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Salmon MK, Kshirsagar RS, Eide JG, Sweis AM, Davin K, Prasad A, Ungerer H, Stevens E, Ig‐Izevbekhai K, Tripathi S, Locke TB, Lin T, Sweis BM, Kohanski MA, Adappa ND, Palmer JN. Postoperative mometasone irrigations improve quality of life in skull base tumor patients. World J Otorhinolaryngol Head Neck Surg 2023; 9:314-319. [PMID: 38059136 PMCID: PMC10696264 DOI: 10.1002/wjo2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied. We quantified long-term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS. Methods Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019. Data on patient demographics and postoperative treatment with nasal saline irrigation twice daily with and without dissolved steroids (mometasone or budesonide) was collected. Preoperative, and 1-, 3-, 6-, 12-, 18-, and 24-month postoperative Sino-Nasal Outcome Test (SNOT-22) scores were assessed. Results A total of 727 patients were assessed (53.4% males), with 479 patients in the no SI group and 248 patients in the SI group. Preoperative SNOT-22 scores did not differ significantly (P = 0.19). 1-, 3-, 6-, 12-, 18-, and 24-month post-op SNOT-22 scores did not significantly differ between groups. However, mometasone irrigations resulted in significantly lower postoperative 2-year SNOT-22 scores compared to budesonide (P < 0.01) and saline (P = 0.03). Conclusions Though corticosteroid irrigations are routine in managing inflammatory sinus disease, their role in postoperative management after ESBS for tumors is unclear. Our findings suggest that mometasone irrigation may be effective at improving postoperative quality of life in patients after ESBS.
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Affiliation(s)
- Mandy K. Salmon
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rijul S. Kshirsagar
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jacob G. Eide
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Auddie M. Sweis
- Division of Otolaryngology—Head and Neck SurgeryNorthShore University Health System, The University of ChicagoEvanstonIllinoisUSA
| | - Kathleen Davin
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Aman Prasad
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Heather Ungerer
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Elizabeth Stevens
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kevin Ig‐Izevbekhai
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Tran B. Locke
- Department of OtolaryngologyBaylor College of MedicineHoustonTexasUSA
| | - Theodore Lin
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lewis Katz School of MedicineTemple UniversityPhiladelphiaPennsylvaniaUSA
| | - Brian M. Sweis
- Department of NeuroscienceUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James N. Palmer
- Department of Otorhinolaryngology—Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Saleh S, Sullivan SE, Bellile E, Roxbury C, Das P, Hachem RA, Ackall F, Jang D, Celtikci E, Sahin MM, D'souza G, Evans JJ, Nyquist G, Khalafallah A, Mukherjee D, Rowan NR, Camp S, Choby G, Gompel JJV, Ghiam MK, Levine CG, Field M, Adappa N, Locke TB, Rassekh C, Sweis AM, Goyal N, Zacharia B, Wilson MN, Patel S, Gardner PA, Snyderman CH, Wang EW, Glancz LJ, Bagchi A, Dow G, Robertson I, Rangarajan SV, Michael LM, McKean EL. Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society. J Neurol Surg B Skull Base 2022; 83:579-588. [PMID: 36393885 PMCID: PMC9653291 DOI: 10.1055/a-1865-3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72-474.4]). Conclusions The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.
