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Kokavec A, Zahabi S, Rocha T, Rotenberg BW, Sowerby LJ. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08655-4. [PMID: 38652299 DOI: 10.1007/s00405-024-08655-4] [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: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. METHODS A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. RESULTS 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. CONCLUSION Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.
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Affiliation(s)
- Andrew Kokavec
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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McHugh A, Wauchope J, Kieran S, Moran T, O'Duffy F. Ocular lymphoma: overcoming a diagnostic challenge with an endoscopic sinus approach. Ir J Med Sci 2024; 193:555-563. [PMID: 37526870 DOI: 10.1007/s11845-023-03460-0] [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: 03/11/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Ocular lymphomas are rare, indolent tumours that pose a diagnostic challenge. Patients may be asymptomatic or present with symptoms of increased orbital mass. An index of suspicion is required alongside an understanding of the diagnostics and staging required to facilitate expedited multi-disciplinary work-up and management. METHODS A comprehensive literature review was performed. We present a series of three cases, each presenting their own diagnostic challenge. RESULTS Although ocular lymphomas are notoriously difficult to diagnose histologically, our case series show procurement of a diagnostic histological sample using an image-guided endoscopic sinus approach. CONCLUSIONS Although not typically involved in the diagnosis or management, the otolaryngologist may encounter ocular lymphoma masquerading as sinus disease or with disseminated disease at other sites in the head and neck. Endoscopic sinus surgery is considered a safe, effective approach for achieving a histological diagnosis in these cases.
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Affiliation(s)
- Alison McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - Stephen Kieran
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tom Moran
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Fergal O'Duffy
- Mater Misericordiae University Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
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Hofer LK, Jurcisek JA, Elmaraghy C, Goodman SD, Bakaletz LO. Z-Form Extracellular DNA in Pediatric CRS May Provide a Mechanism for Recalcitrance to Treatment. Laryngoscope 2024; 134:1564-1571. [PMID: 37597166 PMCID: PMC10875147 DOI: 10.1002/lary.30986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES We examined sinus mucosal samples recovered from pediatric chronic rhinosinusitis (CRS) patients for the presence of Z-form extracellular DNA (eDNA) due to its recently elucidated role in pathogenesis of disease. Further, we immunolabeled these specimens for the presence of both members of the bacterial DNA-binding DNABII protein family, integration host factor (IHF) and histone-like protein (HU), due to their known role in converting common B-DNA to the rare Z-form. METHODS Sinus mucosa samples recovered from 20 patients during functional endoscopic sinus surgery (FESS) were immunolabelled for B- and Z-DNA, as well as for both bacterial DNABII proteins. RESULTS Nineteen of 20 samples (95%) included areas rich in eDNA, with the majority in the Z-form. Areas positive for B-DNA were restricted to the most distal regions of the mucosal specimen. Labeling for both DNABII proteins was observed on B- and Z-DNA, which aligned with the role of these proteins in the B-to-Z DNA conversion. CONCLUSIONS Abundant Z-form eDNA in culture-positive pediatric CRS samples suggested that bacterial DNABII proteins were responsible for the conversion of eukaryotic B-DNA that had been released into the luminal space by PMNs during NETosis, to the Z-form. The presence of both DNABII proteins on B-DNA and Z-DNA supported the known role of these bacterial proteins in the B-to-Z DNA conversion. Given that Z-form DNA both stabilizes the bacterial biofilm and inactivates PMN NET-mediated killing of trapped bacteria, we hypothesize that this conversion may be contributing to the chronicity and recalcitrance of CRS to treatment. LEVEL OF EVIDENCE NA Laryngoscope, 134:1564-1571, 2024.
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Affiliation(s)
- Llwyatt K. Hofer
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Joseph A. Jurcisek
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital
| | - Charles Elmaraghy
- The Ohio State University College of Medicine
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital
| | - Steven D. Goodman
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital
- The Ohio State University College of Medicine
| | - Lauren O. Bakaletz
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital
- The Ohio State University College of Medicine
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Ahilasamy N, Kumar RD, S S, K S, Rahiman A. Missed Maxillary Sinus Ostium Syndrome and its Management. Indian J Otolaryngol Head Neck Surg 2024; 76:2032-2034. [PMID: 38566669 PMCID: PMC10982247 DOI: 10.1007/s12070-023-04385-x] [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: 10/18/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
The inflammatory process involving the maxillary sinus is often exacerbated by a functional obstruction due to laterally displaced uncinate process which obstructs the infundibulum and the natural ostium. Physiologically the drainage pathway may be adequate but during periods of inflammation resulting in nasal oedema, the ostium/infundibulum interface is inadequate, preventing adequate ventilation and drainage of the maxillary sinus. Incomplete removal of the uncinate process without including the natural ostium may result in failure and recurrence. This method of Middle meatal antrostomy that does not include the natural ostium of the maxillary sinus, leads to the missed ostium sequence and continued sinus disease. Here a case of missed maxillary sinus syndrome and its management is presented. A 28-year-old man with complaints of post nasal drip and Left facial pain for 4 months. 3 years prior the patient underwent functional endoscopic sinus surgery (FESS), following surgery patient had recurrent episode of sinusitis. Diagnostic nasal endoscopy revealed presence of mucopurulent discharge in left middle meatus, CT scan Paranasal sinus was suggestive of opacity in left maxillary sinuses and in left middle meatus with wide maxillary antrostomy. Revision FESS surgery was performed, where two ostia were present was converted into single wide middle meatal antrostomy using a back bitting forceps and microdebrider to avoid maxillary sinus mucus recirculation phenomenon. On follow up 1 year later, patient had no symptoms of repeated sinusitis. Missed maxillary sinus ostium syndrome has to be recognized and timely addressed by joining the natural and surgically created ostia as single wide middle meatal antrostomy window. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04385-x.
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Affiliation(s)
| | - Rajendran Dinesh Kumar
- Department of ENT and Head-Neck Surgery, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka 560074 India
| | - Sowmya S
- Department of ENT and Head-Neck Surgery, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka 560074 India
| | - Srirangaprasad K
- Department of ENT and Head-Neck Surgery, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka 560074 India
| | - Asma Rahiman
- Department of ENT and Head-Neck Surgery, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka 560074 India
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Munafo' C, Loperfido A, Mammarella F, Crosti A, Iannilli F, Millarelli FR, Bellocchi G, Tritapepe L. Safety and efficacy of remifentanil target-controlled infusion for conscious sedation in a pregnant woman: a case report. J Med Case Rep 2024; 18:143. [PMID: 38454441 PMCID: PMC10921671 DOI: 10.1186/s13256-023-04303-3] [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: 07/27/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Every year 2% of pregnant women undergo nonobstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment, regardless of the trimester of pregnancy. However, additional attention should be paid during the first trimester since it has the highest risk of inducing teratogenic mutations; additionally, during the third trimester, due to the possibility of preterm birth and low birth weight of the newborn, great care should be paid. CASE PRESENTATION We present the case of a Caucasian 36-year-old woman during her 21st week of pregnancy, with a normal-sized fetus, according to the gestational age on ultrasound exam, and with no additional risk factors. The patient referred to an increasing nasal obstruction associated with rhinorrhea of the left nasal cavity. She also reported episodes of sleep apnea and hyposmia. The patient received a detailed otolaryngological examination, which allowed for identification of a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a grayish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus, resulting in obstruction of the anterior osteomeatal unit and ethmoidal sinusitis. She was referred for a functional endoscopic sinus surgery using analgosedation with remifentanil target-controlled infusion. DISCUSSION AND CONCLUSION To the very best of our knowledge, this is the first case described in English literature about the use of analgosedation with remifentanil target-controlled infusion for otolaryngology surgery, specifically in functional endoscopic sinus surgery. It could be an interesting option to avoid the use of inhaled anesthetics that could induce fetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, which avoids cases of difficult intubation or any trauma to the airways. An adequate informed consent and appropriate compliance are elements of paramount importance in tailoring the anesthetic strategy for pregnant women who need nonobstetric surgical management.
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Affiliation(s)
- Camilla Munafo'
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
| | | | | | - Arianna Crosti
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy.
| | - Federico Iannilli
- Anaesthesia and Intensive Care Division, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Luigi Tritapepe
- Anaesthesia and Intensive Care Division, San Camillo-Forlanini Hospital Rome, Rome, Italy
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Lamb MM, Russel SM, Farzal Z, Kim S, Stack T, Alicea Delgado D, Mohammad I, Zeatoun A, Klatt-Cromwell CN, Thorp BD, Ebert CS, Kimple AJ, Senior BA, Lopez E. "Left on their own": Left-handedness among rhinologists and otolaryngology trainees. Int Forum Allergy Rhinol 2024; 14:735-737. [PMID: 37409408 DOI: 10.1002/alr.23231] [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: 06/06/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
KEY POINTS Left-hand-dominant (LHD) respondents reported higher rates of training difficulties because of handedness differences. LHD respondents cited particular difficulty with functional endoscopic sinus surgery. Both LHD and right-hand-dominant respondents perceived a need for laterality-specific training during residency.
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Affiliation(s)
- Meredith M Lamb
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah M Russel
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sulgi Kim
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Taylor Stack
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel Alicea Delgado
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ibtisam Mohammad
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Abdullah Zeatoun
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cristine N Klatt-Cromwell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erin Lopez
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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7
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Bulut OC, Lippert BM, Riedel F, Plath M, Hohenberger R. Quality of Life Improvement in Concurrent Septorhinoplasty and Endoscopic Sinus Surgery. Laryngoscope 2024; 134:1239-1245. [PMID: 37706653 DOI: 10.1002/lary.31054] [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: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES Septorhinoplasty (SRPL) and functional endoscopic sinus surgery (FESS) are two frequently performed surgeries to improve quality of life (QoL) in patients with nasal symptoms. It has been demonstrated as a safe combination regarding complication rates, but patient satisfaction in concurrent surgery has not been adequately studied yet. METHODS Patients undergoing sole FESS due to chronic rhinosinusitis (n = 57), sole SRPL (n = 148), and concurrent surgery (n = 62) were prospectively evaluated for their disease-specific QoL before and one year after surgery. Each procedure was performed by the same surgeon (OCB). For SRPL, the patient-reported outcome measures Rhinoplasty Outcomes Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory (FROI-17) were utilized, and for chronic rhinosinusitis, the Sino-Nasal Outcome Test-22 (SNOT22). RESULTS All three groups showed significant improvement in the postoperative QoL measurements (all p < 0.01). The postoperative improvements were slightly smaller in the concurrent surgery group compared with the single surgery groups measured with ROE (combined: +55.2 ± 9.3, single: +58.8 ± 9.8, p = 0.02), FROI total score (combined: +47.6 ± 5.2, single: +49 ± 5.4; p = 0.08) and SNOT22 (combined: +33.1 ± 6.7, single +34.5 ± 7, p = 0.26). CONCLUSIONS SRPL, FESS, and combined surgery improve disease-specific QoL. When applicable, surgeons may offer the benefits of a combined procedure without compromising the QoL gain. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1239-1245, 2024.
