Search

Objective: To assess the perceived symptoms caused by the sinuses as defined by otolaryngology patients and clinicians. Study Design: Multi‐institutional cross‐sectional study. Setting: Six academic outpatient otolaryngology practices. Methods: We performed a multi‐institutional, cross‐sectional study using a semantics‐based questionnaire. Consecutive patients were enrolled at 6 academic otolaryngology centers from June 2020 to May 2021. The primary outcome examined patient and provider definitions for the symptoms caused by the sinuses from a list of 28 proposed terms covering 6 general categories. These data were also collected from otolaryngology faculty at the same institutions. Results: Responses were obtained from 451 patients (54% female, mean age 48.3 years) and 29 otolaryngologists (38% female, mean age 37.4 years). Patients selected a median of 12 terms, compared to 8.5 for otolaryngologists. Among patients, the most frequently selected symptom domains were mucus (419, 92.9%), airflow (412, 91.4%), and pain (389, 86.3%). Compared to clinicians, patients more frequently selected symptoms related to the ear (difference, 48.3%; 95% confidence interval [CI], 34.8%‐59.3%), throat (difference, 35.7%, 95% CI, 22.0%‐47.5%), systemic (difference, 34.4%, 95% CI, 21.2%‐46.0%), mucus (difference, 20.5%, 95% CI, 10.2%‐30.6%), and airflow domains (difference, 19.0%, 95% CI, 8.4%‐29.3%). Multiple domains were selected by 98% of patients and 79% of providers. Conclusion: Semantic differences exist between patients and clinicians regarding the symptoms caused by the sinus with patients having a broader range of perceived symptoms. These differences may provide clues to improve communication between otolaryngologists and their patients. [ABSTRACT FROM AUTHOR]

Objective: To review the current literature regarding the role of biologics in the treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP). Data Sources: PubMed/MEDLINE, EMBASE, Cochrane Review, ClinicalTrials.gov Review Methods: We conducted a comprehensive review of the literature on clinical studies investigating the efficacy of emerging biologics in CRSwNP, with a focus on randomized controlled trials. Conclusions: There appears to be promising evidence to support the safety and efficacy of biologics in CRSwNP with and without asthma for select patients. However, additional large-scale randomized studies with longer follow-up are necessary to determine which patients would benefit the most from these novel systemic treatments. Implications for Practice: Chronic rhinosinusitis with nasal polyposis refractory to medical and surgical therapy remains a challenging clinical problem for otolaryngologists. However, emerging biologic therapies may offer a new therapeutic option for such patients with recalcitrant disease. [ABSTRACT FROM AUTHOR]

Airway epithelia express intrinsic antimicrobial and nutrient-sequestering factors, which contribute to the host defense of the respiratory tract. Hepcidin is an endogenous peptide hormone that serves as a key regulator of iron metabolism, and ferroportin and ZIP8 are iron transporters. All exhibit innate antimicrobial activity. The purpose of this pilot study is to determine if molecules involved in iron regulation are expressed within sinus epithelia and to compare levels of expression between patients with and without chronic rhinosinusitis (CRS). Sinus mucosa was obtained from patients with (n = 19) and without (n = 14) CRS. Real-time polymerase chain reaction following RNA extraction was used to quantify expression of hepcidin, ferroportin, and ZIP8 mRNA. Hepcidin, ferroportin, and ZIP8 were all detected in the sinus epithelia of patients with and without CRS. However, only ZIP8 was significantly changed in CRS, with a 2.5-fold mean increase in mRNA expression relative to controls (P =.005). These findings suggest that ZIP8 may play a role in the innate epithelial defense of the paranasal sinuses. [ABSTRACT FROM AUTHOR]

Objective: To analyze the epidemiologic patterns and survival rates for patients with nasopharyngeal carcinoma over the last three decades. Methods: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program tumor registries were used to identify patients with nasopharyngeal carcinoma in the United States from 1973 to 1999. Incidence and survival rates for each decade were then determined according to age, gender, race, histological type, and stage using the SEER statistical program. Results: From 1973 to 1999, 4680 cases of patients with nasopharyngeal carcinoma in the United States were sampled by the NCI /SEER database. Overall incidence rates for each decade essentially remained unchanged over time (0.7/100,000). Asians exhibited the highest incidence rates (3.0–4.2), followed by blacks (0.7–1.1) and then whites (0.4–0.7). In contrast, survival rates have gradually improved over time for all stages and histological types (35.7% 5-year survival in the 1970s vs. 44.1% in the 1980, and 51% in the 1990s). With respect to race, Asians demonstrated the best 5-year survival rate (62.9%) followed by whites (42.6%) and then blacks (36.2%). However, this may be due to histology, because Asians were also found to have a greater proportion of World Health Organization (WHO) type III cases (27.6%) in comparison to the other 2 groups (22.4% for blacks and 15% for whites). Conclusions: Although the incidence rates of nasopharyngeal carcinoma have remained essentially unchanged in the United States in the last 3 decades, survival rates for each stage and histological subtype have exhibited considerable improvement over time. The higher survival rates in Asians may be partially attributed to the more favorable histology (type III) often seen in this group. EBM rating: B-3. [Copyright &y& Elsevier]

: ObjectiveTo compare the efficacy of vascularized bone grafts and bridging mandibular reconstruction plates for restoration of mandibular continuity in patients who undergo free flap reconstruction after segmental mandibulectomy.: Study design and settingA total of 210 patients underwent microvascular flap reconstruction after segmental mandibulectomy. The rate of successful restoration of mandibular continuity in 151 patients with vascularized bone grafts was compared to 59 patients with soft tissue free flaps combined with bridging plates.: ResultsMandibular continuity was restored successfully for the duration of the follow-up period in 94% of patients who received bone grafts compared with 92% of patients with bridging mandibular reconstruction plates. This difference was not statistically significant. In patients who received bone grafts, most cases of reconstructive failure occurred during the perioperative period and were due to patient death or free flap thrombosis. In patients who received bridging plates, all instances of reconstructive failure were delayed for several months and were due to hardware extrusion or plate fracture.: ConclusionsVascularized bone-containing free flaps are preferred for reconstruction of most segmental mandibulectomy defects in patients undergoing microvascular flap reconstruction. However, use of a soft tissue flap with a bridging mandibular reconstruction plate is a reasonable alternative in patients with lateral oromandibular defects when the nature of the defect favors use of a soft tissue free flap.: SignificanceBoth bone grafts and bridging plates represent effective methods of restoring mandibular continuity following segmental mandibulectomy, with the former being the preferred technique for patients undergoing microvascular reconstruction. [Copyright &y& Elsevier]

Program Description: With continual advances in endoscopic instrumentation and technology, a burgeoning number of rhinologic procedures can now be effectively performed in the office environment. Such interventions have provided therapeutic alternatives in the management of primary and recalcitrant sinonasal disease. The purpose of this miniseminar is to describe the principles and techniques involved in successful implementation of rhinologic surgery in the clinic setting. Both fundamental (turbinate surgery, polypectomy) and advanced sinus procedures (frontal sinusotomy, revision surgery) will be discussed. Appropriate setup, anesthesia, and patient selection will be described. This miniseminar will be conducted by academic leading rhinologists using a multimedia, interactive, case‐based format. Educational Objectives: (1) Discuss current office‐based, rhinologic surgical procedures and their role in the management of sinonasal disease. (2) Describe appropriate patient selection, preparation, and optimal anesthetic and surgical techniques for rhinologic clinic procedures. (3) Assess recent technologic innovations and understand their proper application in rhinologic office‐based surgical procedures. [ABSTRACT FROM AUTHOR]