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Mu C, Song Z, Yu S. Delayed epistaxis after endoscopic transnasal pituitary tumor resection: clinical characteristics, risk factors, treatment and prevention. World J Surg Oncol 2024; 22:146. [PMID: 38822349 PMCID: PMC11143569 DOI: 10.1186/s12957-024-03428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Delayed epistaxis after endoscopic transnasal pituitary tumor resection (ETPTR) is a critical complication, tending to cause aspiration or hemorrhagic shock. This study assessed clinical characteristics, risk factors, and provide treatment and prevention advice of this complication. METHODS This was a retrospective monocentric analysis of 862 patients who underwent ETPTR. Statistical analyses of clinical data revealed the incidence, sources and onset time of delayed epistaxis. Univariate analysis and binary logistic regression were used to identify risk factors. RESULTS The incidence of delayed epistaxis was 2.78% (24/862), with an average onset time of 20.71 ± 7.39 days. The bleeding sources were: posterior nasal septal artery branch of sphenopalatine artery (12/24), multiple inflammatory mucosae (8/24), sphenopalatine artery trunk (3/24) and sphenoid sinus bone (1/24). Univariate analysis and binary logistic regression analysis confirmed that hypertension, nasal septum deviation, chronic rhinosinusitis and growth hormone pituitary tumor subtype were independent risk factors for delayed epistaxis. Sex, age, history of diabetes, tumor size, tumor invasion and operation time were not associated with delayed epistaxis. All patients with delayed epistaxis were successfully managed through endoscopic transnasal hemostasis without recurrence. CONCLUSIONS Delayed epistaxis after ETPTR tends to have specific onset periods and risk factors. Prevention of these characteristics may reduce the occurrence of delayed epistaxis. Endoscopic transnasal hemostasis is recommended as the preferred treatment for delayed epistaxis.
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Affiliation(s)
- Chengzhi Mu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia District, Jinan, Shandong, China
| | - Zhenyu Song
- Department of Neurosurgery, Linyi Traditional Chinese Medical Hospital, Linyi, Shandong, China
| | - Shengyuan Yu
- Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia District, Jinan, Shandong, China.
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Albazee E, Alsubaie HM, Alkanderi R, Althaidy M, Alsafar H, Alsaleh S, Abdulrahman S. Platelet-rich plasma following endoscopic sinus surgery in patients with chronic sinusitis: A systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2024. [PMID: 38816910 DOI: 10.1111/coa.14186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/08/2024] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION To comprehensively evaluate the reported clinical effectiveness of platelet-rich plasma (PRP) in patients with chronic sinusitis undergoing endoscopic sinus surgery (ESS). METHODS We performed a systematic review and meta-analysis of randomised controlled trials (RCTs). Five digital online databases (PubMed, Scopus, Web of Science, Google Scholar and Cochrane CENTRAL) were searched from inception up to 1st May 2023. Our specific outcomes involved postoperative nasal endoscopy scores measured via Lund-Kennedy score or Meltzer score, olfactory sensation scores and pre-operative anosmia duration. All data were pooled as standardised mean difference (SMD) with a 95% confidence interval (CI), using the RevMan software. RESULTS Six RCTs were included in this systematic review and meta-analysis, with a total of 169 patients. The risk of bias in the included RCTs was low in three RCTs, some concerns in one RCT and high risk in two RCTs. The overall analysis of the postoperative nasal endoscopy scores showed that the PRP group had lower scores compared to the control group (n = 3 RCTs, SMD = -1.19; 95% CI [-1.94, -0.44], p = .002). There was no significant difference between the PRP and control groups regarding anosmia duration (n = 2 RCTs, SMD = 0.21; 95% CI [-0.17, 0.59], p = 0.28) or olfactory sensation scores, despite the PRP group having higher scores (n = 2 RCTs, SMD = 0.53; 95% CI [-0.32, 1.39], p = 0.22). CONCLUSION This study highlights the potential advantages of using PRP as an additional treatment for individuals with chronic sinusitis undergoing ESS. The improvements associated with PRP include facilitating wound healing, reducing inflammation and enhancing surgical outcomes. To optimise the use of PRP in clinical settings, future research should focus on conducting larger trials with standardised protocols.
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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
| | - Roaa Alkanderi
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Mubarak Althaidy
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Husain Alsafar
- Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Shawkat Abdulrahman
- Department of Otolaryngology-Head & Neck Surgery, Tallaght University Hospital, Dublin, Ireland
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Bartholomew RA, Zhou H, Boreel M, Suresh K, Gupta S, Mitchell MB, Hong C, Lee SE, Smith TR, Guenette JP, Corrales CE, Jagadeesan J. Surgical Navigation in the Anterior Skull Base Using 3-Dimensional Endoscopy and Surface Reconstruction. JAMA Otolaryngol Head Neck Surg 2024; 150:318-326. [PMID: 38451508 PMCID: PMC11009826 DOI: 10.1001/jamaoto.2024.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Importance Image guidance is an important adjunct for endoscopic sinus and skull base surgery. However, current systems require bulky external tracking equipment, and their use can interrupt efficient surgical workflow. Objective To evaluate a trackerless surgical navigation system using 3-dimensional (3D) endoscopy and simultaneous localization and mapping (SLAM) algorithms in the anterior skull base. Design, Setting, and Participants This interventional deceased donor cohort study and retrospective clinical case study was conducted at a tertiary academic medical center with human deceased donor specimens and a patient with anterior skull base pathology. Exposures Participants underwent endoscopic endonasal transsphenoidal dissection and surface model reconstruction from stereoscopic video with registration to volumetric models segmented from computed tomography (CT) and magnetic resonance imaging. Main Outcomes and Measures To assess the fidelity of surface model reconstruction and accuracy of surgical navigation and surface-CT model coregistration, 3 metrics were calculated: reconstruction error, registration error, and localization error. Results In deceased donor models (n = 9), high-fidelity surface models of the posterior wall of the sphenoid sinus were reconstructed from stereoscopic video and coregistered to corresponding volumetric CT models. The mean (SD; range) reconstruction, registration, and localization errors were 0.60 (0.24; 0.36-0.93), 1.11 (0.49; 0.71-1.56) and 1.01 (0.17; 0.78-1.25) mm, respectively. In a clinical case study of a patient who underwent a 3D endoscopic endonasal transsphenoidal resection of a tubercular meningioma, a high-fidelity surface model of the posterior wall of the sphenoid was reconstructed from intraoperative stereoscopic video and coregistered to a volumetric preoperative fused CT magnetic resonance imaging model with a root-mean-square error of 1.38 mm. Conclusions and Relevance The results of this study suggest that SLAM algorithm-based endoscopic endonasal surgery navigation is a novel, accurate, and trackerless approach to surgical navigation that uses 3D endoscopy and SLAM-based algorithms in lieu of conventional optical or electromagnetic tracking. While multiple challenges remain before clinical readiness, a SLAM algorithm-based endoscopic endonasal surgery navigation system has the potential to improve surgical efficiency, economy of motion, and safety.
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Affiliation(s)
- Ryan A Bartholomew
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Haoyin Zhou
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Maud Boreel
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Krish Suresh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Margaret B Mitchell
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher Hong
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stella E Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - C Eduardo Corrales
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jayender Jagadeesan
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Boyi T, Richmond RL, Kayastha D, Manes RP, Rimmer R. Restarting Antithrombotic Therapies After Endoscopic Sinus Surgery: A Systematic Review. Ann Otol Rhinol Laryngol 2024:34894241245840. [PMID: 38557289 DOI: 10.1177/00034894241245840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Antithrombotic therapies, comprised of both anticoagulant and antiplatelet agents, are routinely paused prior to endoscopic sinus surgery (ESS) to reduce the risk of perioperative hemorrhage. At present, no clear guidelines exist to guide otolaryngologists on when to resume these agents after ESS. Our goal was to systematically review the existing literature related to this topic. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically queried the PubMed, Embase, Ovid, Web of Science, Cochrane, and CINAHL databases to identify publications reporting on antithrombotic and antiplatelet therapy in the context of ESS. The primary outcomes we sought were recommendations on the timing of antithrombotic therapy resumption after ESS. RESULTS Of the 104 unique articles identified, all were screened for relevance by 2 independent reviewers based on title and abstract, 20 underwent full-text review, and 6 met inclusion criteria for analysis. Of these, 3 were literature reviews, 2 were case-control studies, and 1 was a cohort study. All publications discussed when to pause antithrombotic therapy prior to surgery while only 3 articles discussed resumption of these agents. Recommendations were mixed. CONCLUSION A paucity of literature exists on the resumption of antithrombotic therapies after ESS. As a major determining factor in patient morbidity, guideline-based resumption of these therapies is needed.
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Affiliation(s)
- Trinithas Boyi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Rhys L Richmond
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Darpan Kayastha
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - R Peter Manes
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ryan Rimmer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA
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Murtomäki A, Helevä A, Torkki P, Haukka J, Julkunen‐Iivari A, Lemmetyinen R, Mäkelä M, Dietz A, Nuutinen M, Toppila‐Salmi S. Comorbidities of chronic rhinosinusitis in children and adults. Clin Transl Allergy 2024; 14:e12354. [PMID: 38658181 PMCID: PMC11043011 DOI: 10.1002/clt2.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nose and paranasal sinuses lasting ≥12 weeks. CRS may exist with (CRSwNP) or without (CRSsNP) nasal polyps. The aim was to evaluate conditions associated with CRS in a randomized hospital cohort. We hypothesized that comorbidities and surgical procedures differ between pediatric and adult patients. METHODS This study consisted of hospital registry data of a random sample of rhinosinusitis patients (age range 0-89 years) with the diagnosis of J32 or J33, correspondingly, registered during outpatient visits from 2005 to 2019 (n = 1461). The covariates of interest were collected from electronic health records based on ICD-10 codes and keyword searches. RESULTS Among pediatric patients (n = 104), the relative proportions of CRSsNP and CRSwNP were 86% and 14% respectively. The relative proportions of adult patients (n = 1357) with CRSsNP and CRSwNP were 60% and 40%, respectively. The following comorbidities significantly differed (p < 0.05) between pediatric and adult populations: allergy, chronic otitis media, and tonsillar diseases. In total, 41 % of the children and 46% of the adults underwent baseline endoscopic sinus surgery (ESS). Additional surgeries of the ear, nose and pharynx were significantly more common among children compared with adults. Risk of revision after baseline ESS was associated (p < 0.05) with allergy, asthma, eosinophilia, CRSwNP, immunodeficiency or its suspicion, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and number of any diseases ≥2. CONCLUSIONS Our study showed that comorbidities differ between pediatric and adult rhinosinusitis patients, as allergy, asthma and allergy, chronic otitis media, mental health disorders, and tonsils disease were significantly more prevalent among pediatric patients. Children and adults were equally treated with ESS. Notably, children underwent additional surgery on adenoids and tonsils more frequently. The effectiveness of ESS in multimorbid adults should be assessed at an individual level.