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Affiliation(s)
- Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
- HNO-Zentrum Rhein-Neckar, Mannheim, Germany
| | - Burkard M Lippert
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | | | - Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Gill AS, Tullis B, Mace JC, Massey C, Pandrangi VC, Gutierrez JA, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA. Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease? Int Forum Allergy Rhinol 2024. [PMID: 38367249 DOI: 10.1002/alr.23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes. METHODS A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc ) with 95% confidence interval (CI) were calculated. RESULTS A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found. CONCLUSIONS Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benton Tullis
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Conner Massey
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Vivek C Pandrangi
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Indiana, Indianapolis, Indiana, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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Felix V, A L, Ahilasamy N, Narendrakumar V. Alveolar Recess Cell (ARC): A Newly Described Intra Maxillary Sinus Cell with Variable Pneumatisation of Alveolar Process of Maxilla. Indian J Otolaryngol Head Neck Surg 2024; 76:485-489. [PMID: 38440486 PMCID: PMC10908755 DOI: 10.1007/s12070-023-04189-z] [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: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Anatomical variations in the maxillary sinus pneumatisation are limited unlike the ethmoids. We present rare variations of the maxillary sinus along its floor other than septations and includes wide pneumatisation of alveolar and palatal recess with cell formation. An intra-maxillary cell that opens into the maxillary infundibulum well within the sinus is described here and our senior author has coined the new term-alveolar recess cell. Its involvement in the sinus pathologies and additional surgical approaches for the disease clearance is discussed here.
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Affiliation(s)
- Vinod Felix
- Department of ENT, Kimshealth Hospital, PB.NO. 1, Anayara P.O., Thiruvananthapuram, Kerala 695029 India
| | - Lakshmi A
- Department of ENT, Kimshealth Hospital, PB.NO. 1, Anayara P.O., Thiruvananthapuram, Kerala 695029 India
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Gupta R. Balloon Sinuplasty: Our Experience. Indian J Otolaryngol Head Neck Surg 2024; 76:141-144. [PMID: 38440653 PMCID: PMC10909022 DOI: 10.1007/s12070-023-04111-7] [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: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 03/06/2024] Open
Abstract
Chronic rhino sinusitis (CRS) is a common disease. Maxillary sinusitis not cured by the medicines was addressed by the open surgical procedure namely Caldwell Luc operation. Thereafter introduction of nasal endoscopes in 1970's led to the minimally invasive surgery FESS which preserved the physiology of the nose and sinuses. In the year 2002 balloon sinuplasty was introduced in the western world and subsequently in India. Due to various logistics it was not performed and reintroduced in the year 2015 in India. It can be termed as micro minimally invasive surgery wherein anatomy as well as physiology of the nose and sinuses were preserved in cases of medically non responsive mild to moderate sinusitis. 20 cases were selected for exclusive balloon sinuplasty of maxillary sinus. Balloon sinuplasty is a relatively new procedure which can be termed as micro minimally invasive surgery addressing the CRS without the traditional forms for surgery like incision, cutting or microdebriding. The principle is causing microfractures by inflating the sinus opening and thus facilitating the drainage of the sinus contents. No immediate or late post operative complications were noted. Sinus patency 6 months later was present in 90% of the cases. Balloon sinuplasty is an excellent procedure for medically nonresponsive CRS without polyposis. The success rate is spectacular matching the FESS with almost no immediate post operative and late complication. The recurrence rate of sinusitis is low. We conclude that balloon sinuplasty is a micro invasive procedure which saves operating time, time of hospital stay of the patient and delivers excellent result with almost no complications. We hope it could be incorporated as a routine surgery for mild to moderate sinusitis not responding to medicines.
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11
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Weber RK, Hildenbrand T, Kühnel T, Hoffmann TK, Betz C, Sommer F. ["Radical" versus "functional" surgery of the paranasal sinuses-A contradiction?]. HNO 2024; 72:102-112. [PMID: 37880356 DOI: 10.1007/s00106-023-01378-8] [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] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND AND OBJECTIVE The terms "functional" and "radical" paranasal sinus surgery were often considered to be different operations which were mutually exclusive. This overview aims to look at the basics of these terms and surgical procedures and to work out the resulting surgical concepts for clinically relevant indications. MATERIAL AND METHODS Selective literature analysis using the data base PubMed, corresponding textbooks and resulting secondary literature regarding functional and radical or extended paranasal sinus surgery. Similarly, the current literature regarding clinically relevant indications for sinus surgery were analyzed. RESULTS AND CONCLUSION Modern pathophysiological knowledge, anatomically and pathophysiologically substantiated endoscopic surgical procedures and the usage of up to date technical possibilities have resulted in concepts which combine functional and so-called radical or extended surgery of the paranasal sinuses that complement each other and sometimes even overlap. The preoperative diagnosis and definition of underlying diseases are decisive and should be as precise as possible, as the extent and surgical details mainly depend on them: a sole creation of free drainage pathways, an additional creation of anatomical access for subsequent topical treatment or a complete (radical) removal of a pathological process.
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Affiliation(s)
- Rainer K Weber
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Moltkestraße 90, 76133, Karlsruhe, Deutschland.
- Sinus Academy, Karlsruhe, Deutschland.
| | - Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Thomas K Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Christian Betz
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Fabian Sommer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
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12
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Low CM, Wang AR, Yong M, Nayak J, Patel Z, Hwang PH. Impact of dupilumab prescribing on utilization of medical and surgical therapies for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2024. [PMID: 38297486 DOI: 10.1002/alr.23325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
KEY POINTS Increased dupilumab utilization coincided with decreased ESS in patients with CRSwNP between 2019 and 2021. One potential confounder was the concurrent COVID-19 pandemic, which may have negatively impacted surgery utilization rates.
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Affiliation(s)
- Christopher M Low
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Ear, Nose and Throat Center, Park Ridge, Illinois, USA
| | - Allan R Wang
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Yong
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jayakar Nayak
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Zara Patel
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Peter H Hwang
- Division of Rhinology-Sinus and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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13
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Albazee E, Alsubaie HM, AlKandery M, Abdulrahman S, Alsaleh S. Efficacy of perioperative lidocaine infusion on surgical field quality during functional endoscopic sinus surgery: a systematic review and meta-analysis with trial sequential analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08455-w. [PMID: 38231242 DOI: 10.1007/s00405-024-08455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that assessed the efficacy of perioperative intravenous lidocaine versus placebo in improving the quality of surgical field during functional endoscopic sinus surgery (FESS). METHODS PubMed, Scopus, Web of Science, and CENTRAL were thoroughly searched from inception until June 2023. The included RCTs were evaluated via RoB-2 tool. Our primary endpoint included intraoperative surgical field quality, and secondary endpoints involved operative duration, estimated blood loss, time for post-anesthesia care unit (PACU) discharge, postoperative pain, mean difference in heart rate (HR), and mean difference in mean arterial pressure (MAP). Continuous data were pooled as mean difference (MD) or standardized mean difference (SMD) via RevMan software. Also, the certainty of evidence for each outcome were assessed according to the GRADE system. RESULTS Four RCTs with total of 267 patients were included. Regarding the intraoperative quality of surgical field, the results indicated a significant difference in favor of the lidocaine group compared to the placebo group (n = 3 RCTs, MD - 0.80, 95% CI [- 0.98, - 0.61], p < 0.001, moderate certainty of evidence). The trial sequential analysis showed there is a substantial and conclusive evidence. Regarding time for PACU discharge, there was a significant difference that favor lidocaine group (p < 0.05). On the contrary, there was no significant difference between lidocaine and placebo groups in terms of operative duration, estimated blood loss, postoperative pain, mean change in MAP and HR, (p > 0.05). CONCLUSION Our review revealed that lidocaine infusion, compared with a placebo, significantly improved the surgical field and shortened the time required for PACU discharge. However, lidocaine did not reduce surgery time, estimated blood loss, postoperative pain, MAP, or HR.
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Affiliation(s)
- Ebraheem Albazee
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.
| | - Hemail M Alsubaie
- Otorhinolaryngology-Head and Neck Surgery and Communication Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mashael AlKandery
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Shawkat Abdulrahman
- Department of Otolaryngology-Head and Neck Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Saad Alsaleh
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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14
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Weber RK, Sommer F, Heppt W, Hosemann W, Kühnel T, Beule AG, Laudien M, Hoffmann TK, Hoffmann AS, Baumann I, Deitmer T, Löhler J, Hildenbrand T. [Fundamentals and practice of the application of nasal packing in sinonasal surgery]. HNO 2024; 72:3-15. [PMID: 37845539 DOI: 10.1007/s00106-023-01369-9] [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] [Accepted: 08/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVES This paper presents an overview on nasal packing materials which are available in Germany. The current literature is analyzed whether there are robust criteria regarding use nasal packing after sinonasal surgery, whether there are fundamental and proven advantages or disadvantages of products, and what this means in clinical practice. MATERIALS AND METHODS Selective literature analysis using the PubMed database (key words "nasal packing", "nasal tamponade", "nasal surgery", "sinonasal surgery", or "sinus surgery"), corresponding text books and resulting secondary literature. RESULTS AND CONCLUSIONS Because of systematic methodological shortcomings, the literature does not help in the decision-making about which nasal packing should be used after which kind of sinonasal surgery. In fact, individual approaches for the many different clinical scenarios are recommended. In principle, nasal packing aims in hemostasis, should promote wound healing, and should not result in secondary morbidity. Nasal packing materials should be smooth (non-absorbable materials), inert (absorbable materials), and should not exert excessive pressure. Using non-absorbable packing entails the risk of potentially lethal aspiration and ingestion. For safety reasons inpatient control is recommended as long as this packing is in situ. With other, uncritical packing materials and in patients with special conditions, outpatient control could be justified.
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Affiliation(s)
- Rainer K Weber
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.
- Sinus Academy, Karlsruhe, Deutschland.
