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Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sedaghat AR, Caradonna DS, Chandra RK, Franzese C, Gray ST, Halderman AA, Hopkins C, Kuan EC, Lee JT, McCoul ED, O'Brien EK, Pletcher SD, Pynnonen MA, Wang EW, Wise SK, Woodworth BA, Yao WC, Phillips KM. Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control. Int Forum Allergy Rhinol 2023; 13:2004-2017. [PMID: 37042828 DOI: 10.1002/alr.23168] [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: 01/20/2023] [Revised: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control). METHODS Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control. They then classified patients' CRS control without knowledge of patient-reported CRS control. Interrater reliability and agreement of rhinologist-assessed CRS control with patient-reported CRS control and EPOS guidelines were determined. RESULTS CRS control classification with and without knowledge of patient-reported CRS control was highly consistent across rhinologists (κw = 0.758). Rhinologist-assessed CRS control agreed with patient-reported CRS control significantly better when rhinologists had knowledge of patient-reported CRS control (κw = 0.736 vs. κw = 0.554, p < 0.001). Patient-reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists' assessment of CRS control. Rhinologists' CRS control assessments weakly agreed with EPOS CRS control guidelines with (κw = 0.529) and without (κw = 0.538) patient-reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases. CONCLUSIONS This study directly demonstrates the importance of patient-reported CRS control as a dominant influence on rhinologists' CRS control assessment. Knowledge of patient-reported CRS control may better align rhinologists' CRS control assessments and treatment decisions with patients' perspectives.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David S Caradonna
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christine Franzese
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven D Pletcher
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Melissa A Pynnonen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | | | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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3
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Liu MY, Woodworth BA, Kanaan A, Jang DW, Yao WC, Radabaugh JP, Gardner JR, Goros M, Grayson JW, Wang Z, Chen PG. SNOT-22 Quality of Life Scores Improve After Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea. Ann Otol Rhinol Laryngol 2023; 132:1077-1084. [PMID: 36377064 DOI: 10.1177/00034894221133769] [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: 07/20/2023]
Abstract
OBJECTIVES Patients with spontaneous cerebrospinal fluid (CSF) rhinorrhea can experience significant sinonasal symptom burden, leading to poor quality of life (QOL). The objective of this study was to investigate sinonasal outcome test-22 (SNOT-22) scores in patients undergoing endoscopic endonasal surgery for spontaneous CSF rhinorrhea and compare them to patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP). METHODS A multi-institutional retrospective review of patients with spontaneous CSF rhinorrhea and CRSsNP was performed. Pre-surgery and post-surgery SNOT-22 scores and domains were compared within each group. Improvements in SNOT-22 scores after surgery were compared between the groups. RESULTS Ninety-one patients were in the CSF rhinorrhea group and 105 patients were in the CRSsNP group. Within each group, surgery significantly improved total SNOT-22 scores, domain scores, and most of the individual symptoms. Comparing the 2 groups revealed similar improvements in total SNOT-22 scores (P = .244). The CSF rhinorrhea group improved more in runny nose (P < .001), postnasal discharge (P < .001), wake up at night (P = .024), and embarrassed (P = .002). The CRSsNP group improved more in sneezing (P = .027), nasal blockage (P < .001), decreased sense of smell/taste (P = .011), thick nasal discharge (P < .001), facial pain/pressure (P = .008), and the ear/facial domain (P = .010). CONCLUSIONS Patients with spontaneous CSF rhinorrhea experience significant symptom burden. Those who undergo CSF leak repair should experience significant improvement in QOL similar to patients who undergo ESS for CRSsNP as measured by SNOT-22.
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Affiliation(s)
- Matthew Y Liu
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Bradford A Woodworth
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alissa Kanaan
- Division of Rhinology and Allergy, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David W Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Jeffrey Paul Radabaugh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - James Reed Gardner
- Division of Rhinology and Allergy, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Martin Goros
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jessica W Grayson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhu Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Philip G Chen
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
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4
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Yao WC, Pritikin J, Sillers MJ, Barham HP. Two-year outcomes of temperature-controlled radiofrequency device treatment of the nasal valve for patients with nasal airway obstruction. Laryngoscope Investig Otolaryngol 2023; 8:808-815. [PMID: 37621275 PMCID: PMC10446315 DOI: 10.1002/lio2.1089] [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: 01/25/2023] [Revised: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 08/26/2023] Open
Abstract
Background The objective of this study was to evaluate long-term symptom improvements in patients with nasal airway obstruction (NAO) secondary to nasal valve collapse (NVC) following minimally invasive temperature-controlled radiofrequency (TCRF) treatment. Methods A prospective, single-arm, multicenter study in patients >18 years with NAO due to NVC. Inclusion criteria were response to nasal valve dilation (e.g., modified Cottle maneuver) and baseline Nasal Obstruction Symptom Evaluation (NOSE) Scale score ≥60. Patients were treated in the nasal valve region with a TCRF device and followed through 2 years. A responder was ≥20% reduction NOSE Scale score or ≥1 reduction in severity class. Results A total of 122 patients were treated and 91 reached 2 years. The mean baseline NOSE Scale score was 80.3 (95% CI, 78.1-82.6). The adjusted mean change in score at 2 years was -45.8 (95% CI, -53.5 to -38.1), p < 0.001; a 57.0% improvement. The 2-year responder rate was 90.1% (95% CI, 82.3%-94.7%). Significant and sustained symptom improvement was achieved in subpopulations based on sex, age, body mass index, baseline NAO severity, nasal surgery history, NVC mechanism, septal deviation, and other anatomic contributors of NAO. No serious adverse events with a relationship to the study device and/or procedure were reported. Conclusions Minimally invasive TCRF device treatment of the internal nasal valve for NAO is well tolerated and leads to significant and sustained improvement in NAO symptom severity through 2 years, including in patients with both static and dynamic NVC, septal deviation, turbinate enlargement, or prior nasal surgery. Level of Evidence 2b.
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Affiliation(s)
- William C. Yao
- Department of Otorhinolaryngology‐Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science CenterHoustonTexasUSA
| | | | | | - Henry P. Barham
- Sinus and Nasal Specialists of LouisianaBaton RougeLouisianaUSA
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5
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Asi KW, Cameron BH, Friedman ER, Radabaugh JP, Citardi MJ, Luong AU, Yao WC. Dural sinus narrowing in patients with spontaneous anterior skull base cerebrospinal fluid leak. Laryngoscope Investig Otolaryngol 2023; 8:621-626. [PMID: 37342101 PMCID: PMC10278120 DOI: 10.1002/lio2.1063] [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: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023] Open
Abstract
Objectives Current evidence suggests a link between idiopathic intracranial hypertension (IIH) and spontaneous cerebrospinal fluid (sCSF) leak, as well as between IIH and dural venous sinus (DVS) narrowing. However, there are limited data linking DVS narrowing and sCSF leak. This study aims to determine the prevalence of DVS narrowing in patients with sCSF leak. Methods A retrospective review of all patients with sCSF leak that presented to a tertiary academic center from 2008 to 2019. Preoperative imaging was independently reviewed by two neuroradiologists to evaluate for DVS narrowing. Available literature was used to estimate the prevalence of DVS narrowing in the general population to allow for comparison. Data were analyzed using Exact binomial test. Results Analysis of 25 patients with appropriate imaging revealed the majority were women (21/25, 84%) with a mean age of 51.89 years (SD 13.96). The majority of these patients were found to have narrowing of the DVS (20/25, 80%). In patient with sCSF leaks, there was a significantly higher proportion of patients with DVS narrowing compared with published literature examining this condition in the general population (80% vs. 40%, CI 0.59-0.93, p < .001). Conclusion The prevalence of DVS narrowing in patients with sCSF leaks is substantial and likely greater than the general population. Moreover, there appears to be narrowing in most patients with sCSF leak. Preoperative radiological evaluation of the DVS using MR venography may be useful in patients with sCSF leaks as DVS stenosis may be an underdiagnosed etiology. Further study is needed to evaluate this. Level of Evidence IV.
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Affiliation(s)
- Karim W. Asi
- Department of Otorhinolaryngology‐Head and Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Brian H. Cameron
- Department of Otorhinolaryngology‐Head and Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | | | | | - Martin J. Citardi
- Department of Otorhinolaryngology‐Head and Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Amber U. Luong
- Department of Otorhinolaryngology‐Head and Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - William C. Yao
- Department of Otorhinolaryngology‐Head and Neck Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTexasUSA
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Trimble DJ, Dawes BH, Zeineddine HA, Guttenberg KB, Yao WC, Bhattacharjee M, Blackburn SL. Neurofibroma of the internal carotid artery cavernous sympathetic plexus: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE2375. [PMID: 37070686 PMCID: PMC10550638 DOI: 10.3171/case2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Intracranial carotid sympathetic plexus (CSP) nerve sheath tumors have rarely been reported in the literature. This study describes the first reported case of a CSP neurofibroma and the first case of a CSP nerve sheath tumor treated via an endoscopic endonasal approach followed by adjuvant radiosurgery. OBSERVATIONS A 53-year-old man presented with 3 days of headaches and diplopia and was found to have a complete left abducens nerve palsy. Computed tomography (CT) revealed a smoothly dilated left carotid canal, CT angiography revealed a superiorly displaced left internal carotid artery (ICA), and magnetic resonance imaging revealed a T2-hyperintense and avidly enhancing lesion in the left cavernous sinus encasing the ICA. The patient underwent subtotal resection via an endoscopic transsphenoidal transcavernous approach followed by Gamma Knife radiosurgery. LESSONS Nerve sheath tumors arising from the CSP are extremely rare but need to be considered when assessing unusual cavernous sinus lesions. The clinical presentation is dependent on the anatomical location of the tumor and its relationship to the ICA. The optimal treatment paradigm is unknown.
