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Hathi K, Nam YSJ, Fowler J, Dishan B, Madou E, Sowerby LJ, MacNeil SD, Nichols AC, Strychowsky JE. Improving Operating Room Efficiency in Otolaryngology-Head and Neck Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38769856 DOI: 10.1002/ohn.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/27/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE One minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022. REVIEW METHODS Published English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting for scoping reviews was followed. RESULTS The search yielded 9316 no-duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on-call cases. CONCLUSION The current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers.
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Affiliation(s)
- Kalpesh Hathi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - You Sung Jon Nam
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - James Fowler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Brad Dishan
- Corporate Academics, Health Sciences Library, London Health Sciences Center, London, Ontario, Canada
| | - Edward Madou
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
| | - Julie E Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada
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Kokavec A, Zahabi S, Rocha T, Rotenberg BW, Sowerby LJ. Assessing the safety and tolerability of rhinologic surgery under local anesthetic: an 8-year retrospective analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08655-4. [PMID: 38652299 DOI: 10.1007/s00405-024-08655-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. METHODS A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. RESULTS 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. CONCLUSION Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures.
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Affiliation(s)
- Andrew Kokavec
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Sarah Zahabi
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
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Fieux M, Carsuzaa F, Charriot J, Michel J, Subtil F, Sowerby LJ, Radulesco T, Favier V. Cross-cultural adaptation of the CRS-PRO questionnaire into French. J Otolaryngol Head Neck Surg 2023; 52:77. [PMID: 38066656 PMCID: PMC10709834 DOI: 10.1186/s40463-023-00683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Chronic rhinosinusitis (CRS), encompasses many different clinical patterns with variable response to treatment. Precise criteria specifying disease severity and control are lacking in the current literature. Our aim was to perform a cross-cultural adaptation of the CRS-PRO, creating a French version for use as a routine questionnaire in the assessment of patients with CRS. METHODS The CRS-PRO questionnaire was translated according to the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) through a three-step procedure including a backward translation. RESULTS Seven of 12 items were initially discordant between the three translators before achieving consensus (Step 1). Two of 12 items were discordant between the backward translation and the initial CRS-PRO version regarding the word "mucus"(Step 2). Step 3 allowed the creation of a French proof-read version of the CRS-PRO questionnaire. Thirty patients were included for initial validation, mean age of 49.2 ± 15 years and 63.3% (19/30) male. It took them 67 ± 23 s to complete the questionnaire without any patients requiring more than 2 min. CONCLUSION This study presents the French version of the CRS-PRO questionnaire-an adapted, validated, and well-accepted instrument to evaluate the CRS symptoms in the French speaking population.
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Affiliation(s)
- Maxime Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre-Bénite Cedex, France.
- Université de Lyon, Université Lyon 1, 69003, Lyon, France.
- Univ Paris Est Creteil, INSERM, IMRB, 94010, Créteil, France.
- CNRS EMR 7000, 94010, Créteil, France.
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | - Jeremy Charriot
- Service de Pneumologie, Centre Hospitalo-Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Justin Michel
- ENT - Head and Neck Surgery Department, APHM, La Conception University Hospital, Aix Marseille University, Marseille, France
- CNRS, IUSTI, Aix Marseille University, Marseille, France
| | - Fabien Subtil
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, Villeurbanne, France
| | - Leigh J Sowerby
- Department of Otolaryngology, University of Western Ontario, London, ON, Canada
| | - Thomas Radulesco
- ENT - Head and Neck Surgery Department, APHM, La Conception University Hospital, Aix Marseille University, Marseille, France
- CNRS, IUSTI, Aix Marseille University, Marseille, France
| | - Valentin Favier
- Service d'ORL et de chirurgie cervico-faciale, Centre Hospitalo-Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
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Sowerby LJ, Almubarak Z, Biadsee A, Rocha T, Hopkins C. Coronavirus disease 2019 related parosmia: an exploratory survey of demographics and treatment strategies. J Laryngol Otol 2023; 137:1256-1260. [PMID: 37194063 PMCID: PMC10627779 DOI: 10.1017/s0022215123000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To investigate the clinical features, therapeutic efficacy and symptom time course of post-coronavirus disease 2019 parosmia. METHODS A 22-item online questionnaire was distributed to AbScent research group and Facebook coronavirus disease 2019 anosmia group adult members to assess clinical features, interventions and their subjective efficacy for parosmia. RESULTS A total of 209 participants (86 per cent females) reported: smell loss on average 3 days after coronavirus symptoms, recovery 4 weeks later, and first parosmia symptoms 12 weeks post infection. Respondents reported 10 per cent body weight loss, and listed onion and garlic as significant parosmia triggers. Regarding quality of life, depression was the most cited item (54 per cent). Smell training was trialled by 74 per cent of participants, followed by nasal corticosteroid spray (49 per cent). Stellate ganglion block, trialled by 16 per cent of respondents, had the highest reported improvement (45 per cent), with 21 per cent reporting a sustained benefit - the highest rate amongst registered treatment options. CONCLUSION Post-coronavirus parosmia has a significant impact and remains challenging to treat. Stellate ganglion block appears to be successful relative to other reported treatments. Further research into the pathophysiology, efficacy and mechanism of stellate ganglion block effect is warranted.
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Affiliation(s)
- L J Sowerby
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Z Almubarak
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - A Biadsee
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Otorhinolaryngology – Head and Neck Surgery, Meir Medical Center, Kfar-Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Rocha
- Department of Otolaryngology – Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - C Hopkins
- Department of ENT, Guy's Hospital, London, UK
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Tselapedi-Sekeitto B, Rocha T, Sowerby LJ, Rotenberg B, Biadsee A. Telemedicine as an environmental ally - The social, financial, and environmental impact of virtual care in the otolaryngology clinic. Am J Otolaryngol 2023; 44:103791. [PMID: 36706717 PMCID: PMC9851917 DOI: 10.1016/j.amjoto.2023.103791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Synchronous virtual care rapidly expanded worldwide amid the COVID-19 pandemic to provide remote medical assessment, minimizing contact and disease transmission risk. Despite its benefits, such an abrupt expansion has shed light on the need to address patients' level of satisfaction with this service delivery. The purpose of this study was to investigate patients' satisfaction, travel cost, productivity loss, and CO2 emissions involved with synchronous virtual care and in-person assessments in rhinology and sleep apnea clinics. MATERIALS AND METHODS This prospective comparative study included patients managed via virtual care, or in-person clinic visit at St. Joseph Hospital, London, Canada, from December/2020 to April/2021, with rhinology pathologies or sleep apnoea. Patient satisfaction questionnaire (PSQ-18) scores were assessed. The overall scores of respondents were recorded including cost implications. RESULTS A total of 329 patients were invited, 28.5 % responded (n = 93). 33 virtual care (age 48 ± 6), and 60 in-person (age 51 ± 19). There was no statistical significance in PSQ-18 scores. However, under a diagnosis-based subgroup analysis, allergic rhinitis patients on virtual care presented a significantly lower PSQ-18 scores on the general satisfaction (3.28 vs. 4.25, p = 0.04). The time spent with the doctor was directly correlated with age for patients seen in-person (r = 0.27; p = 0.037). The estimated loss of productivity for the Virtual care group was CAD 12, patients assessed in-person presented an average loss of productivity about six times higher (CAD 74 ± 40). CONCLUSIONS Overall patients' satisfaction did not depend on whether they were seen virtually or in-person. However, time spent with the doctor contributed to higher satisfaction levels, but only among older patients who were seen in person. Nonetheless, allergic rhinitis patients seemed less satisfied with the virtual care option. Virtual care demonstrates economic benefits.
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Affiliation(s)
- Boipelo Tselapedi-Sekeitto
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ameen Biadsee
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Otorhinolaryngology - Head and Neck Surgery, Meir Medical Center, Kfar-Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Dickie A, Rocha T, Maniaci A, Ingrassia A, Maria Saibene A, Spagnolini S, Locatello LG, Tucciarone M, Radulesco T, Rotenberg B, Sowerby LJ. How deep do you go? Clinical prediction of nasopharyngeal depth based on facial measurements. Clin Anat 2023; 36:285-290. [PMID: 36477854 DOI: 10.1002/ca.23985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
Nasopharyngeal depth (ND) prediction is clinically relevant in performing medical procedures, and in enhancing technique accuracy and patient safety. Nonetheless, clinical predictive variables and normative data in adults remain limited. This study aimed to determine normative data on ND and its correlation to external facial measurements. A multicenter cross-sectional study obtained data from adults presenting to otolaryngology clinics at five sites in Canada, Italy, and Spain. Investigators compared endoscopically measured depth from the nasal sill (soft tissue between the nasal ala and columella) to nasopharynx along the nasal floor to the "curved distance from the alar-facial groove along the face to the tragus" and "distance from the tragus to a plane perpendicular to the philtrum." When sinus computed tomography images were available, the distance from the nasopharynx to the nasal sill was also collected. 371 patients participated in the study (41% women; 51 years old, SD 18). Average ND was 9.4 cm (SD 0.86) and 10.1 cm (SD 0.9) for women and men, respectively (p < 0.001; 95% CI 0.46-0.86). Perpendicular distance was strongly correlated to ND (r = 0.775; p < 0.001), with an average underestimation of 0.1 cm (SD 0.65; 95% CI 0.06-0.2). The equation: ND (cm) = perpendicular distance*0.773 + 2.344, generated from 271 randomly selected participants, and validated on 100 participants, resulted in a 0.03 cm prediction error (SD 0.61; 95% CI -0.08-0.16). Nasopharyngeal depth can be approximated by the distance from the tragus to a plane perpendicular to the philtrum.