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - Fabian Sommer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Werner Heppt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Werner Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Heliosklinikum Stralsund, Stralsund, Deutschland
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Achim Georg Beule
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Deutsches Zentrum für Erkrankungen der oberen Atemwege, Münster, Deutschland
| | - Martin Laudien
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel, Kiel, Deutschland
| | - Thomas K Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Anna Sophie Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Ingo Baumann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
| | - Jan Löhler
- Deutscher Berufsverband der HNO-Ärzte e. V., Neumünster, Deutschland
| | - Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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15
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Lerner DK, Gray M, Liu K, Al-Awady A, Omorogbe A, Ninan S, Goldrich DY, Schaberg M, Del Signore A, Govindaraj S, Iloreta AM. Gabapentin and postoperative pain and opioid consumption: A double-blind randomized controlled trial of perioperative pain management for sinus surgery. Am J Otolaryngol 2024; 45:104108. [PMID: 37948826 DOI: 10.1016/j.amjoto.2023.104108] [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: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The link between post-operative narcotic prescription and opioid misuse has spurred a nationwide effort to reduce perioperative opioid use. Previous work has suggested that perioperative gabapentin may reduce post-operative pain and opioid consumption across different procedures, although the optimal regimen remains to be defined. METHODS Chronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS) with or without septoplasty were randomized to receive a 7-day pre- and post-operative course of placebo or gabapentin, starting at 300 mg daily and titrated to 300 mg three times daily, in a double-blind fashion. Primary endpoint was pain level using a validated visual analog scale (VAS). Secondary endpoints included post-operative opioid consumption and side effects, as well as modified Lund-Kennedy endoscopy, Lund-Mackay, and SNOT-22 scores. RESULTS Analysis of 35 patients (20 gabapentin, 15 control) showed no significant difference in mean postoperative VAS (p = 0.18) or postoperative opioid consumption between the placebo and gabapentin groups (2.3 and 4.8 oxycodone tablets respectively, p = 0.18). 15 of 35 patients did not require any post-operative oxycodone tablets, and only two patients required more than six tablets. CONCLUSION Preliminary results show no significant change in pain after FESS with or without septoplasty in patients taking 7-day pre- and post-operative gabapentin versus placebo. Results also showed no significant difference in opioid consumption between the treatment and placebo groups. Post-operative pain scores and opioid requirements are both quite low following FESS. Many patients do not need opioids at all, suggesting that routine initial post-operative opioid prescriptions can be limited accordingly.
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Affiliation(s)
- David K Lerner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mingyang Gray
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Liu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aisosa Omorogbe
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sen Ninan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Y Goldrich
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madeleine Schaberg
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Cannavicci A, Lechien JR, Saibene AM, Calvo-Henriquez C, Maniaci A. The impact of confounding factors on the association between chronic rhinosinusitis, obesity and disease recurrence: A critical commentary. Am J Otolaryngol 2024; 45:104045. [PMID: 37722220 DOI: 10.1016/j.amjoto.2023.104045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Angelo Cannavicci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), 75001 Paris, France; Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Jérôme R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), 75001 Paris, France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
| | - Alberto M Saibene
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), 75001 Paris, France; Department of Otolaryngology - Head and Neck, San Paolo Hospital, University of Milan, Milan, Italy
| | - Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), 75001 Paris, France; Service of Otolaryngology, Rhinology Unit, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), 75001 Paris, France; Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy.
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17
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Abdelnaseer U, El Sayed Salem A, Shawky BH, Yousef A. Assessment of Nasal Obstruction Symptoms and Pulmonary Function Following Functional Endoscopic Sinus Surgery ( FESS) in Chronic Rhinosinusitis with Nasal Polyps. Indian J Otolaryngol Head Neck Surg 2023; 75:3235-3241. [PMID: 37974679 PMCID: PMC10646092 DOI: 10.1007/s12070-023-03898-9] [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: 01/08/2023] [Accepted: 05/25/2023] [Indexed: 11/19/2023] Open
Abstract
The upper and lower airways are typically subjected to identical inflammatory stimuli and comprise a single organ that is functionally connected. 40 patients with chronic rhinosinusitis with nasal polyps who had failed medical treatment and undergone FESS participated in our study. Prior to surgery and three months after surgery, nasal obstruction symptoms were measured using the NOSE score system and pulmonary function tests were evaluated using spirometry. The mean Nose Score was 70 before surgery but dropped to 4 afterward, with a p value < 0.001 showing a statistically significant improvement in the nasal symptoms following FESS. The mean pre-operative FVC, FEV1, and FEV1/FVC% values were 3.19, 2.53, and 78.81%, respectively, while the mean post-operative values were 3.14, 2.5, and 79.01%. Following FESS, there wasn't a statistically significant change in lung function tests. Our study showed that percentage of change of total NOSE score has a statistically significant Negative correlation with percentage of change of pulmonary function tests parameters. This study demonstrates the positive effects of FESS on nasal polyposis patients' quality of life and nasal obstruction symptoms without having any negative impacts on the lower airways.
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Affiliation(s)
- Usama Abdelnaseer
- Otolaryngology Department, Kasr Al-Aini, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman El Sayed Salem
- Pulmonology Department, Kasr Al-Aini, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Bola Hosny Shawky
- Otolaryngology Department, Kasr Al-Aini, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Yousef
- Kasr Al-Aini, Faculty of Medicine, Cairo University, Cairo, Egypt
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18
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Gupta M, Srivastava A, Kanaujia P, Kanaujia SK, Gautam HK, Saxena NS, Verma A, Singh S. Assessment of Nasal Obstruction in Patients Undergoing Functional Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:3565-3574. [PMID: 37974819 PMCID: PMC10645868 DOI: 10.1007/s12070-023-04019-2] [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: 05/13/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
Aim & objectives-To assess and compare the nasal obstruction in patients before and after undergoing FESS using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy. Introduction- Chronic Rhinosinusitis with, or without nasal polyps can lead to nasal obstruction. Patients refractory to medical treatment undergo Functional endoscopic sinus surgery (FESS). FESS has been shown to improve subjective quality of life outcomes and objective endoscopic improvement. Material & methods- A prospective study conducted in the department of Ear, Nose & Throat, of a tertiary care medical college and associated Hospital between January 2021 and October 2022. Subjective and objective assessment of nasal obstruction was done using Visual analogue scale, Rhinomanometry and Diagnostic nasal endoscopy before and after surgery at 1st, 3rd and 6th month. Results- Post FESS, there was a significant improvement in nasal obstruction on Visual analogue scale, sinuses were healthy and drainage was adequate on Diagnostic nasal endoscopy, statistically significant (P < 0.05) decrease in nasal resistance was seen on Rhinomanometry. Conclusion- A good subjective outcome on Visual analogue scale and a good objective outcome on Diagnostic nasal endoscopy and Rhinomanometry can be obtained with FESS in patients with Chronic Rhinosinusitis.
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Affiliation(s)
- Mayank Gupta
- Department of ENT, G.S.V.M. Medical College, Kanpur, U.P. India
| | | | - Preeti Kanaujia
- Department of Physiology, G.S.V.M. Medical College, Kanpur, India
| | - S. K. Kanaujia
- Department of ENT, G.S.V.M. Medical College, Kanpur, U.P. India
| | | | - N. S. Saxena
- Department of ENT, G.S.V.M. Medical College, Kanpur, U.P. India
| | - Ashok Verma
- Department of Physiology, G.S.V.M. Medical College, Kanpur, India
| | - Shiroman Singh
- Central Research Centre, G.S.V.M. Medical College, Kanpur, India
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19
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Gillanders SL, McHugh A, Lacy PD, Thornton M. Safe surgical training: evaluation of a national functional endoscopic sinus surgery model simulation course using the Kirkpatrick evaluation model. Ir J Med Sci 2023; 192:3039-3042. [PMID: 36800053 PMCID: PMC9936104 DOI: 10.1007/s11845-023-03309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Simulation is a rapidly developing field in modern undergraduate skills education and postgraduate surgical training. AIM We aim to evaluate simulation training as a tool for higher surgical training in functional endoscopic sinus surgery (FESS) using the Kirkpatrick evaluation model. METHODS This was a prospective cohort study in which a qualitative survey and multiple-choice questionnaire were distributed to otolaryngology trainees pre- and post-FESS training course using simulation models. Participants' reactions and interpretations of the models were assessed. Pre- and post-simulation knowledge and subjective skills were assessed. RESULTS A total of 21 trainees completed the course. Trainees reported simulation models to be accurate representations of human anatomy 95% and easy to use 90%. There was an improvement in anatomical 54 to 62% (Z = 76, p0.03) and procedural 65 to 72% (Z = 87, p0.03) knowledge overall. CONCLUSION Simulation training is an effective method of postgraduate education. This has been particularly useful following reduced operative exposure in the COVID-19 era.
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Affiliation(s)
| | - Alison McHugh
- Royal College of Surgeons, Dublin, Ireland
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Peter D Lacy
- Royal College of Surgeons, Dublin, Ireland
- Beaumont Hospital Dublin, Dublin, Ireland
| | - Mona Thornton
- Royal College of Surgeons, Dublin, Ireland
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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20
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Clarke K, Wilde C, Walker A, Nghiem AZ, Little S, Osborne SF. Combined upper lid skin crease and endoscopic approach to frontal sinus mucocoeles. Orbit 2023:1-8. [PMID: 38032741 DOI: 10.1080/01676830.2023.2287638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE This case series describes the ophthalmic manifestations of frontal sinus mucoceles and reports the long-term surgical outcomes of a combined endoscopic and upper-lid skin crease drainage approach carried out jointly with otorhinolaryngology. METHODS We present a retrospective case review of 18 orbits and 15 patients presenting with frontal sinus mucocoeles, all of whom underwent drainage via an adapted anterior orbitotomy approach between January 2015 and July 2023. Data collection included preoperative and postoperative examination findings (visual acuity, extraocular motility, lid retraction, and lagophthalmos), mucocoele recurrence, cosmetic satisfaction, and surgical complications. Patients were followed up for an average of 22 months. RESULTS All patients underwent successful frontal mucocoele drainage via a modified anterior orbitotomy and simultaneous endonasal approach. At presentation, three (20%) had extraocular restriction leading to diplopia, and six (40%) had proptosis in the eye adjacent to the mucocoele. One patient presented acutely with no light perception in the affected eye due to compressive optic neuropathy. All patients who had reduced extraocular motility before surgery regained full motility post-operatively. Treatment was successful in all cases, and there was no documented mucocoele recurrence during follow-up. Satisfactory aesthetic outcomes were achieved in all cases. Reported complications included temporary forehead numbness and ptosis of the affected eyelid, which resolved without intervention. CONCLUSION The modified anterior orbitotomy approach to frontal mucocoeles allows optimal frontal sinus access and mucocoele treatment while preserving cosmesis.