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Affiliation(s)
| | | | | | | | | | - Meenakshi Bhattacharjee
- Pathology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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7
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Tang DM, Grafmiller K, Sreenath SB, Wu A, Yao WC, Sindwani R. Improving the Accuracy of Maxillary Sinus Balloon Dilation Using Virtual Reality Navigation: A Proof-of-Concept Study. Am J Rhinol Allergy 2023:19458924231164844. [PMID: 36949553 DOI: 10.1177/19458924231164844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The ability to reliably and accurately cannulate the natural ostium of the maxillary sinus during balloon sinus dilation (BSD) has been criticized. Conventional computed tomography (CT)-guided navigation systems are helpful when dilating other sinuses, but they fail to provide meaningful feedback to guide accurate dilation of the maxillary sinus. OBJECTIVE This study explores the potential impact of a new navigation system with virtual reality (VR) functionality on successful BSD of the maxillary sinus. METHODS Using the established methodology, a cadaveric evaluation of the accuracy of maxillary BSD with a VR-equipped navigation system and balloon was undertaken. The natural ostium was landmarked on CT images with a beacon, and a VR intrasinus camera view was used to guide balloon dilation by a team of 2 rhinologists. Following the procedure, uncinectomies were performed to directly assess the accuracy of dilation. Standardized video clips with a 30° endoscopic view of the area were reviewed by 3 blinded rhinologists from different institutions who were not part of the procedures. Dilation of the natural ostium was scored as "successful," "unsuccessful," or "unsure." RESULTS Sixteen maxillary BSDs were completed in 8 cadavers using VR navigation. The medial wall of the maxillary sinus showing the natural ostium as well as any accessory ostia were readily visualized and labeled with a beacon in all cases using the 3D virtual rendering feature. Dilations were scored using a standardized rubric. Any "unsure" responses from the reviewers were categorized as "unsuccessful" for analysis purposes. The accuracy rate for dilation of the maxillary sinus natural ostium was 77%. Despite the use of cadaveric tissues, a fair interrater agreement (kappa 0.21) was achieved. CONCLUSION Using VR navigation appears to improve the accuracy of cannulating the natural ostium during maxillary BSD, which could lead to better outcomes. Further study in live subjects is warranted.
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Affiliation(s)
- Dennis M Tang
- Department of Otolaryngology-Head and Neck Surgery, 5149Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin Grafmiller
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, California
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, 12250Indiana University, Indianapolis, Indiana
| | - Arthur Wu
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles Medical Center, Los Angeles, California
| | - William C Yao
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Houston, Houston, Texas
| | - Raj Sindwani
- 2569Cleveland Clinic Foundation, Head and Neck Institute, Cleveland, Ohio
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8
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Ahmad JG, Citardi AJ, Luong AU, Yao WC. Three-Dimensional Printed Models to Accelerate Resident Surgical Learning Curve for Standard Endoscopic Sinus Surgery Techniques. Ear Nose Throat J 2022:1455613221120049. [PMID: 35953445 DOI: 10.1177/01455613221120049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Endoscopic sinus surgery presents significant visuospatial challenges to surgical trainees. We tested the utility of novel 3D printed models to simulate sinus surgery tasks to improve endoscopic skillsets in resident trainees. Methods: This was a prospective quality improvement study of 10 ENT residents (PGY1-5). Participants rotated through 4 stations with different 3D simulation training modules designed to enhance endoscopic skillsets in the axial, sagittal and coronal planes (e.g., straight forceps to grasp a bead from a ledge, angled instruments to cannulate openings). Participants completed a self-assessment survey on the subjective sinus surgical skills using a visual analog scale before and after tasks. Two- tailed paired T-tests were used to analyze the data. Results: All residents rated their post-intervention "overall sinus surgery skills" higher than pre-intervention. They rated simulations to provide more significant utility as an adjunct to surgical education after the intervention. All but one participant reported improved spatial awareness working with the endoscopes and surgical instruments. There was subjectively improved proficiency in using 0-degree and angled endoscopes as well as cutting, grasping, and curved instruments after the intervention. The simulations led to subjective improvements in spatial awareness, bimanual dexterity, and increased confidence in selecting correct surgical instruments. Conclusion: Our set of novel 3D printed models to improve sinus surgery skillset was well accepted by the resident cohort. The 3D models can serve as an adjunct tool to traditional residency education.
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Affiliation(s)
- Jumah G Ahmad
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Alexander J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
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Liu MY, Gardner JR, Woodworth BA, Jang DW, Kanaan A, Radabaugh JP, Yao WC, Goros M, Challa M, Grayson JW, Wang Z, Chen PG. Individual SNOT-22 Items Aid in Differentiating Between Spontaneous Cerebrospinal Fluid Rhinorrhea and Chronic Rhinosinusitis Without Nasal Polyps. Ann Otol Rhinol Laryngol 2022; 132:698-704. [PMID: 35833241 DOI: 10.1177/00034894221111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a diagnostic challenge due to its overlapping symptomatology with other sinonasal diseases. The objective of this study was to investigate whether items on the sinonasal outcome test (SNOT)-22 could suggest a diagnosis of spontaneous CSF rhinorrhea versus chronic rhinosinusitis without nasal polyps (CRSsNP). METHODS A multi-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea and a control group of CRSsNP patients was performed. Individual SNOT-22 scores and domain scores were compared. RESULTS One hundred fifteen patients were included in both cohorts. Of the patients in the CSF rhinorrhea group, 48% were misdiagnosed as chronic rhinosinusitis (CRS) prior to the correct identification of a CSF leak. On bivariate analysis, the CSF rhinorrhea group scored significantly higher on the SNOT-22 for runny nose (P < .001) and was more likely to designate this symptom as most important (P < .001). The CRSsNP group scored significantly higher in nasal blockage (P < .001), thick nasal discharge (P < .001), facial pain/pressure (P < .001), and in the ear/facial (P < .001) and rhinologic (P = .003) domains. Multivariable logistic regression revealed that runny nose (P < .001) was most predictive of spontaneous CSF rhinorrhea while nasal blockage (P < .001), thick nasal discharge (P < .001), and facial pain/pressure (P = .001) were predictive of CRSsNP after adjusting for relevant confounders. No significant difference was observed in total SNOT-22 scores between groups (P = .676). CONCLUSIONS Spontaneous CSF rhinorrhea is commonly misdiagnosed as other sinonasal pathologies. However, individual SNOT-22 items can help aid in suggesting a CSF leak. Spontaneous CSF rhinorrhea should be suspected in patients who have high SNOT-22 scores for runny nose and report this symptom as most important, but have lower scores related to the other cardinal symptoms of CRS.
