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  • 1
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    Comparing the efficacy of Silastic and gloved‐Merocel middle meatal spacers for functional endoscopic sinus surgery: a randomized controlled trial
    Wiley ; 2018
    In:  International Forum of Allergy & Rhinology Vol. 8, No. 8 ( 2018-08), p. 948-954
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 8, No. 8 ( 2018-08), p. 948-954
    Abstract: Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved‐Merocel (GM) spacers following FESS. Methods A double‐blind, randomized controlled trial (RCT) was conducted in adults requiring bilateral FESS for chronic rhinosinusitis (CRS) ± nasal polyposis. Participants served as their own controls, with each subject receiving both a Silastic and GM spacer. Spacers were inserted into the MMS during FESS and left in situ for 6 days. Participants were reviewed at 6 days, 5 weeks, and 12 weeks postoperatively. The presence of synechiae and scarring were evaluated endoscopically. Inflammation, discharge, and pain during spacer removal were assessed using a visual analogue scale (VAS). Results Forty‐eight participants (96 nasal cavities) were recruited. Preoperatively, Lund‐Mackay computed tomography (CT) scores were similar between Silastic‐treated and GM‐treated cavities (6.38 ± 2.35 vs 6.18 ± 2.17). The incidence of synechiae and scarring did not differ significantly between spacers up to 12 weeks postoperatively. Pain during spacer removal was significantly greater for Silastic than GM spacers (2.13 ± 1.34 vs 1.51 ± 1.23, p = 0.020). Facial pain prior to removal and extent of discharge did not differ significantly between spacers. Conclusion Following FESS, patients report less pain during removal of GM than Silastic spacers. However, the likelihood of synechiae and scarring did not differ between either of the spacers.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2018.8.issue-8
    DOI: 10.1002/alr.22119
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 2
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    Frontal Ostium Grade (FOG): A New Computer Tomography Grading System for Endoscopic Frontal Sinus Surgery
    Wiley ; 2020
    In:  Otolaryngology–Head and Neck Surgery Vol. 163, No. 3 ( 2020-09), p. 611-617
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 163, No. 3 ( 2020-09), p. 611-617
    Abstract: The location and size of the frontal sinus ostium are critical in determining surgical difficulty. The more anterior the ostium, the more difficult is the surgical access. We propose a novel computed tomography (CT) grading specific to the anatomical position of the frontal ostium. Study Design Observational study followed by a prospective part. Settings Tertiary rhinology practice Subject and Methods On a specified sagittal CT cut, a vertical line was drawn through the posterior edge of the frontal process of the maxilla (frontal buttress/beak) along its vertical axis (reference [R‐] line). A second (S‐) line was placed at the point of upturn of the skull base. Based on if the S‐line was posterior or anterior to the R‐line, the frontal ostium was graded positive and more easily accessible or negative and thereby more challenging, respectively. If both lines overlapped, then a neutral (0) grading existed. Results A total of 297 CTs (594 ostia) were analyzed. In total, 394 (65%) ostia were grade positive, 52 (8.75%) were grade negative, and 103 (17.3%) were grade neutral. Ninety frontal sinusotomies were then performed using this grading system: 48 were positive, 21 negative, and 21 neutral. The average time to complete a frontal sinusotomy was 9.96 minutes for grade positive compared to 11.4 minutes for neutral and 16.05 minutes for grade negative ( P 〈 . 005). Conclusion This novel anatomical CT grading system is designed to be useful in planning and predicting the level of difficulty in endoscopic frontal sinus surgery.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820917400
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2008453-5
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  • 3
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    A population‐based study investigating chronic rhinosinusitis and the incidence of asthma
    Wiley ; 2016
    In:  The Laryngoscope Vol. 126, No. 6 ( 2016-06), p. 1296-1302
    Details
    In: The Laryngoscope, Wiley, Vol. 126, No. 6 ( 2016-06), p. 1296-1302
