Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observatio...Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.展开更多
Purpose:Odontogenic maxillary sinusitis(OMS)is frequently encountered in otorhinolaryngologists'clinical practice.Endoscopic sinus surgery(ESS)instead of surgeries in intraoral approach has been widely applied amo...Purpose:Odontogenic maxillary sinusitis(OMS)is frequently encountered in otorhinolaryngologists'clinical practice.Endoscopic sinus surgery(ESS)instead of surgeries in intraoral approach has been widely applied among OMS.However appropriate treatments due to the causes of the OMS as well as the outcome have been less investigated,meanwhile the inherent incidence of OMS may be still on the rise.This study was designed to conclude our systematic treatment within follow-up examination.Materials and methods:In this retrospective study patients confirmed diagnosis of OMS who had systematic follow-up examinations were analyzed.Medical histories of otorhinolaryngologists and dentists were reviewed as well as preoperative examination protocols.Result:Consecutive 29 Patients(10 women,19 men)were included.41.4%(12/29)patients experienced facial pain as the most frequent symptom.69.0%(20/29)patients admitted firstly to otorhinolaryngologists,13 patients were treated with surgical procedure while 7 patients lacking of surgical indication were transferred to dentists.31.0%(9/29)patients were advised by dentist for being suspected of maxillary sinusitis,including 7 patients suffered from sinonasal complications of dental treatment(SCDT).Conventional dental treatment(root planning,root end surgery,extraction)was the most common cause.Follow up for a mean of 15.1(ranges from 6 to 96)months showed 29 patients maintaining open maxillary ostium on endoscopic examination or improving on CT except recurrence in one patient with SCDT.Conclusion:Patients should be inspected by dentists carefully when the patient has symptoms rather than sinusitis-like symptoms,the possibility of OMS should always be considered.Dental examination can help to determine whether a maxillary sinusitis has a dental origin,periodontitis and odontogenic radicular cysts still are the most common causes comparing with iatrogenic factors.Patients treated with ESS showed better tolerance and fewer postsurgical complications.Not all patients with OMS including SDCT need definitely surgery whether ESS or intraoral approach,removing dental focus followed with antibiotics would be optimistic choice.展开更多
Objective:To review and evaluate outcomes of patients with aspirin-exacerbated respiratory disease(AERD)following endoscopic sinus surgery and subsequent aspirin desensitization.Methods:Electronic searches of OVID MED...Objective:To review and evaluate outcomes of patients with aspirin-exacerbated respiratory disease(AERD)following endoscopic sinus surgery and subsequent aspirin desensitization.Methods:Electronic searches of OVID MEDLINE(1948 to September 10,2019),EMBASE(1980 to September 10,2019),and PubMed were performed on September 10,2019.A systematic review of the literature was performed using the 2009 PRISMA guidelines.Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery and aspirin desensitization were considered appropriate for inclusion.Publications were written in English and included patients aged 18 years or older.Results:Six studies met inclusion criteria for this systematic review.The primary outcome measure was change in symptom profile measured by patient-reported quality of life scores.The results demonstrate statistically significant improvement in symptoms following endoscopic sinus surgery,with sustained improvement following aspirin desensitization.Revision surgery rates were significantly lower in patients maintained on aspirin therapy.Conclusion:This review suggests that surgery followed by aspirin desensitization results in improvement in both subjective and objective outcome measures.The adjunctive use of aspirin desensitization allows for long-term stability in symptom scores.Recurrence of polyps and worsening symptoms requiring revision surgery occurs when aspirin maintenance therapy is inter-rupted.展开更多
Background and objective: Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following...Background and objective: Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods: The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results: In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But theP value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion: Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.展开更多
<strong>Introduction:</strong> Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacen...<strong>Introduction:</strong> Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. <strong>Objective:</strong> To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. <strong>Method:</strong> Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. <strong>Result:</strong> Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. <strong>Conclusion:</strong> Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.展开更多