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Affiliation(s)
- Kirsty Clarke
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline Wilde
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Abigail Walker
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Allan Z Nghiem
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Sarah Little
- Adnexal Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah F Osborne
- Adnexal Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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21
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Ramkumar SP, Marks L, Lal D, Marino MJ. Outcomes of limited versus extensive surgery for chronic rhinosinusitis: A systematic review and meta-analysis. Int Forum Allergy Rhinol 2023; 13:2096-2100. [PMID: 37184241 DOI: 10.1002/alr.23178] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 02/14/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Abstract
KEY POINTS There is no consensus on the extent of appropriate surgery for chronic rhinosinusitis (CRS), particularly CRS without polyps (CRSsNP). There is wide heterogeneity in the definition of "limited" and "extensive" endoscopic sinus surgery (ESS). Studies on the appropriate extent of surgery for CRS are needed.
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Affiliation(s)
- Shreya P Ramkumar
- Department of Otolaryngology, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Lisa Marks
- Division of Education, Department of Library Services, Mayo Clinic, Phoenix, Arizona, USA
| | - Devyani Lal
- Department of Otolaryngology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Michael J Marino
- Department of Otolaryngology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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22
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Stępiński MJ, Banaszewski J. Intranasal Synechiae as Complications of Rhinosurgical Treatment-A Review of Current Knowledge. J Clin Med 2023; 12:6831. [PMID: 37959296 PMCID: PMC10648208 DOI: 10.3390/jcm12216831] [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: 09/06/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Intranasal adhesions (synechiae) develop as a result of improper healing of the nasal mucosa. Their incidence ranges from 6.8% to 36% of rhinosurgical procedures. The aim of this study was to review the available publications and monographs dealing with intranasal adhesions-both in the context of formation and risk factors. The study used a review of the literature to determine the articles and studies available in the following medical databases: MEDLINE (National Library of Medicine's), PubMed, and Google Scholar. The following search terms were used: synechiae nasal + synechial nasal + intranasal adhesions + nasal adhesions. The time criterion of available materials was not applied. Available filters in the search engines were used to narrow down the search results. Artificial intelligence was not applied. The review indicated that the risk of intranasal adhesions correlates with the type of surgery, the surgical technique, the dressing materials, and wound care in the postoperative period. Every case requires an individualized approach. Nasal septum separators, (self-)dissolving dressings and (in selected cases) Mitomycin C were investigated thoroughly. Further studies are required which may result in a universal classification system for intranasal adhesions.
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Affiliation(s)
- Mateusz J. Stępiński
- Department of Laryngology with Maxillofacial Surgery Subdepartment, Multidisciplinary Regional Hospital, Dekerta 1, 66-400 Gorzow Wielkopolski, Poland
| | - Jacek Banaszewski
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland
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Stan C, Ujvary LP, Blebea CM, Vesa D, Tănase MI, Tănase M, Pop SS, Rădeanu DG, Maniu AA, Cosgarea M. Sheep's Head as an Anatomic Model for Basic Training in Endoscopic Sinus Surgery. Medicina (Kaunas) 2023; 59:1792. [PMID: 37893511 PMCID: PMC10608182 DOI: 10.3390/medicina59101792] [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] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: This study aims to establish the sheep head as a viable anatomical model for training in functional endoscopic sinus surgery through comprehensive anatomical examination and training-based assessment of participants' satisfaction. Materials and Methods: Participants were divided into three groups according to their prior experience in endoscopic sinus surgery; in total, 24 participants were included. Each participant in the study was assigned to perform the designated procedures on a single sheep's head. Following the completion of the procedures, each participant was provided with a 14-item comprehensive satisfaction questionnaire with a scale attributed from 1 to 5. The normality of distribution was checked by applying the Shapiro-Wilk Test. The Kruskal-Wallis test was applied to compare study group sentiment of agreement towards individual procedures. Results: No significant differences were noted between the answers of the different groups. For the resident group, the average satisfaction score was 4.09 ± 0.54; junior specialist group 4.00 ± 0.55; for the senior specialist group overall satisfaction average score was 4.2 ± 0.77. Conclusions: The sheep's head can be successfully used for learning and practicing manual skills and the use of instruments specific to functional endoscopic sinus surgery. Moreover, the sheep head model can be used for training in other diagnostic or surgical procedures in the field of otorhinolaryngology, such as endoscopy of the salivary glands, open laryngotracheal surgery, or in otologic surgery, but also in other different surgical fields such as neurosurgery, ophthalmology or plastic surgery. Despite the differences between the ovine model and human anatomy, it provides a resourceful and cost-effective model for beginners in endoscopic nasal surgery.
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Affiliation(s)
- Constantin Stan
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
- Department of Surgical Clinic, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania
| | - Laszlo Peter Ujvary
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Cristina Maria Blebea
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Doiniţa Vesa
- Department of Surgical Clinic, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 800008 Galați, Romania
| | - Mihai Ionuţ Tănase
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Mara Tănase
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Septimiu Sever Pop
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Doinel Gheorghe Rădeanu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Alma Aurelia Maniu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
| | - Marcel Cosgarea
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.); (C.M.B.); (M.I.T.); (M.T.); (S.S.P.); (D.G.R.); (A.A.M.); (M.C.)
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Conti DM, Correa EJ, Scadding GK. Is endoscopic sinus surgery sufficient to modify the evolution of adult AERD? Aspirin desensitization as a maintenance factor: systematic review. Front Allergy 2023; 4:1250178. [PMID: 37744694 PMCID: PMC10516441 DOI: 10.3389/falgy.2023.1250178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Aspirin desensitization (AD) and aspirin therapy after desensitization (ATAD) are therapeutic interventions for patients with aspirin-exacerbated respiratory disease (AERD). Our aim is to investigate whether its addition to endoscopic sinus surgery (ESS) improves the overall prognosis of the disease. Methods A systematic review of the current literature including adult patients with a positive diagnosis of AERD undergoing endoscopic sinus surgery (ESS) in the context or in absence of upper airway comorbidity, prior to AD + ATAD. Conclusion This review concludes that the surgical approach is beneficial in AERD, but its effects are short-lived. Surgery should be considered initially with subsequent AD + ATAD in AERD patients, due to the sustained improvement achieved compared to those receiving ESS alone.
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Affiliation(s)
- Diego M. Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - Eduardo J. Correa
- Otolaryngology Department, Hospital Comarcal de la Línea de La Concepción, Cádiz, Spain
| | - Glenis K. Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, United Kingdom
- Division of Immunity and Infection, University College, London, United Kingdom
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25
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Raja H, Patel K. Functional endoscopic sinus surgery: assessing the readability and quality of online information. Ann R Coll Surg Engl 2023; 105:639-644. [PMID: 36374281 PMCID: PMC10471431 DOI: 10.1308/rcsann.2022.0123] [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] [Accepted: 08/11/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the readability and quality of online information on functional endoscopic sinus surgery (FESS). METHODS The term 'functional endoscopic sinus surgery' was entered into the Google, Bing and Yahoo search engines. The first 30 websites for each search engine were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade (FKG), Simple Measure of Gobbledygook (SMOG) Index, and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated. RESULTS Thirty-three websites met the inclusion criteria. The mean and standard deviations for the FRES, FKG, SMOG, GFI, and DISCERN scores were 49 (13.1), 10.9 (2.5), 10.2 (1.9), 13.6 (2.4), and 51.1 (12.8), respectively. A positive correlation was noted between the FRES and DISCERN (R=0.357, p=0.041). CONCLUSIONS Online information on FESS is generally written above the recommended reading levels and of fair quality.
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Affiliation(s)
- H Raja
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - K Patel
- University Hospitals Birmingham NHS Foundation Trust, UK
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Rangics A, Répássy GD, Gyulai-Gaál S, Dobó-Nagy C, Tamás L, Simonffy L. Management of Odontogenic Sinusitis: Results with Single-Step FESS and Dentoalveolar Surgery. J Pers Med 2023; 13:1291. [PMID: 37763059 PMCID: PMC10532572 DOI: 10.3390/jpm13091291] [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: 07/16/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Odontogenic sinusitis (OS) is a well-known and important border of specialties in otorhinolaryngology and dentoalveolar surgery. Odontogenic sinusitis can develop due to iatrogenic harm or odontogenic infection. The gold standard diagnostic method is clinical and radiological-CBCT (cone beam computed tomography)-examination. The treatment of this condition requires collaboration between ENT and dentoalveolar surgery specialists and can be non-surgical or surgical based on staging. This paper aims to share the results of our clinical study whereby complex therapy was administered by a dentoalveolar surgeon and an otorhinolaryngologist in cooperation. PATIENTS AND METHODS We conducted a retrospective study comprising 111 OS patients who underwent complex therapy between 2016 and 2023 at Semmelweis University, Budapest, Hungary. All patients were treated with concurrent FESS (functional endoscopic sinus surgery) and dentoalveolar surgery. Follow-up was based on symptoms, clinical examination and CBCT imaging. RESULTS Of the 111 patients, 107 were successfully treated with concurrent FESS and dentoalveolar surgery, and only 4 had further symptoms following the complex therapy and needed retreatment. CONCLUSIONS The complex, single-session therapy involving FESS and oral surgery is an effective treatment method, which is less invasive and associated with fewer complications compared to previous interventions, such as the Luc-Caldwell procedure.
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Affiliation(s)
- Anna Rangics
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - Gábor Dénes Répássy
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
| | - Szabolcs Gyulai-Gaál
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - Csaba Dobó-Nagy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary;
- Department of Voice Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - László Simonffy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1085 Budapest, Hungary; (A.R.); (S.G.-G.); (C.D.-N.); (L.S.)