    Abstract: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses, associated with reduced health‐related quality of life and increased utilization of healthcare services. Chronic upper and lower respiratory diseases often coexist, although the extent to which CRS is associated with developing asthma remains unclear. To investigate the effect of CRS on receiving a subsequent diagnosis of asthma, we used data from a previously conducted national, longitudinal survey. Methods Respondents from the Canadian National Population Health Survey from 1998/1999 to 2010/2011 were used. Data were analyzed from 11,555 (66.9%) subjects, ≥ 19 years of age and reporting no asthma at baseline. Respondents were reviewed for 12 years to determine the cumulative incidence of asthma. Logistic regression was used to estimate the effect of CRS on the development of asthma, adjusting for age, gender, body mass index, cigarette smoking, and food‐ or nonfood‐related allergies. Results During the 12‐year study period, 6.0% (95% confidence interval [CI] [95% CI] : 5.4%–6.7%) of respondents developed asthma. Baseline CRS (odds ratio [OR]: 2.7, 95% CI: 1.9–3.9), female gender (OR: 1.4, 95% CI: 1.1–1.8), and allergies (OR: 2.6, 95% CI: 2.1 – 3.3) were significantly associated with developing asthma. After adjustment, respondents with CRS were significantly more likely to develop asthma than non‐CRS counterparts (OR: 2.0, 95% CI: 1.4–2.9). Conclusion Results indicate that one in 13 individuals with CRS will be subsequently diagnosed with asthma. Given the economic burden and use of healthcare services associated with asthma, providers managing CRS may consider increased awareness and subsequent treatment for asthma. Level of Evidence 4. Laryngoscope , 126:1296–1302, 2016
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v126.6
    DOI: 10.1002/lary.25831
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2026089-1
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  • 4
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    Blood transfusion requirements for endoscopic sinonasal inverted papilloma resections
    Springer Science and Business Media LLC ; 2013
    In:  Journal of Otolaryngology - Head & Neck Surgery Vol. 42, No. 1 ( 2013-12)
    Details
    In: Journal of Otolaryngology - Head & Neck Surgery, Springer Science and Business Media LLC, Vol. 42, No. 1 ( 2013-12)
    Type of Medium: Online Resource
    ISSN: 1916-0216
    URL: Article
    DOI: 10.1186/1916-0216-42-44
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 2436698-5
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  • 5
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    The Sino‐Nasal Outcome Test–22 as a tool to identify chronic rhinosinusitis in adults with cystic fibrosis
    Wiley ; 2015
    In:  International Forum of Allergy & Rhinology Vol. 5, No. 12 ( 2015-12), p. 1111-1117
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 5, No. 12 ( 2015-12), p. 1111-1117
    Abstract: Chronic rhinosinusitis (CRS) is becoming increasingly prevalent in adults with cystic fibrosis (CF), as the median age of survival rises for these individuals. Delayed identification of CRS may contribute to worsening health‐related quality of life and increased treatment burden. Our objective was to investigate the utility of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) as a tool to identify CRS in adults with CF. Methods In this cross‐sectional study, participants were sampled from an adult‐specific CF clinic in Vancouver, Canada, between September 2013 and April 2014. CRS was determined by use of standardized diagnostic guidelines. Participants completed the SNOT‐22 and medical charts were reviewed for additional predictor variables. Logistic regression was used to compare the SNOT‐22 as a univariable predictor variable to a multivariable prediction model, in order to best differentiate CRS and non‐CRS participants. Results Ninety‐three of 101 adults provided written informed consent. The prevalence of CRS was 56.3% (95% confidence interval [CI], 45.9% to 66.3%). Individuals with CRS reported significantly higher SNOT‐22 scores than non‐CRS participants (mean difference: 13.9; 95% CI, 6.1 to 21.7). The optimal SNOT‐22 score to differentiate CRS was 21 out of 110 (sensitivity: 76%, specificity: 61%, positive predictive value: 71%, likelihood ratio: 1.9). Conclusion Compared to the current diagnostic gold standard, SNOT‐22 scores greater than 21 sufficiently identified adults with CF presenting with concomitant CRS. The SNOT‐22 is a simple instrument that can easily be implemented in adult CF clinics to assist care providers identify individuals requiring more detailed assessment or referral to a sinus clinic.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2015.5.issue-12
    DOI: 10.1002/alr.21607
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 6