Background and objective::Sinus surgery has seen significant changes over the years with advancements in instruments,endoscopes and imaging.This study aimed to use Hospital Episode Statistics(HES)data to review the to...Background and objective::Sinus surgery has seen significant changes over the years with advancements in instruments,endoscopes and imaging.This study aimed to use Hospital Episode Statistics(HES)data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period.We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.Methods::Data from HES was extracted for the years 2010-2019.The operative(OPCS-4)codes relevant to all sinus procedures between E12.1 and E17.9 were analysed.After examination of overall sinus related procedures,further subgroup analysis was performed with regards to open or endoscopic techniques.Results::The total number of sinus procedures performed between 2010 and 2019 was 89,495.There was an increase in endoscopic surgeries by 21.1%and a decrease of open surgeries 35.3%during this time.There was an overall increase in maxillary,frontal and sphenoid sinus procedures,with a decrease in ethmoid sinus and lateral rhinotomy operations.There was an increase in the proportion of endoscopic cases overall by 5.7%and for all sinuses individually.Conclusion::Overall,we see an increase in sinus surgery over the last 9 years from 2010 to 2019.These findings are in keeping with our initial hypotheses.Although our data set is limited by coding,and lack of patient factors,it represents most,if not all,of the data in England over a large study period.It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.展开更多
The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal poly...The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.展开更多
Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As...Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.展开更多
Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadave...Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.展开更多
Odontogenic sinusitis(ODS)is more common than historically reported,and is under-represented in the sinusitis literature.ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental...Odontogenic sinusitis(ODS)is more common than historically reported,and is under-represented in the sinusitis literature.ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures,and most commonly presents unilaterally.ODS clinical features,microbiology,and diagnostic and treatment paradigms are also distinct from rhinosinusitis.ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers,and clinicians must be able to suspect and confirm the condition.ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography,overt maxillary dental pathology on computed tomography,unilateral middle meatal purulence on nasal endoscopy,foul smell,and odontogenic bacteria in sinus cultures.Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence,edema,or polyps.Dental providers should confirm dental pathology through appropriate examinations and imaging.Once ODS is confirmed,a multidisciplinary shared decision-making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions.Oral antibiotics are generally ineffective at resolving ODS,especially when there is treatable dental pathology.When both the dental pathology and sinusitis are addressed,resolution can be expected in 90%-100%of cases.For treatable dental pathology,while primary dental treatment may resolve the sinusitis,a significant percentage of patients still require endoscopic sinus surgery.For patients with significant sinusitis symptom burdens,primary endoscopic sinus surgery is an option to resolve symptoms faster,followed by appropriate dental management.More well-designed studies are necessary across all areas of ODS.展开更多
Objectives:Resection of the middle turbinate(MT)during endoscopic sinus surgery(ESS)has been a controversial topic among otolaryngologists for many years.Some studies advocate resection and have shown improved outcome...Objectives:Resection of the middle turbinate(MT)during endoscopic sinus surgery(ESS)has been a controversial topic among otolaryngologists for many years.Some studies advocate resection and have shown improved outcomes postoperatively,while studies favoring preservation show a decreased incidence of postoperative complications.The current practice pattern regarding this subject is unknown.The goal of this study was to learn the current practice of MT resection during ESS among otolaryngologists.Method:We performed an electronic anonymous survey of practicing otolaryngologists.Results:We found that the majority of the 252 responders stated that they will perform an MT resection in certain clinical situations,while there is a small subset that advocates never resecting the MT for inflammatory sinus disease(n=6,2.4%).Participants were significantly more likely to perform MT resection in patients undergoing revision compared to primary ESS for all conditions included.The complication of greatest concern among participants was iatrogenic frontal sinus obstruction,while empty nose was of the least concern.The majority of participants responded that MT resection was of extreme or moderate benefit for improved visualization and drug delivery postoperatively.When compared to general otolaryngologists,fellowship-trained rhinologists were less concerned about potential complications following MT resection and were more likely to perceive an extreme or moderate benefit from turbinate resection postoperatively.Conclusion:There remains debate over MT resection among otolaryngologists,but the results of this study show that the majority of participating otolaryngologists will perform a resection in certain clinical situations.展开更多
The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative i...The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.展开更多
Pediatric skull base lesions are complex and challenging disorders.Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team.Adult ...Pediatric skull base lesions are complex and challenging disorders.Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team.Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements,multidisciplinary team approaches,and continued innovation.Similar principles continue to advance the care delivered to the pediatric population.The approach and management of these lesions varies considerably based on tumor anatomy,pathology,and surgical goals.An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.展开更多
文摘Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.