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Affiliation(s)
- Aada Murtomäki
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
| | - Alma Helevä
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Programme of the Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Paulus Torkki
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Jari Haukka
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Anna Julkunen‐Iivari
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Riikka Lemmetyinen
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Mika Mäkelä
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aarno Dietz
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
- Department of OtorhinolaryngologyKuopio University HospitalWellbeing Services County of North SavoKuopioFinland
| | - Mikko Nuutinen
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Sanna Toppila‐Salmi
- Inflammation CenterSkin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Department of OtorhinolaryngologyUniversity of Eastern FinlandJouensuu, KuopioFinland
- Department of OtorhinolaryngologyKuopio University HospitalWellbeing Services County of North SavoKuopioFinland
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Almarzouq WF, Alsharhan SS. Nontraumatic oculomotor nerve palsy following endoscopic sinus surgery. J Family Community Med 2024; 31:79-81. [PMID: 38406226 PMCID: PMC10883432 DOI: 10.4103/jfcm.jfcm_253_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024] Open
Abstract
The proximity of the paranasal sinuses to the orbit and its contents increases the chances of injuries during endoscopic sinus surgery (ESS). We present an extremely rare case of transient oculomotor nerve palsy with no direct injury following ESS, which has never been reported in the literature. The proper clinical approach and medical management are also discussed in this case report.
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Affiliation(s)
- Wasan F. Almarzouq
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salma S. Alsharhan
- Department of Otorhinolaryngology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Yağmur AR, Çıvgın E, Özcan KM, Yurtsever Kum N, Karakuş MF, Dere HH. Analysis of the Correlation of the Lamina Papyracea-to-Midline Distance with the Location of Anterior Ethmoidal Artery and Keros Classification. Indian J Otolaryngol Head Neck Surg 2023; 75:3146-3151. [PMID: 37974786 PMCID: PMC10646039 DOI: 10.1007/s12070-023-03931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 11/19/2023] Open
Abstract
The aim of the study was to investigate the relations between anatomical structures that are susceptible to inadvertent injuries during the surgery using preoperative computed tomography (CT) scans. 153 CT scans were reviewed and the distance from the lamina papyracea (LP) to the midline and the distance of the anterior ethmoidal artery (AEA) to the skull base were measured bilaterally. Also, the depth of olfactory fossa was measured and categorized using the Keros classification. The measurements were analyzed to determine whether LP-to-midline distance was correlated with the distance between the AEA and the skull base and Keros classification. Additionally, correlation of Keros classification with the distance from the AEA to the skull base was investigated. In a total of 306 measurements, 26 (%8.49) were classified as Keros type I, 200 (65.35%) as Keros type II and 80 (25.14%) as Keros type III. Statistically, LP-to-midline distances on the right and left sides were significantly associated with the distance from the AEA to the skull base on the same side (R:p < 0.001, L:p = 0.01) and the Keros classification on the same side (R:p < 0.001, L:p = 0.004). Also, a significant association was found between the Keros classification and the distance from the AEA to the skull base (R:p < 0.001, L:p = 0.02). The locations of anatomical structures are defined in relation to each other during the development of maxillofacial bones. CT scans should be examined and anatomical structures and relations among them reviewed very carefully before ESS. Otherwise, some accidental injuries may arise during the surgery while trying to avoid complications. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03931-x.
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Affiliation(s)
- Ali Rıza Yağmur
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara Lokman Hekim University, Ankara, Turkey
| | - Esra Çıvgın
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara City Hospital, Ankara, Turkey
| | - Nurcan Yurtsever Kum
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, Head and Neck Surgery, Ordu University, Ordu, Turkey
| | - Hacı Hüseyin Dere
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara City Hospital, Ankara, Turkey
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8
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Katwal S, Kumar RR, Ansari MA, Suwal S, Ghimire P. Computed tomographic assessment of risk of anterior skull base injury of adult patients in tertiary care centre: a cross-sectional study. Ann Med Surg (Lond) 2023; 85:5892-5898. [PMID: 38098544 PMCID: PMC10718351 DOI: 10.1097/ms9.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/17/2023] [Indexed: 12/17/2023] Open
Abstract
Background and objectives Functional endoscopic sinus surgery (FESS) carries the risk of anterior skull base injury. Understanding computed tomography of the paranasal sinuses (CT PNS) and anatomical variations is crucial before surgery. Several classifications, including Kero's, Gera's, and Thailand-Malaysia-Singapore (TMS), assess the risk of skull base injury. The objective was to determine the risk of anterior skull base injury using CT PNS in adult patients. Methods A study of 188 patients with head and paranasal sinus pathologies used CT scans to measure olfactory fossa depth, the angle between lamina papyracea and horizontal plane, and the distance from the orbital rim to the cribriform plate. Variations were classified using Kero's, Gera's, and TMS classifications. Results The study involved 188 individuals aged 18-85, with OF depths ranging from 0.1 to 0.52 cm. Kero's Class I was observed in 82.44% and 81.38% of individuals, while distances from orbital floor to cribriform plate and ethmoidal roof ranged from 1.37 to 2.93 cm. TMS Type I was observed in all individuals, and the angle between lateral lamella of the cribriform plate and cribriform plate ranged from 34° to 85°. Gera's Class II was observed in 77.12% and 84.57% of individuals. Conclusion CT PNS provides important anatomical information for assessing the risk of skull base injury during FESS. Kero's, Gera's, and TMS classifications can be utilized to evaluate this risk. The study findings provide insights into the variations in olfactory fossa depth, distance measurements, and angle, which can aid in preoperative planning and reducing complications during FESS in Nepalese populations.
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Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura
| | | | | | - Sundar Suwal
- Department of Radiology, Maharajgunj Medical College, Kathmandu
| | - Prasoon Ghimire
- Department of Radiology, Dhaulagiri Hospital, Baglung, Nepal
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Yong M, Kirubalingam K, Desrosiers MY, Kilty SJ, Thamboo A. Cost-effectiveness analysis of biologics for the treatment of chronic rhinosinusitis with nasal polyps in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:90. [PMID: 37838713 PMCID: PMC10576384 DOI: 10.1186/s13223-023-00823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 07/13/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Dupilumab, omalizumab, and mepolizumab are the three biologics currently approved for use in CRSwNP in Canada. Despite evidence of efficacy, their cost-effectiveness, which is a key factor influencing prescribing patterns, has not yet been compared to each other. METHODS A cost-effectiveness model using quality-adjusted life years (QALYs) was constructed using a Decision Tree Markov analysis. A third-party healthcare payer perspective and a 10-year time horizon was used. A willingness-to-pay (WTP) threshold of 50,000 Canadian dollars (CAD) per QALY was used to determine cost-effectiveness. Dupilumab, omalizumab, and mepolizumab were each compared to each other. RESULTS Omalizumab was the most cost-effective biologic using current estimates of cost and efficacy in CRSwNP. Using omalizumab as a baseline, dupilumab had an ICER of $235,305/QALY. Mepolizumab was dominated by omalizumab and dupilumab at the current drug prices and estimates of efficacy. Sensitivity analyses determined that when increasing the WTP threshold to $150,000/QALY, dupilumab became cost-effective compared to omalizumab in 22.5% of simulation scenarios. Additionally, altering dosing frequency had a significant effect on cost-effectiveness. CONCLUSION When comparing the relative cost-effectiveness of biologics in recalcitrant CRSwNP, omalizumab currently appears to be the most cost-effective option. Future reductions in drug prices, adjustments to currently approved dosing regimens, better patient selection, and improvements in sinus surgery outcomes will challenge the current cost-effectiveness models and necessitate reassessment as treatments for CRSwNP continue to evolve.
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Affiliation(s)
- Michael Yong
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada
| | | | - Martin Y Desrosiers
- Department of Otolaryngology, Centre de Recherche du Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Shaun J Kilty
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Thamboo
- Division of Otolaryngology, Head and Neck Surgery, University of British Columbia Faculty of Medicine, 1081 Burrard Street, Vancouver, BC, V5Z 1Y6, Canada.
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10
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Jan B, Alfattani N, Ali R, Ageel A. Recovery From Visual Loss After Endoscopic Endonasal Decompression of Iatrogenic Orbital Abscess. EAR, NOSE & THROAT JOURNAL 2023:1455613231200831. [PMID: 37743762 DOI: 10.1177/01455613231200831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Orbital complications are the second most common complications of endoscopic sinus surgery (ESS), and orbital hematoma is the most frequent orbital complication. An orbital abscess is usually associated with rhinosinusitis, and a few cases of orbital abscesses occurring after orbital trauma have been reported. However, orbital abscess occurring after ESS is rare. Herein, we present a case of a right orbital abscess that developed after bilateral ESS, performed at an outside facility, and decreased vision in the right eye to light perception only. The visual loss persisted for 3 days, after which the patient was referred to our hospital for urgent management. The cause of abscess formation might have been an infected stagnant orbital venous hematoma that occurred as a complication of ESS. A defect in the right lamina papyracea and emphysema were confirmed on computed tomography. Orbital symptoms started immediately after ESS, and vision deteriorated to light perception only and lasted for 3 days, which was considered a high-grade risk factor for irreversible blindness by the ophthalmology team. Urgent endoscopic endonasal orbital decompression was performed to drain the orbital abscess, and maximal medical treatment was initiated, which included intravenous corticosteroids, intravenous broad-spectrum antibiotics, topical intranasal corticosteroids, irrigation, and topical antibiotic eye drops. Close follow-up assessments were performed by the infectious diseases team, and the ophthalmology team performed frequent orbital assessments. The patient recovered from blindness, which was an unexpected outcome.
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Affiliation(s)
- Bayan Jan
- Department of Otorhinolaryngology-Head and Neck Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Naif Alfattani
- Department of Otorhinolaryngology-Head and Neck Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Riham Ali
- Department of Otorhinolaryngology-Head and Neck Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ahed Ageel
- Department of Otorhinolaryngology-Head and Neck Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
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11
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Westfall E, Fridirici Z, El-Kouri N, McSpadden R, Loochtan M, Stankiewicz J. Diagnosis and Management of Orbital Fat Exposure During Endoscopic Sinus Surgery. EAR, NOSE & THROAT JOURNAL 2023; 102:573-579. [PMID: 34092086 DOI: 10.1177/01455613211015438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The orbital complication rate during endoscopic sinus surgery (ESS) is <1%. Orbital fat exposure during ESS can herald orbital complications including orbital hematoma, extraocular muscle trauma, optic nerve injury, or blindness. The objective of this study was to evaluate the current consensus regarding diagnosis and management of orbital fat exposure during ESS. METHODS A 24-point survey focused on orbital fat exposure during ESS was distributed to American Rhinologic Society members. Also, a retrospective review of 25 cases of orbital fat exposure drawn from the principal investigator's 30-year experience was performed. RESULTS Over 10 000 surgical cases of the principal investigator were reviewed. Twenty-five patients had orbital fat exposure. Five developed minor complications while 2 were major (ie, temporary vision changes). Two hundred thirty-six surgeons responded to the survey; 93% had encountered orbital fat during ESS; 88% of surgeons identify orbital fat by either its appearance endoscopically or the "bulb press" test. Almost every responding surgeon will cautiously avoid further manipulation in the area of orbital fat exposure. Nearly half will immediately curtail the extent of surgery. Surgeons do not significantly change postoperative management. Considerations regarding observation in postanesthesia care unit, close follow-up, and strict nose blowing precautions are common. CONCLUSION Orbital fat exposure during ESS is a rarely discussed, but clinically important. Orbital fat exposure can be a harbinger for major orbital complications that should be recognized by endoscopic appearance and confirmed with the bulb press test. Caution with "no further manipulation" of orbital fat is the guiding principle for intraoperative management, while postoperative management is generally expectant.Level 4 Evidence.