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Affiliation(s)
- Alexander Dickie
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Taciano Rocha
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia ENT Section, University of Catania, Catania, Italy
| | - Angelo Ingrassia
- Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia ENT Section, University of Catania, Catania, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Sofia Spagnolini
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | | | - Manuel Tucciarone
- Department of Otorhinolaryngology, University Hospital of Jerez, Cádiz, Spain
| | - Thomas Radulesco
- Aix-Marseille Univ, APHM, IUSTI, CNRS, La Conception University Hospital, Department of Oto-Rhino-Laryngology Head and Neck Surgery, Marseille, France
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Biadsee A, Crosby L, Chow W, Sowerby LJ. Cost minimization analysis of nasopharyngoscope reprocessing in community practice. J Otolaryngol Head Neck Surg 2023; 52:8. [PMID: 36750881 PMCID: PMC9906939 DOI: 10.1186/s40463-022-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/16/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level. METHODS Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs. RESULTS Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system. CONCLUSIONS The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.
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Affiliation(s)
- Ameen Biadsee
- grid.39381.300000 0004 1936 8884Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada ,grid.415250.70000 0001 0325 0791Department of Otolaryngology- Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lauren Crosby
- grid.22072.350000 0004 1936 7697Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Winsion Chow
- grid.28046.380000 0001 2182 2255Deptartment of Otolaryngology- Head and Neck Surgery, University of Ottawa, Ottawa, ON Canada
| | - Leigh J Sowerby
- Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Neposlan J, Sowerby LJ, Biadsee A. Mepolizumab for the treatment of chronic rhinosinusitis with nasal polyps in adults. Expert Rev Respir Med 2023; 17:109-118. [PMID: 36795844 DOI: 10.1080/17476348.2023.2181794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The treatment paradigm for chronic rhinosinusitis with nasal polyps (CRSwNP) is complex, consisting of a combination of conservative, medical and surgical management. High rates of recurrence despite current standard of care has led to the search for treatments that can improve outcomes and limit the treatment burden for patients living with this chronic condition. AREAS COVERED Eosinophils are granulocytic white blood cells that proliferate as part of the innate immune response. IL5 is an inflammatory cytokine implicated in the development of eosinophil-associated diseases that has emerged as a target for biologic therapy. Mepolizumab (NUCALA) is a humanized antiIL5 monoclonal antibody that represents a novel therapeutic approach to CRSwNP. The results of multiple clinical trials are encouraging but its real-world implementation requires a thorough cost-benefit analysis across a range of clinical situations. EXPERT OPINION : Mepolizumab is an emerging biologic therapy that shows promising potential for the treatment of CRSwNP. It appears to provide both objective and subjective improvement as an addon therapy to standard of care treatment. Its specific role in treatment algorithms remains a topic of discussion. Future research surrounding its efficacy and cost effectiveness as compared to alternative options is needed.
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Affiliation(s)
- Josh Neposlan
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology- Head & Neck Surgery, Western University, London, ON, Canada
| | - Ameen Biadsee
- Department of Otolaryngology- Head & Neck Surgery, Western University, London, ON, Canada.,Department of Otolaryngology- Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, TelAviv, Israel
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Hathi K, Fowler J, Zahabi S, Dzioba A, Madou E, Gunz AC, Sowerby LJ, Nichols AC, Strychowsky JE. Attitudes and Perceptions of Canadian Otolaryngology‐Head and Neck Surgeons and Residents on Environmental Sustainability. OTO Open 2023; 7:e40. [PMID: 36998559 PMCID: PMC10046710 DOI: 10.1002/oto2.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design Cross-sectional virtual survey. Setting Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.
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Affiliation(s)
- Kalpesh Hathi
- Faculty of Medicine Dalhousie Medicine New Brunswick Saint John New Brunswick Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Sarah Zahabi
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anna C. Gunz
- Department of Paediatrics Western University Ontario London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
- Department of Paediatrics Western University Ontario London Canada
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Maza-Solano J, Biadsee A, Sowerby LJ, Calvo-Hernández C, Tucciarone M, Rocha T, Maniaci A, Saibene AM, Chiesa-Estomba CM, Radulesco T, Metwaly O, Lechien JR, Alobid I, Locatello LG. Chronic rhinosinusitis with nasal polyps management in the biologic therapy era: an international YO-IFOS survey. Eur Arch Otorhinolaryngol 2022; 280:2309-2316. [PMID: 36454385 DOI: 10.1007/s00405-022-07762-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To investigate the consistency between the international guidelines recommendations and worldwide standard practices regarding diagnostic work-up and follow-up strategies for managing patients with Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) in the era of monoclonal antibodies. METHODS A questionnaire developed by the Rhinology section of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) included items regarding the management of CRSwNP patients, monoclonal prescription, surgical and follow-up procedures, awareness of biologicals availability, and other relevant clinical practices. The online survey was directed to otolaryngologists and distributed in Europe, North America, South America, and the Middle East through otolaryngological and/or rhinological societies. RESULTS A total of 202 responses were analyzed; the mean participants' age was 45 ± 11 (73% men and 27% women), and 31% were from the United States, Canada 19%, Europe 45%, Middle East and South America 5%. Only 60% of the respondents declared using validated symptoms and endoscopic score systems in their clinical practice. Several practice discrepancies emerged in our cohort, including preferred surgical approach, prescription of preoperative oral steroids, and perioperative antibiotics (59% and 58%, respectively), as well as divergent awareness levels of available biologics for CRSwNP worldwide. CONCLUSIONS CRSwNP needs a complex and time-consuming assessment, according to the latest guidelines. There seems to be a gap between these recommendations and the real-world data, which should draw more attention to bringing them into uniform clinical practice in the near future.
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Affiliation(s)
- Juan Maza-Solano
- Rhinology Unit, Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen Macarena, Seville, Spain
| | - Ameen Biadsee
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.
- Department of Otolaryngology-Head and Neck Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Christian Calvo-Hernández
- Department of Otolaryngology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Tucciarone
- Department of Otolaryngology and Head and Neck Surgery, University Hospital of Jerez, Cádiz, Spain
| | - Taciano Rocha
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Carlos M Chiesa-Estomba
- Otorhinolaryngology-Head and Neck Surgery Department, Donostia University Hospital, Biodonostia Research Institute, St. Sebastien, Spain
| | - Thomas Radulesco
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, Aix-Marseille Univ, APHM, IUSTI, CNRS, La Conception University Hospital, Marseille, France
| | - Osama Metwaly
- Otorhinolaryngology-Head and Neck Surgery Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
| | - Jerome R Lechien
- Department of Otolaryngology, Polyclinique de Poitiers, Elsan Hospital, Poitiers, France
| | - Isam Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic, University of Barcelona, CIPERES, Spain
| | - Luca Giovanni Locatello
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
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11
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Hamilton S, Rotenberg BW, Sowerby LJ. Correction to: Evaluation of septal perforation size using a novel measuring device. Eur Arch Otorhinolaryngol 2022; 279:5683. [PMID: 36065024 DOI: 10.1007/s00405-022-07625-y] [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: 11/03/2022]
Affiliation(s)
- Stefan Hamilton
- Department of Otolaryngology-Head and Neck Surgery, St. Joseph's Healthcare Centre, Western University, 268 Grosvenor St., London, ON, N6A 4V2, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, St. Joseph's Healthcare Centre, Western University, 268 Grosvenor St., London, ON, N6A 4V2, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, St. Joseph's Healthcare Centre, Western University, 268 Grosvenor St., London, ON, N6A 4V2, Canada.
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12
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Biadsee A, Payne S, Sowerby LJ. Can we make biologic therapy more affordable? Int Forum Allergy Rhinol 2022; 12:1087-1088. [PMID: 35666044 DOI: 10.1002/alr.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Ameen Biadsee
- Department of Otolaryngology--Head and Neck Surgery, Western University, London, ON, Canada.,Department of Otolaryngology--Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Spencer Payne
- Department of Otolaryngology--Head and Neck Surgery, UVA, Charlottesville, Virginia, USA
| | - Leigh J Sowerby
- Department of Otolaryngology--Head and Neck Surgery, Western University, London, ON, Canada
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13
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Instrum RS, Koch RW, Rocha T, Rohani SA, Ladak H, Agrawal SK, Sowerby LJ. Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers. Laryngoscope 2022; 133:38-42. [PMID: 35102548 PMCID: PMC9015425 DOI: 10.1002/lary.30034] [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: 12/10/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Nasopharyngeal swabs currently remain the gold standard for COVID-19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false-negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D-printed nasal swab simulator to expedite health care workers' skill acquisition. STUDY DESIGN Prospective pre-post interventional study. METHODS A nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID-19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self-evaluate procedure accuracy. A five-point Likert scale was collected regarding the NSTT's educational value and procedural fidelity. RESULTS Sixty-two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self-assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety-four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty-one indicated that the simulator should be used at all COVID-19 testing sites, with 77% stating province-wide implementation was warranted. CONCLUSIONS The nasal swab task trainer is an effective educational tool that appears well-suited for improved skill acquisition in COVID-19 testing and may be useful for training other nasal swab applications. LEVEL OF EVIDENCE 3 Laryngoscope, 133:38-42, 2023.
