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Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

Background Controversy regarding the usefulness of routine histopathological examination of bilateral nasal polyps removed during endoscopic sinus surgery to identify occult diagnoses still exists. There is a paucity of high-level evidence in the literature. Methods A systematic review and meta-analysis was conducted. Two independent reviewers were used. Pooled proportions and numbers needed to screen were calculated. A cost per life year model was generated based on varying survival benefits and compared to other Canadian screening programs to provide financial context. Results Six studies (n = 3772 patients) were included. Of the 3772 patients, 3751 had a pre-operative clinical and post-operative pathological diagnosis of inflammatory nasal polyps. Agreement proportion was 99.44 %. There were 18 unexpected benign and three unexpected malignant diagnoses identified. This translated to a proportion of 0.48 and 0.08 % respectively. Number needed to screen was 210 and 1258 respectively. Pooled proportion for expected findings using a random effect model was 0.99 (95 % CI = 0.99–1). Pooled proportion for unexpected benign findings using a random effect model was 0.00522 (95 % CI = 0.00133–0.01). Pooled proportion for unexpected malignant findings using a random effect model was 0.00107 (95 % CI = 0.000147–0.00283). The cost to pick up one unexpected benign diagnosis was $14557.2. The cost to pick up 1 unexpected malignant diagnosis was $87204.56. Cost per quality life year calculated ranged from 3211.83 to $64677.58 based on varying assumptions on the survival benefits of identifying an unexpected malignancy. Conclusions Routine pathological examination in screening for neoplasia may be low yield, however, no compelling evidence was found to cease such practice. Surgeons should exercise individual judgment in requesting routine examination. Electronic supplementary material The online version of this article (doi:10.1186/s40463-015-0100-8) contains supplementary material, which is available to authorized users.

To assess patient adherence to nasal spray regimens after endoscopic sinus surgery (ESS) and to study factors that predict adherence.A three-arm, randomized, blinded, controlled trial was conducted at a tertiary care academic hospital, studied via a prospective longitudinal survey, of 60 consecutive chronic rhinosinusitis patients managed with ESS and started on one of three postoperative nasal spray regimens. Structured telephone interviews were conducted after surgery over a 12-month period using a validated questionnaire that assessed both spray adherence and barriers to adherence. Patient demographics, time post-ESS, preoperative Sino-Nasal Outcome Test (SNOT) scores, Lund-Mackay scores, adherence risk factors, and polyp grades were used as covariates with logistic regression.Overall, 57.4% of patients were nonadherent. Logistic regression showed that preoperative SNOT scores (p = .018, 95% CI = 0.84-0.98), time post-ESS (p = .016, 95% CI = 1.02-1.22), and the presence of an adherence risk factor (p = .03, 95% CI = 1.18-26.99) significantly predicted whether a patient was adherent and correctly classified 70.4% of all patients. Age, gender, and nasal spray regimen did not predict adherence (p.05).The majority of patients were nonadherent to post-ESS nasal sprays, irrespective of which nasal spray regimen they were on. Preoperative SNOT scores, time post-ESS, and the presence of an adherence risk factor predicted adherence. With this knowledge, otolaryngologists can selectively employ strategies to improve adherence in high-risk patients and possibly improve ESS outcomes.

A deviated septum can be corrected by either a conventional "open" or endoscopic approach. Controversy exists regarding comparative outcomes between these two techniques. Our objective was to compare the two according to subjective and objective criteria.Prospective, single-blinded, randomized, controlled trial.Over a 6-month period, all patients diagnosed with a septal deviation meeting strict inclusion/exclusion criteria were recruited. Patients were randomly assigned to either the conventional or the endoscopic group. Outcome measures included surgical time, intraoperative complications, and pre- and postoperative data from the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Chi-square and t-tests were used for statistical analyses.Sixty-three patients were enrolled in the study: 32 in the endoscopic group and 31 in the conventional group. There were subjective postoperative improvements in the NOSE scores across all participants and within both groups (endoscopic: preoperative mean score = 14.7, postoperative mean score = 7.4, p.05; conventional: preoperative mean score = 15.2, postoperative mean score = 6.3, p.05), with no differences found between groups (p = .61). However, objective outcomes such as operative time (p.001) and intraoperative complications (p = .01) favoured the endoscopic group.The endoscopic approach for septoplasty may be considered superior to the traditional approach for the correction of septal deviation.