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    The effect of head position on the distribution of topical nasal medication using the Mucosal Atomization Device: a cadaver study
    Wiley ; 2013
    In:  International Forum of Allergy & Rhinology Vol. 3, No. 12 ( 2013-12), p. 958-962
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 3, No. 12 ( 2013-12), p. 958-962
    Abstract: The Mucosal Atomization Device (MAD) distributes medication throughout the paranasal sinuses for patients with chronic rhinosinusitis (CRS). Determining the optimal head position is important to ensure maximal delivery of medication to the sinus cavities. The objective of this work was to determine the effect of the lying‐head‐back (LHB) and head‐down and forward (HDF) position, on the distribution of topical nasal medication via MAD in cadaver specimens. Methods Twenty specimens having received complete functional endoscopic sinus dissection were chosen. The MAD was used to administer 2 mL of fluorescein‐impregnated saline solution through the nose in both the LHB and HDF positions. Fluorescein was identified on 11 predetermined anatomical areas using a blue light filter. Three blinded investigators assessed endoscopic images to determine the presence of fluorescein. Results A total of 440 anatomical locations (n = 20 cadavers) received administration of the fluorescein nasal spray in the LHB or HDF position. LHB position had significantly greater total distribution to all pertinent anatomical sites than the HDF position (76% vs 41%; p 〈 0.001; 95% confidence interval [CI], 0.26–0.44). The proportion of staining was significantly greater for the ethmoid ( p = 0.11; 95% CI, 0.05–0.66), frontal ( p 〈 0.01; 95% CI, 0.20–0.80), and sphenoid sinuses ( p = 0.03; 95% CI, 0.07–0.73) when compared to the HDF position. Conclusion A greater distribution of medication to the sinonasal cavities was observed in the LHB position compared to the HDF position. These areas are of particular clinical relevance in postsurgical patients with refractory CRS.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2013.3.issue-12
    DOI: 10.1002/alr.21222
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 7
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    Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial
    Wiley ; 2014
    In:  International Forum of Allergy & Rhinology Vol. 4, No. 11 ( 2014-11), p. 877-884
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 4, No. 11 ( 2014-11), p. 877-884
    Abstract: The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes even a small amount of bleeding a potentially significant hindrance. It is thought that irrigation with hot saline during surgery may improve surgical field of view by producing a hemostatic effect. Our objective was to assess the effectiveness of hot saline irrigation (HSI) compared to room temperature saline irrigation (RTSI) in the control of intraoperative bleeding during FESS. Methods Sixty‐two chronic rhinosinusitis (CRS) patients undergoing FESS were randomized to 2 treatment arms in an equal ratio. Subjects received either HSI (49°C) or RTSI (18°C), 20 mL every 10 minutes, for the duration of FESS. The Boezaart endoscopic field of view grading system was the primary outcome measure. Boezaart score, heart rate, and mean arterial blood pressure (MABP) were recorded at 10‐minute intervals between irrigations. Results Mean endoscopic surgical field of view (Boezaart score) did not significantly differ between the HSI and RTSI groups (1.5 ± 0.6 vs 1.3 ± 0.5; p = 0.23). However, when FESS was longer than 2 hours in duration, the Boezaart scores were significantly better in the HSI group (1.6 ± 0.6 vs 1.2 ± 0.4; p = 0.04). We found that blood loss per minute was significantly reduced ( p = 0.02) in all cases in which HSI was used (2.3 ± 1.0) compared to RTSI (1.7 ± 1.1). Despite this, heart rate ( p = 0.32) and MABP ( p = 0.14) did not significantly differ between treatment groups. Conclusion HSI may be beneficial in improving surgical field of view in FESS after 2 hours of operating time. A significant reduction in rate of blood loss may be attained with HSI.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2014.4.issue-11
    DOI: 10.1002/alr.21376
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 8
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    Association between Chronic Rhinosinusitis and Health-Related Quality of Life in Adults with Cystic Fibrosis
    American Thoracic Society ; 2015
    In:  Annals of the American Thoracic Society ( 2015-05-26), p. 150526140002000-
    Details
    In: Annals of the American Thoracic Society, American Thoracic Society, ( 2015-05-26), p. 150526140002000-
    Type of Medium: Online Resource
    ISSN: 2329-6933 , 2325-6621
    URL: Article