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Affiliation(s)
- Ryan S. Instrum
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Robert W. Koch
- School of Biomedical EngineeringWestern UniversityLondonOntarioCanada
| | - Taciano Rocha
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Seyed Alizera Rohani
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Hanif Ladak
- Department of Electrical and Computer EngineeringWestern UniversityLondonOntarioCanada
| | - Sumit K. Agrawal
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
| | - Leigh J Sowerby
- Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and DentistryWestern UniversityLondonOntarioCanada
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14
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Bachert C, Sousa AR, Han JK, Schlosser RJ, Sowerby LJ, Hopkins C, Maspero JF, Smith SG, Kante O, Karidi-Andrioti DE, Mayer B, Chan RH, Yancey SW, Chaker AM. Mepolizumab for chronic rhinosinusitis with nasal polyps: treatment efficacy by comorbidity and blood eosinophil count. J Allergy Clin Immunol 2022; 149:1711-1721.e6. [PMID: 35007624 DOI: 10.1016/j.jaci.2021.10.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the Phase III SYNAPSE study, mepolizumab reduced nasal polyp (NP) size and nasal obstruction in chronic rhinosinusitis with NP (CRSwNP). OBJECTIVE To assess the efficacy of mepolizumab in patients from SYNAPSE grouped by comorbid asthma, aspirin-exacerbated respiratory disease (AERD), and baseline blood eosinophil count (BEC). METHODS SYNAPSE, a randomized, double-blind, 52-week study (NCT03085797), included patients with severe bilateral CRSwNP eligible for surgery despite intranasal corticosteroid treatment. Patients received 4-weekly subcutaneous mepolizumab 100 mg or placebo plus standard of care for 52 weeks. Co-primary endpoints were change in total endoscopic NP score (Week 52) and nasal obstruction visual analog scale (VAS) score (Weeks 49-52). Subgroup analyses by comorbid asthma and AERD status, and post hoc by BEC, were exploratory. RESULTS Analyses included 407 patients (289 with asthma; 108 with AERD; 371 and 278 with BEC counts ≥150 or ≥300 cells/μL, respectively). The proportion of patients with ≥1-point improvement from baseline in NP score was higher with mepolizumab versus placebo across comorbid diseases (asthma: 52.9% vs 29.5%; AERD: 51.1% vs 20.6%) and baseline BEC subgroups (<150 cells/μL: 55.0% vs 31.3%; ≥150 cells/μL: 49.5% vs 28.1%; <300 cells/μL: 50.7% vs 29.0%; ≥300 cells/μL: 50.4% vs 28.1%). A similar trend was observed in patients without comorbid asthma or AERD. More patients had >3-point improvement in nasal obstruction VAS score with mepolizumab versus placebo across comorbid subgroups. CONCLUSION Mepolizumab reduced polyp size and nasal obstruction in CRSwNP regardless of the presence of comorbid asthma or AERD. CLINICAL IMPLICATION Mepolizumab should be considered for the treatment of CRSwNP, particularly in patients with comorbid asthma or AERD.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory and Department of Oto-Rhino-Laryngology, Ghent University and Ghent University Hospital, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden; First Affiliated Hospital, Sun Yat-sen University, International Airway Research Center, Guangzhou, China
| | - Ana R Sousa
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | - Joseph K Han
- Department of Otolaryngology, Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Claire Hopkins
- ENT Department, Guys and St Thomas's Hospital, and King's College, London, UK
| | - Jorge F Maspero
- Allergy and Respiratory Research Unit, Fundación CIDEA, Buenos Aires, Argentina
| | - Steven G Smith
- Respiratory Therapeutic Area Unit, GSK, Research Triangle Park, NC, USA
| | - Oliver Kante
- Global Clinical Sciences and Delivery, GSK Munich, Germany
| | | | | | - Robert H Chan
- Clinical Sciences, GSK R&D, Brentford, Middlesex, UK
| | | | - Adam M Chaker
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Otolaryngology and Center for Allergy and Environment, Munich, Germany.
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15
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Sowerby LJ, Nichols A, Sommer DD, Moore C, Fraser D, Arts E. Absence of Viable SARS-CoV-2 Virus in Surgical Smoke Produced During Electrocautery. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Rocha T, Rhem R, Sowerby LJ, Dolovich MB. Handling budesonide nebules to maximize the dispensed drug. Pediatr Allergy Immunol 2021; 32:1566-1568. [PMID: 34002879 DOI: 10.1111/pai.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Taciano Rocha
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rod Rhem
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Myrna B Dolovich
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, ON, Canada
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17
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Sowerby LJ, Nichols AC, Gibson R, Sommer DD, Moore C, Fraser DD, Arts E. Assessing the Risk of SARS-CoV-2 Transmission via Surgical Electrocautery Plume. JAMA Surg 2021; 156:883-885. [PMID: 34019099 PMCID: PMC8140389 DOI: 10.1001/jamasurg.2021.2591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, St Joseph's Hospital, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Richard Gibson
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Corey Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Douglas D Fraser
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Eric Arts
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
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18
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Chin CJ, Hathi K, McDonough M, Sowerby LJ. Should Oral Antibiotics Be Prescribed Routinely Postendoscopic Sinus Surgery? Laryngoscope 2021; 132:726-727. [PMID: 34216148 DOI: 10.1002/lary.29737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/20/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Christopher J Chin
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Kalpesh Hathi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Mitchell McDonough
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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19
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Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Sowerby LJ, Bogdanov V, Grafmans D. Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany. HNO 2021; 69:658-665. [PMID: 34086058 PMCID: PMC8176277 DOI: 10.1007/s00106-021-01075-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
Purpose The SARS-CoV‑2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Follow-up data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic. Methods As in the initial survey, German ORLs were addressed via e‑mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV‑2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated. Results Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV‑2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV‑2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole. Conclusion The data reflect a unique long-term survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV‑2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups. Supplementary Information The online version of this paper (10.1007/s00106-021-01075-4) contains the German version of the COVID-19 questionnaire. The article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field. The additional material can be found at the article under “Ergänzende Inhalte”. ![]()
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Affiliation(s)
- Michael Herzog
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University, Halle-Wittenberg, Halle (Saale), Germany.
| | - Achim G Beule
- Dept. of Otorhinolaryngology, University Hospital Münster, Münster, Germany
- Dept. of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Christoffer Lüers
- Dept. of Otorhinolaryngology, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Vasyl Bogdanov
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany
| | - Daniel Grafmans
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany
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20
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Affiliation(s)
- James Fowler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ont
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ont.
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21
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Sowerby LJ, Patel KB, Schmerk C, Rotenberg BW, Rocha T, Sommer DD. Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease - a randomized crossover trial. J Otolaryngol Head Neck Surg 2021; 50:27. [PMID: 33892819 PMCID: PMC8063291 DOI: 10.1186/s40463-021-00502-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition. This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement. Methods Prospective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points. Results A total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference. Conclusions A short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD. Trial registration NCT01778465 (www.clinicaltrials.gov) Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00502-4.
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Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada.
| | - Krupal B Patel
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Crystal Schmerk
- Department of Medicine, Western University, London, ON, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Department of Surgery, McMaster University, Hamilton, ON, Canada
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22
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Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Sowerby LJ, Grafmans D. Results of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany. Eur Arch Otorhinolaryngol 2021; 278:1247-1255. [PMID: 32897443 PMCID: PMC7477736 DOI: 10.1007/s00405-020-06345-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE SARS-CoV-2 is detected on the mucosa of the upper airways to a high degree. In the course of the COVID-19 pandemic, otorhinolaryngologists (ORL) are assumed to be at high risk due to close contact with the mucosa of the upper airways. No data are yet available providing evidence that ORLs have an increased risk of infection. METHODS German ORLs were invited via e-mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association to participate in a web-based survey about infection with SARS-CoV-2 and development of COVID-19. Data of infections and concomitant parameters in German ORLs were collected and compared to the total number of infections in Germany. RESULTS Out of 6383 German ORLs, 970 (15%) participated. 54 ORLs reported testing positive for SARS-CoV-2. Compared to the total population of Germany, ORLs have a relative risk of 3.67 (95% CI 2.82; 4.79) of contracting SARS-CoV-2. Domestic quarantine was conducted in 96.3% of cases. Two individuals were admitted to hospital without intensive care. No casualties were reported. In 31 cases, the source of infection was not identifiable whereas 23 had a clear medical aetiology: infected patients: n = 5, 9.26%; medical staff: n = 13, 14.1%. 9.26% (n = 5) of the identified cases were related to contact to infected family members (n = 3), closer neighbourhood (n = 1) or general public (n = 1). There was no identified increased risk of infection due to performing surgery. CONCLUSION German ORLs have an almost 3.7-fold risk of contracting SARS-CoV-2 compared to the population baseline level. Appropriate protection appears to be necessary for this occupational group.
