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Objective: The pathophysiology of empty nose syndrome (ENS) remains unclear despite significant research. The pathophysiologic mechanism of ENS was systematically reviewed. Data Sources: MEDLINE and Embase. Review Methods: Data were systematically reviewed for studies that provided original data on pathophysiology. Results: A total of 2476 studies were screened, and 19 met the inclusion criteria: 13 case-control and 6 cross-sectional. Nine pathophysiologic themes were identified. • Demographics: ENS symptoms had no relationship with climatic factors. • Symptomatology: ENS patients demonstrated high symptom severity. • Mental health: Anxiety and depression including hyperventilation were reported in >50% of ENS patients and correlated with ENS symptom severity. • Anatomic features: Structural changes in response to turbinate surgery were similar between ENS and non-ENS patients. • Airflow analysis: Airflow parameters were similar between ENS and non-ENS patients after turbinate surgery. On computational fluid dynamic analysis, differences were found on multiple outcomes. • Diagnostic testing: The menthol detection test was impaired in ENS, and cotton placement in the airway improved ENS symptoms. • Cognitive function: Functional magnetic resonance imaging showed activation in emotional processing area during breathing. • Olfactory function: Subjective impairment was reported in ENS, but quantitative measures were similar to non-ENS patients. • Mucosal physiology/innate immunity: Turbinate histopathology in ENS showed a tissue-remodeling pattern. Nasal nitric oxide level was lower in ENS patients. Conclusion: There is evidence of high comorbid mental health disorders in ENS patients. An abnormal trigeminal-thermoreceptor response may be present in some patients. The influence of altered airflow and the evidence of surgery as the cause for ENS are unclear. [ABSTRACT FROM AUTHOR]

Objective: To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. Data Sources: Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles. Review Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis. Results: A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%). Conclusion: The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis. [ABSTRACT FROM AUTHOR]

Objectives: Surgical trainee burnout has gained attention recently as a significant factor leading to poorer quality of patient care, decreased productivity, and personal dysfunction. As a result, we aimed to determine the prevalence and associated risk factors for burnout among otolaryngology-head and neck surgery (OHNS) trainees in Australia.Study Design: Cross-sectional survey.Setting: National cohort of accredited OHNS trainees in Australia.Subjects and Methods: Participants completed the Maslach Burnout Inventory (MBI). Trainee burnout was defined if any threshold of the 3 MBI domains-emotional exhaustion, depersonalization, or personal accomplishment-reached an established high threshold. Demographic data on potential predictors of burnout, such as stressors, workload, satisfaction, and support systems, were collected from survey responses. Predictors were compared with the burnout status.Results: Of 67 OHNS trainees, 60 responded (66.7% men). Burnout was common among respondents, with 73.3% suffering from burnout in at least 1 of the 3 MBI domains (70.0%, emotional exhaustion; 46.7%, depersonalization; 18.3%, personal accomplishment). Trainee burnout was significantly influenced by training location (chi-square, P = .05), living geographically apart from social supports (odds ratio [OR], 3.49; chi-square, P = .007), number of years trained rurally or away from social supports (Kendall's tau-B, P = .03), difficulty balancing work and nonwork commitments (OR, 10.0; chi-square, P = .03), training negatively affecting their partner or family (OR, 14.30; chi-square, P = .05), and feeling uncomfortable approaching a supervisor (OR, 2.50; chi-square, P < .0001).Conclusion: Burnout was found to be very common among OHNS trainees in Australia. The statistically significant predictors identified should be addressed to minimize trainee burnout. [ABSTRACT FROM AUTHOR]

Objective: Olfactory neuroblastoma and the management of neck disease has posed considerable challenges to the treating physician. The aims of the study were to determine the incidence and factors influencing neck disease and to identify at-risk patients with cervical node-negative disease at presentation.Study Design: Multicenter case series with retrospective chart review.Setting and Subjects: In sum, 113 patients with a histopathologic diagnosis of olfactory neuroblastoma across 6 tertiary hospitals in Australia and the United States.Methods: Treatment modalities for the primary site and neck included surgery, radiotherapy, and combined therapy. Treatment outcomes were measured in relation to date of primary treatment, and long-term follow-up was recorded. Disease-free survival was calculated as time for patients to develop delayed neck disease following primary treatment.Results: A total of 113 patients (46 females, 49.7 ± 13.2 years) were identified with a median follow-up of 41.5 months (interquartile range, 58.2); 7.1% of patients presented with primary neck disease, while 8.8% of patients presented with delayed neck disease. Neck disease was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ(2) = 5.66, P = .13). Histologic grade was higher in patients with primary neck disease (χ(2) = 16.22, P = .001). Positive surgical margins were associated with a higher risk of delayed neck disease as compared with clear surgical margin (17.9% vs 5%, P = .034).Conclusion: Neck metastasis is an important clinical consideration for olfactory neuroblastoma at presentation and in surveillance. Primary treatment of the neck could be considered in select patients. Long-term surveillance of the neck and primary site is essential. [ABSTRACT FROM AUTHOR]