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Affiliation(s)
- Matthew Y Liu
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - James Reed Gardner
- Division of Rhinology and Allergy, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Bradford A Woodworth
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David W Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
| | - Alissa Kanaan
- Division of Rhinology and Allergy, Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
| | - Jeffrey Paul Radabaugh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Martin Goros
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Megana Challa
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jessica W Grayson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhu Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Philip G Chen
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
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10
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Saini AT, Jiang ZY, Starr NC, Talmadge J, Schmale I, Radabaugh P, Yao WC, Luong AU, Citardi MJ. Are NSAIDs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty: A randomized controlled study. Int Forum Allergy Rhinol 2021; 12:910-916. [PMID: 34936232 DOI: 10.1002/alr.22941] [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] [Received: 03/07/2021] [Revised: 10/21/2021] [Accepted: 12/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) and septoplasty are commonly performed procedures without standardized post-operative pain regimens. There is reluctance to prescribe opioids for postoperative pain given their potential for abuse. NSAIDS have been previously demonstrated to reduce or even obviate the need for opioid pain medications after otolaryngologic surgeries, but prospective validation is lacking. METHODS A randomized controlled study comparing the efficacy of diclofenac sodium to hydrocodone/acetaminophen (APAP) following ESS with or without septoplasty was performed. Participants were given a 100 mm visual analog pain scale (VAS) at postoperative day (POD) 1, 2, 3, and 5 following ESS. Two-sample t-tests were used to compare pain scores between groups. RESULTS One hundred patients enrolled, and 74 patients provided pain scores to the survey. Pain was greatest for both groups on postoperative day one. Treatment with diclofenac sodium versus hydrocodone/APAP did not statistically impact pain scores at POD 1, 2, 3, or 5. No cases of epistaxis requiring an emergency room visit or return to the operating room were noted during the study period. CONCLUSIONS Diclofenac sodium may be non-inferior to hydrocodone/APAP in treating pain after ESS with or without septoplasty in opioid naïve patients without preexisting pain conditions. Further studies with larger samples are warranted to investigate the potential superiority of diclofenac to hydrocodone/APAP in certain patients after ESS and septoplasty. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alok T Saini
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Zi Y Jiang
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicole C Starr
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jason Talmadge
- Department of Otolaryngology and Communicative Sciences, Medical College of Wisconsin, Kenosha, Wisconsin, USA
| | - Isaac Schmale
- Department of Otolaryngology - Head and Neck Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Paul Radabaugh
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology - Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Radabaugh JP, Asi K, Jiang ZY, Jayavelu S, Yao WC, Luong AU, Citardi MJ. Assessing the utility of intrathecal fluorescein in endoscopic repair of anterior skull base cerebrospinal fluid leaks. Int Forum Allergy Rhinol 2021; 12:967-970. [PMID: 34910851 DOI: 10.1002/alr.22947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/15/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022]
Affiliation(s)
- J Paul Radabaugh
- Baptist Medical Center Jacksonville, Department of Otolaryngology, Jacksonville, FL, USA.,The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
| | - Karim Asi
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
| | - Zi Y Jiang
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
| | - Swetha Jayavelu
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
| | - William C Yao
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
| | - Amber U Luong
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Martin J Citardi
- The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Otorhinolaryngology - Head and Neck Surgery, Houston, TX, USA
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12
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Schmale IL, Yao WC, Citardi MJ. Hydraulic dissection technique during endoscopic sinus surgery using a novel balloon sinus dilation device. Laryngoscope Investig Otolaryngol 2021; 6:899-903. [PMID: 34667831 PMCID: PMC8513423 DOI: 10.1002/lio2.638] [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: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than a decade after its introduction, some rhinologic surgeons have incorporated the technique of balloon sinus dilation (BSD) technology into "hybrid" endoscopic sinus surgery (ESS) procedures. A novel BSD device which can be placed over standard surgical instruments, including surgical navigation instruments, has recently been introduced. We present a case series in which this device was used as a hydraulic dissection tool to aid safe efficient surgery in difficult-to-access locations of the paranasal sinuses during hybrid ESS procedures. OBJECTIVE Highlight the potential role of hydraulic dissection techniques during ESS utilizing BSD. METHODS Retrospective case series of patients who underwent ESS performed in part with a novel BSD device. RESULTS A total of 10 patients who underwent hybrid ESS with BSD were reviewed. In all 10 cases, the novel BSD device was used without complication. The device was used over straight and curved suctions while being tracked with surgical navigation in all cases. Thirteen posterior ethmoid dissections, 12 sphenoidotomies, and 8 frontal sinusotomies were assisted with the device. For the selected dissections in which the balloon was utilized, the operating surgeon found it to be helpful in creating more space in difficult to access areas which allowed for continued safe surgical dissection. CONCLUSIONS Sinus balloon devices can be used as a hydraulic dissection tool and may be a useful adjunct during ESS. The novel dilation system used in this study, which deploys a sinus balloon device over standard surgical instruments with surgical navigation, provides even more opportunity to accurately dissect difficult areas of the paranasal sinuses safely and efficiently. Further studies evaluating the exact role of sinus balloon devices used as a hydraulic dissection tool during ESS are warranted. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Isaac L. Schmale
- Department of Otolaryngology Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - William C. Yao
- Department of OtorhinolaryngologyMcGovern Medical School, The University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Martin J. Citardi
- Department of OtorhinolaryngologyMcGovern Medical School, The University of Texas Health Science Center at HoustonHoustonTexasUSA
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13
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Jiang ZY, Huang Z, Schmale I, Brown EL, Lorenz MC, Patlovich SJ, Goswami K, Wilson HB, Ahmad J, Alexander R, Bryan W, Burke L, Citardi MJ, Elias J, Ho T, Jacob J, Low G, Miramón P, Patki AU, Yao WC, Luong AU. N95 respirator reuse, decontamination methods, and microbial burden: A randomized controlled trial. Am J Otolaryngol 2021; 42:103017. [PMID: 33857782 DOI: 10.1016/j.amjoto.2021.103017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effectiveness and ease of N95 respirator decontamination methods in a clinic setting and to identify the extent of microbial colonization on respirators associated with reuse. METHODS In a prospective fashion, N95 respirators (n = 15) were randomized to a decontamination process (time, dry heat, or ultraviolet C light [UVC]) in outpatient clinics. Each respirator was re-used up to 5 separate clinic sessions. Swabs on each respirator for SARS-CoV-2, bacteria, and fungi were obtained before clinic, after clinic and post-treatment. Mask integrity was checked after each treatment (n = 68). Statistical analyses were performed to determine factors for positive samples. RESULTS All three decontamination processes reduced bacteria counts similarly. On multivariate mixed model analysis, there were an additional 8.1 colonies of bacteria (95% CI 5.7 to 10.5; p < 0.01) on the inside compared to the outside surface of the respirators. Treatment resulted in a decrease of bacterial load by 8.6 colonies (95% CI -11.6 to -5.5; p < 0.01). Although no decontamination treatment affected the respirator filtration efficiency, heat treatments were associated with the breakdown of thermoplastic elastomer straps. Contamination with fungal and SARS-CoV-2 viral particles were minimal to non-existent. CONCLUSIONS Time, heat and UVC all reduced bacterial load on reused N95 respirators. Fungal contamination was minimal. Heat could permanently damage some elastic straps making the respirators nonfunctional. Given its effectiveness against microbes, lack of damage to re-treated respirators and logistical ease, UVC represents an optimal decontamination method for individual N95 respirators when reuse is necessary.
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Radabaugh JP, Richani-Riverol K, Luong AU, Yao WC, Ho T, Citardi MJ. Transorbital-transsinus resection of sinonasal malignancy with extraconal orbital extension. Int Forum Allergy Rhinol 2021; 12:128-131. [PMID: 34259384 DOI: 10.1002/alr.22859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey Paul Radabaugh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Karina Richani-Riverol
- Ruiz Department of Ophthalmology and Visual Science, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Tang Ho
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
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15
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Schmale IL, Yao WC, Luong AU, Citardi MJ. The role of CT and endoscopy in the evaluation of patients referred for intranasal Cryoablation. Am J Otolaryngol 2021; 42:102971. [PMID: 33667795 DOI: 10.1016/j.amjoto.2021.102971] [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: 02/01/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cryoablation (CA) of the posterior nasal nerves has garnered increasing interest as an office-based procedure for chronic rhinitis (CR). Standardized preoperative evaluation, specifically the role of computed tomography (CT) and nasal endoscopy, has yet to be defined. We report a series of patients who underwent CT and endoscopy as part of CR work-up in patients referred for CA. OBJECTIVE Highlight the importance of both nasal endoscopy and CT scan in the evaluation of CR given significant overlap of symptoms and common occurrence of related sinonasal conditions. METHODS Retrospective analysis of all patients referred to a single tertiary rhinology practice for CA was performed. RESULTS Fifteen patients were sent for CA by medical allergists. Five patients were deemed CA candidates, and 1 patient received only medical CR treatment. Four patients had evidence of incomplete prior sinus surgery and/or continued chronic rhinosinusitis on endoscopic exam. These 4 patients received a combination of medical and surgical management with either complete resolution or improvement in CR symptoms. In 3 patients, CT confirmed chronic rhinosinusitis that was not apparent on endoscopy, and received a combination of medical and surgical management with symptom improvement. In the last two patients, final diagnoses were nasal valve collapse and recurrent acute rhinosinusitis. CONCLUSIONS Referrals for CA are becoming more common and the optimal preoperative work up remains unclear. In this limited retrospective review, 67% of patients had diagnoses other than CR and thus were not deemed candidates for CA. Both CT and endoscopy are complementary to a detailed history and physical examination and can aid in CA candidate selection.
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Affiliation(s)
- Isaac L Schmale
- Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America.
| | - William C Yao
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Amber U Luong
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Martin J Citardi
- Department of Otorhinolaryngology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States of America
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16
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Talmadge J, Jiang ZY, Zebda DA, Yao WC, Luong AU, Citardi MJ. Contour Map Point Distribution and Surgeon Experience Level Affect Accuracy of Surgical Navigation in a Pilot Study. Ann Otol Rhinol Laryngol 2021; 131:397-402. [PMID: 34121472 DOI: 10.1177/00034894211005982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reliable use of surgical navigation depends upon the registration process. The gold standard is paired-point registration with bone-anchored fiducials, but contour-map registration is more practical. Surgeons may employ variable contour maps and less experienced team members often perform this critical step. The impact of these practices on target registration error (TRE) is not well-studied. METHODS A dry lab set-up consisting of a navigation system (Fusion ENT, Medtronic, Jacksonville, FL) and a sinus phantom with 2 mm radiopaque spheres in the sphenoid and ethmoid regions was developed. A CT (0.625 mm slice thickness) was obtained. Registration was performed with a contour-based protocol. Accuracy was determined using the software's distance measurement tool. Registration was performed with narrow-field (NF; forehead points medial to the mid-pupillary line) and wide field (WF; entire forehead) contour maps. An experienced rhinologist and a resident surgeon performed each registration in triplicate and TRE at the sphenoid and ethmoid markers was measured in triplicate. RESULTS WF mapping had a lower TRE than NF (1.09 mm [95% Confidence Interval (CI) 0.96-1.22] vs 1.68 mm [95% CI 1.50-1.86]). The experienced surgeon had a lower TRE compared to the resident (1.21 mm [95% CI 1.08-1.34] vs 1.54 mm [95% CI 1.35-1.74]). CONCLUSIONS In this navigation model, wide field mapping offers better accuracy than narrow-field mapping, and an experienced surgeon seemed to achieve better accuracy than a resident surgeon. These observations have potential implications for the use of this technology in the operating room.