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27
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Englhard AS, Ledderose GJ. Anatomical findings in patients with chronic rhinosinusitis without nasal polyps requiring revision surgery. Braz J Otorhinolaryngol 2023; 89:101287. [PMID: 37442058 PMCID: PMC10362179 DOI: 10.1016/j.bjorl.2023.101287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/25/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES For the treatment of chronic rhinosinusitis functional endoscopic sinus surgery is a well-established therapy with high initial success rates. However, a significant proportion of patients have persistent disease requiring revision surgery. To date, studies including data of large patient collectives are missing. In this study, we aimed to identify anatomic factors increasing the need for revision surgery in a large patient collective with chronic rhinosinusitis without nasal polyps. METHODS Data were collected retrospectively on patients with recurrent or persistent chronic rhinosinusitis without nasal polyps requiring revision surgery. The patients' symptomatology, endoscopic and radiographic findings were analyzed. Preoperatively, patients were evaluated with endoscopic examination of the nose and paranasal sinuses. In all individuals computed tomography of the sinuses was performed. Images were evaluated according to the Lund-Mackay system. Information was also collected intraoperatively. RESULTS 253 patients were included. The most common anatomic factor was incomplete anterior ethmoidectomy (51%), followed by residual uncinated process (37%), middle turbinate lateralization (25%), incomplete posterior ethmoidectomy (20%), frontal recess scarring (19%), and middle meatal stenosis (9%). Other factors such as persistent sphenoid pathology was less frequent. CONCLUSION Iatrogenic causes with inadequate resection of obstructing structures seem to be a principal risk factor for recurrent chronic rhinosinusitis and the need for revision sinus surgery. Meticulous attention in the area of the ostiomeatal complex during surgery with ventilation of obstructed anatomy as well as avoidance of scarring and turbinate destabilization may reduce the failure rate after primary endoscopic sinus surgery. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Anna Sophie Englhard
- Klinikum der Universität München, Department of Otorhinolaryngology ‒ Head and Neck Surgery, Marchioninistr, Munich, Germany.
| | - Georg Johannes Ledderose
- Klinikum der Universität München, Department of Otorhinolaryngology ‒ Head and Neck Surgery, Marchioninistr, Munich, Germany; ENT-Center Dr. Lübbers & Kollegen, Weilheim, Germany
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Calvo-Henriquez C, Viera-Artiles J, Rodriguez-Iglesias M, Rodriguez-Rivas P, Maniaci A, Yáñez MM, Martínez-Capoccioni G, Alobid I. The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review. J Clin Med 2023; 12:jcm12103605. [PMID: 37240711 DOI: 10.3390/jcm12103605] [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: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Jaime Viera-Artiles
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Rhinology and Skull Base Department, Marqués de Valdecilla Hospital, PC 39008 Santander, Spain
| | - Miguel Rodriguez-Iglesias
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Paula Rodriguez-Rivas
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Antonino Maniaci
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia" ENT Section, University of Catania, 95123 Catania, Italy
| | - Miguel Mayo Yáñez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Hospital Complex of La Coruña, PC 15001 La Coruña, Spain
| | - Gabriel Martínez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 70123 Paris, France
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain
| | - Isam Alobid
- Service of Otolaryngology, Rhinology and Skull Base Department, Clinic Hospital, PC 08036 Barcelona, Spain
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Yu AJ, Rice D, Ge M, Wrobel B, Gallagher T, Smith S, Ference E. Unplanned 30-Day ER Visit Rate and Factors Associated With ER Visits After Ambulatory Sinus Surgery. Am J Rhinol Allergy 2023:19458924231174686. [PMID: 37198899 DOI: 10.1177/19458924231174686] [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: 05/19/2023]
Abstract
BACKGROUND Emergency room (ER) visits after surgery can be inconvenient and costly to the patient and the healthcare system. Estimates of the 30-day ER visit rate following ambulatory sinus procedures and their risk factors are largely unknown in the literature. OBJECTIVE To determine the 30-day postoperative ER visit rate following ambulatory sinus procedures and the causes and risk factors associated with ER visits. METHODS This is a retrospective, cohort study using data from the State Ambulatory Surgery and Services Databases (SASD) and the State Emergency Department Databases (SEDD) for California, New York, and Florida in 2019. We identified adult (18 years old) patients with chronic rhinosinusitis who underwent ambulatory sinus procedures from the SASD. Cases were linked to the SEDD to identify ER visits occurring within 30 days after the procedure. Logistic regression models were used to identify patient- and procedure-related risk factors associated with the 30-day postoperative ER visit. RESULTS Among the 23 239 patients, the 30-day postoperative ER visit rate was 3.9%. The most common reason for ER visit was bleeding (32.7%). A total of 56.9% of the ER visits occurred within the first week. In the multivariate analysis, factors associated with ER visits included Medicare (odds ratio [OR] 1.29 [1.09-1.52], P = .003), Medicaid (OR 2.06 [1.69-2.51], P < .001), self-pay/no insurance (OR 1.44 [1.03-2.00], P = .031), chronic kidney disease/end-stage renal disease (OR 1.63 [1.06-2.51], P = .027), chronic pain/opioid use (OR 2.70 [1.02-7.11], P = .045), and a disposition other than home (OR 12.61 [8.34-19.06], P < .001). CONCLUSION The most common reason for ER visit after ambulatory sinus procedures was bleeding. An increased ER visit rate was associated with certain demographic factors and medical comorbidities but not with procedure characteristics. This information can help us identify the patient populations who are at higher risk for ER visits to improve their postoperative recovery.
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Affiliation(s)
- Alison J Yu
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Dale Rice
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Marshall Ge
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Bozena Wrobel
- Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Tyler Gallagher
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stephanie Smith
- Department of Otolaryngology, Northwestern University, Chicago, Illinois
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Özdemir A, Bayar Muluk N, Bekin Sarikaya PZ, Yilmazsoy Y. Supraorbital ethmoid cells (SOECs), anterior ethmoid artery notch and ethmoid roof relation in PNSCT. J Clin Neurosci 2023; 110:7-11. [PMID: 36780783 DOI: 10.1016/j.jocn.2023.02.003] [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: 11/28/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES We investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT). METHODS The PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined. RESULTS SOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 ± 1.81 mm in the SOEC group and 0.68 ± 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 ± 2.66 mm in type 3, 3.35 ± 1.35 mm in type 2 and 3.48 ± 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased. CONCLUSION In more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).
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Affiliation(s)
- Adnan Özdemir
- Kırıkkale University, Faculty of Medicine, Radiology Department, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey.
| | | | - Yunus Yilmazsoy
- Bolu Abant İzzet Baysal University, Faculty of Medicine, Radiology Department, Bolu, Turkey
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Deva FAL. Comparison of Conventional Nasal Douching with Corticosteroid Nasal Douching in Chronic Rhinosinusitis Patients Post Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:875-880. [PMID: 37206786 PMCID: PMC10188850 DOI: 10.1007/s12070-022-03389-3] [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: 03/21/2022] [Accepted: 12/07/2022] [Indexed: 01/17/2023] Open
Abstract
Objectives Chronic rhinosinusitis has a preponderance for recurrence even after functional endoscopic sinus surgery. Nasal Douching with saline has been used for decades as a treatment and as an adjunct following surgery. Steroid nasal wash has been introduced recently for the postoperative management of patients with chronic rhinosinusitis. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis with and without polyps. Methods This prospective study was done over a period of 2 years involving 70 chronic rhinosinusitis patients with and without nasal polyps who underwent functional endoscopic sinus surgery. The patients were divided into two groups, in group A, patients were given saline nasal douching and in group B, the budesonide nasal douching. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before and 1, 2, 4, and 6 months after the nasal irrigation. Results In group A, the mean SNOT-22 score improved from 52.5 ± 9.1 before irrigation to 22.1 ± 11.3 after 6 months of irrigation. The LK endoscopy score also improved from 7.2 ± 2.1 before irrigation to 2.1 ± 1.2 after 6 months. In group B, the mean SNOT-22 score improved from 48.9 ± 10.6 before irrigation to 19.8 ± 11.7 after 6 months of irrigation. The endoscopy score also improved from 6.9 ± 2.3 before irrigation to 1.5 ± 1.1 after 6 months. The mean SNOT-22 and Lund-Kennedy scores improved in both groups. Group B with budesonide irrigation was found to have improved significantly than the saline nasal irrigation group, however, the difference between the 2 groups was not significant. Conclusion Nasal douching with budesonide is an effective postoperative treatment for chronic rhinosinusitis with polyps. The addition of budesonide in douching improves the quality of life and reduces the chance of recurrence.
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Chapurin N, Khan S, Gutierrez J, Soler ZM. Economics of Medical and Surgical Management of Chronic Rhinosinusitis with Nasal Polyps: A Contemporary Review. Am J Rhinol Allergy 2023; 37:227-231. [PMID: 36848274 DOI: 10.1177/19458924221147501] [Citation(s) in RCA: 1] [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: 03/01/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) is a chronic inflammatory condition with significant patient morbidity and associated healthcare costs. While the economic burden of CRS overall has been previously described, the economic impact of CRSwNP has received less attention. Patients with CRSwNP have higher disease burden and healthcare resource utilization than those with CRS without nasal polyposis. Rapid evolution of medical management in recent years with the use of targeted biologics warrants further investigation into the economic burden of CRSwNP. OBJECTIVE Provide an updated review of the literature on the economic impact of CRSwNP. METHODS A literature review. RESULTS Research shows that patients with CRSwNP have higher direct costs and usage of ambulatory services compared to matched non-CRS controls. Patients undergoing functional endoscopic sinus surgery (FESS) incur roughly $13,000 in costs which is particularly relevant given the rate of disease recidivism and need for revision surgery associated with CRSwNP. Disease burden additionally leads to indirect costs through loss of wages and productivity due to work absenteeism and presenteeism, with estimates of up to roughly $10,000 lost in mean annual productivity cost in refractory CRSwNP. Several studies have shown FESS to be more cost-effective in intermediate and long-term management than medical therapy with biologics, despite similar long-term outcomes with respect to quality-of-life metrics. CONCLUSION CRSwNP is a chronic condition with high recurrence rates making it a challenge to manage over time. Current research suggests that FESS is more cost-effective than medical management, including use of newer biologics. Further investigation into both direct and indirect costs associated with medical management is warranted to perform accurate cost-effectiveness analyses and allow for the best allocation of limited healthcare resources.
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Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sofia Khan
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jorge Gutierrez
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, 2345Medical University of South Carolina, Charleston, South Carolina, USA
| | - Zachary M Soler
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology and Endoscopic Skull Base Surgery, 2345Medical University of South Carolina, Charleston, South Carolina, USA
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Park MJ, Park HI, Ahn KM, Kim JH, Chung YS, Jang YJ, Yu MS. Features of Odontogenic Sinusitis Associated With Dental Implants. Laryngoscope 2023; 133:237-243. [PMID: 35179239 DOI: 10.1002/lary.30069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN Case-control study. METHODS This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE 4 Laryngoscope, 133:237-243, 2023.