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Affiliation(s)
| | | | - Nadeem El-Kouri
- Loyola University Chicago, Stritch School of Medicine, IL, USA
| | | | | | - James Stankiewicz
- Loyola University Medical Center, Maywood, IL, USA
- Loyola University Chicago, Stritch School of Medicine, IL, USA
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Jeong J, Park C, Yoon Y, Lee D, Cho S. Randomized comparison of effects of two different remifentanil dose on surgical conditions during endoscopic sinus surgery. BMC Anesthesiol 2023; 23:292. [PMID: 37644385 PMCID: PMC10464051 DOI: 10.1186/s12871-023-02253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The combination of propofol and remifentanil results in better surgical field conditions during endoscopic sinus surgery than inhalation anesthesia. This study compared surgical field conditions between two groups receiving low or high concentration of remifentanil and hemodynamic variables using non-invasive cardiac monitoring. METHODS Fifty-four patients between ASA I or II, were randomly assigned to either the high-concentration remifentanil group (HR), effect-site concentration of 8 ng/mL or the low-concentration remifentanil group(LR), effect-site concentration of 4 ng/mL. Surgical condition was evaluated using the Boezaart Surgical Field Grading Scale presented by Boezaart. Cardiac output was measured using non-invasive cardiac monitoring (CSN-1901). RESULTS In terms of surgical conditions, the HR group showed significantly lower values than the LR group (p = 0.021) at 90 min after the start of surgery. Heart rate was significantly lower in the HR group than the LR group at 30, 60, and 90 min after the start of surgery (30 min; p = 0.005, 60 min; p = 0.002, 90 min; p = 0.001). There was a statistically significant decrease of cardiac output in the HR group compared to the LR group immediately after endotracheal intubation and at 30, 60, and 90 min after the start of surgery (Base; P = 0.222, Intubation; P = 0.016, 30 min; p = 0.014, 60 min; P = 0.012, 90 min; P = 0.008). However, in the case of stroke volume, there was no significant difference between the two groups in all measurements. CONCLUSION When comparing the HR group and the LR group, the surgical condition was improved at 90 min after the start of surgery. MAP was lower in the HR group and this was a result of reduction in cardiac output primarily attributed to the decrease in heart rate rather than a decrease in stroke volume. TRIAL REGISTRATION Clinical Trial Registry of the Republic of Korea (KCT0006453).
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Affiliation(s)
- JinHyeok Jeong
- Department of Otorhinolaryngology, Hanyang University Guri Hospital, Guri-Si, Gyeonggi-Do, Republic of Korea
| | - ChanWoo Park
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - YoungJoon Yoon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - DoJae Lee
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea
| | - SangYun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, 249-1, Gyomun-Dong, Guri-Si, Gyeonggi-Do, 471-701, Republic of Korea.
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13
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Liu X, Wang P, Li M, Chen G. Incidence, risk factors, management and prevention of severe postoperative epistaxis after endoscopic endonasal transsphenoidal surgery: a single center experience. Front Surg 2023; 10:1203409. [PMID: 37564115 PMCID: PMC10410146 DOI: 10.3389/fsurg.2023.1203409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Objective Postoperative epistaxis is a very rare but severe complication after endoscopic endonasal transsphenoidal surgery (EETS) that can lead to catastrophic consequences. However, the incidence, risk factors, management and prevention of postoperative epistaxis remain unclear. Patients and methods Consecutive patients with pituitary adenoma (PA), Rathke's cleft cyst, craniopharyngioma, or clival chordoma who received EETS in our department between September 2020 and November 2022 were retrospectively analyzed. The incidence, risk factors, management and prevention of postoperative epistaxis were investigated and analyzed. Results A total of 557 consecutive patients who received EETS were included in this study. Eight patients (1.4%) (7 PAs and 1 Rathke's cleft cyst) experienced severe postoperative epistaxis. The size of the PAs was 9.6 mm-46.2 mm, with a median size of 22.1 mm. Epistaxis occurred 4 h to 30 days (median 14.5 days) postoperatively. Bleeding was stopped in 3 patients after nasal packing with iodoform gauze. The remaining 5 patients for whom nasal packing was insufficient were all sent to the operating room, and posterior nasal septal artery (PNSA) bleeding was identified and successfully treated with endoscopic bleeding artery electrocauterization under general anesthesia. In the EETS, all 8 patients had downward extension of the septal mucosal incision, in which 6 had intraoperative bleeding of PNSA that were cauterized by bipolar diathermy. Four patients had causative factors, including administration of antiplatelet agents, Valsalva-like manoeuvre, nose blowing and removal of nasal packing, respectively. No patients had recurrent epistaxis during the follow-up period. Conclusion Post-EETS epistaxis is a rare but severe complication that could lead to catastrophic consequences, and one of the most common bleeding sources is the PNSA. Endoscopic bleeding artery electrocauterization under general anesthesia may be a safe, economic and effective measure for epistaxis refractory to nasal packing. Avoiding excessive downward extension of the septal mucosal incision could contribute to the prevention of postoperative epistaxis.
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Affiliation(s)
- Xiaohai Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Pengfei Wang
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
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Preethi A, Venkatraman R, Karthika U, Rangapriya A. Evaluation of the Efficacy of Magnesium Sulfate in Reducing Blood Loss in Functional Endoscopic Sinus Surgery: A Randomized Double-Blinded Controlled Trial. Cureus 2023; 15:e38636. [PMID: 37284355 PMCID: PMC10241315 DOI: 10.7759/cureus.38636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives The primary concern in functional endoscopic sinus surgery (FESS) is maintaining a clear and unobstructed surgical field. Achieving this objective necessitates controlled hypotension, which can aid in the surgical dissection process and reduce the overall duration of the operation. This study aims to evaluate the efficacy of a sole bolus injection of intravenous magnesium sulfate in FESS. The outcomes measured include blood loss, surgical field grading, the additional intraoperative requirement of fentanyl, stress attenuation during laryngoscopy and endotracheal intubation, and extubation time. Methods In this prospective, double-blinded, randomized control trial (CTRI/2021/04/033052), 50 patients scheduled for FESS were randomly divided into two groups: Group M received 50 mg/kg MgSO4 in 100 ml normal saline, and Group N received 100 ml plain normal saline 15 min before induction. The study assessed total blood loss, measured by blood collected from the surgical field and weighing gauze. The surgical field grading was assessed by a six-point Fromme and Boezaart scale. We also observed stress attenuation during laryngoscopy and endotracheal intubation, additional intraoperative fentanyl requirements, and time taken for extubation. The sample size was estimated using the G power calculator 3.1.9.2 (http://www.gpower.hhu.de/). Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using Statistical Package for Social Sciences version 20.0 (IBM Corp., Armonk, NY). Results The demographic data and duration of the surgery were comparable in both groups. The total blood loss in Group M was 100.40 ml ±60.71 ml, which is lower than Group N (133.80 ml ±59.7 ml) with a p-value of 0.016. In addition, the surgical field grading was also better in Group M. The total vecuronium consumption was significantly lower in Group M, which was (7.23±0.84 mg); in Group N, it was (10.64±1.74 mg) with a p-value of 0.0001, respectively. The dosage of additional fentanyl in Group N was 38.46 mcg ± 8.99 mcg, more than in Group M (33.64 mcg ± 11.20 mcg). The time required for extubation was similar in both groups. The duration of the surgery was significantly more significant in Group M (150.0 ±31.36) than in Group N (205.0 ±32.79), with a p-value of 0.0001, respectively. Furthermore, the mean arterial pressure after induction, at 2 min and 4 min after laryngoscopy, was less in Group M, with p=0.001, p=0.003, and p<0.0001, respectively, when compared with Group N. The heart rate after induction, at 2 min and 4 min after laryngoscopy, was also less in Group M, with p=0.016, p=0.003, and p=0.003, respectively, when compared with Group N. The Ramsay Sedation Score was higher in Group M than in Group N's fourth, eighth, and sixteenth hour, with p=0.001, p=0.021, and p=0.001, respectively, in the postoperative period. The sedation score was statistically insignificant after that. No complications were encountered during the study. Conclusion We conclude that a single bolus dose of MgSO4 reduced surgical blood loss more effectively than in the control group. The surgical field grading was also better in Group M, as was the stress attenuation during laryngoscopy and endotracheal intubation. The intraoperative fentanyl requirement was not statistically significant. The time for extubation was similar between the groups. No other adverse effects were encountered during the study.
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Alvarez L, Querubin J, Bedoya J, Mejia A, Sánchez J. Cost-utility analysis of dupilumab compared with endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. Evaluation in Colombia, a developing country. Expert Rev Pharmacoecon Outcomes Res 2023; 23:571-578. [PMID: 36976904 DOI: 10.1080/14737167.2023.2196407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) compromise's respiratory function, sleep, concentration, work capacity and quality of life, generating high costs for patient and health systems. The aim of the study was to analyze the cost-utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP. RESEARCH DESIGN AND METHODS We developed a model-based cost-utility analysis from the perspective of the Colombian health system to compare Dupilumab vs endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations). RESULTS The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of QALYs, surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs. CONCLUSIONS From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost-utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgeries performance.