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Affiliation(s)
- Jason Talmadge
- Department of Otolaryngology & Communication Sciences, The Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Denna A Zebda
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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17
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Tyler MA, Lam K, Marino MJ, Yao WC, Schmale I, Citardi MJ, Luong AU. Revisiting the controversy: The role of fungi in chronic rhinosinusitis. Int Forum Allergy Rhinol 2021; 11:1577-1587. [PMID: 34076362 DOI: 10.1002/alr.22826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022]
Abstract
In the last two decades, the development of culture-independent genomic techniques has facilitated an increased appreciation of the microbiota-immunity interactions and their role in a multitude of chronic inflammatory diseases such as chronic rhinosinusitis (CRS), asthma, inflammatory bowel disease and dermatitis. While the pathologic role of bacteria in chronic inflammatory diseases is generally accepted, the understanding of the role of fungi remains controversial. Chronic rhinosinusitis, specifically the phenotype linked to nasal polyps, represents a spectrum of chronic inflammatory diseases typically characterized by a type 2 immune response. Studies on the microbiota within sinus cavities from healthy and diseased patients have focused on the bacterial community, mainly highlighting the loss of diversity associated with sinus inflammation. Within the various CRS with nasal polyps (CRSwNP) phenotypes, allergic fungal rhinosinusitis presents an opportunity to investigate the role of fungi in chronic type 2 immune responses as well as the antifungal immune pathways designed to prevent invasive fungal diseases. In this review, we examine the spectrum of fungi-associated sinus diseases highlighting the interaction between fungal species and host immune status on disease presentation. With a focus on fungi and type 2 immune response, we highlight the current knowledge and its limitations of the sinus mycobiota along with cellular interactions and activated molecular pathways linked to fungi.
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Affiliation(s)
- Matthew A Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota School of Medicine, Minnesota, Minneapolis, USA
| | - Kent Lam
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Virginia, Norfolk, USA
| | - Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Isaac Schmale
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester, Rochester, New York, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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18
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Chen PG, Levy JM, Choby G, Smith K, Yao WC, Halderman A, Oakley GM, Brunworth J, Alt JA. Characterizing the complexity of frontal endoscopic sinus surgery: a multi-institutional, prospective, observational trial. Int Forum Allergy Rhinol 2020; 11:941-945. [PMID: 33275315 DOI: 10.1002/alr.22746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 11/14/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | - Kristine Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Ashleigh Halderman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
| | - Gretchen M Oakley
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Joseph Brunworth
- Department of Otolaryngology-Head and Neck Surgery, St Louis University Hospital, St Louis, MO
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
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19
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Gong SW, Ahmadi S, Blackburn SL, Ulin L, Citardi MJ, Luong A, Yao WC. Sniffin' Sticks to Measure Olfactory Function and Recovery Following Bilateral Superior Turbinate Resection as Part of Endoscopic Transsphenoidal Approach. Ann Otol Rhinol Laryngol 2020; 130:636-642. [PMID: 33084356 DOI: 10.1177/0003489420965621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extended endoscopic transsphenoidal (EET) approaches can include complete resection of both superior turbinate (ST) for wider exposure. Moreover, ST resection has been associated with postoperative olfactory impairment. OBJECTIVE We sought to determine the impact of bilateral ST resection on olfaction during a transsphenoidal approach. METHOD A prospective observational study was conducted on 29 patients undergoing endoscopic skull base surgery sparing the olfactory tracts at a tertiary academic center. Olfactory function was measured with Sniffin' Sticks at the preoperative visit, 2-weeks and 6 to 8 weeks postoperatively. All components: odor threshold (OT), odor discrimination (OD), odor identification (OI) and composite scores (TDI = OT+OD+OI) were evaluated. RESULT Study was completed in 15 patients with 14 excluded due to a variety of reasons. At 2 weeks, a significant decrease was noted in composite scores (32.3 ± 5.4 vs. 23.8 ± 5.8, P < .05) and OT (7.7 vs. 3.2, P < .05). There was a significant increase in olfactory scores between post-op weeks 2 and 6 to 8 weeks in TDI (23.8 vs. 31.4, P < .05) as well as in OT (3.2 vs. 7.6, P < .05), OD (9.4 vs. 11.1, P < .05), and OI (11.1 vs. 12.7, P < .05). No significant difference was found between TDI (32.3 ± 5.4 vs. 31.4 ± 5.1), OT (7.7 vs. 7.6), OD (11.4 vs. 11.1) and OI (13.2 vs. 12.7) from preoperative and 6-8 weeks postoperative visits. CONCLUSION Patients undergoing bilateral ST resection during EET procedures experience transient hyposmia postoperatively. However, the olfactory function normalizes to preoperative levels at 6 to 8 weeks. The resection of the bilateral superior turbinate does not appear to decrease olfactory function.
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Affiliation(s)
- Shaina W Gong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - Sorour Ahmadi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - Spiros L Blackburn
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - Lindsey Ulin
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - Amber Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, TX, USA
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LeConte B, Low GMI, Citardi MJ, Yao WC, Eguia AA, Luong AU. Aerosol generation with common rhinologic devices: cadaveric study conducted in a surgical suite. Int Forum Allergy Rhinol 2020; 10:1261-1263. [PMID: 32767719 PMCID: PMC7436219 DOI: 10.1002/alr.22679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Bailey LeConte
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Garren M I Low
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Arturo A Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
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21
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Lu G, Shiver TM, Blackburn SL, Yao WC, Bhattacharjee MB, Zhu JJ. Full Remission of Long-Term Premenstrual Dysphoric Disorder-Like Symptoms Following Resection of a Pituitary Adenoma: Case Report. Am J Case Rep 2020; 21:e922797. [PMID: 32769963 PMCID: PMC7440754 DOI: 10.12659/ajcr.922797] [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] [Indexed: 11/30/2022]
Abstract
Patient: Female, 44-year-old Final Diagnosis: Pituitary adenoma Symptoms: Depression and anxiety Medication:— Clinical Procedure: — Specialty: Neurosurgery • Psychiatry
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Affiliation(s)
- Guangrong Lu
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth®), McGovern Medical School, Houston, TX, USA
| | - Tiana M Shiver
- Internal Medicine and Endocrinology, Memorial Hermann Texas Medical Center, Houston, TX, USA
| | - Spiros L Blackburn
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth®), McGovern Medical School, Houston, TX, USA
| | - William C Yao
- Department Otorhinolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at Houston (UTHealth®), McGovern Medical School, Houston, TX, USA
| | - Meenakshi B Bhattacharjee
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston (UTHealth®), McGovern Medical School, Houston, TX, USA
| | - Jay-Jiguang Zhu
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth®), McGovern Medical School, Houston, TX, USA
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Christopherson DA, Yao WC, Lu M, Vijayakumar R, Sedaghat AR. High-Efficiency Particulate Air Filters in the Era of COVID-19: Function and Efficacy. Otolaryngol Head Neck Surg 2020; 163:1153-1155. [DOI: 10.1177/0194599820941838] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aerosol-generating procedures in the office represent a major concern for health care–associated infection of patients and health care providers by SARS-CoV-2, the causative agent for coronavirus disease 2019 (COVID-19). Although the Centers for Disease Control and Prevention has not yet provided any recommendations for the use of portable air purifiers, air purifiers with high-efficiency particulate air (HEPA) filters have been discussed as an adjunctive means for decontamination of SARS-CoV-2 aerosols in health care settings. This commentary discusses HEPA filter mechanisms of action, decontamination time based on efficiency and flow rate, theoretical application to SARS-CoV-2, and limitations. HEPA filter functionality and prior guidance from the Centers for Disease Control and Prevention for SARS-CoV-1 suggest theoretical efficacy for HEPA filters to decontaminate airborne SARS-CoV-2, although direct studies for SARS-CoV-2 have not been performed. Any portable HEPA purifier utilization for SARS-CoV-2 should be considered an adjunctive infection control measure and undertaken with knowledge of HEPA filter functionality and limitations in mind.
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Affiliation(s)
- David A. Christopherson
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - William C. Yao
- Department of Otorhinolaryngology–Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mingming Lu
- Department of Chemical and Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Ahmad R. Sedaghat
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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23
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Zebda D, Jiang ZY, Gibson MM, Pham C, Ahmadi S, Floren S, Yao WC, Citardi MJ, Luong AU. Double-blinded randomized prospective trial of intranasal capsaicin treatment for nonallergic rhinitis. Int Forum Allergy Rhinol 2020; 11:24-30. [PMID: 33045140 DOI: 10.1002/alr.22637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nonallergic rhinitis (NAR) is currently a diagnosis of exclusion with an unclear pathophysiologic mechanism and limited treatment options. In patients diagnosed with NAR based on symptoms, negative skin testing and positive optical rhinometry (ORM), the study's objective was to evaluate the therapeutic action of intranasal capsaicin in the management of rhinitic symptoms and the effect on ORM readings. METHODS Patients with a history of NAR underwent screening by a diagnostic intranasal capsaicin challenge with ORM and skin-prick testing. Twenty-two NAR patients were enrolled and randomized to either treatment with 0.1mM capsaicin (n = 11) or placebo (n = 11). Treatment consisted of 5 consecutive intranasal applications separated by 1 hour with follow-up at 4 and 12 weeks. At each visit, subjects underwent intranasal capsaicin challenge with ORM reading and a visual analog scale scoring of rhinitis symptoms. RESULTS Treatment with intranasal capsaicin resulted in a median change with improvement in total symptom score (TSS) of -5 from baseline vs an increase of 2 with placebo at 4 weeks, which remained significantly different between the groups at 12 weeks (p = 0.03). At 12 weeks posttreatment, 60% of the intervention group vs 80% of placebo-treated patients still met objective criteria for NAR by ORM. CONCLUSION Using ORM in the objective diagnosis of NAR, this trial showed that intranasal 0.1mM capsaicin not only improved rhinitic symptoms but also objectively reduced nasal reactivity and nasal congestion with a 40% responder rate at 12 weeks as noted by ORM.
