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  • 1
    Online Resource
    Online Resource
    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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  • 2
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    Omalizumab therapy for refractory allergic fungal rhinosinusitis patients with moderate or severe asthma
    Elsevier BV ; 2015
    In:  American Journal of Otolaryngology Vol. 36, No. 5 ( 2015-09), p. 672-677
    Details
    In: American Journal of Otolaryngology, Elsevier BV, Vol. 36, No. 5 ( 2015-09), p. 672-677
    Type of Medium: Online Resource
    ISSN: 0196-0709
    URL: Article
    DOI: 10.1016/j.amjoto.2015.05.008
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2041649-0
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  • 3
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    Five‐degree, 10‐degree, and 20‐degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double‐blind randomized controlled trial
    Wiley ; 2014
    In:  International Forum of Allergy & Rhinology Vol. 4, No. 1 ( 2014-01), p. 61-68
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 4, No. 1 ( 2014-01), p. 61-68
    Abstract: Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery (FESS) is a safe, simple, and cost‐free method that has been found to reduce intraoperative blood loss. However, the critical angle of RTP that produces the least amount of bleeding without compromising surgical technique and safety remains unanswered. The objective of this study was to assess the effects of 5‐degree, 10‐degree, and 20‐degree RTP (5‐RTP, 10‐RTP, and 20‐RTP, respectively) on intraoperative bleeding during FESS. Methods This double‐blind randomized controlled trial involved 75 patients with chronic rhinosinusitis (CRS) with and without nasal polyposis undergoing FESS. Twenty‐five patients were enrolled into each group: 5‐RTP, 10‐RTP, and 20‐RTP. Boezaart endoscopic field‐of‐view score (BS), total blood loss (TBL), mean arterial blood pressure (MABP), operating time, and blood loss per minute were recorded. An intention‐to‐treat analysis was used, with a Bonferroni adjustment for multiple comparisons. Results Intervention groups were comparable in age, sex, nasal polyposis, and disease severity. Mean values of BS and TBL were as follows: 5‐RTP (2.0, 231 mL), 10‐RTP (1.8, 230 mL), and 20‐RTP (1.4, 135 mL). The differences in means were significant for BS ( p 〈 0.01) and TBL ( p = 0.03). There was no significant difference in MABP ( p = 0.85), operating time ( p = 0.10), or blood loss per minute ( p = 0.11) between the 3 groups. Pairwise comparison between 5‐RTP vs 20‐RTP found significant difference in BS ( p 〈 0.01) but not TBL ( p = 0.04). Significance was not found in similar comparisons of 10‐RTP vs 20‐RTP and 5‐RTP vs 10‐RTP ( p 〉 0.03). Conclusion FESS in 20‐RTP produced the best BS and lowest blood loss without compromising surgical technique.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2014.4.issue-1
    DOI: 10.1002/alr.21249
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 4
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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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  • 5
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    Online Resource
    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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  • 6
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    Medical management of allergic fungal rhinosinusitis following endoscopic sinus surgery: an evidence‐based review and recommendations
    Wiley ; 2014
    In:  International Forum of Allergy & Rhinology Vol. 4, No. 9 ( 2014-09), p. 702-715
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 4, No. 9 ( 2014-09), p. 702-715
    Abstract: Allergic fungal rhinosinusitis (AFRS) is a subset of polypoid chronic rhinosinusitis that is characterized by the presence of eosinophilic mucin with fungal hyphae within the sinuses and a Type I hypersensitivity to fungi. The treatment of AFRS usually involves surgery in combination with medical therapies to keep the disease in a dormant state. However, what constitutes an optimal medical regimen is still controversial. Hence, the purpose of this article is to provide an evidence‐based approach for the medical management of AFRS. Methods A systemic review of the literature on the medical management of AFRS was performed using Medline, EMBASE, and Cochrane Review Databases up to March 15, 2013. The inclusion criteria were as follows: patients 〉 18 years old; AFRS as defined by Bent and Kuhn; post–sinus surgery; studies with a clearly defined end point to evaluate the effectiveness of medical therapy in postoperative AFRS patients. Results This review identified and assessed 6 medical modalities for AFRS in the literature: oral steroids; topical steroids; oral antifungals; topical antifungals; immunotherapy; and leukotriene modulators. Conclusion Based on available evidence in the literature, postoperative systemic and standard topical nasal steroids are recommended in the medical management of AFRS. Nonstandard topical nasal steroids, oral antifungals, and immunotherapy are options in cases of refractory AFRS. No recommendations can be provided for topical antifungals and leukotriene modulators due to insufficient clinical research reported in the literature.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2014.4.issue-9