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Affiliation(s)
- Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Stephen E. Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Emily Bellile
- Cancer Data Science, Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Christopher Roxbury
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, United States
| | - Paramita Das
- Department of Neurosurgery, University of Chicago, Chicago, Illinois, United States
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - Feras Ackall
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - David Jang
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Muammer Melih Sahin
- Department of Otolaryngology–Head and Neck Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Glen D'souza
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gurston Nyquist
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Adham Khalafallah
- Department of Neurosurgery, University of Miami/Jackson Health System, Miami, Florida, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nicholas R. Rowan
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Samantha Camp
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Neurosurgery and Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael K. Ghiam
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Corinna G. Levine
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Melvin Field
- Orlando Neurosurgery, Orlando, Florida, United States
| | - Nithin Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tran B. Locke
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Christopher Rassekh
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Auddie M. Sweis
- Division of Otolaryngology–Head and Neck Surgery, Northshore University Health System, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Brad Zacharia
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Meghan N. Wilson
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Shivam Patel
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Paul A. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snyderman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric W. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Laurence Johann Glancz
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
- Manchester Skullbase Unit, Salford Royal Hospital, Manchester, United Kingdom
| | - Ananyo Bagchi
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Graham Dow
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Iain Robertson
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology, Head-Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Erin L. McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States
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Eide JG, Salmon MK, Kshirsagar RS, Patel TD, Davin KM, Prasad A, Stevens EM, Ungerer H, Sweis AM, Locke TB, Lee JY, Grady MS, Yoshor D, Storm PB, Adappa ND, Palmer JN. Reconstruction with Mucosal Graft Reduces Recurrence After Endoscopic Surgery of Rathke Cleft Cyst. World Neurosurg 2022; 167:e664-e669. [PMID: 36028104 DOI: 10.1016/j.wneu.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Rathke cleft cysts (RCCs) arise from the development of the Rathke pouch. Recurrence is common after either drainage or cyst removal. The endoscopic endonasal approach (EEA) is increasingly utilized for the management of RCC. Various techniques have been described to try to reduce the rates of recurrence. We studied the effect of fenestration with a nasoseptal flap (NSF) on recurrence rates by comparing a cohort of patients undergoing this technique to a cohort of patients undergoing conventional drainage. METHODS Patients who underwent EEA for RCC between 2011 and 2020 were identified and divided into 2 cohorts: conventional fenestration versus fenestration with NSF. Surgical approach, reconstructive method, and recurrences were recorded. Primary end point was symptomatic or radiographic recurrence. RESULTS 21 patients were identified undergoing EEA. An NSF was used to line the cyst cavity in 11 cases. Conventional fenestration without mucosal reconstruction was performed in the remaining 10 cases. In the cases without NSF, 5 (50%) developed recurrence requiring revision surgery, while there was only one recurrence in the NSF group (P < 0.05). In patients requiring revision, all had an NSF placed and none had a second recurrence of their RCC. CONCLUSIONS NSF placement into a fenestrated RCC is useful to prevent cyst reaccumulation and reoperation. Typical fenestration carries an unacceptably high rate of recurrence.
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Affiliation(s)
- Jacob G Eide
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mandy K Salmon
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rijul S Kshirsagar
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tapan D Patel
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen M Davin
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth M Stevens
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heather Ungerer
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Evanston, Illinois, USA
| | - Tran B Locke
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - John Y Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Sean Grady
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Yoshor
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James N Palmer
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Tripathi SH, Ungerer HN, Rullan-Oliver B, Patel T, Sweis AM, Maina IW, Kohanski MA, Palmer JN, Adappa ND, Bosso JV. Similarities between allergen sensitivity patterns of central compartment atopic disease and allergic rhinitis. Int Forum Allergy Rhinol 2022; 12:1299-1302. [PMID: 35132826 DOI: 10.1002/alr.22983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Siddhant H Tripathi