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Affiliation(s)
- Denna Zebda
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Micah M Gibson
- Department of Otolaryngology, Emory University, Atlanta, GA
| | | | - Sorour Ahmadi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Samuel Floren
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX
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Schmale IL, Vandelaar LJ, Luong AU, Citardi MJ, Yao WC. Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art. Ear Nose Throat J 2020; 100:NP475-NP486. [PMID: 32453646 DOI: 10.1177/0145561320928202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not changed, advances in image guidance technology, including the incorporation of intraoperative imaging, have the potential to enhance surgical education, allow for more rigorous preoperative planning, and aid in more complete surgery with improved outcomes. OBJECTIVES Provide a clinical update regarding the use of image guidance and intraoperative imaging in the field of rhinology and endoscopic skull base surgery with a focus on current state of the art technologies. METHODS English-language studies published in PubMed, Cochrane, and Embase were searched for articles relating to image-guided sinus surgery, skull base surgery, and intraoperative imaging. Relevant studies were reviewed and critical appraisals were included in this clinical update, highlighting current state of the art advances. CONCLUSIONS As image guidance and intraoperative imaging systems have advanced, their applications in sinus and skull base surgery have expanded. Both technologies offer invaluable real-time feedback on the status and progress of surgery, and thus may help to improve the completeness of surgery and overall outcomes. Recent advances such as augmented and virtual reality offer a window into the future of IGS. Future advancements should aim to enhance the surgeon's operative experience by improving user satisfaction and ultimately lead to better surgical results.
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Affiliation(s)
- Isaac L Schmale
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Laura J Vandelaar
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
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Vandelaar LJ, Jiang ZY, Saini A, Yao WC, Luong AU, Citardi MJ. PHQ-9 and SNOT-22: Elucidating the Prevalence of Depression in Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2019; 162:142-147. [PMID: 31711363 DOI: 10.1177/0194599819886852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) has been associated with comorbid depression, yet the prevalence of depression among all patients with CRS is not well described. The Patient Health Questionnaire-9 (PHQ-9), a validated instrument for diagnosing depression, has been used to assess depression in a variety of clinical settings. PHQ-9 scores ≥10 are the threshold for a depression diagnosis. The purpose of this study was to assess the prevalence of depression in a rhinology practice and compare the PHQ-9 with the 22-item Sinonasal Outcome Test (SNOT-22). STUDY DESIGN Retrospective chart review. SETTING Tertiary rhinology practice. SUBJECTS AND METHODS During the 2-month period ending April 30, 2018, all rhinology patients were asked to complete the PHQ-9 and SNOT-22. RESULTS Among 216 patients, 46 (21.3%) had a self-reported history of depression, and 39 (18.1%) had a PHQ-9 score ≥10. Of the 39 patients screening positive for depression, 18 (41.9%) had no history of depression. Comparison of PHQ-9 with overall SNOT-22 score had a Pearson's coefficient of 0.632 (P < .005). Logistic regression showed that the highest 2 quintiles of SNOT-22 scores had an odds ratio of 60.6 (95% CI, 9.7-378.3) for a positive depression screen (PHQ-9 score ≥10). CONCLUSION Depression rates (estimated by PHQ-9 responses) among rhinology patients are similar to chronic disease populations; depression may be underdiagnosed in rhinology patients. Higher SNOT-22 scores were associated with higher PHQ-9 scores. Further studies are warranted to understand the impact of comorbid conditions of depression and CRS in patient quality of life.
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Affiliation(s)
- Laura J Vandelaar
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alok Saini
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Vandelaar LJ, Hanson B, Marino M, Yao WC, Luong AU, Arias CA, Ramakrishnan V, Citardi MJ. Analysis of Sinonasal Microbiota in Exacerbations of Chronic Rhinosinusitis Subgroups. OTO Open 2019; 3:2473974X19875100. [PMID: 31555757 PMCID: PMC6749786 DOI: 10.1177/2473974x19875100] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Microbiome analyses now allow precise determination of the sinus microbiota of patients with exacerbations of chronic rhinosinusitis (CRS). The aim of this report is to describe the sinus microbiota of acute exacerbations in CRS clinical subgroups (with nasal polyps [CRSwNP], without nasal polyps [CRSsNP], and allergic fungal rhinosinusitis [AFRS]). Study Design Retrospective chart review. Setting Tertiary rhinology practice. Subjects and Methods A retrospective review was performed of all patients whose sinus microbiota were assayed via a commercially available microbiome technology during an acute CRS exacerbation during the 2-year period ending December 31, 2016. All samples were sinus aspirates collected under endoscopic visualization in clinic. Results Samples from a total of 134 patients (65 CRSsNP, 55 CRSwNP, and 14 AFRS) were reviewed. The observed richness (number of taxa >2% relative abundance) ranged between 1 and 11 taxa, with an average of 3 taxa per specimen. The most common bacteria in all groups were Staphylococcal spp (including Staphylococcus aureus), Streptococcus spp, Pseudomonas spp, and Escherichia spp. S aureus had an increased prevalence in CRSsNP and AFRS as compared with CRSwNP. Otherwise, the sinus microbiota were markedly similar among all 3 clinical subgroups. Conclusions Many bacterial types are identified during acute CRS exacerbation according to DNA-based detection techniques. Bacterial richness was remarkably low in all samples. Few differences in the patterns among clinical subgroups were observed. Further investigation is warranted to determine the clinical significance of these observations and their role in current clinical algorithms.
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Affiliation(s)
- Laura J Vandelaar
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Blake Hanson
- Department of Epidemiology, Human Genetics & Environment Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, Department of Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Cesar A Arias
- Department of Epidemiology, Human Genetics & Environment Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, Department of Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Vijay Ramakrishnan
- Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Haider AA, Marino MJ, Yao WC, Citardi MJ, Luong AU. The Potential of High-Throughput DNA Sequencing of the Paranasal Sinus Microbiome in Diagnosing Odontogenic Sinusitis. Otolaryngol Head Neck Surg 2019; 161:1043-1047. [PMID: 31382814 DOI: 10.1177/0194599819866692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
OBJECTIVE High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin. STUDY DESIGN Case series with chart review. SETTING Single tertiary care academic medical center. SUBJECTS AND METHODS A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane. RESULTS Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%). CONCLUSION This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis.
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Affiliation(s)
- Asad A Haider
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael J Marino
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,McGovern Medical School, The University of Texas Health Science Center at Houston, Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, Houston, Texas, USA
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Dietz CJ, Sun H, Yao WC, Citardi MJ, Corry DB, Luong AU. Aspergillus fumigatusinduction of IL‐33 expression in chronic rhinosinusitis is PAR2‐dependent. Laryngoscope 2019; 129:2230-2235. [DOI: 10.1002/lary.28000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Caroline J. Dietz
- Department of Otolaryngology–Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
- the Center for Immunology and Autoimmune Diseases, Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
| | - Hua Sun
- Department of Otolaryngology–Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
- the Center for Immunology and Autoimmune Diseases, Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
| | - William C. Yao
- Department of Otolaryngology–Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
| | - Martin J. Citardi
- Department of Otolaryngology–Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
| | - David B. Corry
- Department of Medicine and the Biology of Inflammation CenterBaylor College of Medicine Houston Texas U.S.A
| | - Amber U. Luong
- Department of Otolaryngology–Head and Neck SurgeryMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
- the Center for Immunology and Autoimmune Diseases, Institute of Molecular MedicineMcGovern Medical School at the University of Texas Health Science Center Houston Texas U.S.A
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Abstract
PURPOSE OF REVIEW To review innate lymphoid cells (ILCs) and their role in chronic rhinosinusitis (CRS). RECENT FINDINGS The immune system consists of the innate and adaptive response. Until the recognition of ILCs, chronic inflammatory diseases were characterized by cytokines linked only to T helper cells. However, these immune responses are now described more broadly to include contributions from both the innate and adaptive immunity. In CRS, focus had been on ILC2s in CRS with nasal polyps. These studies also highlight the importance of epithelial cell-derived cytokines in coordinating these responses. In addition to indirect crosstalk via cytokines, ILCs and T helper cells can utilize the OX40/OX40 ligand and major histocompatibility complex class II pathways to directly interact and coordinate responses. In addition to T helper cells, ILCs contribute to the inflammatory response associated with CRS. The understanding of these cells along with pathways that activate and perpetuate these cells leads to new potential therapeutic targets for CRS treatment.