Objective. To critically and systematically review the data available on the sinonasal application of nasal nitric oxide measurement, particularly its use as a diagnostic, prognostic, or treatment effect indicator.Data Sources. EMBASE 1980 to February 10, 2010; Medline 1950 to February 10, 2010; Cochrane Collaboration database; NHS Evidence Health Information Resources database.Review Methods. The databases were searched using a search strategy designed to include manuscripts relevant both to nitric oxide measurement and sinus or nasal problems. A title search was carried out on these manuscripts to select those relevant to clinical or basic science aspects of nitric oxide measurement. A subsequent abstract search selected those manuscripts concerning the application of nitric oxide measurement to sinonasal problems. The manuscripts selected were subject to a full-text review to extract data sets of nasal nitric oxide readings for different patient groups.Results. Initially, 1088 manuscripts were selected. A title search found 335 manuscripts of basic scientific or clinical interest. An abstract search found 35 manuscripts directly relating to nitric oxide measurement in sinonasal disease. Full-text analysis produced 20 studies with extractable data on nasal nitric oxide levels in clearly defined patient groups. Studies did not show sufficient homogeneity to enable substantial meta-analysis of aggregated data.Conclusion. Current evidence shows that nasal nitric oxide is not a clinically useful measure for sinonasal disease. Although there is some evidence that sinus surgery is associated with lowered nasal nitric oxide levels, there is no evidence that this is associated with deterioration in sinus health. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To evaluate whether topical steroids provide symptomatic relief in patients with chronic rhinosinusitis without polyps. Data Sources: MEDLINE, EMBASE, and Cochrane CENTRAL databases. Review Methods: Systematic review and meta-analysis was performed of the articles identified by two independent reviewers of all randomized controlled trials that had evaluated intranasal corticosteroids in patients with chronic rhinosinusitis (CRS) without polyps. The quality of included studies was evaluated, and results synthesized using standard random-effects meta-analytical methods. Results: Of 424 potential studies, only nine randomized trials involving 657 patients in total were eligible. Quality of design and reporting was suboptimal, with only one trial adhering to accepted standards for reporting. Five trials combined outcome measures and reported on overall response of CRS without polyps to topical steroids. The summary estimate for overall response to treatment showed no significant benefit and substantial variability among studies (5 trials: RR 0.75, 95% CI 0.50-1.10, P = 0.14, χ2 = 13.78, I2 = 66.2%). Total symptom score was reported in three trials with a standardized mean difference favoring topical steroids (RR 0.63, 95% CI 0.16-1.09, P = 0.009), with no evidence of heterogeneity (χ2 = 3.03, P = 0.22). Although the data were limited, there were no reports of increased adverse effects with topical steroids. Conclusion: There is insufficient evidence to demonstrate a clear overall benefit for topical steroids in CRS without polyps; however, their use appears safe and may show some symptomatic benefit. A class effect among different topical steroids cannot be assumed, and further trials are required. [Copyright &y& Elsevier]

Objective: High success rates for endoscopic dacryocystorhinostomy (END‐DCR) in partial nasolacrimal duct obstruction (NLDO) have been reported, but comparisons with complete NLDO are lacking. This study compares the success of primary END‐DCR with respect to the preoperative nasolacrimal duct patency and reviews factors associated with failure. Method: Retrospective review of END‐DCRs performed at a tertiary referral center. Partial and complete NLDO were defined by the presence or absence of flow into the nose with lacrimal sac washout (SWO), respectively. Intraoperative findings including thickness of bone, level and state of the common canaliculus, state of inflammation, and contents of the lacrimal sac during END‐DCR were recorded. For patients with at least 3 months follow‐up, the outcome of resolution of epiphora (none/partial/complete), postop Jones 1 (J1; positive/ negative) and endoscopy of the neo‐ostium (closed/partially or fully‐open) were defined. Results: A total of 245 primary END‐DCRs were reviewed (mean age, 63.6 ± 5.3 years, 70% women). Based on SWO, the groups were defined as 39.6% and 60.4% complete NLDO. Overall improvement in epiphora was 95.5%. In cases where symptoms improved, absence of flow into nose on SWO was associated with a higher rate of complete resolution (93.6% vs 84.9%, RR 1.102 [1.001, 1.213]). The ostia were fully open in 93.9% and postop J1 was positive in 97.1% of patients and were not different between groups. Conclusion: END‐DCR is highly successful for both types of NLDO. Preoperative absence of flow into nose on SWO was associated with slightly higher chance of complete resolution. [ABSTRACT FROM AUTHOR]