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  • 1
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    Online Resource
    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
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  • 3
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    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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  • 4
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    Online Resource
    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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  • 5
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    Online Resource
    Comparing the Reverse Trendelenburg and Horizontal Position for Endoscopic Sinus Surgery : A Randomized Controlled Trial
    Wiley ; 2013
    In:  Otolaryngology–Head and Neck Surgery Vol. 148, No. 2 ( 2013-02), p. 308-313
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 148, No. 2 ( 2013-02), p. 308-313
    Abstract: To determine whether the 15‐degree reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery improves endoscopic field of view and reduces intraoperative blood loss when compared with the horizontal position (HP). Study Design A prospective, randomized controlled trial. Setting St Paul’s Sinus Centre, Vancouver, Canada. Subjects Patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, receiving functional endoscopic sinus surgery were included. Patients were excluded if they had severe or uncontrolled hypertension and cardiovascular disease, continued use of anticoagulants, impaired coagulation, or a sinonasal tumor. Methods Sixty‐four patients with CRS undergoing functional endoscopic sinus surgery (FESS) were randomized to either 15‐degree RTP (experimental arm) or HP (control arm) from October 2011 to February 2012. Boezaart endoscopic field‐of‐view grading system was the primary outcome measure. Lund‐Mackay computed tomography (CT) score, total blood loss, blood loss per minute, mean arterial pressure, heart rate, anesthetic technique, and surgery time were also recorded. Results There was a significant difference in mean Boezaart scoring between RTP and HP: 1.66 vs 2.33 ( P 〈 . 001), with RTP producing a better endoscopic field of view. There was also a lower total blood loss and blood loss per minute with RTP ( P =. 01, P =. 03). There was no significant difference in disease severity ( P 〉 . 05), time of surgery ( P 〉 . 05), or mean arterial pressure ( P 〉 . 05) between the 2 surgical positions. Conclusion The 15‐degree RTP improves the endoscopic field of view and reduces blood loss during FESS. We would therefore recommend its use.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599812466529
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 6
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    Online Resource
    Potential risk factors associated with the development of synechiae following functional endoscopic sinus surgery
    Springer Science and Business Media LLC ; 2018
    In:  European Archives of Oto-Rhino-Laryngology Vol. 275, No. 5 ( 2018-5), p. 1175-1181
    Details
    In: European Archives of Oto-Rhino-Laryngology, Springer Science and Business Media LLC, Vol. 275, No. 5 ( 2018-5), p. 1175-1181
    Type of Medium: Online Resource
    ISSN: 0937-4477 , 1434-4726
    URL: Article
    DOI: 10.1007/s00405-018-4936-1
    RVK:
    XA 26650
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1459042-6
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  • 7
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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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  • 8
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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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  • 9
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    A Systematic Review of Factors Associated with Health-Related Quality of Life in Adolescents and Adults with Cystic Fibrosis
    American Thoracic Society ; 2015
    In:  Annals of the American Thoracic Society Vol. 12, No. 3 ( 2015-03), p. 420-428
    Details
    In: Annals of the American Thoracic Society, American Thoracic Society, Vol. 12, No. 3 ( 2015-03), p. 420-428
    Type of Medium: Online Resource
    ISSN: 2329-6933 , 2325-6621
    URL: Article
    DOI: 10.1513/AnnalsATS.201408-393OC
    Language: English
    Publisher: American Thoracic Society
    Publication Date: 2015
    detail.hit.zdb_id: 2702474-X
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  • 10
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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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