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Heather N Ungerer
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Bianca Rullan-Oliver
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Tapan Patel
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Auddie M Sweis
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Ivy W Maina
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Michael A Kohanski
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - James N Palmer
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - Nithin D Adappa
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
| | - John V Bosso
- Division of Rhinology, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine
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5
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Locke TB, Sweis AM, Douglas JE, Ig-Izevbekhai KI, Stevens EM, Civantos AM, McCarty EB, Kumar A, Kohanski MA, Kennedy DW, Palmer JN, Bosso JV, Adappa ND. Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease Based on the 12-Item Short Form Survey. Am J Rhinol Allergy 2021; 35:790-797. [PMID: 33691498 DOI: 10.1177/19458924211001640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is optimally managed by endoscopic sinus surgery (ESS) followed by aspirin therapy after desensitization (ATAD). Most AERD quality of life (QOL) studies use the 22-item Sinonasal Outcomes Test (SNOT-22), which focuses predominantly on sinonasal outcomes. OBJECTIVE This study seeks to assess QOL outcomes in AERD patients after ESS and ATAD via the 12-item Short Form Survey (SF-12), a well-validated QOL measure for general health status of chronic conditions. METHODS Retrospective review of 112 AERD patients who underwent ESS followed by ATAD at our institution between 2016 and 2019. SF-12 was collected preoperatively, postoperatively/pre-AD, and serially post-AD (1-3, 4-6, 7-12, and >12 months). Optum® PRO CoRE software was used to compare data to national norms. ANOVA was performed comparing physical component summary (PCS), mental component summary (MCS) and eight health domains (physical functioning, role physical, general health, bodily pain, vitality, social functioning, role emotional, and mental health). RESULTS AERD patients showed improvement in PCS scores across all timepoints after ESS and ATAD (p = 0.004). When stratified by gender, women demonstrated an improvement in PCS scores (p = 0.004). Within the domains, there were significant improvements in social functioning (SF), role physical (RP), and bodily pain (BP) at all timepoints (SF: p = 0.006; RP: p = 0.005; BP: p < 0.001). CONCLUSIONS AERD patients undergoing ESS and ATAD show improvement in physical QOL and 3 of the 8 health domains as measured by the SF-12. Future studies can use the SF-12 to study the impact of AERD treatment versus other chronic diseases and health demographics.
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Affiliation(s)
- Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Evanston, Illinois
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin I Ig-Izevbekhai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth M Stevens
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth B McCarty
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Kumar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John V Bosso
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Sweis AM, Locke TB, Ig-Izevbekhai KI, Lin TC, Kumar A, Douglas JE, Corr AM, Civantos AM, Tripathi SH, Kennedy DW, Kohanski MA, Palmer JN, Adappa ND, Bosso JV. Effectiveness of endoscopic sinus surgery and aspirin therapy in the management of aspirin-exacerbated respiratory disease. Allergy Asthma Proc 2021; 42:136-141. [PMID: 33685558 DOI: 10.2500/aap.2021.42.210002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.
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Affiliation(s)
- Auddie M. Sweis
- From the Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, University of Chicago, Pritzker School of Medicine, Evanston, Illinois
| | - Tran B. Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kevin I. Ig-Izevbekhai
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Theodore C. Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Jennifer E. Douglas
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Andrew M. Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alyssa M. Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Siddhant H. Tripathi
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - David W. Kennedy
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael A. Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - James N. Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Nithin D. Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John V. Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania; and
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7
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Douglas JE, Civantos AM, Locke TB, Sweis AM, Hadjiliadis D, Hong G, Dorgan DJ, Kohanski MA, Palmer JN, Adappa ND. Impact of novel CFTR modulator on sinonasal quality of life in adult patients with cystic fibrosis. Int Forum Allergy Rhinol 2020; 11:201-203. [PMID: 33070454 DOI: 10.1002/alr.22716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Auddie M Sweis
- Division of Otolaryngology-Head and Neck Surgery, NorthShore University Health System, The University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Denis Hadjiliadis
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Dorgan
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA
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8
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Locke TB, Sweis AM, Gleeson PK, Lin TC, Civantos AM, Parhar HS, Corr AM, Kumar A, Salmon MK, Kohanski MA, Palmer JN, Bosso JV, Adappa ND. Age as a factor in treatment of aspirin-exacerbated respiratory disease: relationship to required aspirin maintenance dose after desensitization. Int Forum Allergy Rhinol 2020; 10:1180-1181. [PMID: 32761891 DOI: 10.1002/alr.22665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Patrick K Gleeson