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Affiliation(s)
- Marn Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Inha University School of Medicine, Incheon, South Korea
| | - Han Ick Park
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Heui Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoo-Sam Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Ju Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Myeong Sang Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Chua AJK, Jafar ABHA, Citardi MJ. Osteoradionecrosis of the lamina papyracea leading to recurrent orbital infections-A case study. Int Forum Allergy Rhinol 2022; 13:1055-1057. [PMID: 36547990 DOI: 10.1002/alr.23123] [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: 11/18/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Osteoradionecrosis (ORN) is a well-known complication of radiotherapy (RT) to the sino-nasal cavity and nasopharynx. Here, we report a case of recurrent orbital infections secondary to ORN of the lamina papyracea (LP). A 66-year-old female presented to our unit with right periorbital swelling and pain after having undergone chemotherapy and proton beam irradiation to her ethmoid sinuses for sino-nasal undifferentiated carcinoma (SNUC) 5 years prior. She had also undergone endoscopic sinus surgery for chronic rhinosinusitis about a year prior to the current presentation. Her post-operative course was notable for recurrent episodes of pre-septal cellulitis occurring about 3 months apart that were increasingly severe. Examination revealed right proptosis, and endoscopy showed an exposed and denuded LP with scant crusting of the ethmoid sinuses. Microbial studies did not yield any significant growth, and imaging showed enhancement of the right orbit. The working diagnosis was acute right orbital cellulitis secondary to ORN of the right LP. She was treated with broad spectrum intravenous antibiotics and systemic steroids, but experienced minimal symptomatic improvement. She then underwent endoscopic resection of the right LP, and histopathological examination showed osteonecrosis on an inflammatory background. Post-operatively, all orbital symptoms resolved and she was well at 6 months' follow up. In the discussion, we highlight additional factors in our patient that may have contributed to this clinical presentation, and hope that this report raises awareness of a rare complication of RT to the sino-nasal cavity.
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Affiliation(s)
| | - Ali B H A Jafar
- University of Texas Health Science Center at Houston, Houston, Texas, USA
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Bonavolontà P, Togo G, Fossataro F, Romano A, Abbate V, Iaconetta G, Califano L. Recurrence of Exophthalmos after 10 Years from Orbital Floor Decompression for Dysthyroid Orbitopathy: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:4673-4675. [PMID: 36742715 PMCID: PMC9895134 DOI: 10.1007/s12070-021-03003-y] [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: 07/30/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
Dysthyroid orbitopathy or Graves' ophthalmopathy (GO) is an autoimmune disease with a complex pathogenesis that usually occur in patients with hyperthyroidism. Surgical decompression of the orbit is an accepted and validated treatment of thyroid eye disease (TED). This is a case of a patient with left exophthalmos and ipsilateral maxillary sinusitis after 10 years from the surgical bone decompression of the orbital floor for TED.
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Affiliation(s)
- Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
| | - Federica Fossataro
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
| | - Antonio Romano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
| | | | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, Naples, Italy
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Tikka S, Chaithra BG, Sharma SB, Janakiram TN. A Feasible, Low-Cost, Capsicum and Tomato Model for Endoscopic Sinus and Skull Base Surgery Training. Indian J Otolaryngol Head Neck Surg 2022; 74:4565-4570. [PMID: 36742779 PMCID: PMC9895242 DOI: 10.1007/s12070-021-02583-z] [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: 02/16/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023] Open
Abstract
To describe and standardize an easily available, viable, low-cost capsicum and Tomato model for endoscopic sinus and Skull Base surgery training. Rhinology fellows performed the following stimulated endoscopic sinus exercises using the capsicum and tomato models at our centre using a Karl Storz angled Endoscope and Medtronic Debrider with various angled blades. Each student dissected 10 specimens before training these procedures on human patients, and the benefit of the capsicum and tomato models training was evaluated. 10 rhinology fellows of comparable academic level participated in the training. All participants agreed that the capsicum and tomato model dissections improved their skills in using powered instruments and endoscopic instruments, 90% agreed that the dissections improved their hand-eye coordination, precision, the manoeuvrability of angled blades and confidence with respect to their further training in human patients. A novel technique of low-cost model using Capsicum and Tomato has been used for training fellows in endoscopic sinus and Skull Base surgery. However, no standardization of this training has been performed to ensure that it is a valuable tool for learning and skill-building. The standardized method described in this study increased the skills and confidence of the fellows before beginning their training on human patients. Moreover, our results demonstrate the feasibility of the model, considering its cost-effectiveness and easy availability. A novel technique of low-cost simulation exercises using capsicum and tomato have been described. Future studies with this model should be conducted to assess whether the resulting increase in skills prevents and reduces medical errors, increases patient safety, reduces training costs, and improves the quality of otolaryngological care.
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Ahilasamy N, Narendrakumar V, Kumar RD, Sarath NS. Local Anaesthetic Nerve Blocks in Endoscopic Nasal and Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:602-607. [PMID: 36514428 PMCID: PMC9741691 DOI: 10.1007/s12070-021-03044-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 12/15/2022] Open
Abstract
In the present era, Hemostasis in Endoscopic nasal and sinus surgeries are challenging even with appropriate use of instrumentation and surgical skills. This can be addressed with appropriate local anaesthesia and nerve blocks. Expertise in performing surgery under local anaesthesia can be acquired over years of surgical training. The objective of this article is to define complete nerve blocks which can be used in endoscopic nasal surgeries.
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Affiliation(s)
| | | | - Rajendran Dinesh Kumar
- Department of ENT and Head-Neck Surgery,, Rajarajeswari Medical College and Hospital, Bengaluru, 560074 Karnataka India
| | - N Sai Sarath
- Department of ENT and Head-Neck Surgery,, Rajarajeswari Medical College and Hospital, Bengaluru, 560074 Karnataka India
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Sharma P, Patel H, Sharma N, Mittal K, Raje A, Yashlaha C. Postoperative Pain Assessment in Patients Undergoing Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 2022; 74:4632-4639. [PMID: 36742514 PMCID: PMC9895160 DOI: 10.1007/s12070-021-02929-7] [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: 04/05/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Post-operative pain management after functional endoscopic sinus surgery for chronic rhinosinusitis is a field with lack of proper guidance and research. Aim of this study was to study post-operative pain and its management. In this prospective observational study 52 patients undergoing functional endoscopic sinus surgery were examined using Quality Improvement in Post-operative Pain Management (QUIPS) questionnaire post-operatively on 1st day, 2nd day and day of 1st follow up permitting standard assessment of all pain related parameters, outcome, and process parameters. Pain was relatively low after surgery throughout with nominal increase on 2nd day and relatively diminishing on 1st follow up day. Positive pain counselling and many other factors affect pain and related parameters in the patients. Opioid analgesics can be effectively avoided in these patients and pain management protocol should be established for all surgeries along with judicious use of analgesics and proper use of positive pain counselling.
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Affiliation(s)
- Pritosh Sharma
- Department of ENT & Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan India
| | - Heer Patel
- Ashwaraj-II Bunglows, nr. baghban party plot, Thaltej-shilaj road, Thaltej, Ahmedabad, Gujarat 380059 India
| | - Nitin Sharma
- Department of ENT & Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan India
| | - Kanak Mittal
- Department of ENT & Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan India
| | - Anushree Raje
- Department of ENT & Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan India
| | - Chirag Yashlaha
- Department of ENT & Head and Neck Surgery, Geetanjali Medical College, Udaipur, Rajasthan India
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Cengiz AB, Gumuslu BC, Tansuker HD, Ogreden S, Oktay MF. The Comparison of Inflammatory Markers for the Prediction of Recurrence of the Nasal Polyp After Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:881-887. [PMID: 36452578 PMCID: PMC9702484 DOI: 10.1007/s12070-020-01952-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022] Open
Abstract
During the past decade, several inflammation-based periferic prognostic systems have been reported in the field of chronic rhinosinusitis with nasal polyps (CRSwNP). Recently, C-reactive protein (CRP) and albümin ratio (CAR) showed its impact on a large variety of diseases conditions that cause chronic inflammation. We aimed to compare the inflammatory markers in patients with recurrent and non-recurrent nasal polyps and if a significant inflammatory profile is associated with multiple recurrences. The study concerned 144 patients who underwent FESS for CRSwNP from 2012 to 2017 and had a postoperative follow-up longer than 12 months and 120 healthy individuals. We evaluated the impact of the CAR, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, eosinophil-to-lymphocyte ratio (ELR) between patients with and without polyp recurrences and control groups. There was a statistically significant difference in CRP, CAR and ELR values between multiple recurrence group and no-recurrence group (p = 0.02; 0.004; 0.019 respectively), mean eosinophil and CRP values, CAR, NLR and ELR was significantly higher in NP patients than control group (p < 0.001). The receiver operating curve analysis showed CAR and ELR as a potential marker of recurrence of NP (AUC = 0.713 and 0.613, respectively p < 0.001). The cutoff values for were 1.03 for CAR and 0.22 for ELR. The mean CRP, CAR and ELR were significantly higher in patients with CRSwNP whose disease recurred after surgery. CAR may be a potential marker to predict the recurrence before endoscopic sinus surgery as well as ELR in CRSwNP disease.
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Affiliation(s)
- Abdurrahman Bugra Cengiz
- Department of Otorhinolaryngology, University of Medical Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Bekir Can Gumuslu
- Department of Otorhinolaryngology, University of Medical Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Hasan Deniz Tansuker
- Department of Otorhinolaryngology, University of Medical Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sahin Ogreden
- Department of Otorhinolaryngology, University of Medical Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Faruk Oktay
- Department of Otorhinolaryngology, University of Medical Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Akbar Ali M, Manish Jaiswal D, Sameer Ahamed DB, Kumari V, Alam S. A Study of Anatomical Variations of Sphenoid Sinus on CT PNS: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1690-1693. [PMID: 36452840 PMCID: PMC9702421 DOI: 10.1007/s12070-021-02842-z] [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: 07/22/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022] Open
Abstract
Sphenoid sinus anatomical variations are very common, its prior knowledge is very essential while doing skull base surgery to avoid catastrophic complications which might be due to damage of surrounding neurovascular structures. This retrospective observational study was done to examine the different anatomical variations of sphenoid sinus on CT PNS which was conducted in KMCH, Katihar from May 2019 to April 2020 involving 60 cases above 15 years of age who had undergone CT PNS. Sellar type of pneumatization was seen in 66.7%, pterygoid process pneumatization was seen in 25%. Single septation was present in 43.3%, septum attached to optic nerve was seen in 33.3%, onodi cell was seen in 36.7%, anterior clinoid process pneumatization was seen in 13.3% of cases. By this study we came to a conclusion that preoperative assessment of sphenoid sinus anatomy and its variations is mandatory to avoid surrounding neurovascular structure damage and CSF leak.