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Affiliation(s)
- Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinik für Hals-Nasen-Ohrenheilkunde, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany.
| | - Achim G Beule
- Department of Otorhinolaryngology, University Hospital Münster, Munster, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Christoffer Lüers
- Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Leigh J Sowerby
- Department of Otolaryngology, Head and Neck Surgery, Western University, London, ON, Canada
| | - Daniel Grafmans
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinik für Hals-Nasen-Ohrenheilkunde, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany
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Sowerby LJ, Fowler J. The authors reply to: "Systemic absorption of intranasal corticosteroids may occur and can potentially affect the hypothalamic-pituitary-adrenal axis". CMAJ 2021; 193:E427. [PMID: 33753369 PMCID: PMC8096384 DOI: 10.1503/cmaj.78206] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leigh J Sowerby
- Associate professor, Otolaryngology-Head and Neck Surgery, Western University, London, Ont
| | - James Fowler
- Resident, Otolaryngology-Head and Neck Surgery, Western University, London, Ont
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Abstract
Background In the specialty of Otolaryngology – Head and Neck Surgery, intranasal corticosteroids are the mainstay treatment for inflammatory processes within the nasal cavity. All too often, physician prescribing patterns are based on previous training, personal experience, and interactions with industry. The purpose of this commentary is to review the nuances of each intranasal corticosteroid. Commentary There are nine intranasal corticosteroids approved for use in Canada. Each are discussed in detail, including their indication, bioavailability, effects on intranasal environment, and factors around patient adherence. Off-label use of budesonide irrigations is also discussed and cost information is presented in reference format for all available intranasal corticosteroids. Conclusion Although the efficacy of each intranasal corticosteroid has been shown to be similar, prescribing should be tailored based on bioavailability, intranasal environment, and factors that impact patient adherence such as dosing, cost and tolerability. Graphical abstract ![]()
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Affiliation(s)
- James Fowler
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, 3St. Joseph's Hospital, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Fowler J, Sowerby LJ. Utilisation des corticostéroïdes intranasaux. CMAJ 2021; 193:E399-E400. [PMID: 33722836 PMCID: PMC8096399 DOI: 10.1503/cmaj.201266-f] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- James Fowler
- Département d'otorhinolaryngologie et de chirurgie cervico-faciale, Université Western, London, Ont
| | - Leigh J Sowerby
- Département d'otorhinolaryngologie et de chirurgie cervico-faciale, Université Western, London, Ont.
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Hiebert NM, Chen BA, Sowerby LJ. Variability in instructions for performance of nasopharyngeal swabs across Canada in the era of COVID-19 - what type of swab is actually being performed? J Otolaryngol Head Neck Surg 2021; 50:5. [PMID: 33509292 PMCID: PMC7841972 DOI: 10.1186/s40463-020-00490-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background The primary method of surveillance for the presence of SARS-CoV-2 is with nasopharyngeal swabs. Given the significant demand for nasopharyngeal swabs, a large number of previously untrained and unfamiliar staff are now performing this test. It was noted that there was significant heterogeneity in instructions for performing nasopharyngeal swabs in Canada, in contrast to the guidance provided by the Centers for Disease Control and Prevention (CDC), and the Pan American Health Organization (PAHO). The objective of this study was to review the instructions provided across Canada and contrast them to those of the CDC and PAHO. Methods A standard series of steps for nasopharyngeal swab performance was outlined based on the CDC, PAHO, and New England Journal of Medicine instructions. A comprehensive search was performed in August 2020 to identify nasopharyngeal swab guidelines provided by public health in the provinces and territories of Canada. Regional health authority guidance was also collected. Instructions provided were contrasted against the standardized steps. Results Instructions were identified for all provinces and territories, and for 81 regional health authorities. From the provincial and territorial guidelines, 10/13 (77%) cleared the nasal passages before swab insertion, 11/13 (85%) tilted the patient’s head back slightly, 12/13 (92%) inserted the swab parallel to the palate, but only 3/13 (23%) inserted the swab to at least a depth of two-thirds the distance between the patient’s nose and ear. A clear majority (81%) of regional health authority guidelines followed their respective provincial guidelines. For depth of insertion, Quebec provided a pictogram but no distance or technique for estimation. Six provinces and territories - Northwest Territories, Nunavut, Ontario, Saskatchewan, Prince Edward Island and Alberta - recommended 4 cm or one-half the distance from nostrils to ear. British Columbia and Manitoba recommended a 7 cm depth of insertion. Nova Scotia recommended one-half to two-thirds the distance from nose to ear. Lastly, Newfoundland, New Brunswick and the Yukon recommended an insertion from nose to the external ear canal. Conclusion There is significant heterogeneity in guidance for nasopharyngeal swab performance across Canada. The instructions provided by the majority of provinces and territories in Canada would not be effective in reaching the nasopharynx. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-020-00490-x.
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Affiliation(s)
- Nole M Hiebert
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada.
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Kilty S, Thavorn K, Janjua A, Lee J, MacDonald K, Meen E, Micomonaco D, Rotenberg B, Sowerby LJ, Tewfik M, Adams S, Frenette H, Lasso A, Fergusson DA. Endoscopic polypectomy performed in clinic for chronic rhinosinusitis with nasal polyps: study protocol for the EPIC multicentre randomised controlled trial. BMJ Open 2020; 10:e042413. [PMID: 33268434 PMCID: PMC7713191 DOI: 10.1136/bmjopen-2020-042413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) is common, with a Canadian prevalence of 5%, and associated with significant morbidity. Understandably, CRS impairs workplace productivity but that productivity substantially increases following surgical treatment. CRS with nasal polyps (CRSwNP), the most common type of CRS, is usually treated with a combination of medications and endoscopic sinus surgery (ESS). Historically, surgical treatment has only been performed in the operating room at a cost of about $C3500. However, recent studies have shown that a de-escalated procedure, endoscopic polypectomy performed in clinic (EPIC), can provide an improvement in patient symptoms to levels equal to those for ESS. Moreover, EPIC has additional proposed advantages including shorter recovery time, significantly lower cost to the healthcare system and shorter wait time for the patient. There is currently insufficient evidence to draw conclusions about the superiority of polypectomy or ESS for the management of CRSwNP. METHODS AND ANALYSIS We designed a multicentre, open-label, randomised controlled trial to evaluate whether EPIC was non-inferior to the current clinical standard, ESS for the treatment of CRSwNP. The primary outcome is the Sinonasal Outcome Test-22 score measured at baseline and at 3 months after surgery. Other outcomes include peak nasal inspiratory flow, quality of life measured by the EuroQoL 5 Dimensions 5 Levels questionnaire and work impairment using the Work Productivity and Activity Impairment Questionnaire.We aim to recruit 140 patients from sites across Canada. Participants will be randomly assigned to EPIC or ESS and followed up for 3 months in clinic after the procedure. Additionally, participants will enter a 5-year long-term follow-up period. ETHICS AND DISSEMINATION This study was approved by the Ottawa Health Sciences Network Research Ethics Board for all sites in Ontario, Canada (study number CTO0801). Sites located outside of Ontario obtained approval from their local/institutional research ethics board. TRIAL REGISTRATION NUMBER NCT02975310.
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Affiliation(s)
- Shaun Kilty
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Otolaryngology- Head & Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Arif Janjua
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - John Lee
- Department of Otolaryngology-Head and Neck Surgery, Saint Michael's Hospital, Toronto, Ontario, Canada
| | - Kristian MacDonald
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eric Meen
- Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Damian Micomonaco
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Susan Adams
- Patient Representative, Ottawa, Ontario, Canada
| | | | - Andrea Lasso
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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28
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Sowerby LJ, Patel ZM. Reply: Correspondence-International Registry of Otolaryngologist-Head and Neck Surgeons with COVID-19. Int Forum Allergy Rhinol 2020; 10:1342. [PMID: 32827240 PMCID: PMC7461297 DOI: 10.1002/alr.22689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology- Head & Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
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Sowerby LJ, Stephenson K, Dickie A, Lella FAD, Jefferson N, North H, De Siati RD, Maunsell R, Herzog M, Nandhan R, Trozzi M, Dehgani-Mobaraki P, Melkane A, Callejas C, Miljeteig H, Smit D, Reynoso DD, Moura JE, Hermansson A, Peer S, Burnell L, Fakhry N, Chiesa-Estomba C, Önerci Çelebi Ö, Karpischenko S, Sobol S, Sargi Z, Patel ZM. International registry of otolaryngologist-head and neck surgeons with COVID-19. Int Forum Allergy Rhinol 2020; 10:1201-1208. [PMID: 32735062 DOI: 10.1002/alr.22677] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND It has become clear that healthcare workers are at high risk, and otolaryngology has been theorized to be among the highest risk specialties for coronavirus disease 2019 (COVID-19). The purpose of this study was to detail the international impact of COVID-19 among otolaryngologists, and to identify instructional cases. METHODS Country representatives of the Young Otolaryngologists-International Federation of Otolaryngologic Societies (YO-IFOS) surveyed otolaryngologists through various channels. Nationwide surveys were distributed in 19 countries. The gray literature and social media channels were searched to identify reported deaths of otolaryngologists from COVID-19. RESULTS A total of 361 otolaryngologists were identified to have had COVID-19, and data for 325 surgeons was available for analysis. The age range was 25 to 84 years, with one-half under the age of 44 years. There were 24 deaths in the study period, with 83% over age 55 years. Source of infection was likely clinical activity in 175 (54%) cases. Prolonged exposure to a colleague was the source for 37 (11%) surgeons. Six instructional cases were identified where infections occurred during the performance of aerosol-generating operations (tracheostomy, mastoidectomy, epistaxis control, dacryocystorhinostomy, and translabyrinthine resection). In 3 of these cases, multiple operating room attendees were infected, and in 2, the surgeon succumbed to complications of COVID-19. CONCLUSION The etiology of reported cases within the otolaryngology community appear to stem equally from clinical activity and community spread. Multiple procedures performed by otolaryngologists are aerosol-generating procedures (AGPs) and great care should be taken to protect the surgical team before, during, and after these operations.