文摘Purpose:Odontogenic maxillary sinusitis(OMS)is frequently encountered in otorhinolaryngologists'clinical practice.Endoscopic sinus surgery(ESS)instead of surgeries in intraoral approach has been widely applied among OMS.However appropriate treatments due to the causes of the OMS as well as the outcome have been less investigated,meanwhile the inherent incidence of OMS may be still on the rise.This study was designed to conclude our systematic treatment within follow-up examination.Materials and methods:In this retrospective study patients confirmed diagnosis of OMS who had systematic follow-up examinations were analyzed.Medical histories of otorhinolaryngologists and dentists were reviewed as well as preoperative examination protocols.Result:Consecutive 29 Patients(10 women,19 men)were included.41.4%(12/29)patients experienced facial pain as the most frequent symptom.69.0%(20/29)patients admitted firstly to otorhinolaryngologists,13 patients were treated with surgical procedure while 7 patients lacking of surgical indication were transferred to dentists.31.0%(9/29)patients were advised by dentist for being suspected of maxillary sinusitis,including 7 patients suffered from sinonasal complications of dental treatment(SCDT).Conventional dental treatment(root planning,root end surgery,extraction)was the most common cause.Follow up for a mean of 15.1(ranges from 6 to 96)months showed 29 patients maintaining open maxillary ostium on endoscopic examination or improving on CT except recurrence in one patient with SCDT.Conclusion:Patients should be inspected by dentists carefully when the patient has symptoms rather than sinusitis-like symptoms,the possibility of OMS should always be considered.Dental examination can help to determine whether a maxillary sinusitis has a dental origin,periodontitis and odontogenic radicular cysts still are the most common causes comparing with iatrogenic factors.Patients treated with ESS showed better tolerance and fewer postsurgical complications.Not all patients with OMS including SDCT need definitely surgery whether ESS or intraoral approach,removing dental focus followed with antibiotics would be optimistic choice.
文摘Objective:To review and evaluate outcomes of patients with aspirin-exacerbated respiratory disease(AERD)following endoscopic sinus surgery and subsequent aspirin desensitization.Methods:Electronic searches of OVID MEDLINE(1948 to September 10,2019),EMBASE(1980 to September 10,2019),and PubMed were performed on September 10,2019.A systematic review of the literature was performed using the 2009 PRISMA guidelines.Studies with both preoperative and postoperative data for patients with AERD who underwent sinus surgery and aspirin desensitization were considered appropriate for inclusion.Publications were written in English and included patients aged 18 years or older.Results:Six studies met inclusion criteria for this systematic review.The primary outcome measure was change in symptom profile measured by patient-reported quality of life scores.The results demonstrate statistically significant improvement in symptoms following endoscopic sinus surgery,with sustained improvement following aspirin desensitization.Revision surgery rates were significantly lower in patients maintained on aspirin therapy.Conclusion:This review suggests that surgery followed by aspirin desensitization results in improvement in both subjective and objective outcome measures.The adjunctive use of aspirin desensitization allows for long-term stability in symptom scores.Recurrence of polyps and worsening symptoms requiring revision surgery occurs when aspirin maintenance therapy is inter-rupted.
文摘Background and objective: Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.Methods: The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.Results: In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But theP value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.Conclusion: Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.
文摘<strong>Introduction:</strong> Paranasal sinuses mucoceles are benign, epithelial lined, mucus filled lesions, causing destruction of the adjacent sinus walls, and with further gradual extension to adjacent structures, serious morbidities and mortalities may occur. <strong>Objective:</strong> To emphasize on the efficacy of endonasal endoscopic marsupialization in the treatment of paranasal sinus mucoceles. <strong>Method:</strong> Retrospective descriptive study on paranasal sinus mucocele cases operated on endoscopically by the author (AAM), in the 10-year-period from to 2009-2019. <strong>Result:</strong> Total of 23 cases were included, 16 were males and 7 females, age ranging between 14 - 76 years, with a mean age of 45 years Location of mucoceles varied between: Frontal 7 cases (30%), Fronto-ethmoidal 6 cases (26%), Isolated Ethmoidal accounted for 3 cases (13%), sphenoidal 4 cases (17%), maxillary were 3 cases (13%) all of the 23 cases underwent endonasal endoscopic complete marsupialization, none of them required combination with external approach in-spite of different locations and complications, with no recurrence in a mean follow up period of 2.4 years. <strong>Conclusion:</strong> Endonasal endoscopic approach is a safe, efficient approach in the treatment of most paranasal sinus mucocele case in their different presentations and locations.
文摘Background and objective::Sinus surgery has seen significant changes over the years with advancements in instruments,endoscopes and imaging.This study aimed to use Hospital Episode Statistics(HES)data to review the total number of sinus related procedures performed in both adults and children across England and identify whether there were any trends across the study period.We predicted an increase in endoscopic sinus procedures with a decline in open approaches to the paranasal sinuses.Methods::Data from HES was extracted for the years 2010-2019.The operative(OPCS-4)codes relevant to all sinus procedures between E12.1 and E17.9 were analysed.After examination of overall sinus related procedures,further subgroup analysis was performed with regards to open or endoscopic techniques.Results::The total number of sinus procedures performed between 2010 and 2019 was 89,495.There was an increase in endoscopic surgeries by 21.1%and a decrease of open surgeries 35.3%during this time.There was an overall increase in maxillary,frontal and sphenoid sinus procedures,with a decrease in ethmoid sinus and lateral rhinotomy operations.There was an increase in the proportion of endoscopic cases overall by 5.7%and for all sinuses individually.Conclusion::Overall,we see an increase in sinus surgery over the last 9 years from 2010 to 2019.These findings are in keeping with our initial hypotheses.Although our data set is limited by coding,and lack of patient factors,it represents most,if not all,of the data in England over a large study period.It is therefore useful to add to previous studies when demonstrating the increasing popularity of endoscopic sinus surgery over open procedures.
