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Objective: Chronic rhinosinusitis (CRS) has been associated with comorbid depression, yet the prevalence of depression among all patients with CRS is not well described. The Patient Health Questionnaire-9 (PHQ-9), a validated instrument for diagnosing depression, has been used to assess depression in a variety of clinical settings. PHQ-9 scores ≥10 are the threshold for a depression diagnosis. The purpose of this study was to assess the prevalence of depression in a rhinology practice and compare the PHQ-9 with the 22-item Sinonasal Outcome Test (SNOT-22).Study Design: Retrospective chart review.Setting: Tertiary rhinology practice.Subjects and Methods: During the 2-month period ending April 30, 2018, all rhinology patients were asked to complete the PHQ-9 and SNOT-22.Results: Among 216 patients, 46 (21.3%) had a self-reported history of depression, and 39 (18.1%) had a PHQ-9 score ≥10. Of the 39 patients screening positive for depression, 18 (41.9%) had no history of depression. Comparison of PHQ-9 with overall SNOT-22 score had a Pearson's coefficient of 0.632 (P < .005). Logistic regression showed that the highest 2 quintiles of SNOT-22 scores had an odds ratio of 60.6 (95% CI, 9.7-378.3) for a positive depression screen (PHQ-9 score ≥10).Conclusion: Depression rates (estimated by PHQ-9 responses) among rhinology patients are similar to chronic disease populations; depression may be underdiagnosed in rhinology patients. Higher SNOT-22 scores were associated with higher PHQ-9 scores. Further studies are warranted to understand the impact of comorbid conditions of depression and CRS in patient quality of life. [ABSTRACT FROM AUTHOR]

Objective: High-throughput DNA sequencing of the paranasal sinus microbiome has potential in the diagnosis and treatment of sinusitis. The objective of this study is to evaluate the use of high-throughput DNA sequencing to diagnose sinusitis of odontogenic origin.Study Design: Case series with chart review.Setting: Single tertiary care academic medical center.Subjects and Methods: A chart review was performed of DNA sequencing results from the sinus aspirates obtained under endoscopic visualization in 142 patients with sinusitis. The identification of any potentially pathogenic bacteria associated with oral flora in a sample was classified as a positive result for sinusitis of odontogenic etiology. The sensitivity, specificity, and predictive values of using high-throughput DNA sequencing to diagnose sinusitis of odontogenic etiology were determined, with the patient's computed tomography sinus scan as the reference standard. On computed tomography scans, an odontogenic source was determined by the presence of a periapical lucency perforating the schneiderian membrane.Results: Seven of the 142 patients enrolled in this study had an odontogenic source based on computed tomography scans. Relative to this reference standard, high-throughput DNA sequencing produced a sensitivity of 85.7% (95% CI, 42.1%-99.6%), a specificity of 81.5% (95% CI, 73.9%-87.6%), a positive predictive value of 19.4% (95% CI, 13.1%-27.7%), and a negative predictive value of 99.1% (95% CI, 94.7%-99.9%).Conclusion: This study supports the use of high-throughput DNA sequencing in supplementing other methods of investigation for identifying an odontogenic etiology of sinusitis. [ABSTRACT FROM AUTHOR]