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Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Kate Stephenson
- Department of Paediatric Otolaryngology, Birmingham Children's Hospital, Birmingham, UK
| | - Alexander Dickie
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Federico A Di Lella
- Department of Otorhinolaryngology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Niall Jefferson
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Adult and Children's' Hospitals, Newcastle, NSW, Australia
| | - Hannah North
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Westmead and Westmead Hospital, Sydney, NSW, Australia
| | - R Daniele De Siati
- Department of Otorhinolaryngology, Saint-Luc University Hospital, University of Louvain, Brussels, Belgium
| | - Rebecca Maunsell
- Department of Otorhinolaryngology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Michael Herzog
- Department of Otorhinolaryngology-Head and Neck Surgery, Carl-Thiem-Klinikum, Cottbus, Germany
| | - Raghu Nandhan
- Department of Otorhinolaryngology - Head and Neck Surgery, Madras ENT Research Foundation, Chennai, India
| | - Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Puya Dehgani-Mobaraki
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Department of Otorhinolaryngology and Head and Neck Surgery, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | - Antoine Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Harald Miljeteig
- Norwegian Society of Otorhinolaryngology-Head and Neck Surgery, Nesttun, Norway
| | - Diane Smit
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Joao Eloi Moura
- Department of Otorhinolaryngology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ann Hermansson
- Department of Otolaryngology, Lund University, Lund, Sweden
| | - Shazia Peer
- Division of Otorhinolaryngology, University of Cape Town, Cape Town, South Africa
| | - Lisa Burnell
- ENT Morningside, Morningside Mediclinic, Sandton, Johannesburg, South Africa
| | - Nicolas Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Hôpitaux Universitaires de Marseille Conception, Assistance Publique-Hôpitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Özlem Önerci Çelebi
- Department of Otolaryngology-Head and Neck Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sergei Karpischenko
- Department of Otolaryngology, Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, First Pavlov State Medical University, Saint Petersburg, Russia
| | - Steven Sobol
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami, Miami, FL
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA
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Simon F, Peer S, Michel J, Bruce IA, Cherkes M, Denoyelle F, Fagan JJ, Harish M, Hong P, James A, Jia H, Krishnan PV, Maunsell R, Modi VK, Nguyen Y, Parikh SR, Patel N, Pullens B, Russo G, Rutter MJ, Sargi Z, Shaye D, Sowerby LJ, Yung M, Zdanski CJ, Teissier N, Fakhry N. IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO-IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat. Laryngoscope 2020; 131:E732-E737. [PMID: 33270236 PMCID: PMC7891442 DOI: 10.1002/lary.29020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Abstract
Objectives/Hypothesis Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design DELPHI survey. Methods Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos of scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence 5 Laryngoscope, 131:E732–E737, 2021
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Affiliation(s)
- François Simon
- Department of Pediatric Otolaryngology, Necker-Sick Children's Hospital, AP-HP-University of Paris, Paris, France
| | - Shazia Peer
- Division of Otolaryngology, University of Cape Town and Red Cross Children's Hospital, Rondebosch, South Africa
| | - Justin Michel
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Aix Marseille University, APHM, University Institute of Industrial Thermal Systems, La Conception University Hospital, Marseille, France
| | - Iain A Bruce
- Division of Infection, Immunity, and Respiratory Medicine, Royal Manchester Children's Hospital, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Maryana Cherkes
- Departement of Otolaryngology, Lviv City Children's Clinical Hospital, Lviv National Medical University, Lviv, Ukraine
| | - Françoise Denoyelle
- Department of Pediatric Otolaryngology, Necker-Sick Children's Hospital, AP-HP-University of Paris, Paris, France
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town and Red Cross Children's Hospital, Rondebosch, South Africa
| | | | - Paul Hong
- Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adrian James
- Department of Otolaryngology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Huan Jia
- Department of Otolaryngology-Head Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - P Vijaya Krishnan
- Department of Otorhinolaryngology, Madras Ear Nose and Throat Research Foundation, Chennai, Tamil Nadu, India
| | - Rebecca Maunsell
- Department of Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas UNICAMP, Campinas, Brazil
| | - Vikash K Modi
- Pediatric Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Yann Nguyen
- Department of Otorhinolaryngology, Pitié-Salpêtrière Hospital, Robotic and surgical innovation research group, Inserm, Pasteur, "Innovative Technologies and Translational Therapeutics for Deafness," Hearing Institute, Sorbonne University, AP-HP, Paris, France
| | - Sanjay R Parikh
- Seattle Children's Hospital, University of Washington, Seattle, Washington, U.S.A
| | - Nirmal Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Sydney and Macquarie University, Sydney, New South Wales, Australia
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Gennaro Russo
- Department of Otorhinolaryngology, Monaldi Hospital, Naples, Italy
| | - Michael J Rutter
- Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - David Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Matthew Yung
- Department of Otolaryngology, Ipswich Hospital, Colchester, United Kingdom
| | - Carlton J Zdanski
- Division of Pediatric Otolaryngology/Head and Neck Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Natacha Teissier
- Department of Pediatric Otolaryngology, Robert-Debré Hospital, AP-HP-University of Paris, Paris, France
| | - Nicolas Fakhry
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, Aix Marseille University, APHM, Language and Speech Laboratory, La Conception University Hospital, Marseille, France
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31
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Radulesco T, Lechien JR, Sowerby LJ, Saussez S, Chiesa-Estomba C, Sargi Z, Lavigne P, Calvo-Henriquez C, Lim CM, Tangjaturonrasme N, Vatanasapt P, Dehgani-Mobaraki P, Fakhry N, Ayad T, Michel J. Correction to: Sinus and anterior skull base surgery during the COVID-19 pandemic: systematic review, synthesis and YO-IFOS position. Eur Arch Otorhinolaryngol 2020; 278:2661. [PMID: 32776196 PMCID: PMC7415350 DOI: 10.1007/s00405-020-06278-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Thomas Radulesco
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France. .,Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France. .,Aix-Marseille University, IUSTI, 13013, Marseille, France.
| | - Jerome R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Leigh J Sowerby
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Sven Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Carlos Chiesa-Estomba
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Zoukaa Sargi
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philippe Lavigne
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Christian Calvo-Henriquez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Chwee Ming Lim
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology Head and Neck Surgery, Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Napadon Tangjaturonrasme
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology Head of Division of Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patravoot Vatanasapt
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puya Dehgani-Mobaraki
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Otolaryngology Head and Surgery, Gubbio-Gualdo Tadino Hospital, USL Umbria 1, Gubbio, Italy.,Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Nicolas Fakhry
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France
| | - Tareck Ayad
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Justin Michel
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.,Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France.,Aix-Marseille University, IUSTI, 13013, Marseille, France
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Chiesa-Estomba CM, Lechien JR, Radulesco T, Michel J, Sowerby LJ, Hopkins C, Saussez S. Patterns of smell recovery in 751 patients affected by the COVID-19 outbreak. Eur J Neurol 2020; 27:2318-2321. [PMID: 32677329 PMCID: PMC7405216 DOI: 10.1111/ene.14440] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Post-viral olfactory dysfunction is well established and has been shown to be a key symptom of COVID-19 with more than 66% of European and US patients reporting some degree of loss of smell. Persistent olfactory dysfunction appears to be commonplace and will drive the demand for general practitioner, otolaryngology or neurology consultation in the next few months - evidence regarding recovery will be essential in counselling our patients. METHODS This was a prospective survey-based data collection and telemedicine follow-up. RESULTS In total, 751 patients completed the study, of whom 477 were females and 274 males. The mean age of the patients was 41 ± 13 years (range 18-60). There were 621 patients (83%) who subjectively reported a total loss of smell and 130 (17%) a partial loss. After a mean follow-up of 47 ± 7 days (range 30-71) from the first consultation, 277 (37%) patients still reported a persistent subjective loss of smell, 107 (14%) reported partial recovery and 367 (49%) reported complete recovery. The mean duration of the olfactory dysfunction was 10 ± 6 days (range 3-31) in those patients who completely recovered and 12 ± 8 days (range 7-35) in those patients who partially recovered. CONCLUSIONS According to our results, at this relatively early point in the pandemic, subjective patterns of recovery of olfactory dysfunction in COVID-19 patients are valuable for our patients, for hypothesis generation and for treatment development.
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Affiliation(s)
- C M Chiesa-Estomba
- COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - J R Lechien
- COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.,Department of Otolaryngology - Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - T Radulesco
- COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Oto-Rhino-Laryngology Head and Neck Surgery, Aix Marseille Univ, APHM, IUSTI, La Conception University Hospital, Marseille, France
| | - J Michel
- COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - L J Sowerby
- COVID-19 Task Force of the Young Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.,Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | | | - S Saussez
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.,Department of Otolaryngology - Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.,Department of Head and Neck Surgery, EpiCURA Hospital, Hornu, Belgium
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Radulesco T, Lechien JR, Sowerby LJ, Saussez S, Chiesa-Estomba C, Sargi Z, Lavigne P, Calvo-Henriquez C, Lim CM, Tangjaturonrasme N, Vatanasapt P, Dehgani-Mobaraki P, Fakhry N, Ayad T, Michel J. Sinus and anterior skull base surgery during the COVID-19 pandemic: systematic review, synthesis and YO-IFOS position. Eur Arch Otorhinolaryngol 2020; 278:1733-1742. [PMID: 32710178 PMCID: PMC7380149 DOI: 10.1007/s00405-020-06236-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/20/2020] [Indexed: 01/29/2023]
Abstract
Purpose The COVID-19 pandemic has caused significant confusion about healthcare providers’ and patients’ pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic. Methods PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. Results 15 International publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients’ COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited. Conclusions Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing the use of PPE is essential with sinus and anterior skull base surgery.
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Affiliation(s)
- Thomas Radulesco
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France.
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France.
