on age, sex, race, household income quartile, insurance status, hospital size, hospital region, and hospital teaching status. Results: A total of 181 patients underwent TORS for head and neck cancer in the years 2009 and 2011. With regard to demographic factors, Hispanic patients and those within the lowest 2 income quartiles were significantly less likely to undergo TORS when compared with white patients and those within the highest income quartile (odds ratio [ORs] 0.27 confidence interval [CI; 0.09-0.80], 0.48 CI [0.29-0.80], 0.54 CI [0.34-0.87]). With regard to hospital characteristics, patients treated at hospitals in the northeast and south and those treated at nonteaching hospitals were significantly less likely to undergo TORS than those treated at hospitals in the west and those treated at teaching hospitals (ORs 0.48 CI [0.31-0.73], 0.43 CI [0.28-0.64], 0.27 [0.16-0.44]). There were no significant differences found between patients of different age groups or patients treated at different sized hospitals. Conclusions: Racial, socioeconomic, and regional disparities exist in the availability of TORS to head and neck cancer patients.
Collapse
|
43
|
Abstract
Cancers of the oral cavity account for approximately 3% of malignancies diagnosed annually in the United States. As with other upper aerodigestive tract cancers, 5-year survival rates for oral cavity cancers decrease with delayed diagnosis. Cancers of the oral cavity are thought to progress from premalignant/precancerous lesions, beginning as hyperplastic tissue and developing into invasive squamous cell carcinoma. Despite the general accessibility of the oral cavity during physical examination, many malignancies are not diagnosed until late stages of disease. To prevent malignant transformation of these oral precursor lesions, multiple screening and detection techniques have been developed to address this problem.
Collapse
Affiliation(s)
- Toby O Steele
- Department of Otolaryngology, Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA.
| | | |
Collapse
|