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Affiliation(s)
- Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, 77030, USA. .,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, 77030, USA. .,, Houston, USA.
| | - Hua Sun
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, 77030, USA.,Center for Immunology and Autoimmune Diseases, Institute of Molecular Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, 77030, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, 77030, USA
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Abstract
Office-based rhinologic procedures have seen a dramatic rise in incidence over the last decade. It is crucial to select appropriate patients and understand which pathologies may be amenable to in-office procedures. It behooves the otolaryngologist to be familiar with the array of technologic advances that are expanding the limits of office-based rhinology and to have a solid understanding of the technical nuances of using these technologies in the clinic. This article highlights the issues associated with some of the more common office-based sinus procedures, and provides practical information on set-up and reimbursement.
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Affiliation(s)
- Alok T Saini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine, 740 S. Limestone, E300E, Lexington, KY 40536, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Marino MJ, Luong A, Yao WC, Citardi MJ. Nonpharmacological Relaxation Technology for Office-Based Rhinologic Procedures. ORL J Otorhinolaryngol Relat Spec 2019; 81:48-54. [PMID: 30836361 DOI: 10.1159/000488323] [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: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Office-based rhinologic procedures are increasingly performed to control costs and enhance patient convenience. Adequate management of pain and anxiety is essential for the technical performance of these procedures, in addition to ensuring patient comfort. Pharmacologic agents are often used to manage anxiety and pain. Nonpharmacological adjuncts may be useful for achieving these effects without oral opioids and benzodiazepines. METHODS Charts of patients who underwent office-based rhinologic procedures with the NuCalm system (Solace Lifesciences, Inc., Wilmonton, DE, USA) in combination with local anesthesia were reviewed. NuCalm is a proprietary system that combines cranial electrotherapy stimulation, neuroacoustic software, light-blocking lenses, and topical γ--aminobutyric acid. Patients rated their pain and anxiety before, during, and after the procedure. RESULTS Twenty-five patients underwent office procedures using the NuCalm system. Preoperative anxiety (2.00) was significantly higher than postoperative anxiety (1.25) according to patient reporting on a 5-point scale (p = 0.005). Preoperative pain (1.83) was not significantly different from intraoperative (2.54) and postoperative pain (2.04, p = 0.054). CONCLUSIONS A variety of office-based rhinologic procedures are technically feasible and can be performed with adequate patient comfort without the use of oral drugs. Adjuncts to pharmacologic agents may enhance pain control and anxiety management and improve patient tolerance of these procedures.
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Affiliation(s)
- Michael J Marino
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA,
| | - Amber Luong
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - William C Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology - Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Jensen BT, Holbrook EH, Chen PG, Luong AU, Marino MJ, Yao WC. The intraoperative accuracy of maxillary balloon dilation: a blinded trial. Int Forum Allergy Rhinol 2019; 9:452-457. [PMID: 30629822 DOI: 10.1002/alr.22286] [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] [Received: 09/04/2018] [Revised: 10/31/2018] [Accepted: 12/11/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Balloon sinus dilation (BSD) is a commonly performed sinus procedure in the United States. Several cadaveric studies have evaluated BSD accuracy and the maxillary sinus has consistently been shown to be the most challenging to cannulate. We designed an independent study to evaluate the intraoperative accuracy of maxillary sinus BSD. METHODS A prospective, single-blinded trial evaluating the accuracy of maxillary sinus BSD was performed using 2 commercially available BSD systems (guidewire- and probe-based systems) randomly assigned to patients undergoing endoscopic surgery for chronic rhinosinusitus without nasal polyps (CRSsNP) or a skullbase approach in patients without sinus disease. All patients underwent maxillary BSD followed by uncinectomy to reveal dilation of the natural maxillary sinus ostia. The recorded procedures were reviewed by 3 fellowship-trained rhinologists from different institutions blinded to the BSD system utilized. The primary endpoint compared accuracy of maxillary BSD attempts. The secondary endpoint compared accuracy between the 2 systems. RESULTS Twenty-nine maxillary BSD procedures were performed in 18 patients (age range, 20-79 years; mean, 51 years) without nasal polyposis undergoing maxillary antrostomy as part of a more extensive procedure. BSD was successful in 18 of 29 (62%) attempts and unsuccessful in 9 of 29 (31%) attempts, with statistically "almost perfect" interrater agreement (kappa = 0.86). There was no statistical difference between the 2 BSD systems (p = 0.81). CONCLUSION Maxillary BSD appeared to be less accurate in living patients when compared with findings from previously published cadaver studies. There were no differences in accuracy between the probe- and guidewire-based systems. This is the first non-industry-sponsored study evaluating maxillary sinus BSD in living patients. Further studies are needed to investigate the clinical implications of our findings.
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Affiliation(s)
- Brett T Jensen
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Philip G Chen
- Department of Otolaryngology, University of Texas Health Science Center, San Antonio, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | | | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
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Villarreal R, Wrobel BB, Macias-Valle LF, Davis GE, Prihoda TJ, Luong AU, McMains KC, Weitzel EK, Yao WC, Brunworth J, Clark DW, Nair S, Valdés CJ, Halderman A, Jang DW, Sivasubramaniam R, Zhang Z, Chen PG. International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system. Int Forum Allergy Rhinol 2018; 9:39-45. [PMID: 30216705 DOI: 10.1002/alr.22200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/05/2018] [Accepted: 07/31/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). METHODS Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement. RESULTS Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98. CONCLUSION Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.
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Affiliation(s)
- Ricardo Villarreal
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Bozena B Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Luis F Macias-Valle
- Department of Otolaryngology Head and Neck Surgery, Hospital Español de México, Mexico City, México
| | - Greg E Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Thomas J Prihoda
- Department of Pathology, University of Texas Health San Antonio, Graduate School of Biomedical Sciences, San Antonio, TX
| | - Amber U Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Erik K Weitzel
- United States Army Institute of Surgical Research Fort Sam Houston, TX
| | - William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Joe Brunworth
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - David W Clark
- Department of Otolaryngology, Texas A&M University College of Medicine/Baylor Scott & White Health, Temple TX
| | - Salil Nair
- Department of Otolaryngology, Auckland Hospitals and University of Auckland, Auckland, New Zealand
| | - Constanza J Valdés
- Department of Otolaryngology- Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ashleigh Halderman
- Department of Otolaryngology Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - David W Jang
- Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC
| | | | - Zhipeng Zhang
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX
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Lam K, Luong AU, Yao WC, Citardi MJ. Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications. Am J Rhinol Allergy 2018; 32:310-317. [PMID: 29732935 DOI: 10.1177/1945892418773637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.
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Affiliation(s)
- Kent Lam
- 1 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Amber U Luong
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - William C Yao
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Martin J Citardi
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Tyler MA, Zhang CC, Saini AT, Yao WC. Cutting-edge endonasal surgical approaches to thyroid ophthalmopathy. Laryngoscope Investig Otolaryngol 2018; 3:100-104. [PMID: 29721541 PMCID: PMC5915818 DOI: 10.1002/lio2.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/29/2017] [Accepted: 01/30/2018] [Indexed: 11/08/2022] Open
Abstract
Objective Thyroid orbitopathy is a poorly understood extrathyroidal manifestation of Graves' disease that can cause disfiguring proptosis and vision loss. Orbital decompression surgery for Graves' orbitopathy (GO) can address both cosmetic and visual sequelae of this autoimmune condition. Endonasal endoscopic orbital decompression provides unmatched visualization and access to inferomedial orbital wall and orbital apex. This review examines the state of the art approaches employed in endonasal endoscopic orbital decompression for GO. Methods Review of literature evaluating novel surgical maneuvers for GO. Results Studies examining the efficacy of endonasal endoscopic orbital decompression are heterogenous and retrospective in design; however, they reveal this approach to be a safe and effective technique in the management of GO. Conclusion Subtle variations in endoscopic techniques significantly affect postsurgical outcomes and can be tailored to the specific clinical indication in GO making endonasal endoscopic decompression the most versatile approach available. Level of Evidence NA.
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Affiliation(s)
- Matthew A Tyler
- Department of Otorhinolaryngology-Head & Neck Surgery McGovern Medical School, University of Texas Health Science Center at Houston Texas U.S.A
| | - Caroline C Zhang
- Department of Otorhinolaryngology-Head & Neck Surgery McGovern Medical School, University of Texas Health Science Center at Houston Texas U.S.A
| | - Alok T Saini
- Department of Otorhinolaryngology-Head & Neck Surgery McGovern Medical School, University of Texas Health Science Center at Houston Texas U.S.A
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery McGovern Medical School, University of Texas Health Science Center at Houston Texas U.S.A
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Marino MJ, Luong A, Yao WC, Citardi MJ. Management of Odontogenic Cysts by Endonasal Endoscopic Techniques: A Systematic Review and Case Series. Am J Rhinol Allergy 2018; 32:40-45. [DOI: 10.2500/ajra.2018.32.4492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Odontogenic cysts and tumors of the maxilla may be amendable to management by endonasal endoscopic techniques, which may reduce the morbidity associated with open procedures and avoid difficult reconstruction. Objective To perform a systematic review that evaluates the feasibility and outcomes ofendoscopic techniques in the management of different odontogenic cysts. A case series of our experience with these minimally invasive techniques was assembled for insight into the technical aspects of these procedures. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to identify English-language studies that reported the use of endoscopic techniques in the management of odontogenic cysts. Several medical literature data bases were searched for all occurrences in the title or abstract of the terms “odontogenic” and “endoscopic” between January 1, 1950, and October 1, 2016. Publications were evaluated for the technique used, histopathology, complications, recurrences, and the follow-up period. A case series of patients who presented to a tertiary rhinology clinic and who underwent treatment of odontogenic cysts by an endoscopic technique was included. Results A systematic review identified 16 case reports or series that described the use of endoscopic techniques for the treatment of odontogenic cysts, including 45 total patients. Histopathologies encountered were radicular (n = 16) and dentigerous cysts (n = 10), and keratocystic odontogenic tumor (n = 12). There were no reported recurrences or major complications for a mean follow-up of 29 months. A case series of patients in our institution identified seven patients without recurrence for a mean follow-up of 10 months. Conclusion Endonasal endoscopic treatment of various odontogenic cysts are described in the literature and are associated with effective treatment of these lesions for an average follow-up period of >2 years. These techniques have the potential to reduce morbidity associated with the resection of these lesions, although comparative studies would better define specific indications.