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Anchan SV, Shah V, Jalisatgi RR, Naik AS, Sidappa R, Pandurangi AS. A Comparative Study of Interventions of Middle Turbinate Medialization in Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:1706-1712. [PMID: 36452729 PMCID: PMC9701921 DOI: 10.1007/s12070-021-02861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
The shape and position of middle turbinate play an important role in ventilation and drainage of the osteomeatal complex. The preservation of middle turbinate is one of the major goals of functional endoscopic sinus surgery (FESS). Middle turbinate intervention is essential to prevent obliteration of osteomeatal complex. The aim of this prospective study is to postulate which middle turbinate intervention is most effective and compare the results with conventional technique. In this randomized controlled study, 60 patients were included of the age group of 15-60 years who presented to the Otorhinolaryngology OPD of our institute between November 2017 to June 2019 with symptoms of chronic sinusitis with clinical and radiological evidence and who underwent FESS. The patients were divided into three group, Group A-Bolgerization (n = 20), Group B-Vicryl-conchopexy (n = 20) and Group C-No intervention, Control group (n = 20). The patency of middle meatus and the status of middle turbinate (medialized or lateralized or neither of the two) was ascertained postoperatively. Improvement in symptoms was also evaluated. The middle turbinate was medialized in 90% of Group A and 95% of Group B cases. The middle turbinate was neither medialized nor lateralized in 70% of patients in Group C. 70% of the patients in Group A and 80% of patients in Group B had complete improvement in symptoms with no recurrence of sinusitis compared to Group C in which only 50% of the patients had improvement in symptoms due to development of synechiae. Medialization of the middle turbinate should be considered as one of the essential steps of FESS as it helps in improving the surgical outcome.
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Affiliation(s)
- Shibani Vittal Anchan
- Department of ENT, SDM College of Medical Sciences and Hospital, Affiliated to SDM University, Dharwad, Karnataka India
| | - Vidit Shah
- Department of ENT, SDM College of Medical Sciences and Hospital, Affiliated to SDM University, Dharwad, Karnataka India
| | - Roshan Ramchandra Jalisatgi
- Department of ENT, SDM College of Medical Sciences and Hospital, Affiliated to SDM University, Dharwad, Karnataka India
| | - Ashok Shekappa Naik
- Department of ENT, SDM College of Medical Sciences and Hospital, Affiliated to SDM University, Dharwad, Karnataka India
| | - Rashmi Sidappa
- Department of ENT, SDM College of Medical Sciences and Hospital, Affiliated to SDM University, Dharwad, Karnataka India
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Smith DH, Falco JJ, Devarakonda AK, Holmes TW, Shirley B, Prosser JD. Cystic fibrosis exacerbations treated with medical therapy with and without concurrent sinus surgery. Int J Pediatr Otorhinolaryngol 2022; 161:111249. [PMID: 35932623 DOI: 10.1016/j.ijporl.2022.111249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This analysis investigates any potential differences in pulmonary function test (PFT) outcomes among pediatric patients with cystic fibrosis (CF) receiving both medical management (MM) and functional endoscopic sinus surgery (FESS) versus MM alone for CF exacerbation. STUDY DESIGN Prospective cohort. SETTING Pediatric tertiary care facility. METHODS The data was prospectively collected from July 2011 to March 2020. Diagnosis of CF and age ≤ to 18 were required. All patients were hospitalized and treated for CF exacerbations with both FESS with MM and MM alone at variable time intervals, although the order of initial treatment received differed. Two-way ANOVA with repeated measures were used to determine the effect of receiving FESS with MM versus MM alone on PFT outcomes over time (during admission, at discharge, at 3 months, at 6 months, and at 12 months). RESULTS 13 pediatric patients, 7 of which had FESS with MM initially and 6 who had MM alone initially, and 20 events of both FESS and MM were included for analysis. For PFT outcomes, there was no statistically significant two-way interaction between treatment type and time following treatment, p = 0.492. The main effect of treatment did not show a statistically significant difference in FEV1 between treatment types, p = 0.737. There was no statistically significant association between treatment type and time between hospital readmission in months, p = 0.111. CONCLUSION There was no significant difference between PFT outcomes in pediatric patients hospitalized for CF exacerbation treated with MM with or without FESS at any time interval.
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Ahilasamy N, Narendrakumar V, Rajendran DK. Supra Maxillary Cell (SMC): An Anatomical variant of Ethmoid Sinus. Indian J Otolaryngol Head Neck Surg 2022; 74:870-874. [PMID: 36452601 PMCID: PMC9701942 DOI: 10.1007/s12070-020-01947-1] [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: 03/31/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022] Open
Abstract
65 year old female presented with complaints of Right sided nasal obstruction of 1 year duration, intermittent nasal discharge for the past 6 months, without much significant improvement in medical management. Computerized tomography of paranasal sinuses revealed presence of supra maxillary cell (SMC) which was infected, along with sphenoid sinus (Heterodense lesion-suggestive of probable Fungal sinusitis). Patient underwent Functional Endoscopic Sinus Surgery with Septoplasty under local anesthesia. Among the paranasal sinuses, the ethmoid sinus has the largest number of anatomical variations. Important structures near the ethmoid sinus are usually in danger during the endoscopic sinus surgery due to its extreme anatomical variations. Posterior ethmoid cells can also expand towards and into the Maxillary sinus, which drains into the superior nasal meatus, referred to as the Ethmo maxillary sinus. This clinical report highlights about similar anatomical variation in the paranasal sinuses. We report a case of similar type of cell, only difference is it drains into middle meatus, situated mostly over the maxillary sinus alone along its entire width and the senior author has coined a term for it as supra maxillary cell (SMC).
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Affiliation(s)
| | | | - Dinesh Kumar Rajendran
- Department of ENT and Head-Neck Surgery, Rajarajeshwari Medical College and Hospital, Bengaluru, 560074 Karnataka India
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Salati H, Singh N, Khamooshi M, Vahaji S, Fletcher DF, Inthavong K. Nasal Irrigation Delivery in Three Post- FESS Models From a Squeeze-bottle Using CFD. Pharm Res 2022; 39:2569-2584. [PMID: 36056272 PMCID: PMC9556402 DOI: 10.1007/s11095-022-03375-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
Purpose Nasal saline irrigation is highly recommended in patients following functional endoscopic sinus surgery (FESS) to aid the postoperative recovery. Post-FESS patients have significantly altered anatomy leading to markedly different flow dynamics from those found in pre-op or non-diseased airways, resulting in unknown flow dynamics. Methods This work investigated how the liquid stream disperses through altered nasal cavities following surgery using Computational Fluid Dynamics (CFD). A realistic squeeze profile was determined from physical experiments with a 27-year-old male using a squeeze bottle with load sensors. The administration technique involved a head tilt of 45-degrees forward to represent a head position over a sink. After the irrigation event that lasted 4.5 s, the simulation continued for an additional 1.5 s, with the head orientation returning to an upright position. Results The results demonstrated that a large maxillary sinus ostium on the right side allows saline penetration into this sinus. The increased volume of saline entering the maxillary sinus limits the saline volume available to the rest of the sinonasal cavity and reduces the surface coverage of the other paranasal sinuses. The average wall shear stress was higher on the right side than on the other side for two patients. The results also revealed that head position alters the sinuses’ saline residual, especially the frontal sinuses. Conclusion While greater access to sinuses is achieved through FESS surgery, patients without a nasal septum limits posterior sinus penetration due to the liquid crossing over to the contralateral cavity and exiting the nasal cavity early.
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Affiliation(s)
- Hana Salati
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - Narinder Singh
- Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, 2145, Westmead, New South Wales, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, 3004, Melbourne, Victoria, Australia
| | - Sara Vahaji
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia
| | - David F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, 2145, New South Wales, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, 3083, Bundoora, Victoria, Australia.
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Kimple AJ, Senior BA, Naureckas ET, Gudis DA, Meyer T, Hempstead SE, Resnick HE, Albon D, Barfield W, Benoit MM, Beswick DM, Callard E, Cofer S, Downer V, Elson EC, Garinis A, Halderman A, Hamburger L, Helmick M, McCown M, McKinzie CJ, Phan H, Rodriguez K, Rubenstein RC, Severin A, Shah G, Shenoy A, Sprouse B, Virgin F, Woodworth BA, Lee SE. Cystic Fibrosis Foundation otolaryngology care multidisciplinary consensus recommendations. Int Forum Allergy Rhinol 2022; 12:1089-1103. [PMID: 35089650 PMCID: PMC9545592 DOI: 10.1002/alr.22974] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystem disease that often requires otolaryngology care. Individuals with CF commonly have chronic rhinosinusitis but also present with hearing loss and dysphonia. Given these manifestations of CF, otolaryngologists are frequently involved in the care of patients with CF; however, there is limited consensus on optimal management of sinonasal, otologic, and laryngologic symptoms. METHODS The Cystic Fibrosis Foundation convened a multidisciplinary team of otolaryngologists, pulmonologists, audiologists, pharmacists, a social worker, a nurse coordinator, a respiratory therapist, two adults with CF, and a caregiver of a child with CF to develop consensus recommendations. Workgroups developed draft recommendation statements based on a systematic literature review, and a ≥80% consensus was required for acceptance of each recommendation statement. RESULTS The committee voted on 25 statements. Eleven statements were adopted recommending a treatment or intervention, while five statements were formulated recommending against a specific treatment or intervention. The committee recommended eight statements as an option for select patients in certain circumstances, and one statement did not reach consensus. CONCLUSION These multidisciplinary consensus recommendations will help providers navigate decisions related to otolaryngology consultation, medical and surgical management of CF-CRS, hearing, and voice in individuals with CF. A collaborative and multidisciplinary approach is advocated to best care for our patients with CF. Future clinical research is needed utilizing standardized, validated outcomes with comprehensive reporting of patient outcome, effects of modulator therapies, and genetic characteristics to help continue to advance care, decrease morbidity, and improve the quality of life for individuals with CF.