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, University of Pennsylvania, Philadelphia, PA
| | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Harman S Parhar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Andrew M Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Mandy K Salmon
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - John V Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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9
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Sweis AM, Locke TB, Ig-Izevbekhai KI, Lin TC, Gleeson PK, Civantos AM, Kumar A, Corr AM, Kohanski MA, Palmer JN, Bosso JV, Adappa ND. Major complications of aspirin desensitization and maintenance therapy in aspirin-exacerbated respiratory disease. Int Forum Allergy Rhinol 2020; 11:115-119. [PMID: 32671928 DOI: 10.1002/alr.22643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment of aspirin-exacerbated respiratory disease (AERD) includes endoscopic sinus surgery (ESS) and aspirin desensitization (AD) with aspirin therapy after desensitization (ATAD). The objective of this study was to determine the rate of major complications associated with aspirin use that resulted in the discontinuation of aspirin therapy. METHODS This study was a retrospective chart review of patients with AERD who underwent ESS, AD, and ATAD at a single AERD tertiary center between July 2016 and February 2019. Complications associated with aspirin that resulted in the discontinuation of aspirin therapy were analyzed via analysis of variance and logistic regression. RESULTS In total, 109 AERD patients underwent ESS with subsequent AD. Ten patients (9.2%) discontinued therapy after AD, before starting ATAD. Eight patients (7.3%) discontinued therapy after starting ATAD. There were 91 patients (83.5%) with no complications throughout ATAD. Reasons for discontinuation included gastritis, upper gastrointestinal (GI) bleed, anaphylaxis, persistent sinonasal symptoms, recurrent epistaxis, asthma exacerbation, and a nummular rash. There was no significant correlation between complication rate and (1) aspirin doses (analysis of variance [ANOVA] F: 0.69; p = 0.51), (2) gender (odds ratio [OR] 0.56; 95% confidence interval [CI], 0.19 to 1.65; p = 0.30), (3) age (OR 1.04; 95% CI, 0.96 to 1.09; p = 0.06), or (4) race/ethnicity (OR 1.12; 95% CI, 0.88 to 1.44; p = 0.36). CONCLUSION AD with ATAD was associated with only a 0.92% incidence of a clinically significant GI bleed, and only a 0.92% incidence of anaphylaxis. A remaining 16 patients (14.7%) discontinued aspirin therapy due to minor clinical sequelae. These findings demonstrate that the majority of AERD patients tolerate AD with ATAD without any major complications.
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Affiliation(s)
- Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | | | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Patrick K Gleeson
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Ankur Kumar
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Andrew M Corr
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Michael A Kohanski
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - James N Palmer
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - John V Bosso
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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10
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Sweis AM, Locke TB, Douglas JE, Lin TC, Sweis BM, Civantos AM, Kennedy DW. Management of chronic rhinosinusitis with steroid nasal irrigations: A viable nonsurgical alternative in the COVID-19 era. Int Forum Allergy Rhinol 2020; 10:1108-1109. [PMID: 32573106 PMCID: PMC7361584 DOI: 10.1002/alr.22646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Auddie M Sweis
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Tran B Locke
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - Theodore C Lin
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.,Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Brian M Sweis
- Department of Neuroscience, University of Minnesota, Minneapolis, MN
| | - Alyssa M Civantos
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
| | - David W Kennedy
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA
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11
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Glispie DM, Sweis AM, Sims HS. Laryngology Clinic: Solitary Tracheal Papilloma. Ear Nose Throat J 2019; 99:194-195. [PMID: 30922107 DOI: 10.1177/0145561319837476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Deonna M Glispie
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Auddie M Sweis
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - H Steven Sims
- Chicago Institute for Voice Care, University of Illinois Medical Center, Chicago, IL, USA
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12
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Sweis AM, Guttikonda D, Walner DL, Hamming KK, Lygizos NA, Geissler G. Adenomatous multinodular goiter causing airway obstruction in an infant. Laryngoscope 2014; 124:2636-9. [PMID: 24622964 DOI: 10.1002/lary.24677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/12/2022]
Abstract
Nontoxic adenomatous multinodular goiter (AMNG) in infants is a rare condition. We discuss an extremely rare case of a nontoxic AMNG in a 3-month-old female presenting with airway obstruction. Surgical resection of the mass was performed to reduce the burden on the airway and for diagnosis. The literature is reviewed, and the clinical characteristics, pathology, and surgical treatment are discussed.
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