Objective Allergic fungal rhinosinusitis (AFRS) is a clinical subtype of chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by eosinophilic mucin, evidence of fungal elements within the mucin, fungal-specific type I hypersensitivity, and characteristic computed tomography findings. It remains controversial whether AFRS represents a disease with a unique pathophysiology from chronic rhinosinusitis or is merely a severe form of CRSwNP. The goal of this study was to identify molecular features unique to AFRS. Study Design Cross-sectional case-control. Setting Single academic tertiary referral institution. Subjects and Methods Subjects included 86 patients undergoing endoscopic sinus surgery: CRSwNP (n = 34), AFRS (n = 37), and healthy controls (n = 15). Pathway and correlation analyses were performed with whole-genome microarray data for study patients undergoing surgery for recalcitrant chronic rhinosinusitis. Our findings were confirmed with quantitative polymerase chain reaction and immunohistochemical studies. Results AFRS was uniquely characterized by a pronounced association with adaptive T helper 2-associated immune gene expression. AFRS exhibited altered expression of proteins associated with secretory salivary peptides-namely, histatin, a peptide with known antifungal activity in the oral cavity. Furthermore, the expression of histatins correlated negatively with that of type 2 inflammatory mediators. We confirm the decreased expression of histatins in AFRS when compared with CRSwNP by quantitative polymerase chain reaction and localized its expression to a submucosal cell population. Conclusion There exist clear molecular profiles that distinguish AFRS from CRSwNP. This divergence translates into an altered ability to control fungal growth and may in part explain some of the phenotypical differences between CRSwNP and AFRS. [ABSTRACT FROM AUTHOR]

Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices. Conclusion Expert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted to evaluate optical rhinometry (ORM) by using nasal provocation testing (NPT) for the diagnosis of fungal allergic rhinitis (AR). In the study, patients with clinical history of AR were exposed to Alternaria or Aspergillus antigens; and baseline measurements were taken with an optical and acoustic rhinometer (AcR). The study concluded that fungal antigens did not lead to early phase changes in blood flow in fungal-sensitive AR patients.

Abstract: Objective: To evaluate optical rhinometry (ORM) as an objective evaluation of nasal patency using nasal provocation testing with Dermatophagoides farinae (Df) as compared with acoustic rhinometry. Study Design: Prospective pilot. Setting: Academic rhinologic practice. Subjects and Methods: Five adult healthy controls and five adult subjects with allergic rhinitis (AR) underwent nasal provocation testing with increasing concentrations of Df while undergoing ORM. The minimum concentration of Df causing a positive reading was recorded. Nasal cross-sectional area was measured before and after testing using acoustic rhinometry. Nasal patency was assessed subjectively after each challenge with the visual analogue scale. Results: The median amount of Df causing a positive response on ORM was less in AR patients as compared to healthy controls, at 5000 AU/mL and greater than 10,000 AU/mL, respectively. There was a statistically significant correlation between the change in optical density in ORM and subjective nasal congestion after increasing Df challenges (r = 0.63; P = 0.0007). Similarly, there was a statistically significant correlation between change in optical density by ORM and both minimum cross-sectional areas as measured by acoustic rhinometry (r = −0.60, P = 0.03; and r = −0.64, P = 0.02, respectively). Conclusion: This is the first study to show a correlation between optical rhinometry and acoustic rhinometry during nasal provocation testing with Df. In addition, the data support a correlation of optical rhinometry to subjective symptoms of nasal congestion. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with Df. [Copyright &y& Elsevier]

Abstract: Objective: Optical rhinometry is a new method that quantifies light extinction in optical density to assess nasal blood volume as a measure of nasal patency. The purpose of this study is to evaluate optical rhinometry as an objective evaluation of nasal patency using nasal provocation testing with histamine and oxymetazoline. Study Design: Prospective pilot. Setting: Academic tertiary rhinologic practice. Subjects and Methods: Convenience sample of five adult subjects with allergic rhinitis and five adult normal subjects who underwent challenge with histamine and oxymetazoline. Patients underwent challenge with increasing concentrations of histamine to determine the amount of histamine needed to cause a positive optical rhinometry reading. The same subjects then underwent histamine challenge with this amount followed by oxymetazoline. Nasal patency was assessed subjectively after each challenge with the visual analog scale. Results: The median histamine amount needed to cause a positive response was statistically lower in allergic rhinitis as compared with nonallergic subjects at 150 μg and 300 μg, respectively (P = 0.04). When comparing the optical rhinometry with subjective nasal congestion after histamine and oxymetazoline challenges, there was a statistically significant correlation with r = 0.79 (P = 0.00003). Conclusion: This initial study demonstrates a correlation between subjective symptoms of nasal patency and objective measurements with the optical rhinometer. Less histamine amount necessary to incite nasal congestion in allergic rhinitis suggests that these patients may be primed to the effects of histamine. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with histamine and oxymetazoline. [Copyright &y& Elsevier]