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Affiliation(s)
- Leidy Alvarez
- Program in Health Economics Evaluation, Faculty of Medicine and Economics, University of Antioquia, Medellín Colombia
| | - Juan Querubin
- Program in Health Economics Evaluation, Faculty of Medicine and Economics, University of Antioquia, Medellín Colombia
| | - Juan Bedoya
- Otorhinolaryngology Service, University of Antioquia, Medellín Colombia
| | - Aurelio Mejia
- Program in Health Economics Evaluation, Faculty of Medicine and Economics, University of Antioquia, Medellín Colombia
| | - Jorge Sánchez
- Group of Clinical and Experimental Allergy, Hospital "Alma Mater de Antioquia", Universidad de Antioquia, Medellín, Colombia
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Ramkumar SP, Lal D, Miglani A. Considerations for shared decision-making in treatment of chronic rhinosinusitis with nasal polyps. FRONTIERS IN ALLERGY 2023; 4:1137907. [PMID: 36970067 PMCID: PMC10036764 DOI: 10.3389/falgy.2023.1137907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
Shared decision-making is an approach where physicians and patients work together to determine a personalized treatment course. Such an approach is integral to patient-centered care in chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP is a chronic inflammatory condition of the sinonasal cavity that can severely impact physical health, smell, and quality of life (QOL). Traditional standard-of-care treatment options include topical (i.e. sprays) and oral corticosteroids and endoscopic sinus surgery, but more recently, novel corticosteroid delivery methods (i.e. high volume irrigations, recently-approved exhalation breath-powered delivering devices, and drug-eluting steroid implants) and 3 new FDA approved biologics directed against type II immunomodulators have become available. The availability of these therapeutics offers exciting new opportunities in CRSwNP management but requires personalized and shared-decision making as each modality has variable impacts on CRSwNP and related comorbid conditions. Studies have published treatment algorithms, but the practical use of these lean guidelines is heavily influenced by the lens of the treating physician, the most common being otolaryngologists and allergy immunologists. Clinical equipoise occurs when there is no basis for one intervention to be regarded as “better” than another. While most guidelines, in general, support the use of topical corticosteroids with or without oral corticosteroids followed by ESS for the majority of unoperated CRSwNP patients, there are situations of clinical equipoise that arise particularly in CRSwNP who have failed surgery or those with severe comorbid conditions. In the shared decision-making process, clinicians and patients must consider symptomatology, goals, comfort, compliance, treatment efficacy, and treatment cost when determining the initial choice of therapy and escalation of therapy with the potential use of multiple modalities for recalcitrant CRSwNP. A summary of salient considerations that might constitute shared decision-making is presented in this summary.
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Affiliation(s)
- Shreya P. Ramkumar
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Devyani Lal
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
| | - Amar Miglani
- Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic Hospital, Phoenix, AZ, United States
- Correspondence: Amar Miglani
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Alrajhi AA, Alghamdi AS, Baali MH, Altowairqi AF, Khan MF, Alharthi AS, Albazee E, Abu-Zaid A. Efficacy of prophylactic pre-operative desmopressin administration during functional endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis of randomised placebo-controlled trials. Clin Otolaryngol 2023; 48:139-150. [PMID: 36536598 DOI: 10.1111/coa.14020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the efficacy of prophylactic desmopressin versus placebo among patients undergoing functional endoscopic sinus surgery (FESS). DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). SETTING The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, and Web of Science databases were screened from inception until 18 March 2022. PARTICIPANTS Patients undergoing FESS. MAIN OUTCOME MEASURES Primary efficacy endpoints comprised intraoperative blood loss, visual clarity, and operation time. Secondary endpoints comprised side effects. The efficacy endpoints were summarised as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). RESULTS Five RCTs comprising 380 patients (desmopressin = 191 patients and placebo = 189 patients) were included. Collectively, the included RCTs had an overall low risk of bias. The pooled results showed that the mean intraoperative blood loss (n = 5 RCTs, MD = -37.97 ml, 95% CI [-56.97, -18.96], p < .001), 5-point Boezaart scores (n = 2 RCTs, MD = -.97, 95% CI [-1.21, -.74], p < .001), and 10-point Boezaart scores (n = 2 RCTs, MD = -3.00, 95% CI [-3.61, -2.40], p < .001) were significantly reduced in favour of the desmopressin group compared with the placebo group. Operation time did not significantly differ between both groups (n = 5 RCTs, MD = -3.73 min, 95% CI [-14.65, 7.18], p = .50). No patient in both groups developed symptomatic hyponatremia (n = 3 RCTs, 194 patients) or thromboembolic events (n = 2 RCTs, 150 patients). CONCLUSIONS Among patients undergoing FESS, prophylactic administration of desmopressin does not correlate with significant clinical benefits. Data on safety is limited. Future research may explore the synergistic antihaemorrhagic efficacy and safety of tranexamic acid (TXA) plus desmopressin versus TXA alone among patients undergoing FESS.
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Affiliation(s)
- Abdullah Abdulaziz Alrajhi
- Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Abdullah Shakhs Alghamdi
- Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammed Hassan Baali
- Department of Otolaryngology and Head and Neck Surgery, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Abdulaziz Fahad Altowairqi
- Department of Otolaryngology and Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Meshal Fahad Khan
- Department of Otolaryngology and Head and Neck Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ahmad Saad Alharthi
- Department of Otolaryngology and Head and Neck Surgery, Al-Hada Armed Forces Hospital, Taif, Saudi Arabia
| | - Ebraheem Albazee
- Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Bolger WE, Ishii M. Anatomic misconceptions regarding the agger nasi cell: A preliminary analysis utilizing endoscopic anatomic dissection and three-dimensional computed tomography. Clin Anat 2023; 36:267-276. [PMID: 36446520 DOI: 10.1002/ca.23982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
The agger nasi cell is a key anatomic landmark in endoscopic frontal sinus surgery. However, discord amongst authors regarding anatomic definition and prevalence raises questions of its suitability as a surgical landmark. The purpose of this investigation is to evaluate the agger nasi cell using radiographic imaging correlated with endoscopic anatomic dissection to consider the cell's role as a surgical landmark and to explore if three-dimensional computed tomography (3D-CT) technology can provide enhanced insight into this anatomy. CT scans of 11 cadaveric sinonasal complexes were studied using triplanar CT or 3D-CT scanning with stereoscopic 3D imaging. Endoscopic dissections were performed and video recorded. Attention was given to identify agger nasi pneumatization and its origin. Pneumatization of the agger nasi region was noted in 4/11 cases (36.4%) (in two cases the pneumatization arose from the frontal recess, in two from a true agger nasi cell). The agger nasi region appeared as solid unpneumatized bone in 4/11 cases (36.4%). In 3/11 cases (27.3%) limited pneumatization was noted, bordering on but not pneumatizing the agger nasi proper. It may be confusing for otolaryngologic surgeons in training to rely on the "agger nasi cell" as a surgical landmark due to misconceptions regarding the anatomy, prevalence and anatomic definitions. Using standard CT scans to teach anatomy may have shortcomings as compared to the gold standard of surgical dissection. However, new 3D-CT holds promise to more accurately reflect small microanatomic features and provide an improved road map of a patient's anatomy in surgery.
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Affiliation(s)
- William E Bolger
- Division of Otorhinolaryngology, University of Florida Medical School, Jacksonville, Florida, USA
| | - Masaru Ishii
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland, USA
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Jones G, Hemmerich C, Rucker B, Wise A, Kee M, Johnson A, Brame L, Hamilton T, Vassar M. Harms reporting by systematic reviews for functional endoscopic sinus surgery: a cross-sectional analysis. Eur Arch Otorhinolaryngol 2023; 280:2805-2819. [PMID: 36595047 DOI: 10.1007/s00405-022-07803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate the completeness of harms reporting in systematic reviews (SRs) pertaining to functional endoscopic sinus surgery (FESS). METHODS Using a cross-sectional study design, we performed a comprehensive search using MEDLINE (PubMed and Ovid), EMBASE, Epistemonikos, and the Cochrane Database of Systematic Reviews databases for SRs regarding FESS on May 15th, 2022. Returns were screened and data were extracted in a masked, duplicate manner. Following established methodology, we extracted general study characteristics, harms items, and overall methodological quality for each SR in our sample. Corrected covered area (CCA) was calculated for SR dyads. For data analysis, using Stata 16.1 we performed a bivariate analysis between variables. RESULTS Fifty-five SR's were included in our sample after excluding 375 studies that did not meet our inclusion criteria. Of the included SRs, 19 (19/55, 34.5%) did not report harms and 39 (39/55, 70.9%) reported half of the harms items or fewer. Our study found that 23 (23/55, 41.8%) of SRs demonstrated a method of harms data collection, 26 (26/55, 47.3%) of SRs had patients available for harms analysis in their results, and 25 (25/55, 45.5%) of SRs had a balanced discussion of harms and benefits of FESS. Fifty-two SRs were appraised as "critically low" quality using AMSTAR-2. A significant association was found between completeness of harms reporting (Mahady) and whether harms were listed as a primary outcome. No other associations were statistically significant. Two SR dyads had CCAs between 20% and 50% overlap and were compared for unique and shared harms. CONCLUSIONS Our study demonstrates gaps in harms reporting regarding FESS in SRs. We recommend future studies implement guidelines such as the STROCCS guidelines or the harms extension of the PRISMA guidelines to improve harms reporting. Accurate harms reporting may advance patient safety and promote a more objective risk-benefit analysis for physicians and patients.
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Affiliation(s)
- Garrett Jones
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA.
| | - Christian Hemmerich
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA
| | - Austin Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Lacy Brame
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Tom Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK, 74107, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Li H, Du Y, Yang W, Wang Y, Su S, Zhao X, Wang G. Inhalational Anesthesia is Noninferior to Total Intravenous Anesthesia in Terms of Surgical Field Visibility in Endoscopic Sinus Surgery: A Randomized, Double-Blind Study. Drug Des Devel Ther 2023; 17:707-716. [PMID: 36923107 PMCID: PMC10010121 DOI: 10.2147/dddt.s401750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/14/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose Regarding the quality of surgical field visibility, previous studies and meta-analyses comparing total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) in endoscopic sinus surgery (ESS) have presented inconsistent findings. Considering that IA has some advantages over TIVA, we aimed to test the hypothesis that IA with sevoflurane-remifentanil is noninferior to TIVA with propofol-remifentanil in terms of surgical field visibility quality during ESS. Patients and Methods In this randomized, double-blind, noninferiority clinical trial, 110 adult patients were recruited and randomly assigned to the IA (n = 55) or TIVA (n = 55) group. The primary outcome was the quality of surgical field visibility, as measured by the intraoperative mean Boezaart score (BS). Additionally, post hoc analysis was performed for patients with Lund-Mackay scores of ≤ 12 or > 12. Other secondary outcomes included total blood loss, bleeding rate, total fluid, mean arterial pressure, heart rate, dose of remifentanil for anesthesia maintenance, end-tidal CO2, length of stay in the post anesthesia care unit, postoperative hypoxemia, sore throat, and nausea. Results The intraoperative mean BS of the IA group was noninferior to that of the TIVA group [medians with interquartile ranges (IQRs), 2.0 (1.7-2.2) vs 2.0 (1.8-2.1), P = 0.923]. Moreover, post hoc analysis confirmed no difference between IA and TIVA for patients with Lund-Mackay scores ≤ 12 (P = 0.403) or > 12 (P = 0.226). No differences in total blood loss, bleeding rate, or other intraoperative indicators or complications were observed between groups. Conclusion Regarding surgical field visibility during ESS, IA with sevoflurane-remifentanil is noninferior to TIVA with propofol-remifentanil anesthesia maintenance.