    DOI: 10.1002/alr.21352
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 7
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    Online Resource
    The Interrater and Intrarater Reliability of the Philpott‐Javer Staging System Based on Level of Training
    Wiley ; 2014
    In:  Otolaryngology–Head and Neck Surgery Vol. 150, No. 4 ( 2014-04), p. 538-541
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 150, No. 4 ( 2014-04), p. 538-541
    Abstract: The Philpott‐Javer postoperative endoscopic mucosal staging system for allergic fungal rhinosinusitis has previously demonstrated acceptable interrater reliability among rhinologists. There are, however, numerous learners involved in patient care at tertiary centers. This study aims to analyze the interrater and intrarater reliability of this system among learners in otolaryngology at different stages in training. Study Design A prospective analysis of retrospectively collected endoscopic photographs. Setting A tertiary care teaching hospital (January 2013). Subjects Fifty patients undergoing routine follow‐up. Method Three photographs from each of 50 patients undergoing routine postsurgical nasoendoscopy were reviewed. Images were played twice, 1 week apart, in 2 differently randomized cycles and scored according to Philpott‐Javer criteria by a rhinologist, a rhinology fellow, a senior otolaryngology resident, a junior otolaryngology resident, and a medical student. Interobserver reliability was assessed using the intraclass correlation coefficient, while intrarater reliability was assessed by Shrout‐Fleiss κ values. Agreement between each learner and the rhinologist was also assessed using κ values. Results The interclass correlation among the 5 raters was 0.7600 (95% confidence interval, 0.6917‐0.8161) for the Philpott‐Javer scoring system, suggesting substantial reliability. Intrarater data showed substantial to almost‐perfect reliability (κ values between 0.668 and 0.815) among all raters using this system. There was also moderate to substantial agreement between the learners and the rhinologist (κ values between 0.534 and 0.710). Conclusion Results suggest that the Philpott‐Javer staging system has acceptable intrarater and interrater reliability among learners of differing levels of clinical experience and is suitable for evaluating progress following surgery.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599814521761
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 2008453-5
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  • 8
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    Online Resource
    The safety and efficacy of short‐term budesonide delivered via mucosal atomization device for chronic rhinosinusitis without nasal polyposis
    Wiley ; 2014
    In:  International Forum of Allergy & Rhinology Vol. 4, No. 5 ( 2014-05), p. 397-402
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 4, No. 5 ( 2014-05), p. 397-402
    Abstract: Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic‐pituitary‐adrenal (HPA) axis. Methods Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide (1 mg) via MAD or via INSI twice a day for 60 days. The adrenocorticotropic hormone (ACTH) stimulation test and 22‐item Sinonasal Outcomes Test (SNOT‐22) questionnaire were administered on days 1, 30, and 60 of the study. Plasma budesonide and cortisol levels were simultaneously quantified using a high‐performance liquid chromatography–tandem mass spectrometry technique. Results There was no indication of adrenal suppression in either group (n = 20) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group. Quality of life, as indicated by SNOT‐22, did not differ between groups at 60 days ( p = 0.404; 95% confidence interval [CI], −37.2 to 15.9), but SNOT‐22 scores for patients using MAD did show statistically significant improvement at 60 days compared to baseline ( p = 0.02). Conclusion The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2014.4.issue-5
    DOI: 10.1002/alr.21280
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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