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Affiliation(s)
- Adam J. Kimple
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
| | - Brent A. Senior
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
| | - Edward T. Naureckas
- Department of Pulmonary MedicineCritical Care MedicineUniversity of Chicago MedicineChicagoIllinoisUSA
| | - David A. Gudis
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center/New York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ted Meyer
- Department of Otolaryngology/Head & Neck SurgeryThe University of North CarolinaChapel HillNorth CarolinaUSA
- Department of Otolaryngology – Head and Neck SurgeryMedical University of South CarolinaSouth CarolinaUSA
| | | | | | - Dana Albon
- Department of Internal MedicineDivision of Pulmonary and Critical CareUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Wayne Barfield
- Pediatric and Adult CF CenterMedical University of South CarolinaSouth CarolinaUSA
| | - Margo McKenna Benoit
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Daniel M. Beswick
- Department of Head and Neck SurgeryUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Eliza Callard
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Shelagh Cofer
- Mayo Clinic‐Otolaryngology (ENT)/Head and Neck SurgeryRochesterMinnesotaUSA
| | | | - E. Claire Elson
- Department of PharmacyChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Angela Garinis
- Oregon Hearing Research CenterOregon Health & Science UniversityPortlandOregonUSA
| | - Ashleigh Halderman
- Department of Otolaryngology/Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Lisa Hamburger
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Meagan Helmick
- Community Advisor to the Cystic Fibrosis FoundationBethesdaMarylandUSA
| | - Michael McCown
- Department of PediatricsWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Cameron J. McKinzie
- Department of PharmacyUniversity of North Carolina Medical CenterChapel HillNorth CarolinaUSA
| | - Hanna Phan
- College of Pharmacy, Department of Clinical Pharmacy, The University of MichiganC.S. Mott Children's Hospital, Michigan MedicineMichiganUSA
| | - Kenneth Rodriguez
- Department of OtolaryngologyUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
| | - Ronald C. Rubenstein
- Allergy and Pulmonary Medicine, Department of PediatricsWashington University School of MedicineSt. LouisMissouriUSA
| | - Ashley Severin
- Department of Social WorkChildren's Mercy Kansas CityKansas CityMissouriUSA
| | - Gopi Shah
- Department of Otolaryngology/Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ambika Shenoy
- Department of Pediatrics, Division of Pediatric PulmonologyNemours Alfred I. duPont Hospital for ChildrenWilmingtonDelawareUSA
| | - Brittney Sprouse
- Department of Pediatrics, Division of Pediatric PulmonologyNemours Alfred I. duPont Hospital for ChildrenWilmingtonDelawareUSA
- University of Chicago MedicineChicagoIllinoisUSA
| | - Frank Virgin
- Department of Otolaryngology – Head and Neck SurgeryMonroe Carell Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Bradford A. Woodworth
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Stella E. Lee
- Brigham and Women's Hospital, Division of Otolaryngology‐Head & Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
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Ditha BA, Sutikno B. Extraction of sphenochoanal polyp with functional endoscopic sinus surgery approach: A rare case and review article. Int J Surg Case Rep 2022; 97:107429. [PMID: 35905676 DOI: 10.1016/j.ijscr.2022.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sphenochoanal polyp, a rare case of nasal polyp, is a benign mass that originates in the sphenoid sinus and develops into a choanal polyp. CASE PRESENTATION A 36-year-old Indonesian male complained of irregular right nasal obstruction and runny nose for one year. Physical examination showed soft tissue mass in the right nasal cavity, cyst retention in the right maxillary sinus, right sphenoid sinus, and cervical spondylosis. Diagnosis of sphenochoanal polyp was supported by nasoendoscopy and CT-Scan of paranasal sinuses. The patient got medical care and underwent functional endoscopic sinus surgery (FESS) and rinsed the nose with normal saline and topical steroids. Evaluation at six months after the surgery, the patient came without complaint and showed no sign of polyp mass or cysts recurrence, so the patient was declared to have a full recovery. DISCUSSION FESS is proven effective for managing sphenochoanal polyp and minimizes complications post-surgery and repetition of the polyp. CONCLUSION FESS is recommended for management of sphenochoanal polyp in term of minimizing recurrency.
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Hassanin SW, Kshirsagar RS, Eide JG, Chang J, Liang J, Palmer JN, Adappa ND. Image-Guided Surgical Device Failures in Functional Endoscopic Sinus Surgery: A MAUDE Analysis. Laryngoscope 2022; 133:1310-1314. [PMID: 35833501 DOI: 10.1002/lary.30296] [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: 03/30/2022] [Revised: 05/24/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Image-guided surgery (IGS) devices have become widely used for anatomic localization during functional endoscopic sinus surgery (FESS). However, there are no studies that analyze the post-market complications associated with IGS device use during FESS. The objective of this study was to better characterize post-market complications associated with the use of IGS devices during sinus surgery. METHODS The US Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for event reports associated with neurological stereotaxic devices utilized in IGS between the dates of January 1, 2016 and December 31, 2020. Medical device reports that were analyzed for this study pertained strictly to FESS. RESULTS There were 1873 reports involving IGS devices for FESS included in this study. Fifty-five reports involved adverse events to patients (2.9%) and 1818 (97.1%) involved device malfunctions. Of the adverse events to patients, the most common included cerebrospinal fluid leakage (45.6%), tissue damage (12.7%), and nervous system injury (3.6%). The most commonly reported device malfunction was imprecision (21.1%). CONCLUSION IGS devices are widely utilized in FESS. Of the medical device reports between 2016 and 2020, less than 3% resulted in adverse events. Further studies of the infrequent post-market complications of IGS devices used in FESS can help guide surgeons on the risks of their clinical use. LEVEL OF EVIDENCE 4-Retrospective database survey without controls Laryngoscope, 2022.
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Affiliation(s)
- Samir W Hassanin
- Department of Medical Education, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, U.S.A
| | - Rijul S Kshirsagar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jacob G Eide
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jeremy Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Jonathan Liang
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, U.S.A
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, U.S.A
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48
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Karpischenko SA, Vereschagina OE, Stancheva OA, Bibik PR, Kaplun DI, Bogachev MI, Kayumov AR. Case Report: Oncocytic Schneiderian Papilloma Originating From the Sphenoid Sinus. Front Med (Lausanne) 2022; 9:621705. [PMID: 35445038 PMCID: PMC9014847 DOI: 10.3389/fmed.2022.621705] [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: 10/26/2020] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
A rare case of oncocytic Schneiderian papilloma originating from the sphenoid sinus characterised, for 3 years, by non-specific symptoms of severe headache, a block of nasal breathing, and deprecating sense of smell was presented by an elderly female patient. Sphenoid sinus functional endoscopic sinus surgery (FESS), with a one-block tumour excision, through an endonasal approach, with a histological study of removed tumour masses, were performed on the patient. Long observation in the post-operative period was necessary, considering the risk of recurrence and malignancy of oncocytic Schneiderian papilloma (OSP). Although the oncocytic papilloma of the sphenoid sinus is rare, non-specific symptoms make this pathology easily misdiagnosed. Thus, any isolated unilateral process in the paranasal sinuses with long-existing symptoms must be given careful attention due to the chance of this process being an inverted papilloma with malignization. CT scan indicating a unilateral opacification of paranasal sinuses with local calcifications is a typical manifestation, and endoscopic sphenoidotomy can be recommended as a treatment of choice.
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Affiliation(s)
- Sergey A Karpischenko
- Ear, Nose and Throat (ENT) Department, First Pavlov State Medical University, St. Petersburg, Russia
| | - Olga E Vereschagina
- Ear, Nose and Throat (ENT) Department, First Pavlov State Medical University, St. Petersburg, Russia
| | - Olga A Stancheva
- Ear, Nose and Throat (ENT) Department, First Pavlov State Medical University, St. Petersburg, Russia
| | - Pavel R Bibik
- Ear, Nose and Throat (ENT) Department, First Pavlov State Medical University, St. Petersburg, Russia
| | - Dmitry I Kaplun
- Department of Automation and Control Processes, St. Petersburg Electrotechnical University "LETI", St. Petersburg, Russia
| | - Mikhail I Bogachev
- Research Centre for Digital Telecommunication Technologies, St. Petersburg Electrotechnical University "LETI", St. Petersburg, Russia
| | - Airat R Kayumov
- Research Centre for Digital Telecommunication Technologies, St. Petersburg Electrotechnical University "LETI", St. Petersburg, Russia.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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49
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Chen T, Pathak S, Hong EM, Benson B, Johnson AP, Svider PF. Diagnosis and Management of Barosinusitis: A Systematic Review. Ann Otol Rhinol Laryngol 2022; 132:50-62. [PMID: 35130739 DOI: 10.1177/00034894211072353] [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
OBJECTIVE To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. METHODS A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. RESULTS Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). CONCLUSION Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment.
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Affiliation(s)
- Tiffany Chen
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Shivani Pathak
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Ellen M Hong
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Brian Benson
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA.,Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew P Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Aurora, CO, USA
| | - Peter F Svider
- Hackensack University Medical Center, Hackensack, NJ, USA.,Bergen Medical Associates, Emerson, NJ, USA
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50
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Hintschich CA, Pade J, Petridis P, Hummel T. Presurgical olfactory function as an indicator of the outcome of functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps. Eur Arch Otorhinolaryngol 2022; 279:5727-33. [PMID: 35748932 DOI: 10.1007/s00405-022-07496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to impaired olfactory function and reduced quality of life. When conservative treatments such as nasal irrigation and topical steroids fail, functional endoscopic sinus surgery (FESS) is often necessary, because it improves symptoms and enhances quality of life. MATERIALS AND METHODS A total of 88 patients was included in this prospective study. All subjects underwent an extensive examination both presurgically and 4 months after operations including nasal endoscopy and psychophysical olfactory testing (Sniffin' Sticks). Moreover, disease-specific quality of life was assessed and presurgical CT scans were rated regarding the opacification of the paranasal sinuses. RESULTS Presurgically psychophysical tests showed an overall olfactory dysfunction. Olfactory test results (TDI score) correlated with endoscopic (Lund-Kennedy and Lildtholdt score) and CT scores (Lund-Mackay and TOCS scores). Four months after surgery olfactory function was enhanced and quality of life significantly showed an overall improvement. However, the outcome was dependent on the extent of presurgical olfactory function: olfaction and quality of life improved most pronounced in anosmics compared to hyposmic and especially normosmic patients. CONCLUSIONS This study confirmed that FESS in CRSwNP leads to a significant improvement of both olfaction and disease-specific quality of life. Moreover, preoperative psychophysical assessment of the extent of olfactory dysfunction can help to objectively assess possible risks and expected benefits of the surgery in terms of olfaction and quality of life.
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