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  • 1
    Online Resource
    Online Resource
    International consensus statement on allergy and rhinology: rhinosinusitis 2021
    Wiley ; 2021
    In:  International Forum of Allergy & Rhinology Vol. 11, No. 3 ( 2021-03), p. 213-739
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 11, No. 3 ( 2021-03), p. 213-739
    Abstract: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.v11.3
    DOI: 10.1002/alr.22741
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 2
    Online Resource
    Online Resource
    International Consensus Statement on Allergy and Rhinology: Rhinosinusitis
    Wiley ; 2016
    In:  International Forum of Allergy & Rhinology Vol. 6, No. S1 ( 2016-02)
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 6, No. S1 ( 2016-02)
    Abstract: The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods Evidence‐based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence‐based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AECRS), and pediatric RS. Conclusion As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence‐based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too often the foundation upon which these recommendations are based is comprised of lower‐level evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2016.6.issue-S1
    DOI: 10.1002/alr.21695
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 3
    Online Resource
    Online Resource
    过敏和鼻科学国际共识声明 : 鼻窦炎
    Wiley ; 2016
    In:  International Forum of Allergy & Rhinology Vol. 6, No. S1 ( 2016-02)
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 6, No. S1 ( 2016-02)
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2016.6.issue-S1
    DOI: 10.1002/alr.21695_c
    Language: English
    Publisher: Wiley
    Publication Date: 2016
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  • 4
    Online Resource
    Online Resource
    Pan‐American Clinical Guideline on Rhinosinusitis
    Wiley ; 2012
    In:  Otolaryngology–Head and Neck Surgery Vol. 147, No. S2 ( 2012-08)
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 147, No. S2 ( 2012-08)
    Abstract: This evidence‐based clinical practice guideline (CPG) aims to improve clinical decision making of general practitioners and specialists in the treatment of acute and chronic rhinosinusitis in adults. Support clinicians in clinical decision making for medical treatment with target in the pathophysiological process and evidence‐based efficacy, safety, and tolerability. Method The Pan‐American Association of Otorhinolaryngology and Head and Neck Surgery, in partnership with the Ibero American Agency for Development and Assessment of Health Technologies, developed a clinical practice guideline on medical management of acute and chronic rhinosinusitis in adults. This document provides punctual evidence‐based recommendations for primary care physicians and otolaryngologists on the medical management of these conditions and complies with evidence‐based medicine fundamentals and with well‐validated guidelines methodology as recommended by the National Institute for Clinical Excellence, the National Institutes of Health, and The Scottish Intercollegiate Guidelines Network. Results This document provides from A Grade to D Grade clinical recommendations for treatment of these conditions. The Guideline Development Group made recommendations based on well‐designed, randomized controlled trials and systematic reviews. Some clinical questions could not be answered by high quality research and for these questions a Panel Delphi was conducted to provide clinical guidance. Overall there is a need for well‐designed RCTs and economic assessments to answer most of the gaps of knowledge for the treatment of acute and chronic rhinosinusitis. Conclusion This clinical practice guideline provides guidance for the medical treatment of adults with acute and chronic rhinosinusitis.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599812451426a408
    Language: English
    Publisher: Wiley
    Publication Date: 2012
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  • 5
    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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  • 6
    Online Resource
    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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  • 7
    Online Resource
    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
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  • 8
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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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  • 9
    Online Resource
    Online Resource
    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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  • 10
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    Online Resource
    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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