Abstract: Objective: The objectives of this study were to 1) evaluate anatomical relationships and 2) develop technical correlates for endoscopic anterior skull base (ASB) surgery. Study Design: Cadaver study. Setting: Minimally invasive surgery laboratory. Subjects and Methods: Ten adult fresh-frozen cadaver heads were dissected from December 2006 to December 2007. The endoscopic trans-cribriform, trans-ethmoid approach to the anterior cranial base was refined over these consecutive dissections. Endoscopic orientation along the ventral axis was assessed with 0°, 30°, and 70° rigid telescopes. Anatomical dimensions of the ASB window were measured in the anteroposterior (posterior table of frontal sinus to planum sphenoidale) and transverse (orbit-to-orbit) dimensions at the anterior ethmoid artery (AEA) and posterior ethmoid artery (PEA). Results: Endoscopic cadaveric dissections confirmed technical feasibility of ASB surgery and greatly enhanced understanding of ASB anatomical concepts. The 30° rigid endoscope provided the most optimal view from the frontal sinus to the planum sphenoidale with the least distortion, relative to 0° and 70° scopes. Careful identification of the AEA and PEA was requisite for proper orientation at the ASB. The posterior one third of the ASB was thickest and always required drilling for resection. The mean boundaries of the ASB window were 33.7 mm (anterior to posterior) and 23.5 and 19.1 mm at the AEA and PEA (orbit to orbit), respectively. Conclusion: This prospective cadaveric study outlined key correlates for endoscopic ASB surgery. It serves to highlight the requisite technical steps and anatomical dimensions when the trans-nasal endoscopic route is employed for ASB pathology. [Copyright &y& Elsevier]

Abstract: Objective: To characterize the endoscopic anatomy of the sphenoid sinus and the adjacent clivus and cavernous sinus, and to review patient outcomes for neoplasms in this region. Study Design: Cadaver dissection and chart review. Setting: Cadaver laboratory and tertiary care center. Subjects and Methods: Fresh-frozen cadaver heads were dissected to study the endoscopic anatomy of the sphenoclival region. Retrospective chart review of patients undergoing endoscopic resection of sphenoclival neoplasms between 2000 and 2008 was performed. Results: Transnasal endoscopic access to the sphenoid sinus was obtained in 10 cadaver heads. A clival window with mean dimensions of 1.4 cm × 1.7 cm was created. Through the clival window, identification and dissection of the basilar and vertebral arteries, mamillary bodies, third ventricle, cranial nerves III through VI, and cervical rootlets were possible. Nineteen patients with mean age of 56.2 years were treated. The most common pathologies were inverted papilloma (5), chordoma (4), squamous cell carcinoma (2), and adenoid cystic carcinoma (2). None of the patients required adjunct craniotomies. Nine patients received adjuvant therapies. Thirteen (68.4%) patients had no evidence of disease, five (26.3%) patients were alive with disease, and one (5.3%) patient died of disease at mean follow-up of 32.6 months. Conclusion: The sphenoclival region poses a significant surgical challenge given its central location at the skull base and proximity to critical structures. This study demonstrates that transnasal endoscopic access to the sphenoclival region is technically feasible and allows successful surgical extirpation of tumors with a low complication rate and acceptable patient outcomes. [Copyright &y& Elsevier]