- Aix-Marseille University, IUSTI, 13013, Marseille, France.
| | - Jerome R Lechien
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Leigh J Sowerby
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Sven Saussez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Carlos Chiesa-Estomba
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | - Zoukaa Sargi
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Philippe Lavigne
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Christian Calvo-Henriquez
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Chwee Ming Lim
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otorhinolaryngology Head and Neck Surgery, Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Napadon Tangjaturonrasme
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otolaryngology Head of Division of Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patravoot Vatanasapt
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puya Dehgani-Mobaraki
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Otolaryngology Head and Surgery, Gubbio-Gualdo Tadino Hospital, USL Umbria 1, Gubbio, Italy
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
| | - Nicolas Fakhry
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France
| | - Tareck Ayad
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Justin Michel
- COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Marseille, France
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, 13385, Marseille Cedex, France
- Aix-Marseille University, IUSTI, 13013, Marseille, France
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Sowerby LJ, Harris MS, Joshi R, Johnson M, Jenkyn T, Moore CC. Does endoscopic sinus surgery alter the biomechanics of the orbit? J Otolaryngol Head Neck Surg 2020; 49:44. [PMID: 32586389 PMCID: PMC7318533 DOI: 10.1186/s40463-020-00442-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study is to determine if removal of ethmoid cell septations as commonly performed in endoscopic sinus surgery leads to a change in orbital wall fracture patterns and the force required to create them. Methods Six fresh-frozen cadaveric heads were acquired and underwent endoscopic uncinectomy, maxillary antrostomy, and anterior and posterior ethmoidectomy on one, randomized, side. The contralateral sinuses were used as intra-specimen control. Hyaluronic acid gel globe injections were performed to simulate normal intra-ocular pressure. Post-op CT scans confirmed no orbital fractures or violation of the lamina papyracea prior to trauma testing. Orbital trauma was induced using a guided weight-drop technique. Both orbits were tested in random order, and sequentially higher drops were performed until both the test and control side demonstrated an orbital fracture on CT scan. Results In all six heads, the post-sinus surgery side incurred a medial orbital wall fracture, and no orbital floor fractures were identified. On the other hand, on the control side, all six heads incurred orbital floor fractures at drop heights equal to, or higher than, the surgical side. Fisher’s exact test demonstrated a significant difference in fracture pattern (p < 0.001). Conclusions To our knowledge, this is the first demonstration that the structures removed during sinus surgery may act as a buttress for the medial orbital wall. The anatomic changes of sinus surgery may alter the biomechanics of the orbit and affect the pattern of subsequent traumatic blowout fractures.
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Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Matthew S Harris
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Rootu Joshi
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Tom Jenkyn
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
| | - Corey C Moore
- Department of Otolaryngology - Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Reid JW, Samy A, Jeremic G, Brookes J, Sowerby LJ. Postoperative uvular necrosis: A case series and literature review. Laryngoscope 2020; 130:880-885. [DOI: 10.1002/lary.28096] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jonathan W. Reid
- Department of Otolaryngology—Head and Neck SurgeryWestern University London Ontario Canada
| | - Arjun Samy
- Department of Otolaryngology—Head and Neck SurgeryWestern University London Ontario Canada
| | - Goran Jeremic
- Department of Otolaryngology—Head and Neck SurgeryWestern University London Ontario Canada
| | - Jonathan Brookes
- Department of Anesthesia and Perioperative MedicineWestern University London Ontario Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology—Head and Neck SurgeryWestern University London Ontario Canada
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Reid J, Wehrli B, Sowerby LJ. Spindle Cell Lipomas of the Respiratory Tract: A Case Report and Comprehensive Literature Review. Ann Otol Rhinol Laryngol 2019; 128:1086-1091. [PMID: 31291740 DOI: 10.1177/0003489419862577] [Citation(s) in RCA: 1] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spindle cell lipomas (SCLs) are benign tumors that are characteristically present on the upper back and neck, but in rare cases present throughout the respiratory mucosa, causing hoarseness, stridor, dyspnea, and obstruction. OBJECTIVE To highlight the importance of considering SCL in the diagnosis of benign respiratory tract tumors, a literature review identified all published cases of respiratory tract SCLs, including 2 from our institution: one case in the nasopharynx and 1 in the nasal valve. METHODS All case reports, series and literature reviews from the English literature from 1975 through March 2018 were systematically identified for review in the MEDLINE, EMBASE, and Scopus databases. Two additional cases from our institution were described. RESULTS In total, 24 cases of SCL in the respiratory tract were identified for review. Two cases from our institution are described here, bringing the total of reported cases to 26. Extensive analyses of oral cavity SCLs already exist, so we excluded this site from our review and focused on sites where SCLs may present with respiratory symptoms. Excluding the oral cavity and oropharynx, the most common location described is the larynx. All 26 cases were treated with excision. One tumor required a second surgery, but there were no other complications nor recurrences. CONCLUSION Although rare, SCLs may arise from throughout the respiratory tract and cause dyspnea, hoarseness and stridor. Spindle cell lipoma should be considered in the differential diagnosis of a respiratory tract mass. This diagnosis confers a good prognosis and patients may be reassured that surgery is almost always curative.
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Affiliation(s)
- Jonathan Reid
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
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Biskup M, Dzioba A, Sowerby LJ, Monteiro E, Strychowsky J. Opioid prescribing practices following elective surgery in Otolaryngology-Head & Neck Surgery. J Otolaryngol Head Neck Surg 2019; 48:29. [PMID: 31234932 PMCID: PMC6591868 DOI: 10.1186/s40463-019-0352-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/10/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Prescription opioid abuse has become a major issue across the world and especially in North America. Canada has the second highest number of opioid prescriptions per capita in the world, second only to the United States, with numbers continuing to rise in recent years. Surgeons play a critical role in this discussion as they are responsible for the management of post-operative pain in their patients. The objective of this study is to evaluate the opioid prescribing practices of Otolaryngologists-Head and Neck Surgeons in Canada and determine factors that may influence these practices. METHODS The online survey was distributed to members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Questions surveyed the respondents' demographics and opioid prescribing practices for common pediatric and adult elective surgeries. RESULTS The survey was sent to 670 surgeons and trainees and 121 responses were received (18%). There was representation across all subspecialties with a mix of community and academic surgeons. The most commonly prescribed opioid was Codeine/Acetaminophen, 48.2% (n = 53), in the adult population, and Morphine, 47.1% (n = 41), in the pediatric population. The median total oral morphine equivalents prescribed across all adult surgeries was 123.75 mg (24.75 doses). The surgery with the highest oral morphine equivalents prescribed was tonsillectomy/adenoidectomy for both adult and pediatric patients, with a median of 150 mg (30 doses) for adults and 4.5 mg/kg (23 doses) for pediatrics. Gender, training years, year in residency, or reported level of conservatism did not predict the dose prescribed to either adult or pediatric patients. Due to the relatively low response rate, the generalizability of these results is unclear. CONCLUSIONS Our study demonstrates a wide variability in opioid prescriptions across procedures and within each individual procedure. This variability reflects the lack of guidelines available for post-operative opioid prescribing and suggests that some Otolaryngologists may be prescribing higher doses of opioids than required. Opportunities for improving patient safety and resource stewardship regarding optimal prescribing practices should be explored.
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Affiliation(s)
- Mathew Biskup
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9 Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario Canada
| | - Julie Strychowsky
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada
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Scott JR, Sowerby LJ, Rotenberg BW. Office-based rhinologic surgery: A modern experience with operative techniques under local anesthetic. Am J Rhinol Allergy 2018; 31:135-138. [PMID: 28452711 DOI: 10.2500/ajra.2017.31.4414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Office-based rhinologic procedures have become popularized in recent years with the advent of several minimally invasive techniques. There is a paucity of literature, however, that supports more robust in-clinic procedures, e.g., true endoscopic sinus surgery (ESS). There is a high volume of this work being done at our center, and the objective of this article was to review the safety and tolerability of in-clinic surgeries. METHODS A retrospective chart review was conducted. All the adult patients who underwent in-clinic sinonasal procedures and surgery with a minimum of 3 months of follow-up were included. Information regarding intra- and postoperative complications and revision procedures were recorded. For the ESS procedures, the indication, sinuses operated on, and type of revision were also collected. RESULTS A total of 315 patients met the inclusion criteria. There were 166 turbinoplasties, 118 ESS, 35 septoplasties, 34 rhinoplasties, and 4 septorhinoplasties performed. For the ESS procedures, 74 (62.7%) were bilateral, and experience was had operating in all paranasal sinuses. All ESS work involved opening diseased ostia and was more than just polypectomies. The mean follow-up for the ESS cases was 13.4 months (range, 12-65 months). Complication rates and tolerability measures were comparable with those of other reported in-office sinonasal procedures performed with the patient under local anesthetic. CONCLUSION Office-based rhinologic surgery was safe and well tolerated by the patients. The need for revision ESS in our series was low when considering the extent of surgery that was performed. An in-clinic procedure may avoid a general anesthetic in the operating room for appropriately selected patients.