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Affiliation(s)
- Michael J. Marino
- Department of Otorhinolaryngology—Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Amber Luong
- Department of Otorhinolaryngology—Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - William C. Yao
- Department of Otorhinolaryngology—Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Martin J. Citardi
- Department of Otorhinolaryngology—Head and Neck Surgery, John P. and Kathrine G. McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Marino MJ, Ling LC, Yao WC, Luong A, Citardi MJ. Eustachian tube dysfunction symptoms in patients treated in a tertiary rhinology clinic. Int Forum Allergy Rhinol 2017; 7:1135-1139. [DOI: 10.1002/alr.22030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Accepted: 09/28/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Michael J. Marino
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School; The University of Texas Health Science Center at Houston; Houston TX
| | - Lina Chooi Ling
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School; The University of Texas Health Science Center at Houston; Houston TX
| | - William C. Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School; The University of Texas Health Science Center at Houston; Houston TX
| | - Amber Luong
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School; The University of Texas Health Science Center at Houston; Houston TX
| | - Martin J. Citardi
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School; The University of Texas Health Science Center at Houston; Houston TX
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Yao WC, Corbitt CA, Takashima M. Role of intraoperative ropivacaine in adult post-tonsillectomy pain control: A randomized controlled trial. EAR, NOSE & THROAT JOURNAL 2017; 96:E39-E43. [PMID: 28489244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
We sought to evaluate the efficacy of ropivacaine in post-tonsillectomy pain management in adults and evaluate the timing of intraoperative ropivacaine administration for this purpose. A prospective, double-blinded, randomized, controlled trial with a paired design was performed in 25 consecutive adults undergoing tonsillectomy. To date, no studies examining the efficacy of local anesthetics in post-tonsillectomy pain control have used a paired design to account for the variability in pain difference between individuals. Patients were prerandomized into those receiving tonsillar fossa injections before or after the tonsillectomy. All surgeries were performed by the senior author. The tonsil on 1 side was injected with saline and the tonsil on the other side with ropivacaine. Patient responses were obtained via written questionnaire. Three of 25 patients were excluded from the study. Sixteen of 22 patients had lateralization of pain to 1 side during recovery. No statistically significant difference in pain control was observed between ropivacaine and normal saline. Local anesthetic decreased pain in 7 of 22 patients, and increased pain was experienced on the side with local anesthetic in 9 of 22 patients. Six of 22 patients had no difference in pain from one side to the other. The time to equalization of pain based on laterality was 8.8 and 6.8 days, respectively, in the patients injected before or immediately after the tonsillectomy. Administration of the local anesthetic ropivacaine does not affect post-tonsillectomy pain. Moreover, timing of injection does not affect postoperative pain. We recommend against the use of intraoperative ropivacaine for pain control in patients undergoing tonsillectomy.
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Affiliation(s)
- William C Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas McGovern Medical School, 6431 Fannin St., MSB 5.036, Houston, TX 77030, USA.
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Zhao C, Ma ZG, Mou SL, Yang YX, Zhang YH, Yao WC. Targeting effect of microRNA on CD133 and its impact analysis on proliferation and invasion of glioma cells. Genet Mol Res 2017; 16:gmr-16-01-gmr.16019281. [PMID: 28362995 DOI: 10.4238/gmr16019281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
MiR-200b, a member of the microRNA-200 family, has been identified to be capable of suppressing glioma cell growth through targeting CREB1 or CD133. However, whether miR-200b affects the biological behavior (proliferation, invasion, and migration) of glioma cells is poorly understood. The aim of this study was to evaluate the effect of miR-200b on the biological behavior of glioma cells in vitro. MiRNA-200b mimics, miRNA-200b inhibitor, and mimic control were transfected into conventionally cultured glioma U251 cells, followed by measuring the expression of miR-200b and CD133 in transfected cells by RT-PCR; effect of miR-200b on CD133 mRNA 3'-UTR luciferase activity by luciferase reporter assay; proliferation activity of transfected U251 cells by MTT method; and changes in U251 cell invasion and migration by Transwell method after transfection. Compared to that in the miRNA-200b inhibitor, mimic control, and blank control groups, miRNA-200b expression was significantly increased and CD133 mRNA expression was significantly decreased in the mimic miRNA-200b group in a time-dependent manner (P < 0.05). Meanwhile, dual luciferase reporter assay showed that miR-200b could inhibit CD133 activity through binding to the 3'-UTR of CD133 mRNA (P < 0.05). Furthermore, the proliferation activity and invasion and migration abilities of U251 cells transfected with miRNA-200b mimic were significantly decreased (P < 0.05). In conclusion, overexpression of miR-200b inhibited the proliferation, invasion, and migration of glioma cells possibly through targeting CD133.
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Affiliation(s)
- C Zhao
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Neurosurgery, The People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Z G Ma
- Department of Neurosurgery, Fifth Hospital of PLA, Yinchuan, Ningxia, China
| | - S L Mou
- Department of Laboratory, The People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Y X Yang
- Department of Neurosurgery, The People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Y H Zhang
- Department of Neurosurgery, The People's Hospital of Rizhao, Rizhao, Shandong, China
| | - W C Yao
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Abstract
BACKGROUND The progression from a benign pigmented lesion on the skin to cutaneous melanoma is better understood, and it could be presumed that a similar progression occurs with mucosal lesions. However, to our knowledge, there has never been documentation of melanosis transforming into melanoma over time. OBJECTIVE To describe a transformation of a mucosal melanosis into melanoma. METHODS A 53-year-old man with diffuse melanosis of the nasal cavity underwent surgical resection. RESULTS Pathology revealed melanocytic hyperplasia without evidence of melanoma. The patient was serially examined, with excisions for new areas of melanosis. The pathology progressed to severely atypical melanocytic proliferation and melanoma in situ over a 4-year period. CONCLUSION Nasal melanosis may be a precancerous lesion and may transform into melanoma. All melanosis should be biopsied with close endoscopic observation. Lesions with dysplasia or atypia should be excised due to potential transformation to melanoma.
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Affiliation(s)
- William C. Yao
- From the Department of Otorhinolaryngology, University of Texas McGovern Medical School—Houston, Houston, Texas
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, and
| | - Kevin S. Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, and
| | - Stefan Kraft
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric H. Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, and
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Yao WC, Sedaghat AR, Yadav P, Fay A, Metson R. Orbital Decompression in the Endoscopic Age. Otolaryngol Head Neck Surg 2016; 154:963-9. [DOI: 10.1177/0194599816630722] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/14/2016] [Indexed: 11/16/2022]
Abstract
Objective Postoperative diplopia occurs in up to 45% of patients following orbital decompression for exophthalmos associated with Graves’ orbitopathy. We sought to describe outcomes of our balanced orbital decompression strategy that includes the preservation of a modified inferomedial orbital strut (mIOS). Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods A total of 115 consecutive orbital decompressions were performed on 73 patients (42 bilateral) with Graves’ orbitopathy. All patients underwent (1) a balanced decompression technique incorporating an endoscopic medial and external lateral decompression and (2) a mIOS technique with preservation of the anterior half of the inferomedial orbital strut. A periorbital periosteal (orbital) sling was utilized in patients (n = 54) without threatened vision loss, proptosis >28 mm, or periorbital disruption to prevent prolapse of the medial rectus muscle. Results Utilization of the mIOS technique with or without a sling did not adversely affect the reduction in proptosis (5.1 mm with sling vs 5.0 mm without sling; P = .85).The incidence of new-onset postoperative diplopia was 17% (n = 6). The sling was not associated with postoperative diplopia (odds ratio = 0.54, 95% confidence interval: 0.08-3.40, P = .51), while it was associated with resolution of preexisting diplopia (odds ratio = 6.67, 95% confidence interval: 1.06-42.06, P = .04). No intraoperative complications occurred, and no patients suffered a decrement in visual acuity. Conclusion Balanced orbital decompression utilizing a mIOS in patients with Graves’ orbitopathy provides a safe and effective reduction in proptosis with a low rate of new-onset diplopia as compared with historical values. Utilization of an orbital sling may be beneficial in reducing postoperative diplopia in select patients.