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Affiliation(s)
- He Li
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yingjie Du
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenjing Yang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yue Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shaofei Su
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoyan Zhao
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
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Zhdanava M, Ndife B, Pilon D, Rossi C, Vermette-Laforme M, Lefebvre P, Suh JD. Economic Burden Associated With Nasal Polyposis Recurrence Among Commercially Insured Patients in the United States. Otolaryngol Head Neck Surg 2023; 168:65-73. [PMID: 35349388 DOI: 10.1177/01945998221089187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare health care resource utilization (HRU) and costs among commercially insured patients with nasal polyposis (NP) with and without recurrence after endoscopic sinus surgery (ESS). STUDY DESIGN Retrospective matched cohort study. SETTING Adults with initial ESS or an NP excision after a new NP diagnosis were identified in Optum's Clinformatics Data Mart Database (October 1, 2014-December 31, 2019). METHODS The index date was the date of NP recurrence, identified with a claims-based algorithm for the recurrent cohort, or a random date for the nonrecurrent cohort. Patients in both cohorts were matched 1:1 on baseline characteristics (12 months preindex) via propensity scores and exact matching factors. Annual HRU and costs (2019 US$) were compared between the matched cohorts at 12 months postindex. RESULTS NP recurrence was identified among 3343 of 16,693 patients with initial ESS; after matching, each cohort comprised 1574 patients (median age, 54 years; 40% female) with similar baseline health care costs (recurrent, $34,420; nonrecurrent, $33,737). At 12 months postindex, the recurrent cohort had higher HRU, including 36% and 51% more outpatient and emergency department visits, respectively (all P < .01). Mean health care costs were $9676 higher in the recurrent cohort ($24,039) relative to the nonrecurrent cohort ($14,363, P < .01). The mean cost difference between cohorts was driven by $8211 in additional outpatient costs, as well as $6062 in additional NP-related outpatient costs, in the recurrent cohort (all P < .01). CONCLUSION NP recurrence is associated with a substantial economic burden, which appears to be driven by outpatient services.
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Affiliation(s)
| | - Briana Ndife
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | | | | | | | - Jeffrey D Suh
- UCLA Department of Head and Neck Surgery, David Geffen School of Medicine, Los Angeles, California, USA
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22
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Patel R, Shah S, Vedula S, Omiunu A, Patel P, Eloy JA, Baredes S, Fang CH. Utility of Preoperative Laboratory Testing for Ambulatory Endoscopic Sinonasal Surgery in Low-Risk Patients. Am J Rhinol Allergy 2022; 37:247-252. [PMID: 36343940 DOI: 10.1177/19458924221136648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Preoperative laboratory tests (PLTs) are often obtained prior to outpatient surgical procedures. The objective of this study is to examine the current practice of routine PLT in low-risk patients undergoing ambulatory endoscopic sinonasal surgery (ESS) and to assess whether such testing impacts surgical outcomes. Methods Patients undergoing ambulatory ESS were identified from the 2011 to 2018 NSQIP database. Low-risk patients were defined as American Society of Anesthesiologist class 1 or 2. PLTs were grouped into hematologic, chemistry, coagulation, and liver function tests. Chi-square analyses and independent samples t-tests were conducted to compare categoric and continuous variables, respectively. Results A total of 664 cases met the inclusion criteria, of which 419 (62.1%) underwent at least one PLT. Of these, the most frequent PLT obtained was a complete blood cell count (92.4%). Major complications occurred in 1.5% of patients. There were no statistically significant differences in overall postoperative complications between those with and without PLT ( P = .264). Specifically, no significant difference was seen in the incidence of postoperative bleeding ( P = .184), urinary tract infection ( P = .444), pulmonary embolism ( P = .444), or wound infection ( P = .701). On multivariable analyses, PLT status was not significantly associated with any complication ( P = .097) or unplanned readmission ( P = .898). Conclusions Our analysis did not reveal an association between the use of PLT and postoperative morbidity or unplanned readmission in low-risk patients undergoing outpatient ESS.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sejal Shah
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sudeepti Vedula
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ariel Omiunu
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Prayag Patel
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center – RWJ Barnabas Health, Livingston, New Jersey
| | - Soly Baredes
- Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Christina H. Fang
- Department of Otorhinolaryngology – Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New Jersey
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23
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Trimarchi M, Foglia E, Schettini F, Bellavia D, Vinciguerra A, Petrone P, Torretta S, Pignataro L. Determination of costs for the CSRwNP pathway. A time-driven activity-based costing experiment. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:450-457. [DOI: 10.14639/0392-100x-n1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
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24
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Dallan I, Picariello M, Fiacchini G, Canevari R, Rigante M, Pasquini E, Emanuelli E, Alexandre E, Cristofani-Mencacci L, Castelnuovo P. Intraoperative intraorbital bleeding: considerations from a collaborative and retrospective Italian study with a management algorithm proposal. Rhinology 2022; 60:421-426. [DOI: 10.4193/rhin22.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Intraoperative intraorbital bleeding is a rare but potentially catastrophic event that can lead even to blindness, if not treated promptly. The goal of surgery is to quickly reduce intraorbital pressure thus restoring normal visual function. Aim of our work is to propose a practical algorithm helping the surgeon in the setting of this critical event. Methodology: An Italian multi-institutional retrospective study was conducted. All the cases of intraoperative intra-orbital bleeding requiring at least some form of surgical management were analyzed. Cases simply managed conservatively were excluded from this analysis. Results: Sixteen cases were collected. Of these, 12 were initially treated with a medial wall orbital decompression, while 4 were treated via a lateral canthotomy and inferior cantholysis (LCC). Ten patients recovered completely. Four patients presented post-op sequelae (diplopia, enophthalmous and/or eyelid malpositioning). Two major negative outcomes (blindness) were observed. Conclusions: Timely surgical intervention is critical. According to the setting in which the bleeding occurs, different options are available. LCC is probably the most rapid maneuver that can be done to reduce intraorbital pressure. Anyway, if the patient is still in the OR and a complete ethmoidectomy yet done we advise, as first step, to perform a medial orbital wall decompression.
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25
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Marfowaa GD, Friedland DR, Adams JA, Osinski K, Poetker DM. Medial orbital wall decompression: Demographics influencing surgical follow-up and complications: Impacts on follow-up and complications. Am J Otolaryngol 2022; 43:103578. [PMID: 35988365 DOI: 10.1016/j.amjoto.2022.103578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Identify the impact of demographics and social determinants of health on surgical follow-up and complications after medial orbital wall decompression (MOWD) secondary to thyroid associated orbitopathy (TAO). METHODS Demographics and social determinants of health (age, sex, race, insurance status) for 46 patients undergoing MOWD secondary to TAO were correlated with post-operative compliance and surgical complications by chi-square analyses. RESULTS Among 46 patients, 23 were compliant with follow-up. There was no statistically significant difference between compliance and non-compliance based on age (60.25 vs 56.4, p = .41), sex (71.9 % female vs 85.7 % female, p = .31), race (65.6 % white vs 71.4 % white, p = .70) or insurance status (59.4 % private vs 42.9 % private, p = .30). Complications were noted in 50 % of patients of which sinus infection was most common (47.8 % of complications) and epistaxis rare (4.3 % of complications). No correlation was noted between development of complications and compliance (p = .20). Likewise, age, race and insurance status did not correlate with complications. CONCLUSION For patients undergoing MOWD, no correlations with compliance or complication rate were noted with age, sex, race, or insurance status. A larger cohort may be indicated to identify such patterns. The overall complication rate was 50 % and the increased number of visits may have economic impact. KEY POINTS This study provides a unique chance to assess demographic correlates of compliance and complication while controlling for surgeon preference. There was no association between sociodemographics and compliance or complications.
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Affiliation(s)
- Gifty D Marfowaa
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Jazzmyne A Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kristen Osinski
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States of America; Zablocki VA Medical Center, Milwaukee, WI, United States of America.
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26
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Duvanova ED, Danilov SS, Grusha YO. [Ophthalmic complications of endoscopic sinus surgery]. Vestn Oftalmol 2022; 138:108-113. [PMID: 35488569 DOI: 10.17116/oftalma2022138021108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endoscopic surgery of the accessory nasal sinuses (ANA) is widely used as the main treatment method for ANA diseases. It is a well-proven, safe and effective method. However, occasionally certain complications may occur. Ophthalmic complications are rare but can lead to irreversible changes. Anatomical organization of the orbit and paranasal sinuses contributes to the risk of damaging the eye ball and its appendages. During endoscopic sinus surgeries, lamina papyracea of the ethmoid bone, extraocular muscles, the optic nerve and the lacrimal passages can be damaged. Ophthalmic complications are classified as non-significant, significant and severe. Studying the data obtained with multi-slice computed and/or magnetic resonance tomography and the patient's medical history during the preoperative stage is necessary in order to minimize the risk of such complications, as well as monitoring the clinical data during all stages of treatment.
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Affiliation(s)
- E D Duvanova
- Research Institute of Eye Diseases, Moscow, Russia
| | - S S Danilov
- Research Institute of Eye Diseases, Moscow, Russia
| | - Y O Grusha
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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27
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Clinical study of skill assessment based on time sequential measurement changes. Sci Rep 2022; 12:6638. [PMID: 35459268 PMCID: PMC9033839 DOI: 10.1038/s41598-022-10502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/07/2022] [Indexed: 11/08/2022] Open
Abstract
Endoscopic sinus surgery is a common procedure for chronic sinusitis; however, complications have been reported in some cases. Improving surgical outcomes requires an improvement in a surgeon's skills. In this study, we used surgical workflow analysis to automatically extract "errors," indicating whether there was a large difference in the comparative evaluation of procedures performed by experts and residents. First, we quantified surgical features using surgical log data, which contained surgical instrument information (e.g., tip position) and time stamp. Second, we created a surgical process model (SPM), which represents the temporal transition of the surgical features. Finally, we identified technical issues by creating an expert standard SPM and comparing it to the novice SPM. We verified the performance of our methods by using the clinical data of 39 patients. In total, 303 portions were detected as an error, and they were classified into six categories. Three risky operations were overlooked, and there were 11 overdetected errors. We noted that most errors detected by our method involved dangers. The implementation of our methods of automatic improvement points detection may be advantageous. Our methods may help reduce the time for reviewing and improving the surgical technique efficiently.
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28
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Ramadan HH, Bulbul MG, Asad F, Wasef K, Makary CA. Complications of primary pediatric endoscopic sinus surgery for chronic rhinosinusitis: A 25‐year single surgeon experience. Laryngoscope Investig Otolaryngol 2022; 7:658-661. [PMID: 35734063 PMCID: PMC9194991 DOI: 10.1002/lio2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS). Methods Case series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention. Results A total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Conclusions Complications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury. Level of evidence: 4.