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Affiliation(s)
- John R Scott
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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de Gabory L, Sowerby LJ, DelGaudio JM, Al-Hussaini A, Hopkins C, Serrano E. International survey and consensus (ICON) on ambulatory surgery in rhinology. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S49-S53. [PMID: 29398505 DOI: 10.1016/j.anorl.2017.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Day-case surgery is the gold standard to several surgical procedures in Rhinology. However, few data and guidelines have been published except in the Anglo-Saxon countries and France. The aim of this survey was to propose a list of issues arising during day-case surgery in order to analyze the different constraints encountered around the world. MATERIAL AND METHOD It was a prospective multicenter international email survey. The method was based on the formalized expert consensus methodology. A list of 11 issues was based on literature data and was sent by e-mail to 265 key opinion leaders (KOL) who attended the IFOS congress. RESULTS The response rate was 20% from 27 countries without statistical difference between continents concerning the score on each item. The mean age of KOL was 50±10 years. Their mean length of experience was 21±10 years. Issues in relation with technical resources and experience showed that the last time at which ambulatory surgery in the day is possible was 4:00 PM but responses varied depending the availability of technical resources. Bleeding or hematoma occurred most frequently between the third and fourth postoperative day whatever the surgical procedure. A strong agreement and consensus was obtained concerning the nasal packing, septal contention and their schedule of removal which were not a contraindication of day-case. Also 75% of participants were agreeing with a therapeutic education program to improve the performance of postoperative care and decrease readmission rates. A relative agreement without consensus were obtained for the distance between the day-case unit and home, the role of surgery duration and the impact of anticoagulant and/or antiplatelet drugs in overnight admission and readmission rates. CONCLUSION Practice varies widely owing to local organization constraints and the availability of a dedicated day-case unit seems to be the main limiting factor.
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Affiliation(s)
- L de Gabory
- ENT department, University Hospital of Bordeaux, Pellegrin Hospital, F-X Michelet Center, 33076 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France.
| | - L J Sowerby
- ENT department, Schulich School of Medecine and dentistry, London, Ontario, Canada
| | - J M DelGaudio
- ENT department, Emory University, 30322 Atlanta, GA, United States of America
| | - A Al-Hussaini
- ENT department, University Hospital of Wales, Cardiff, United Kingdom
| | - C Hopkins
- ENT department, Guy's and Saint-Thomas' Hospital, London, United Kingdom
| | - E Serrano
- ENT department, University Hospital Rangueil-Larrey, Toulouse, France
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Sowerby LJ, Rudmik L. The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques. Laryngoscope 2017; 128:64-71. [DOI: 10.1002/lary.26770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/06/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Leigh J. Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry; Western University; London Ontario
| | - Luke Rudmik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
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Abstract
BACKGROUND The problem of postoperative management after frontal sinus surgery remains a challenge. The bilateral opening created in the Draf III procedure does not fit any currently available stent, and patients find rinsing the frontal sinus difficult, which thus decreases compliance. The objective of this study was to demonstrate the successful use of a novel frontal sinus catheter fashioned from a biliary T tube by addressing these issues in patients with complicated sinus disease. METHODS This was a review of 30 patients who underwent a Draf III procedure between January and October 2014, and who had a T-tube stent inserted at the end of the procedure. Patient charts were analyzed for complications such as bleeding, infection, and restenosis as well as indications of ease of rinsing ability after surgery. RESULTS From the chart data, there was only one intraoperative bleed and only one postoperative bleed that required packing. Four patients had infections that required antibiotics after surgery. At the time of data collection, only one patient had signs of restenosis as judged by the operating surgeon. Patients reported an ease of rinsing ability with the T-tube stent. CONCLUSIONS The novel biliary T-tube stent use presented in this article is a promising future direction for postoperative care after extended frontal sinus surgery.
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Affiliation(s)
- Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Scott JR, Ernst HMJ, Rotenberg BW, Rudmik L, Sowerby LJ. Oral corticosteroid prescribing habits for rhinosinusitis: The American Rhinologic Society membership. Am J Rhinol Allergy 2017; 31:22-26. [PMID: 28234148 DOI: 10.2500/ajra.2017.31.4396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the field of otolaryngology, oral corticosteroids (OCS) are widely prescribed for rhinosinusitis. Although there is evidence in the literature regarding specific OCS dosing protocols, it is not known to what extent these recommendations are being followed. OBJECTIVE To examine the current state of OCS prescribing habits for rhinosinusitis by American Rhinologic Society members. METHODS An anonymous online survey was sent to all American Rhinologic Society members. Dosing, frequency, tapering, and overall prescribing habits for OCS were assessed in chronic rhinosinusitis with polyposis (CRSwP) and in chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis. The CRSwP group was subdivided into aspirin-exacerbated respiratory disease, allergic fungal sinusitis, and not otherwise specified. Results were compared with current guidelines. Descriptive statistics were used to analyze data. RESULTS Ninety-three surveys were completed (response rate, 12.9%). Prednisone was the most common OCS prescribed. In the CRSwP-aspirin-exacerbated respiratory disease group (n = 86), the median starting dose was 60 mg (range, 4-80 mg) and the average duration was 8 days (range, 2-28 days). In the CRSwP-allergic fungal sinusitis group (n = 81), the median starting dose was 50 mg (range, 20-60 mg), and the average duration was 6 days (range, 2-35 days). In the CRSwP-not otherwise specified group (n = 84), the median starting dose was 50 mg (range, 20-80 mg) and the average duration was 5 days (range, 1-21 days). OCS were prescribed for chronic rhinosinusitis without polyposis and acute bacterial rhinosinusitis by 66.0 and 62.4% of respondents, respectively. CONCLUSION Significant heterogeneity existed in OCS prescribing habits for rhinosinusitis. Discrepancies were observed between survey results and evidence-based recommendations. Developing standardized OCS treatment protocols for rhinosinusitis may improve the quality of care by optimizing clinical outcomes and reducing the risk of complications.
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Affiliation(s)
- John R Scott
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Harris MS, Rotenberg BW, Roth K, Sowerby LJ. Factors associated with lingual tonsil hypertrophy in Canadian adults. J Otolaryngol Head Neck Surg 2017; 46:32. [PMID: 28412967 PMCID: PMC5392952 DOI: 10.1186/s40463-017-0209-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Hypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea. The underlying etiology of lingual tonsil hypertrophy (LTH) in the adult patient is unclear and likely multifactorial. Previous studies have suggested that the lingual tonsils may undergo compensatory hyperplasia post-tonsillectomy in children, although it is unknown if this occurs or persists into adulthood. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults. Methods Adult patients presenting for consultation to an academic Rhinology/General Otolaryngology practice were eligible for enrollment. Demographic data including age, body mass index (BMI), Reflux Symptom Index (RSI), history of allergy, and history of tonsillectomy was collected via questionnaire. Endoscopic photographs of the base of tongue and larynx were captured. These were graded for LTH and Reflux Finding Scale (RFS) by blinded examiners. Statistical analysis was performed by comparing the mean LTH value to the variables of interest using two-tailed T-test. P < .05 was considered significant. Results One hundred two subjects were enrolled. Age ranged from 18 to 78. 28 patients had previous tonsillectomy. This was not associated with a significant increase in lingual tonsil tissue (r = −0.05, p = 0.61). RFS >7 or RSI >13 was considered positive for laryngopharyngeal reflux. There was no difference in LTH based on RSI positivity (p = 0.44). RFS positivity correlated with increased lingual tonsil tissue (p < 0.05). BMI >30 was associated with increased lingual tonsil hypertrophy (p < 0.05). Conclusions An elevated body mass index and positive Reflux Finding Score are associated with lingual tonsil hypertrophy in adults. Reflux symptom index, history of allergy and history of childhood tonsillectomy are not associated with LTH.
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Affiliation(s)
- Matthew S Harris
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada
| | - Kathryn Roth
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada.
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Sowerby LJ, Mann S, Starreveld Y, Kotylak T, Mechor B, Wright ED. A comparison of radiographic evidence of frontal sinusitis in middle-turbinate sacrificing versus middle-turbinate sparing approaches to the sella. Am J Rhinol Allergy 2017; 30:306-9. [PMID: 27456601 DOI: 10.2500/ajra.2016.30.4326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Initial descriptions of endoscopic approaches to the sella and pituitary involved resecting the middle turbinate (MT) to help improve access and visualization. Modifications of these procedures to preserve the MT have since been described, one rationale being to reduce the incidence of frontal sinusitis. The objective of this study was to establish the incidence of postoperative frontal sinusitis in MT sparing (MTsp) and MT sacrificing (MTsc) approaches to the sella. OBJECTIVE A retrospective cohort study that compared radiographic evidence of frontal rhinosinusitis or frontal recess obstruction after skull base surgery in patients who underwent MTsc and MTsp endonasal approaches to the sella. METHODS Consecutive retrospective review of pre- and postoperative magnetic resonance imaging from two institutions in geographic proximity but with different approaches to the sella. Mucosal thickening in the frontal sinus was measured and graded by a radiologist blinded to patient cohorts. RESULTS Seventy-five patients, based on sample size calculations, were included at each site. Baseline demographics and indications for surgery were not significantly different between the groups. No difference was seen between the groups in the overall grade of radiographic frontal sinusitis seen on postoperative imaging. A total of 8 patients (10%) in the MTsc group had measured mucosal thickening, which was increased from their preoperative scan versus 15 in the MTsp group (20%) (p = 0.10). New mucosal thickening of >1 mm was found in three patients in the MTsc group and eight patients in the MTsp group (p = 0.21); the only patient with postoperative complete frontal sinus opacification was in the MTsp group. CONCLUSIONS The choice of MTsc versus MTsp in endonasal endoscopic approach to the sella does not seem to make a difference in the incidence of postoperative radiographic frontal sinusitis.