    DOI: 10.1513/AnnalsATS.201504-191OC
    Language: English
    Publisher: American Thoracic Society
    Publication Date: 2015
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  • 9
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    The efficacy and safety of an office‐based polypectomy with a vacuum‐powered microdebrider
    Wiley ; 2013
    In:  International Forum of Allergy & Rhinology Vol. 3, No. 11 ( 2013-11), p. 890-895
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 3, No. 11 ( 2013-11), p. 890-895
    Abstract: The waiting time for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) in the Canadian public healthcare system can be lengthy. Many such patients have significant nasal obstruction resulting in a poor quality of life. A simple and safe office‐based polypectomy device to debulk nasal polyps allows immediate alleviation of nasal obstruction and better access for topical medications. The aim of this study is to assess the efficacy, safety, and patient tolerability of a vacuum‐powered microdebrider in the outpatient clinic setting. Methods The clinical charts of patients with CRSwNP who underwent office polypectomy with a vacuum‐powered microdebrider between May 2012 and February 2013 were retrospectively reviewed. These patients were either awaiting surgery or had recurrent polyposis postsurgery that was amenable to office polypectomy. Previously completed procedural and clinical outcomes questionnaires by the patients and surgeon were analyzed. Results Sixty‐eight patients underwent office polypectomy in this case series. Fifty‐nine procedures (87%) were successfully completed. Failed complete polyp resections were due to fibrous polyps (n = 7; 10%), device failure (n = 1; 1.5%), and obstruction from a deviated nasal septum (n = 1; 1.5%). There was a 43% improvement in nasal obstruction score and significant reduction in polyp grade postpolypectomy. Majority of patients (n = 66; 97%) reported a comfort level of “fair” to “excellent.” Bleeding was “light” in 61 cases (90%). There were no complications encountered. Conclusion The vacuum‐powered microdebrider is a safe, effective, and well‐tolerated instrument to resect nonfibrous nasal polyps in the outpatient setting.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2013.3.issue-11
    DOI: 10.1002/alr.21198
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 10
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    Randomized controlled trial: hybrid technique using balloon dilation of the frontal sinus drainage pathway
    Wiley ; 2015
    In:  International Forum of Allergy & Rhinology Vol. 5, No. 2 ( 2015-02), p. 167-173
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 5, No. 2 ( 2015-02), p. 167-173
    Abstract: The objectives of this study were as follows: (1) to evaluate frontal sinus ostial patency following balloon dilation with the Ventera® Sinus Dilation System, compared with frontal sinusotomy (Draf 2a); and (2) to compare mean blood loss and mean surgical time for frontal sinusotomy using balloon dilation compared with traditional surgical methods. Methods A single blinded, randomized, controlled, prospective study was performed at St. Paul's Sinus Center, Vancouver, a tertiary referral rhinology center. Thirty patients undergoing functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS) were randomized to a hybrid approach with exposure of the frontal recess using standard instrumentation and then balloon dilation of 1 frontal sinus drainage pathway and traditional frontal sinusotomy for the opposite side. Blood loss and surgical time for opening the frontal sinus drainage pathway was recorded for each side. Patients acted as their own controls. Ostial patency and size were assessed 5 weeks and 3 months postoperatively using endoscopy. Ostial patency was also recorded at 1 year following surgery. Results All frontal sinus ostia in both groups (n = 30) were successfully opened and were patent with both techniques 3 months postoperatively. All frontal sinus ostia assessed at 1 year (73%) remained patent and none required revision frontal surgery. Balloon dilation showed a mean surgical time of 655 seconds compared to 898 seconds for traditional FESS ( p = 0.03). Mean blood loss was less with balloon dilation (58 mL vs 91 mL; p = 0.008). Conclusion A hybrid balloon technique successfully dilates the frontal sinus drainage pathway with reduced blood loss. Also, short‐term patency appears to be comparable to traditional frontal sinusotomy.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2015.5.issue-2
    DOI: 10.1002/alr.21432
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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