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Affiliation(s)
- Hassan H. Ramadan
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
| | - Mustafa G. Bulbul
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
| | - Fatima Asad
- School of Medicine, West Virginia University Morgantown West Virginia USA
| | - Kareem Wasef
- School of Medicine, West Virginia University Morgantown West Virginia USA
| | - Chadi A. Makary
- Department of Otolaryngology West Virginia University Morgantown West Virginia USA
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29
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Analysis of the Lamina Papyracea Dehiscence Based on Computed Tomography Findings. J Craniofac Surg 2022; 33:e580-e583. [PMID: 35142733 DOI: 10.1097/scs.0000000000008557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Aim to evaluate the incidence and characteristics of nontraumatic dehiscence of the lamina papyracea (LP) via computed tomography (CT). METHODS The authors retrospectively studied 893 patients' history and paranasal sinus CT from February to September 2020. The datum of incidence and the characteristics of LP dehiscence were collected and analyzed. RESULTS The LP dehiscence was identified in 23 of 893 patients (2.58%). Lamina papyracea anatomical variations were categorized into Grade I, II, and III, which account 69.56%, 21.74%, and 8.70% of the entire dehiscence group. The average depth of LP ingression was 5.5 ± 0.7 mm. There was no statistical difference between bilateral incidence. The medial rectus muscle was involved in 3 lesions. In all CT reports, this anatomic variation was misdiagnosed as ethmoid sinusitis in 8 cases. CONCLUSIONS Preoperative cognition of the anatomic variation of LP via CT is conducive to decrease misdiagnosis and postoperative complications.
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30
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Morosanu CO, Lee KS, Keshtkar F, Langton-Hewer C. Syndrome of inappropriate antidiuretic hormone secretion after functional endoscopic sinus surgery. J Surg Case Rep 2022; 2022:rjab603. [PMID: 35070263 PMCID: PMC8776400 DOI: 10.1093/jscr/rjab603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
Functional endoscopic sinus surgery (FESS) is effective in cases of sinusitis where pharmacological treatment has not been successful. Patients undergoing FESS have reported an 85% improvement in symptoms as measured by the quality of life scores. Despite its convincing therapeutic benefit, complications sometimes occur with potentially dire consequences. We report the case of a 69-year-old patient who underwent FESS for recurrent frontal sinusitis and developed a syndrome of inappropriate antidiuretic hormone secretion (SIADH) on Day 3 post-operatively. To our knowledge, this is the first documented case of SIADH arising after an endoscopic intervention for frontal sinusitis.
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Affiliation(s)
| | - Keng Siang Lee
- Correspondence address. Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK. E-mail:
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31
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Afzalzadeh M, Khademi S, Kazemi A, Divanbeigi R. A review of the revisions and complications management procedure in sinus surgery. J Family Med Prim Care 2022; 11:887-895. [PMID: 35495831 PMCID: PMC9051709 DOI: 10.4103/jfmpc.jfmpc_897_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
One of the most standard and least invasive surgical procedures that could be applied mostly for the treatment of inflammation of the paranasal sinuses is endonasal endoscopic sinus surgery. The main objective of this study is to assess the available strategies for avoiding, diagnosis and also dealing with various kinds of potential complications of sinus disorders as well as the symptoms which specify the need for revision endoscopic sinus surgery mainly for the treatment of chronic rhinosinusitis. Based on the objectives of this study, the studies were categorized within four main groups; sinus disorders, diagnosis, management, and treatment. In this regard, wide research has been done in various scientific databases of PubMed, EMBASE, Europe PMC, HubMed, MEDLINE, Scientific Information Database (SID) and Google Scholar. From a total of 315 founded records, the final number of 91 records were reviewed. The rate of complication associated with endoscopic sinus surgery is not much and the improvement of surgical technology and experience could decrease its side effects. Performing immediate extensive surgery among patients who have inflammatory sinonasal disease could modify long-term consequences. Applying endoscopic sinus surgery could yield the most appropriate positive outcomes. For achieving the most suitable surgical consequences, the surgeon should be adequately qualified in diagnosis and facing with any possible complications during the operation in addition to cases with complex and revision problems.
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32
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Karadaghy OA, Peterson AM, Fox M, White J, Bhalla V, Beahm D, Villwock J, Chiu AG. Creation of aNovel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg 2021; 167:611-619. [PMID: 34699279 PMCID: PMC10174269 DOI: 10.1177/01945998211053530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) Identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS). (2) Create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. DATA SOURCES Ovid MEDLINE, Embase and Medline via Embase.com, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. REVIEW METHODS Systematic search was performed using a combination of standardized terms and keywords. Studies were included if they investigated anatomic contributions to persistent CRS requiring RESS or the relationship between anatomic landmarks and surgical morbidity. Identified studies were screened by title/abstract, followed by full-text review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly followed. RESULTS In total, 599 articles met screening criteria, 89 were eligible for full-text review, and 27 studies were included in the final review. The identified anatomic sites of interests are broad; the most frequently cited anatomic region was retained anterior ethmoid cells (22/27 studies), followed by posterior ethmoid cells (14/27 studies). Using the consolidated information, a clinical acronym, REVISIONS, was created: Residual uncinate, Ethmoid cells (agger, Haller, supraorbital), Vessels (anterior and posterior ethmoid), Infundibulum, Septal deviation, I (eye) compartment, Onodi cell, Natural os, and Skull base slope and integrity. CONCLUSIONS The REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.
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Affiliation(s)
- Omar A Karadaghy
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew M Peterson
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Meha Fox
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jacob White
- A. R. Dykes Library, Research & Learning, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Vidur Bhalla
- Department of Surgery, St Luke's Hospital, Kansas City, Missouri, USA
| | - David Beahm
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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33
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Stasiowski MJ, Szumera I, Wardas P, Król S, Żak J, Missir A, Pluta A, Niewiadomska E, Krawczyk L, Jałowiecki P, Grabarek BO. Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery. J Clin Med 2021; 10:jcm10204683. [PMID: 34682812 PMCID: PMC8537175 DOI: 10.3390/jcm10204683] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 01/14/2023] Open
Abstract
Inadequate intraoperative analgesia causes the deterioration of the condition of the surgical field (CSF) as a result of hemodynamic instability. Analgesia monitors are used to guide remifentanil) infusion to optimize intraoperative analgesia. The main aim of the current randomized controlled trial was to investigate the potential advantages of intraoperative analgesia monitoring using surgical Pleth index (SPI)- or pupillometry (PRD)-guided remifentanil administration for managing the volume of total intraoperative blood loss (TEIBL), CSF, and length of operation (LOP) in comparison with the standard practice in patients undergoing endoscopic sinus surgery (ESS). The 89 patients in our study were grouped as follows: 30 patients were assigned to the general analgesia (GA) group, 31 patients were assigned to the SPI group, and 28 patients were assigned to the PRD group. The speed of remifentanil infusion was accelerated by 50% when SPI, PRD, or BSS were increased by >15 points, >5%, or >2, respectively, in adjacent groups until their normalization. The SPI group showed significantly lower TEIBL in comparison to the GA group (165.2 ± 100.2 vs. 283.3 ± 193.5 mL; p < 0.05) and a higher mean arterial pressure (MAP; 73.9 ± 8 vs. 69.2 ± 6.8 mmHg; p < 0.05). In the PRD group, a shorter LOP compared with the GA group was observed (63.1 ± 26.7 min vs. 82.6 ± 33.1 min; p < 0.05). It was noted that the PRD group had a lower total remifentanil consumption than the SPI group (1.3 ± 1.4 vs. 1.8 ± 0.9 mg; p < 0.05). In ASA I-III patients undergoing ESS, intraoperative monitoring based on state entropy and SPI values can optimize the CSF and reduce TEIBL, whereas monitoring based on state entropy and PRD measurements can optimize the cost effectiveness of anesthetic drugs and the use of the operation room.
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Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
- Correspondence:
| | - Izabela Szumera
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
| | - Piotr Wardas
- Chair and Clinical Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Seweryn Król
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of General, Colorectal and Polytrauma Surgery, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-555 Katowice, Poland
| | - Jakub Żak
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
| | - Anna Missir
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Neurosurgery, Regional Hospital in Sosnowiec, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Aleksandra Pluta
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia, 40-555 Katowice, Poland;
| | - Lech Krawczyk
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
| | - Przemysław Jałowiecki
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (I.S.); (S.K.); (A.M.); (A.P.); (L.K.); (P.J.)
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, 41-200 Sosnowiec, Poland;
| | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology in Katowice, 41-800 Zabrze, Poland;
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Smith JD, Correll JA, Stucken CL, Stucken EZ. Ear, Nose, and Throat Surgery: Postoperative Complications After Selected Head and Neck Operations. Surg Clin North Am 2021; 101:831-844. [PMID: 34537146 DOI: 10.1016/j.suc.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Unanticipated complications of ENT surgeries may have profound functional and esthetic consequences for patients. Herein, we provide a broad overview of postoperative complications after ENT surgery, illustrating their unique nature, impact, and principles of management. The discussion is organized by subspecialty to highlight the great anatomic complexity of the head and neck and the importance of critical neurovascular and sensory structures that make ENT an impactful, yet challenging surgical specialty.
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Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jason A Correll
- University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Emily Z Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Yong M, Wu YQ, Howlett J, Ballreich J, Walgama E, Thamboo A. Cost-effectiveness analysis comparing dupilumab and aspirin desensitization therapy for chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease. Int Forum Allergy Rhinol 2021; 11:1626-1636. [PMID: 34309219 DOI: 10.1002/alr.22865] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyposis (CRSwNP) in the setting of aspirin-exacerbated respiratory disease (AERD) is a disease that is difficult to treat and prone to recurrence. Dupilumab is a promising treatment for these patients, but its cost-effectiveness has not yet been compared with aspirin (acetylsalicyclic acid, or ASA) desensitization, a known and effective treatment. We aimed to compare the cost-effectiveness of ASA desensitization with dupilumab therapy for the treatment of CRSwNP in AERD. METHODS Analyses of cost-effectiveness, as measured in quality-adjusted life years (QALYs), and cost-utility, as measured in number of required revision endoscopic sinus surgeries (ESSs), were conducted. RESULTS ASA desensitization after ESS was cost-effective and dominated appropriate medical management. Adding salvage dupilumab was also cost-effective (incremental cost-effectiveness ratio [ICER] $135,517.33), and upfront dupilumab therapy was not cost-effective in any scenario (ICER $273,181.32). The cost-utility analysis demonstrated that, over a 10-year period per patient, appropriate medical management after ESS cost $54,125.31 and resulted in 2.25 revision ESSs, ASA desensitization after ESS cost $53,775.15 and resulted in 2.02 revision ESSs, ASA desensitization with salvage dupilumab cost $121,176.25 and resulted in 1.68 revision ESSs, and upfront dupilumab cost $185,950.34 and resulted in 1.51 revision ESSs. CONCLUSION Dupilumab for the treatment of severe CRSwNP was found to be cost-effective as salvage therapy under the willingness-to-pay threshold of $150,000. Further analysis highlighted that the cost-effectiveness of dupilumab was most sensitive to drug price and expected gains in quality of life. This suggests that additional investigation into improving patient population selection and tailoring treatment algorithms may improve the cost-effectiveness of dupilumab in specific scenarios.