The purpose of our article is to review the use of the DuraSeal Sealant System (Confluent Surgical Inc., Waltham, MA) in the repair of complex cerebrospinal fluid (CSF) leaks in endoscopic skull-base surgery.Retrospective chart review.London Health Sciences Centre.A database of endoscopic skull-base cases between 2007 and 2009 that involved CSF leakage repaired with DuraSeal was created. Demographic data and operative reports were collected and analyzed qualitatively.Recurrence of CSF leak after repair.Five cases were identified that met study criteria. In four of the five cases, the repair was successful. There were no complications related to DuraSeal use. Comparison to a subset of patients using Tisseel Fibrin Sealant (Baxter, Toronto, ON) for repair did not show a significant difference in failure rate (χ2 = 0.029, p = .858).There are a variety of techniques described to repair CSF rhinorrhea, with various studies demonstrating the advantages of using tissue glues in CSF leak repairs. We used DuraSeal in five patients to enhance graft strength and form a watertight seal. The system was effective in the majority of patients. Our study is the first to report on endoscopic endonasal repair of CSF leaks using DuraSeal.

Many Canadians use complementary and alternative medicines (CAMs) to treat their chronic diseases. The objective of this study was to report patients' use of CAM for chronic rhinosinusitis (CRS) and to determine factors predictive of CAM use.A cross-sectional survey was conducted. Self-report questionnaires were administered to patients with CRS using strict inclusion and exclusion criteria. The questionnaire included demographic information, questions pertaining to disease severity, and CAM use for CRS treatment. Statistical analysis was used to compare gender, age range, symptom duration, pharmacotherapy use, and surgical frequency among CAM users and nonusers. A binomial logistic regression model was developed to predict CAM use. Secondary outcome measures included factors predictive of CAM use, type of CAM used, and reasons for using CAM.Data were obtained from 288 patients. Forty-five respondents (15.6%) had used CAM as a treatment for their CRS. CAM users were more likely to be females and more likely to have used each class of pharmacotherapy. On logistic regression, female gender and use of nasal corticosteroids were predictive of CAM use.The use of CAM as treatment of CRS is common. Females and those who have used the various classes of pharmacotherapy are more likely to use CAM. Both female gender and nasal corticosteroid use are predictive of CAM use. Physicians should routinely inquire about CAM use from their patients with CRS.

Multiple options are available for the treatment of snoring. Our objective was to evaluate a palatal implant system in the treatment of snoring caused specifically by retrovelar collapse.Prospective long-term study comparing snoring outcomes pre- and post-soft palate implantation.Snoring patients without significant sleep apnea were offered palatal implantation after assessment via strict inclusion/exclusion criteria. Snoring severity was rated by the bed partner, in a longitudinal fashion, using a Likert scale both in the preoperative and postoperative settings. Paired Student t-tests were used to compare the mean snoring severity preoperatively and at different points of time postoperatively up to 1 year and to compare patient's body mass indices over the study timeline.Data were obtained from 25 patients over a follow-up time of 1 year, for a total of 75 implants. A statistically and clinically significant improvement in the snoring was noted over the 52-week time period of the study in our patient population (mean preoperative score = 9.5, mean 52-week postoperative score = 5.0; p.001). Body mass index did not significantly change over the duration of the study.In our patient population, soft palate implantation was a safe and effective technique for achieving a subjective improvement in the intrusiveness of snoring as noted by the bed partner.