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Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology, Western University, London, Ontario, Canada
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Araslanova R, Allen L, Rotenberg BW, Sowerby LJ. Silent sinus syndrome after facial trauma: A case report and literature review. Laryngoscope 2017; 127:1520-1524. [PMID: 28271509 DOI: 10.1002/lary.26527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The accepted definition of silent sinus syndrome (SSS) excludes posttraumatic cases. To challenge current exclusion criteria of antecedent facial trauma, we have identified all published cases of posttraumatic SSS in English literature, including a new representative case from our institution. DATA SOURCES MEDLINE, EMBASE, and Scopus databases. REVIEW METHODS All case reports and case series published in English literature from 1964 through August 2016 were sequentially identified. Authors of cases with missing information were contacted for completion. RESULTS Thirteen documented cases of posttraumatic SSS were identified through the literature review. An additional case from our institution was presented, bringing the total reported case count to 14. Time from initial trauma to presentation ranged from 2 months to 32 years, with a median duration of 6 months. Endoscopic sinus surgery (ESS) with either concurrent or staged orbital floor implant repair was used to treat posttraumatic SSS in 64% of reported cases. Three patients had ESS alone, with one case showing postoperative improvement in enophthalmos. CONCLUSION Recent emergence of case reports of SSS postorbital and facial trauma challenge the current exclusion criteria of precedent facial trauma. Posttraumatic SSS is rare, but the availability of cross-sectional imaging pre- and postdevelopment of SSS makes a strong case for a causal relationship. Laryngoscope, 127:1520-1524, 2017.
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Affiliation(s)
- Rakhna Araslanova
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Larry Allen
- Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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John-Baptiste A, Sowerby LJ, Chin CJ, Martin J, Rotenberg BW. Comparing surgical trays with redundant instruments with trays with reduced instruments: a cost analysis. CMAJ Open 2016; 4:E404-E408. [PMID: 27975045 PMCID: PMC5143022 DOI: 10.9778/cmajo.20150092] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When prearranged standard surgical trays contain instruments that are repeatedly unused, the redundancy can result in unnecessary health care costs. Our objective was to estimate potential savings by performing an economic evaluation comparing the cost of surgical trays with redundant instruments with surgical trays with reduced instruments ("reduced trays"). METHODS We performed a cost-analysis from the hospital perspective over a 1-year period. Using a mathematical model, we compared the direct costs of trays containing redundant instruments to reduced trays for 5 otolaryngology procedures. We incorporated data from several sources including local hospital data on surgical volume, the number of instruments on redundant and reduced trays, wages of personnel and time required to pack instruments. From the literature, we incorporated instrument depreciation costs and the time required to decontaminate an instrument. We performed 1-way sensitivity analyses on all variables, including surgical volume. Costs were estimated in 2013 Canadian dollars. RESULTS The cost of redundant trays was $21 806 and the cost of reduced trays was $8803, for a 1-year cost saving of $13 003. In sensitivity analyses, cost savings ranged from $3262 to $21 395, based on the surgical volume at the institution. Variation in surgical volume resulted in a wider range of estimates, with a minimum of $3253 for low-volume to a maximum of $52 012 for high-volume institutions. INTERPRETATION Our study suggests moderate savings may be achieved by reducing surgical tray redundancy and, if applied to other surgical specialties, may result in savings to Canadian health care systems.
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Affiliation(s)
- A John-Baptiste
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - L J Sowerby
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - C J Chin
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - J Martin
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
| | - B W Rotenberg
- Department of Anesthesia and Perioperative Medicine (John-Baptiste, Martin); Department of Epidemiology and Biostatistics (John-Baptiste, Martin); Department of Otolaryngology-Head and Neck Surgery (Sowerby, Rotenberg), Interfaculty Program in Public Health (JOhn-Baptiste), Schulich School of Medicine and Dentistry, Western University; and Center for Medical Evidence, Decision Integrity, Clinical Impact (John-Baptiste, Martin), University of Toronto (Chin), Mount Sinai Hospital, Toronto, Ont
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Dhaliwal SS, Sowerby LJ, Rotenberg BW. Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature. Int Forum Allergy Rhinol 2016; 6:661-7. [PMID: 26782715 DOI: 10.1002/alr.21706] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Traumatic optic neuropathy (TON) represents a rare but devastating complication of closed head injuries. No accepted guidelines are available for medical and surgical management algorithms. A systematic review of the literature was performed to determine the optimal timing and candidacy for endoscopic surgical intervention. METHODS A systematic review of multiple databases was performed including Medline-Ovid, EMBASE, and PubMed. Data was extracted and patients stratified based on surgical delay from trauma (≤3 days, >3 days, ≤7 days, or >7 days) as well as preoperative and postoperative vision testing (no light perception [NLP]; light perception [LP]; hand motion [HM]; or finger counting [FC] or better). RESULTS The literature review identified 24 studies meeting inclusion criteria. In the group of patients receiving surgery ≤3 days after the antecedent event, 57% (105/183) had visual improvement, whereas in the >7-days group 51% (145/283) of patients improved. In those with NLP preoperatively, 41% (172/411) saw improvement, whereas those with LP (89%), HM (93%), or FC (85%) fared better. CONCLUSION The literature suggests that surgical intervention for TON is indicated despite delayed presentation, and is a better choice than no intervention at all. Patients with complete blindness on presentation (NLP) tend to have a poorer surgical outcome.
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Affiliation(s)
- Sandeep S Dhaliwal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Sommer DD, Rotenberg BW, Sowerby LJ, Lee JM, Janjua A, Witterick IJ, Monteiro E, Gupta MK, Au M, Nayan S. A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial. Int Forum Allergy Rhinol 2016; 6:385-91. [DOI: 10.1002/alr.21678] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 09/25/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Doron D. Sommer
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
| | - Brian W. Rotenberg
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Canada
| | - John M. Lee
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Arif Janjua
- Division of Otolaryngology-Head and Neck Surgery; University of British Columbia; Vancouver Canada
| | - Ian J. Witterick
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Michael K. Gupta
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
| | - Michael Au
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery McMaster University; Hamilton Canada
- Department of Otolaryngology-Head and Neck Surgery; Cambridge Memorial Hospital; Cambridge Canada
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Scott JR, Wong E, Sowerby LJ. Evaluating the referral preferences and consultation requests of primary care physicians with otolaryngology - head and neck surgery. J Otolaryngol Head Neck Surg 2015; 44:57. [PMID: 26714893 PMCID: PMC4696345 DOI: 10.1186/s40463-015-0114-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/22/2015] [Indexed: 11/15/2022] Open
Abstract
Background No literature exists which examines referral preferences to, or the consultation process with, Otolaryngology. In a recent Canadian Medical Association nation-wide survey of General Practitioners and Family Physicians, Otolaryngology was listed as the second-most problematic specialty for referrals. The purpose of this study was to learn about and improve upon the referral process between primary care physicians (PCPs) and Otolaryngology at an academic centre in Southwestern Ontario. Methods PCPs who actively refer patients to Otolaryngology within the catchment area of Western University were asked to complete a short paper-based questionnaire. Data was analyzed using descriptive statistics. Results A total of 50 PCPs were surveyed. Subspecialty influenced 90.0 % of the referrals made. Specialist wait times altered 58.0 % of referrals. All PCPs preferred to communicate via fax. Half of those surveyed wanted clinical notes from every encounter. Seventy-four percent of respondents wanted inappropriate referrals forwarded to the proper specialist automatically. Twenty-two percent of those surveyed were satisfied with current wait times. A central referral system was favored by 74 % of PCPs. Conclusion Improvements could help streamline the referral and consultation practices with Otolaryngology in Southwestern Ontario. A central referral system and reduction in the frequency of consultative reports can be considered. Electronic supplementary material The online version of this article (doi:10.1186/s40463-015-0114-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John R Scott
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Healthcare, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada.
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Leigh J Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, St. Joseph's Healthcare, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada.
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Siu JM, Rotenberg BW, Franklin JH, Sowerby LJ. Multimedia in the informed consent process for endoscopic sinus surgery: A randomized control trial. Laryngoscope 2015; 126:1273-8. [PMID: 26615812 DOI: 10.1002/lary.25793] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine patient recall of specific risks associated with endoscopic sinus surgery and whether an adjunct multimedia education module is an effective patient tool in enhancing the standard informed consent process. STUDY DESIGN Prospective, randomized, controlled trial. METHODS Fifty consecutive adult patients scheduled for endoscopic sinus surgery at a rhinology clinic of a tertiary care hospital were recruited for this study. Informed consent was studied by comparing the number of risks recalled when patients had a verbal discussion in conjunction with a 6-minute interactive module or the verbal discussion alone. Early recall was measured immediately following the informed consent process, and delayed recall was measured 3 to 4 weeks after patient preference details were also collected. RESULTS Early risk recall in the multimedia group was significantly higher than the control group (P = .0036); however, there was no difference between the groups in delayed risk recall. Seventy-six percent of participants expressed interest in viewing the multimedia module if available online between the preoperative and procedural day. Sixty-eight percent of patients preferred having the multimedia module as an adjunct to the informed consent process as opposed to the multimedia consent process alone. CONCLUSIONS There is an early improvement in overall risk recall in patients who complete an interactive multimedia module, with a clear patient preference for this method. Here we emphasize the well-known challenges of patient education and demonstrate the effectiveness of integrating technology into clinical practice in order to enhance the informed consent process. LEVEL OF EVIDENCE 1b Laryngoscope, 126:1273-1278, 2016.
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Affiliation(s)
- Jennifer M Siu
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Jason H Franklin
- Department of Otolaryngology-Head & Neck Surgery, Queen's University, Kingston, Ontario, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
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