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Affiliation(s)
- Michael Yong
- Faculty of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Yu Qi Wu
- Faculty of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Joel Howlett
- Faculty of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Jeromie Ballreich
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Evan Walgama
- Division of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX
| | - Andrew Thamboo
- Faculty of Medicine, Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
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Levi L, Reuven Y, Ben-Ner D, Koch N, Gunders-Peleg M, Nachalon Y, Koren I, Hazan A, Nakache G, Reifen E, Soudry E. Safety of Endoscopic Sinus Surgery in the Elderly-Are Octogenarian Patients at a Higher Risk? Am J Rhinol Allergy 2021; 36:91-98. [PMID: 34236249 DOI: 10.1177/19458924211025374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surgeons are often faced with concerns regarding the risks versus benefits of endoscopic sinus surgery (ESS) in elderly patients. OBJECTIVE To analyze the risk for complications of ESS in the elderly (age ≥70 years) compared to younger patients, with emphasis on octogenarians. METHODS Retrospective review of medical charts of adult patients who underwent ESS at a tertiary referral center during the years 2014 to 2018. RESULTS We compared 128 elderly patients with 276 matched younger patients. In the elderly group mean age was 76 years (range, 70-91 years ). Thirty-one elderly patients were 80 years or older. Surgical complications in the elderly patients were 3.9%. Minor complications were 2.3% and major complications were 1.7%. The surgical complications rate was similar in the younger group (8%, P value: .127). Medical complications were observed in 2.3% comparing to 0.7% in younger patients. Interestingly, age, revision surgery, extent and duration of surgery, and modality of anesthesia were not identified as risk factors. Only ischemic heart disease (IHD) was identified as a risk factor for complications in a multivariate analysis in elderly patients. Comparison of elderly patients younger than 80 years with octogenarians revealed no difference in complication rate between these groups. CONCLUSIONS Overall, ESS was found to be a safe procedure in elderly patients compared to younger patients. Octogenarian patients should not be denied upfront surgery. IHD is a risk factor for complications in elderly patients.
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Affiliation(s)
- Lirit Levi
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | | | - Noam Koch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Ilan Koren
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alain Hazan
- 36632Rabin Medical Center, Petah Tikva, Israel
| | | | - Ella Reifen
- 36632Rabin Medical Center, Petah Tikva, Israel
| | - Ethan Soudry
- 36632Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Saydy N, Moubayed SP, Desrosiers M. Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis. J Otolaryngol Head Neck Surg 2021; 50:34. [PMID: 34130732 PMCID: PMC8207753 DOI: 10.1186/s40463-021-00515-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients’ perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success. Methods Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings. Results Exploration of themes on patients’ perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients’ QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success. Conclusions Patients’ level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient’s principal complaints within the context of a personalized approach and to refer back to patients’ preoperative goals in their assessment of operative success. Graphical abstract ![]()
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Affiliation(s)
- Nadim Saydy
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada
| | - Sami Pierre Moubayed
- Division of Otolaryngology - Head & Neck Surgery, Sacré-Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Martin Desrosiers
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1051 Sanguinet Street, Montreal, QC, H2X 3E4, Canada.
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Feng M, Lao VF, Choby G, Bolton PB, Marino MJ, Weingarten TN, Humphreys IM, Dhillon SK, Choi BY, Fernandez RA, Mehter NS, Chen PG. Survey of Anesthesiologists on Topical Vasoconstrictors and Intravenous Tranexamic Acid for Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2021; 131:59-70. [PMID: 33840220 DOI: 10.1177/00034894211005940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Topical vasoconstrictors and intravenous tranexamic acid (IV TXA) are safe and efficacious to decrease bleeding and improve the surgical field during endoscopic sinus surgery (ESS). The purpose of this study was to investigate practice patterns, awareness of clinical evidence, and comfort levels among anesthesia providers regarding these hemostatic agents for ESS. METHODS A total of 767 attending anesthesiologists, residents, and certified registered nurse anesthetists (CRNAs) at 5 United States academic centers were invited to participate in a survey regarding their experience with IV TXA and 3 topical vasoconstrictor medications (oxymetazoline, epinephrine, and cocaine) during ESS. RESULTS 330 (47%) anesthesia providers responded to the electronic survey. 113 (97%) residents, 92 (83%) CRNAs, and 52 (68%) attendings managed 5 or fewer ESS cases per month. Two-thirds of providers had not reviewed efficacy or safety literature for these hemostatic agents. Oxymetazoline was perceived safest, followed by epinephrine, IV TXA, and cocaine. Respondents considered potential side effects over surgical field visibility when selecting agents. The majority of providers had no formal training on these agents for ESS, but indicated interest in educational opportunities. CONCLUSION Many anesthesia providers are unfamiliar with safety and efficacy literature regarding agents used to improve hemostasis for ESS, highlighting a need for development of relevant educational resources. Rhinologic surgeons have an opportunity to communicate with anesthesia colleagues on the use of hemostatic agents to improve the surgical field during ESS.
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Affiliation(s)
- Max Feng
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Veronica F Lao
- Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patrick B Bolton
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Michael J Marino
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Sabrina K Dhillon
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Byeong Y Choi
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Roman A Fernandez
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Najma S Mehter
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Qin X, Sun Q, Chen G, Liu J, Gao T, Bai G, Guo Z. Risk factors for postoperative bleeding after endoscopic sinus surgery to treat chronic rhinosinusitis. Acta Otolaryngol 2021; 141:392-396. [PMID: 33586594 DOI: 10.1080/00016489.2021.1878276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although there has been progress in improving endoscopic sinus surgery (ESS), patients undergoing ESS are still at risk of postoperative bleeding. Little attention has been given to identifying specific risk factors for postoperative bleeding after ESS to treat chronic rhinosinusitis (CRS). OBJECTIVES The aim of this study was to identify the incidence and risk factors associated with postoperative bleeding in patients who underwent ESS to treat CRS. MATERIALS AND METHODS Six hundred and five patients with CRS who underwent ESS between 2017 and 2020 were included in this retrospective analysis. Univariate and multivariate analysis was performed to assess the association between the incidence of postoperative bleeding and the background characteristics. RESULTS Out of 605 ESSs, 36 (6.0%) patients developed postoperative bleeding. Multiple logistic regression revealed that the use of antiplatelet and/or anticoagulant drugs, the presence of hypertension and the Lund-Mackay CT score were significantly correlated with the occurrence of postoperative bleeding. CONCLUSION Postoperative bleeding is a common complication following ESS. The risk factors for postoperative bleeding were as follows: the use of antiplatelet and/or anticoagulant drugs, hypertension and the Lund-Mackay CT score.
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Affiliation(s)
- Xuemei Qin
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qing Sun
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guohui Chen
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Liu
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianle Gao
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guangping Bai
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiqiang Guo
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
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Delayed Ocular Motility Restriction After Endoscopic Sinus Surgery in a Patient With Chronic Rhinosinusitis and an Old Medial Orbital Wall Fracture. J Craniofac Surg 2021; 31:e769-e771. [PMID: 33136907 DOI: 10.1097/scs.0000000000006718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The orbital complications of endoscopic sinus surgery, including diplopia and ocular motility restriction, are mainly caused by direct injury to the orbital structures. These complications are rare, but can have catastrophic consequences. Symptoms occur immediately after surgery in most cases. The authors encountered an unusual case of delayed ocular motility restriction after endoscopic sinus surgery in a patient with old medial wall fracture, without direct orbital injury during the procedure. A 77-year-old man with an old medial wall fracture of the right orbit underwent endoscopic sinus surgery for chronic pansinusitis. He complained mild diplopia on right lateral gaze after 2 weeks, which gradually worsened. After 2 months, he exhibited severe lateral gaze movement impairment in the right eye and finally underwent surgical exploration. His symptoms improved after adhesiolysis of the overgrown ethmoid sinus mucosa and periorbital tissue. The authors reported this unusual case and discussed the possible mechanism underlying ocular motility restriction.
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Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang DY, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol 2021; 11:213-739. [PMID: 33236525 DOI: 10.1002/alr.22741] [Citation(s) in RCA: 357] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
I. EXECUTIVE SUMMARY BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document. METHODS ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. RESULTS ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided. CONCLUSION This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS.
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Affiliation(s)
| | | | | | | | | | - Amber U Luong
- University of Texas Medical School at Houston, Houston, TX
| | | | - Zachary Soler
- Medical University of South Carolina, Charleston, SC
| | - Kevin C Welch
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | - Claus Bachert
- Ghent University, Ghent, Belgium.,Karolinska Institute, Stockholm, Sweden.,Sun Yatsen University, Gangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David A Gudis
- Columbia University Irving Medical Center, New York, NY
| | - Daniel L Hamilos
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Richard Harvey
- University of New South Wales and Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | | | - Amin R Javer
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | - Valerie Lund
- Royal National Throat Nose and Ear Hospital, UCLH, London, UK
| | - Kevin C McMains
- Uniformed Services University of Health Sciences, San Antonio, TX
| | | | - Joaquim Mullol
- IDIBAPS Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Alkis J Psaltis
- University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | - Luke Rudmik
- University of Calgary, Calgary, Alberta, Canada
| | - Raymond Sacks
- University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - De Yun Wang
- National University of Singapore, Singapore, Singapore
| | | | | | | | - Carol Yan
- University of California San Diego, La Jolla, CA
| | - Luo Zhang
- Capital Medical University, Beijing, China
| | - Bing Zhou
- Capital Medical University, Beijing, China
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Moffatt DC, McQuitty RA, Wright AE, Kamucheka TS, Haider AL, Chaaban MR. Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis. Am J Rhinol Allergy 2021; 35:674-684. [PMID: 33478255 DOI: 10.1177/1945892421989155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. OBJECTIVE To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. METHODS A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). RESULTS 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (-0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (-0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (-0.225, p = 0.63) and MAP values (-0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. CONCLUSION TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.