Abstract: Objective: To study the presence of biofilm formation in humans with chronic suppurative otitis media (CSOM). Study Design: Cross-sectional study. Setting: Tertiary academic hospital. Subjects and Methods: Patients undergoing middle ear surgery between July 2006 and March 2008. Tissue samples were obtained from 25 patients, of which 20 specimens were successfully processed for this study. The remaining samples were not analyzed due to sample damage or loss during preparation. Of the 20 specimens studied, 10 were harvested as the experimental group from patients with CSOM and the other 10 harvested as controls from patients undergoing otologic surgery for acoustic neuroma, cochlear implant, or routine tympanoplasty. Ages ranged from 26 to 74 years (mean 45 yrs). Male-to-female ratio was 2:3. Scanning electron microscopy and confocal laser scanning microscopy were used to identify the presence of biofilms. Live-dead staining was used to assess whether bacteria present were viable. The outcome measured was the presence of adherent biofilms on middle ear mucosa. Results: Biofilms were present in six of 10 samples (60%) from the CSOM group, but only in one of 10 control samples (10%). Comparative analysis revealed a statistically significant difference (P < 0.05) in the presence of biofilms in specimens from the CSOM group versus the control group. Conclusion: Biofilms were statistically more common in patients with CSOM compared with control patients. [Copyright &y& Elsevier]

Objective: Compare anesthesia with sevoflurane/remifentanyl (SR) to total intravenous anesthesia with propofol/remifentanyl (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in the following parameters: 1) effects on blood flow to the mucosa; 2) amount of blood loss; and 3) surgical field visualization score (SFS). Method: A total of 23 adults undergoing endoscopic sinus surgery for chronic rhinosinusitis within a 6‐month period were randomized to receive SR or PR. The SFS was based on the Boezaart scale. Sinonasal mucosa blood flow was measured by optical rhinometry (OR). Blood loss was recovered with the Neptune Waste Management System. Results: The groups were evenly distributed, with similar clinical characteristics and Lund‐Mackay score. Median blood loss was 105 cc in the PR group and 180 cc in the SR group (P =. 15). The length of surgery was 134 minutes in the PR group and 177 minutes in the SR group (P =. 19). The average SFS was 1.6 in the PR group and 2.0 in the SR group (P =. 22). OR showed a decrease in blood flow to ‐0.1 OR units from the beginning of surgery in the PR group compared with ‐0.4 OR units in the SR group (P =. 02). Conclusion: Our preliminary results suggest that PR appears to be associated clinically to a decreased blood loss, improved surgical field visualization, and decreased operative time in endoscopic sinus surgery. We showed however that blood flow to the nasal cavity appears to be increased with TIVA. [ABSTRACT FROM AUTHOR]

Program Description: Patients with nonallergic rhinitis (NAR) are commonly seen in an otolaryngologist's practice. These patients may have no allergic triggers, may be negative to routine allergy testing, and are therefore diagnosed with NAR. Recent workgroups both in the United States and internationally have attempted to better classify the pathophysiology and phenotype of patients with NAR, with the goal of facilitating more accurate diagnosis and improved treatment. This panel will review, through brief didactic discussions and case presentations, recent knowledge and current understanding of NAR and will highlight methods to improve the management of these frequently challenging patients. Educational Objectives: (1) Discuss the various pathophysiologies and presentations that are grouped under the diagnostic category of nonallergic rhinitis. (2) Review important elements of the diagnostic workup in evaluating the patient with nonallergic rhinitis. (3) Implement treatment strategies for patients diagnosed with nonallergic rhinitis. [ABSTRACT FROM AUTHOR]

Program Description: Chronic cough is an increasingly important public health concern, accounts for a large number of ambulatory care visits, and often involves a protracted clinical course. Otolaryngologists play a critical role in the care of these patients because of our interdisciplinary approach to the aerodigestive tract and our mastery of many procedures used to evaluate and treat related conditions. This miniseminar will present challenging cases with panel discussion and audience participation to emphasize evidence‐based practice and the "state‐of‐the‐art" for patients with chronic cough. Controversial areas will include prioritization, the use of evidence‐based protocols, and the importance of early diagnosis in value‐based health care. Educational Objectives: (1) Describe evidence‐based treatment guidelines in the evaluation and treatment of chronic cough. (2) Use the spectrum of common and uncommon causes of chronic cough with an appreciation of the underlying physiology. (3) Evaluate these complex patients, perform objective testing when indicated, and prescribe appropriate pharmacotherapy for patients with chronic cough. [ABSTRACT FROM AUTHOR]