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Affiliation(s)
- William C. Yao
- Department of Otorhinolaryngology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Ahmad R. Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Prashant Yadav
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Fay
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ralph Metson
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Korkmaz H, Yao WC, Korkmaz M, Bleier BS. Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery. Int Forum Allergy Rhinol 2015; 5:1118-23. [PMID: 26152362 DOI: 10.1002/alr.21590] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 03/15/2015] [Revised: 05/05/2015] [Accepted: 06/03/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Effective topical decongestion is critical for the safe performance of endoscopic endonasal surgery (EES). Despite the vasoconstriction offered by topical concentrated (1:1000) epinephrine (CE), its use has not gained widespread acceptance because of concerns over systemic absorption and its effect on blood pressure and postoperative rebound epistaxis. The purpose of this study was to examine the physiological changes in blood pressure and rate of epistaxis with use of topical CE in a variety of endoscopic nasal procedures. METHODS EES procedures using inhalational anesthesia and topical CE performed on 1140 consecutive patients (14 patients under 18 years) between 2011 and 2014 were evaluated retrospectively. Demographic data, intraoperative hemodynamic parameters, and postoperative epistaxis rates were recorded. RESULTS The mean patient age was 45.8 years (range, 5-97 years). No intraoperative cardiovascular complications related to CE use were found. Four patients (0.35%) developed postoperative epistaxis requiring intervention. The mean estimated blood loss among patients undergoing bilateral sinus surgery, skull-base surgery, and orbital decompression was (mean ± SD) 61.7 ± 51.6 mL, 60.1 ± 115 mL, and 67.9 ± 42.2 mL, respectively. The maximum mean systolic blood pressure among these groups was 108.3 ± 28.3 mmHg, 111.9 ± 27.6 mmHg, and 95.1 ± 31.7 mmHg, respectively. CONCLUSION The use of topical CE is safe when performing endoscopic endonasal procedures. CE was not associated with any intraoperative complications. The profound intraoperative vasoconstriction does not confer a higher rate of postoperative rebound epistaxis.
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Affiliation(s)
- Hakan Korkmaz
- Otorhinolaryngology Department, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - William C Yao
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Mukadder Korkmaz
- Otorhinolaryngology Department, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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Yao WC, Bleier BS. Centrifugal frontal sinus dissection technique: addressing anterior and posterior frontoethmoidal air cells. Int Forum Allergy Rhinol 2015; 5:761-3. [PMID: 25914121 DOI: 10.1002/alr.21523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/15/2015] [Accepted: 02/19/2015] [Indexed: 11/05/2022]
Affiliation(s)
- William C Yao
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Benjamin S Bleier
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
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Yao WC, Bleier BS. A simple, single stage technique to harvest optimal ethmoid bone grafts for caudal septal deflections. Int Forum Allergy Rhinol 2015; 5:622-5. [PMID: 25885185 DOI: 10.1002/alr.21520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Curvature of the caudal septum is a challenging area to surgically address because it is a tip supporting structure. Several methods to straighten the caudal septal deviation have been described to date. One commonly described technique is the placement of a bony septal batten graft. However, the harvest and subsequent ex vivo shaping of the bone graft can be difficult and lead to fracture of the graft superstructure. Here we discuss a novel single stage endoscopic approach to harvest a preformed batten graft and apply it to correct a caudal septal curvature deformity. METHODS Description of a novel endoscopic technique for the single stage harvest of a bone graft for the correction of a caudal septal deflection utilizing an open Jansen-Middleton septum forceps. RESULTS We have successfully utilized this technique in 10 patients with a caudal septal curvature deformity with no complications. All patients had symptomatic improvement of nasal obstruction symptoms. CONCLUSION The open Jansen-Middleton septum forceps allow for a reproducible, single stage, harvest of a bone graft from the perpendicular plate or vomer when addressing a caudal septal deformity using an endoscopic septoplasty approach.
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Affiliation(s)
- William C Yao
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Benjamin S Bleier
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA
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Yao WC, Regone RM, Takashima M. Staining intraoperative topical solutions with fluorescein: enhancing the safety of sinus surgery. Int Forum Allergy Rhinol 2015; 5:870-4. [PMID: 25856496 DOI: 10.1002/alr.21531] [Citation(s) in RCA: 5] [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] [Received: 12/21/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Oxymetazoline HCl 0.05%, 1:100,000 lidocaine with epinephrine (lido+epi), and 1:1000 epinephrine are all colorless solutions employed in sinus surgery. Because lido+epi is injected whereas others are not, care must be taken to label all solutions to avoid inadvertent injection of oxymetazoline or concentrated epinephrine because of life-threatening complications. Dyes have been used to color solutions for visual identification, but efficacy and cost have never been compared. We sought to determine the effectiveness of surgical marking pen (gentian violet) and fluorescein strips as coloring agents in mediums commonly used in sinus surgery. METHODS In this specialty techniques study, 4 liquid mediums (normal saline [NS], 0.05% oxymetazoline, 1:1,000 epinephrine, and lido+epi) and 2 coloring agents (fluorescein strip and surgical marking pen) were combined separately. Photos and absorbance of each solution were obtained at 15-minute intervals over 2 hours using a spectrophotometer. RESULTS Peak absorbance remained stable for all solutions with fluorescein. Absorbance also remained constant for NS (0.37 absorbance units [AU] → 0.37 AU) and oxymetazoline (2.8 AU → 2.8 AU) mixed with marking pen. Absorbance decreased over 2 hours when marking pen was mixed with 1:1000 epinephrine (0.82 AU → 0.32 AU) and lido+epi (1.19 AU → 0.33 AU). Furthermore, the majority of color visibility and absorbance decreased in the first 15 minutes for concentrated epinephrine (0.82 → 0.33) and lido+epi (1.19 → 0.51). Cost of fluorescein strips ($0.14 to $0.20/strip) was less than marking pens ($13 to 46/pen). CONCLUSION Compared to marking pen dye, solutions dyed with fluorescein retained their color and did not decay over time. We recommend fluorescein strips to label colorless materials in the operating room because of their lack of color decay and cost advantages.
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Affiliation(s)
- William C Yao
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Rachel M Regone
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Masayoshi Takashima
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
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Yao WC, Regone RM, Huyhn N, Butler EB, Takashima M. Three-dimensional sinus imaging as an adjunct to two-dimensional imaging to accelerate education and improve spatial orientation. Laryngoscope 2013; 124:596-601. [PMID: 23881572 DOI: 10.1002/lary.24316] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/27/2013] [Accepted: 06/27/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Develop a novel three-dimensional (3-D) anatomical model to assist in improving spatial knowledge of the skull base, paranasal sinuses, and adjacent structures, and validate the utilization of 3-D reconstruction to augment two-dimensional (2-D) computed tomography (CT) for the training of medical students and otolaryngology-head and neck surgery residents. STUDY DESIGN Prospective study. METHODS A study of 18 subjects studying sinus anatomy was conducted at a tertiary academic center during the 2011 to 2012 academic year. An image processing and 3-D modeling program was used to create a color coded 3-D scalable/layerable/rotatable model of key paranasal and skull base structures from a 2-D high-resolution sinus CT scan. Subjects received instruction of the sinus anatomy in two sessions, first through review of a 2-D CT sinus scan, followed by an educational module of the 3-D reconstruction. After each session, subjects rated their knowledge of the sinus and adjacent structures on a self-assessment questionnaire. RESULTS Significant improvement in the perceived understanding of the anatomy was noted after the 3-D educational module session when compared to the 2-D CT session alone (P < .01). Every subject believed the addition of 3-D imaging accelerated their education of sinus anatomy and recommended its use to others. CONCLUSIONS The impression of the learners was that a 3-D educational module, highlighting key structures, is a highly effective tool to enhance the education of medical students and otolaryngology residents in sinus and skull base anatomy and its adjacent structures, specifically in conceptualizing the spatial orientation of these structures.
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Affiliation(s)
- William C Yao
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
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Wen YR, Ho WY, Sun WZ, Or CH, Yeh M, Yao WC, Tai YT. Thromboelastographic study of thrombosis in the implantable central venous access device. Acta Anaesthesiol Sin 1997; 35:223-228. [PMID: 9553238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND In the present study thromboelastography (TEG) was to study whether or not hypercoagulopathy might contribute to the thrombosis of implantable central venous access device (Port-A-Cath, Pharmacia) in cancer patients. METHODS All 76 oncological patients who were enrolled in this study had their R time, alpha angle and MA value measured before Port-A-Cath implantation, of whom 11 patients received re-implantation because of thrombotic device. We compared the measurements of these 11 patients (thrombotic group) with that of 65 patients (control group) who received Port-A-Cath implantation for the first time. According to TEG values the hemostatic status in these patients was classified as hypercoagulable, normal or hypocoagulable for comparison. All patients in the control group were followed up for 3 months for occurrence of thrombosis. RESULTS It was found that no patient in the thrombotic group was associated with hypercoagulopathy. Five patients (7.5%) in the control group was found in hypercoagulable status at the time of catheter insertion but none of them developed clinical thrombosis during three months of observation. There was no significant difference between the two groups for R time, alpha angle but a higher MA value was found in the control group (p < 0.05). Furthermore, the hypercoagulability (7.5% for the control vs. none for the thrombotic group), hypocoagulability (1.5% vs. 9.1%) and normocoagulability (91.0% vs. 90.9%) were not statistically different between the two groups (Fisher exact test, P = 0.229). CONCLUSIONS We conclude that hypercoagulopathy in cancer patients has little, if any, contribution in thrombosis of the implantable central venous access device.
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Affiliation(s)
- Y R Wen
- Department of Anesthesiology, Taipei County Sanchung Hospital, Taiwan, R.O.C
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