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Affiliation(s)
- David C Moffatt
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Robert A McQuitty
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Alex E Wright
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | | | - Ali L Haider
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
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Maggiore G, Pietragalla M, De Amicis C, Nardi C, Bruno C, Gallo O, Bonasera L, Perrone A, Cavallo A, Colagrande S, Taccetti G, Locatello LG. The Risks of Complications During Endoscopic Sinus Surgery in Cystic Fibrosis Patients: An Anatomical and Endoscopic Study. Laryngoscope 2021; 131:E2481-E2489. [PMID: 33464574 DOI: 10.1002/lary.29404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE/HYPOTHESIS An increasing proportion of adult cystic fibrosis (CF) patients is being referred to endoscopic sinus surgery (ESS) in order to relieve the symptoms of chronic rhinosinusitis (CRS). Given that CFTR mutations profoundly alter sinonasal development, we want to explore the relationship between their peculiar surgical anatomy and the risk of postoperative complications. STUDY DESIGN Retrospective case-control study. METHODS Paranasal sinuses CT scans of 103 CF adult patients with CRS were compared to those belonging to a cohort of 100 non-CF adult patients to explore their anatomical differences. Secondly, CF and non-CF patients who received primary/revision ESS were analyzed in order to assess their preoperative CT scan in terms of surgically relevant variants, and according to the CLOSE checklist. Surgical outcomes were statistically compared in order to explore the differences between groups. RESULTS CF group presented more frequently with smaller and less pneumatized paranasal sinuses and a higher Lund-Mckay score compared with controls. No anatomical differences emerged in terms of genotype stratification. Non-CF CRS patients undergoing ESS showed a significantly deeper olfactory fossa and a more frequent supraorbital pneumatization compared to CF patients (P < .001 and P = .031, respectively). Whereas this latter group underwent more often aggressive surgical procedures (P = .001), no difference in terms of postoperative adverse events was found (P = .620). CONCLUSIONS Despite receiving more often aggressive ESS procedures, adult CF patients do not show an increased risk of postoperative complication and this may be linked to a different proportion of anatomical and surgically-relevant variants. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2481-E2489, 2021.
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Affiliation(s)
| | - Michele Pietragalla
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Christian De Amicis
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Cosimo Nardi
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Luigi Bonasera
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Anna Perrone
- Department of Radiology, Anna Meyer Children's University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Department of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Biomedical, Experimental and Clinical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Careggi University Hospital, Florence, Italy
| | - Giovanni Taccetti
- Cystic Fibrosis Center, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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Sharma RK, Dodhia S, Golub JS, Overdevest JB, Gudis DA. Gender as a Predictor of Complications in Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2021; 130:892-898. [PMID: 33412907 DOI: 10.1177/0003489420987418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date. OBJECTIVES This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS. METHODS A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors. RESULTS A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, P = .046). CONCLUSIONS ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Sonam Dodhia
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Justin S Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Pawlowski J, Francois A, Joseph KA. Emergency Control of Large Aneurysmal Bleed During Endoscopic Sinus Surgery: A Case Report. A A Pract 2020; 14:e01327. [PMID: 33031107 DOI: 10.1213/xaa.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Functional endoscopic sinus surgery (FESS) is a commonly performed procedure for the treatment of chronic rhinosinusitis. It is most commonly performed as an outpatient procedure. Complications occur, including injury to the orbits, brain, and bleeding. Intraoperative injury to the internal carotid artery is rare and feared by otolaryngologists and skull base surgeons. Controlling this bleed is difficult and could be fatal. We report a case of intraoperative bleed of an internal carotid artery aneurysm during endoscopic sinus surgery. This case demonstrates that multidisciplinary coordination and prompt management can lead to a favorable outcome.
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Affiliation(s)
- Julius Pawlowski
- From the Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Audrice Francois
- From the Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois
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Şahan MH, Inal M, Muluk NB, Şimşek G. Cribriform Plate, Crista Galli, Olfactory Fossa and Septal Deviation. Curr Med Imaging 2020; 15:319-325. [PMID: 31989883 DOI: 10.2174/1573405614666180314150237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 12/06/2017] [Accepted: 03/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In the present study, we investigated the relationship between olfactory fossa, cribriform plate, crista galli and nasal Septal Deviation (SD). Keros classification of olfactory fossa was also performed. METHODS This study was performed retrospectively. Computerized Tomography (CT) images of 200 adult subjects were observed. Unilateral nasal Septal Deviation (SD) cases were included into the study. On coronal CT scans, SD side and location, SD angle, cribriform plate width, olfactory fossa depth (Keros classification) and width, area of the olfactory fossa, crista galli length, width and pneumatization were evaluated. RESULTS Anterior and anteroposterior deviations were detected mainly. In females, 64.0% and in males, 45.3% of the SDs were located anteriorly. In males, anteroposterior SDs (40.0%) were detected more than females. In anteroposterior SDs, SD angle was higher than anterior SDs. With higher SD angle, crista galli width and height decreased. Cribriform plate width, olfactory fossa height, width and area values of contralateral side were significantly higher than those of the ipsilateral side. For Keros classification, in male group, type 1 (53.3%) and in females, type 2 (57.6%) was detected at ipsilateral side. For contralateral side, type 2 Keros was detected in both genders. Complete crista galli pneumatization was observed in 4.0% and partial pneumatization was detected in 12.0%. In 84% of the patients, there is no Crista galli pneumatization. With the presence of pneumatized crista galli, contralateral Keros values decreased. Crista galli height and contralateral olfactory fossa width showed positive correlation. In older patients, cribriform plate width decreased. CONCLUSION In our study, there was no Keros type 3 olfactory fossa. In males' contralateral side of SD; and in females both ipsilateral and contralateral side of SD, Keros type 2 olfactory fossa were detected. Therefore, during sinus surgery, surgeons should work carefully not to made intracranial penetration.
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Affiliation(s)
- Mehmet Hamdi Şahan
- Radiology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Mikail Inal
- Radiology Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Gökçe Şimşek
- ENT Department, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Leung RM, Smith TL, Kern RC, Chandra RK, Schlosser RJ, Harvey RJ, Conley DB, Lee JM. Should Oral Corticosteroids be Used in Medical Therapy for Chronic Rhinosinusitis? A Risk Analysis. Laryngoscope 2020; 131:473-481. [PMID: 32633822 DOI: 10.1002/lary.28843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/28/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Oral corticosteroid (OCS) as a part of appropriate medical therapy (AMT) (formerly maximal medical therapy) in chronic rhinosinusitis remains controversial. While the risks of OCS are well known, the benefit remains unclear due the absence of a standardized prescribing regimen. Consequently, it is difficult to characterize whether the risks of OCS and its ability to avert endoscopic sinus surgery (ESS) are helpful in AMT. When OCS is highly effective at averting surgery, the lesser risks of OCS would be justified because it can avoid the greater risks of ESS. When OCS is poorly effective at averting ESS, the risks of OCS would not be justified because many patients will be exposed to both risks. This study seeks to identify the threshold effectiveness of OCS at averting ESS that would minimize risk exposure to patients. METHODS A probabilistic risks-based decision analysis was constructed from literature reported incidences and impacts of adverse events of OCS and ESS. Monte Carlo analysis was performed to identify the minimum effectiveness required to avoid further intervention (MERAFI) for chronic sinusitis without nasal polyp (CRSsNP) and chronic sinusitis with nasal polyp (CRSwNP). RESULTS The analysis showed MERAFI results of 20.8% (95% CI 20.7-20.9%) for CRSsNP and 16.8% (95% CI 16.7-16.9%) for CRSwNP. CONCLUSIONS Given reported OCS effectiveness in the range of 34-71% in CRSsNP and 46-63% in CRSwNP, this analysis suggests that the inclusion of OCS in AMT may be the lower risk strategy. LEVEL OF EVIDENCE N/A Laryngoscope, 131:473-481, 2021.
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Affiliation(s)
- Randy M Leung
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Timothy L Smith
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University, Chicago, Illinois, U.S.A
| | - Rakesh K Chandra
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Rodney J Schlosser
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Richard J Harvey
- Department of Otolaryngology, University of New South Wales and Macquarie University, Darlinghurst, New South Wales, Australia
| | - David B Conley
- Department of Otolaryngology, Northwestern University, Chicago, Illinois, U.S.A
| | - John M Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Lee JS, Yang JH, Lee JS. A Case of Transient Visual Disturbance and Ocular Paresis after Endoscopic Sinus Surgery. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2019.00304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Endoscopic sinus surgery (ESS) is widely used as standard surgical treatment for chronic rhinosinusitis. Orbital complications of varying degrees occurred during ESS have been widely reported. If the orbital symptoms occurred immediately after surgery, ocular damage associated with surgery is suspected if the patient’s preoperative ocular function was patent. If immediate action is not taken, permanent visual loss might develop, so it is very important to diagnose orbital complications and take appropriate action. In our case, there was no definite intraorbital hemorrhage when sudden visual loss was noted. The symptoms were fully recovered without further treatment and it is clinically suspected to be caused by transient ocular muscle toxicity of local anesthetics.
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Koizumi M, Suzuki S, Matsui H, Fushimi K, Yamasoba T, Yasunaga H. Trends in complications after functional endoscopic sinus surgery in Japan: A comparison with a previous study (2007-2013vs. 2013-2017). Auris Nasus Larynx 2020; 47:814-819. [PMID: 32418661 DOI: 10.1016/j.anl.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis is considered safe and is widely performed. Techniques and devices for this type of surgery have recently been updated. The purpose of this study was to describe the proportions of complications after FESS (2013-2017) and to compare the results with those from our previous study (2007-2013). METHODS We obtained data on 70,288 patients who underwent FESS from April 2013 to March 2017 from a Japanese national inpatient database. We classified FESS into four types: single sinus surgery (ESS Type 2), multiple sinus surgery (ESS Type 3), whole sinus surgery (ESS Type 4), and extensive sinus surgery (ESS Type 5). We investigated the proportions of complications after FESS, including cerebrospinal fluid leakage, meningitis, orbital injury, severe hemorrhage, and toxic shock syndrome. We performed a multivariable logistic regression analysis with adjustment for within-hospital clustering to evaluate the association between the occurrence of overall complications and patient characteristics. RESULTS The proportion of overall complications was 0.50%. The proportions of patients with cranial complications, orbital complications, hemostasis operations, blood transfusion, and toxic shock syndrome were 0.11%, 0.04%, 0.05%, 0.30%, and 0.03%, respectively. The extent of FESS was not associated with the occurrence of overall complications. The occurrence of overall complications was associated with the severity of comorbidities and the academic hospital status. Asthma and use of a microdebrider were associated with a lower occurrence of overall complications. CONCLUSION The proportion of overall complications after FESS in the present study was similar to that reported in our previous study. The extent of FESS and eosinophilic chronic rhinosinusitis were not associated with the occurrence of overall complications.
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Affiliation(s)
- Megumi Koizumi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Otolaryngology and Head and Neck Surgery, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo 101-8326, Japan.
| | - Sayaka Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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50
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Scangas GA, Wu AW, Ting JY, Metson R, Walgama E, Shrime MG, Higgins TS. Cost Utility Analysis of Dupilumab Versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2020; 131:E26-E33. [PMID: 32243622 DOI: 10.1002/lary.28648] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically-refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost-effectiveness of dupilumab versus ESS for patients with CRSwNP. STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS-24 and SINUS-52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT-22 instrument in both cohorts. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed. RESULTS The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One-way sensitivity analyses showed ESS to be cost-effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855. CONCLUSIONS The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost-effective manner. LEVEL OF EVIDENCE 2C Laryngoscope, 131:E26-E33, 2021.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Center for Global Surgery Evaluation, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, Kentucky, U.S.A
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