文摘The current literature lacks strong guidelines regarding surgical management of patients with aspirin-exacerbated respiratory disease(AERD),who present with the clinical triad of chronic rhinosinusitis with nasal polyposis(CRSwNP),bronchial asthma,and aspirin/nonsteroidal anti-inflammatory drug intolerance.To further define the effectiveness of sinus surgery in treating AERD patients,this review article discusses current evidence regarding outcomes associated with more extensive surgery,the benefits of frontal sinus surgery on polyposis,and the role of Draf III intervention.Numerous studies suggest that Draf III frontal sinusotomy may be an efficacious early intervention due to increased neo-ostial patency and subsequent distribution of topical therapies.Future studies that further investigate the efficacy and safety of extensive surgery in AERD patients are warranted.
文摘Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.
文摘Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.
文摘Odontogenic sinusitis(ODS)is more common than historically reported,and is under-represented in the sinusitis literature.ODS is distinct from rhinosinusitis in that it is infectious sinusitis from an infectious dental source or a complication from dental procedures,and most commonly presents unilaterally.ODS clinical features,microbiology,and diagnostic and treatment paradigms are also distinct from rhinosinusitis.ODS evaluation and management should generally be conducted by both otolaryngologists and dental providers,and clinicians must be able to suspect and confirm the condition.ODS suspicion is driven by certain clinical features like unilateral maxillary sinus opacification on computed tomography,overt maxillary dental pathology on computed tomography,unilateral middle meatal purulence on nasal endoscopy,foul smell,and odontogenic bacteria in sinus cultures.Otolaryngologists should confirm the sinusitis through nasal endoscopy by assessing for middle meatal purulence,edema,or polyps.Dental providers should confirm dental pathology through appropriate examinations and imaging.Once ODS is confirmed,a multidisciplinary shared decision-making process should ensue to discuss risks and benefits of the timing and different types of dental and sinus surgical interventions.Oral antibiotics are generally ineffective at resolving ODS,especially when there is treatable dental pathology.When both the dental pathology and sinusitis are addressed,resolution can be expected in 90%-100%of cases.For treatable dental pathology,while primary dental treatment may resolve the sinusitis,a significant percentage of patients still require endoscopic sinus surgery.For patients with significant sinusitis symptom burdens,primary endoscopic sinus surgery is an option to resolve symptoms faster,followed by appropriate dental management.More well-designed studies are necessary across all areas of ODS.
文摘Objectives:Resection of the middle turbinate(MT)during endoscopic sinus surgery(ESS)has been a controversial topic among otolaryngologists for many years.Some studies advocate resection and have shown improved outcomes postoperatively,while studies favoring preservation show a decreased incidence of postoperative complications.The current practice pattern regarding this subject is unknown.The goal of this study was to learn the current practice of MT resection during ESS among otolaryngologists.Method:We performed an electronic anonymous survey of practicing otolaryngologists.Results:We found that the majority of the 252 responders stated that they will perform an MT resection in certain clinical situations,while there is a small subset that advocates never resecting the MT for inflammatory sinus disease(n=6,2.4%).Participants were significantly more likely to perform MT resection in patients undergoing revision compared to primary ESS for all conditions included.The complication of greatest concern among participants was iatrogenic frontal sinus obstruction,while empty nose was of the least concern.The majority of participants responded that MT resection was of extreme or moderate benefit for improved visualization and drug delivery postoperatively.When compared to general otolaryngologists,fellowship-trained rhinologists were less concerned about potential complications following MT resection and were more likely to perceive an extreme or moderate benefit from turbinate resection postoperatively.Conclusion:There remains debate over MT resection among otolaryngologists,but the results of this study show that the majority of participating otolaryngologists will perform a resection in certain clinical situations.
文摘The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.
文摘Pediatric skull base lesions are complex and challenging disorders.Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team.Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements,multidisciplinary team approaches,and continued innovation.Similar principles continue to advance the care delivered to the pediatric population.The approach and management of these lesions varies considerably based on tumor anatomy,pathology,and surgical goals.An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.
