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Background Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice. Methods This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors. Results We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2–18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications. Conclusion Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure. [ABSTRACT FROM AUTHOR]

Objective: The anterior ethmoidal artery (AEA) is an important structure to identify during endoscopic sinus surgery. Although identification on imaging is easily taught, a consistent endoscopic landmark for the AEA, independent of anatomic ethmoid cell variation, is lacking, leaving many surgeons unclear about the exact location without dependence on navigation. Here, we describe a consistent endoscopic landmark, regardless of anatomical ethmoid variation. Methods: We prospectively enrolled adult patients undergoing endoscopic surgery involving frontal and ethmoid sinuses in this observational study. The AEA landmark was defined simply as the septation or ridge one step back along the ethmoid skull base from the posterior table of the frontal sinus. The gold standard to calculate the sensitivity of our endoscopic landmark was an image‐navigation system, registered to within 1.5 mm accuracy, locating the AEA within three planes. Both endoscopic and computerized tomography (CT) images of the pointer at the landmark were taken simultaneously. The concordance of endoscopic to navigation images was independently assessed by three blinded rhinologists. Results: Forty patients were included in our study with 73 sides analyzed. Diagnoses included chronic rhinosinusitis without polyps (52.5%), with polyps (22.5%), recurrent acute sinusitis (15%), sinonasal tumors (7.5%), and odontogenic sinusitis (2.5%). The AEA was accurately identified using our endoscopic landmark in 97.3% of the cases (71/73). Of the two cases in which the AEA was not found within the landmark, the artery was located ≤1 mm posteriorly. Conclusion: We describe a consistent endoscopic landmark to identify the AEA, conserved across various clinical diagnoses and anatomic variations in sinus structure. Level of Evidence: 3 Laryngoscope, 134:1096–1099, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To investigate how eustachian tube dysfunction symptoms change following surgical treatment of nonsinusitis‐related nasal obstruction. Study Design: Retrospective chart review. Setting: Single academic center. Methods: We assessed patients who underwent septoplasty, turbinate reduction, or both for nasal obstruction. Chronic sinusitis patients were excluded. Eustachian tube dysfunction (ETD) symptoms were studied using the Eustachian Tube Dysfunction Questionnaire (ETDQ‐7), collected preoperatively and postoperatively (1 week, 1 month, 3 months, 6 months postop). Patients with preoperative ETDQ‐7 > 14.5 were considered to have clinically significant symptoms. Sinonasal outcomes test scores were also assessed. Pre‐ and postoperative ETDQ‐7 scores were compared using t test. Multivariate linear regression analysis identified factors associated with ETDQ‐7 change. Results: We analyzed 259 patients. Preoperatively, 37.5% of patients with nasal obstruction had clinically significant ETD symptoms. These patients exhibited significant improvement in ETDQ‐7 at all postoperative timepoints from 23.3 ± 7.6 at baseline to 19.1 ± 9.1 at 1 week, 16.5 ± 8.0 at 1 month, 16.2 ± 7.8 at 3 months, and 16.7 ± 10.4 at 6 months (all P <.01). In patients without baseline ETD symptoms, (baseline ETDQ‐7: 9.1 ± 2.3) ETDQ‐7 scores did not change significantly at postoperative timepoints, except for an acute worsening at 1 week postoperatively (10.7 ± 5.1, P <.001). Regression analysis showed that higher preoperative ETDQ‐7 score (β = −0.84, 95% confidence interval [CI]: −1.10 to −0.59) and postoperative antihistamine spray usage (β = −8.70, 95% CI: −14.20 to −3.20) were associated with ETDQ‐7 improvement, while comorbid GERD (β = 7.50, 95% CI: 3.42‐11.58) and asthma (β = 5.62, 95% CI: 0.80‐10.45) were negatively associated with improvement. Conclusion: Surgical correction of nasal obstruction may improve ETD symptoms. [ABSTRACT FROM AUTHOR]

This article, titled "Risk of Venous Thromboembolism in Endoscopic Skull Base Surgery: A Systematic Review," examines the incidence of venous thromboembolism (VTE) in endoscopic skull base surgery (ESBS) and identifies associated risk factors. The study conducted a systematic literature search and analyzed 39 publications that met the criteria. The pooled VTE rate was found to be 1.9%, with subgroup analyses indicating a pulmonary embolism (PE) rate of 0.9% and a deep vein thrombosis (DVT) rate of 1.4%. Certain factors, such as meningioma, Cushing's syndrome, craniopharyngioma, and chordoma, were associated with an increased risk of VTE. The study also identified potential risk factors, including lumbar drainage placement exceeding a week, prolonged hospital stays, advanced age, malignancies, endocrinopathies, elevated Caprini score, and recent history of stroke. However, there was insufficient data to provide conclusive practice recommendations regarding perioperative anticoagulation. The findings of this study may help inform decision-making and guide future investigations to optimize patient outcomes in ESBS. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the patency of the cavernous sinus (CS) after medial wall resection. The study included 66 patients who underwent endoscopic endonasal approach (EEA) surgeries to resect CS-invading tumors. The results showed that CS patency was achieved in 85% of patients within the first 12 months and 92% by 18 months. Bilateral resection of the CS medial wall and resection for the removal of meningiomas were associated with increased rates of nonpatency. However, the study found that patency versus nonpatency did not have any significant difference in postoperative adverse events or effects. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the use of indocyanine green (ICG) fluorescence angiography to evaluate the impact of surgical and patient factors on the vascular perfusion of nasoseptal flaps (NSFs) in endoscopic skull base surgery (ESBS). The study found that tobacco smokers had lower baseline fluorescence intensity compared to nonsmokers, and patients who underwent a transpterygoid approach had a greater decrease in fluorescence intensity following reconstruction. Other factors, such as revision case, timing of flap harvest, and concurrent septoplasty, did not significantly influence fluorescence intensity. The article concludes that tobacco use and transpterygoid approaches may be associated with decreased vascular perfusion of NSFs. [Extracted from the article]

This article, titled "Outcomes of the Middle Turbinate Swing Technique during the Expanded Endonasal Approach (EEA): A Tertiary Center Experience," explores the use of the middle turbinate (MT) swing technique in skull base surgery. The MT swing technique involves detaching the posterior and lateral attachments of the middle turbinate to allow it to swing laterally into the maxillary sinus, providing better access to the skull base. The study analyzed surgeries performed between January 2021 and August 2023, finding that the MT swing technique did not compromise skull base exposure or tumor resection and had low rates of complications. The authors suggest that further research is needed to investigate the long-term benefits of preserving the middle turbinate during skull base surgery. [Extracted from the article]

Objective: Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology‐head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable. Data Sources and Methods: A scoping review was performed of English‐language peer‐reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen. Results: 171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross‐sectional or survey‐based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n = 37 [21%]), and within subspecialties of otology (n = 38 [22%]) and rhinology/allergy (n = 25 [15%]). Facebook was most frequently used for study recruitment (n = 23 [13.5%]), YouTube for patient education (n = 15 [14.6%]), and Twitter for professional networking (n = 16 [9.4%]). Conclusion: SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well‐controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 133:2447–2456, 2023 [ABSTRACT FROM AUTHOR]

Background: The global prevalence of PASC is estimated to be present in 0·43 and based on theWHO estimation of 470million worldwide COVID-19 infections, corresponds to around 200 million people experiencing long COVID symptoms. Despite this, its clinical features are not well-defined. Methods: We collected retrospective data from 140 patients with PASC in a post-COVID-19 clinic on demographics, risk factors, illness severity (graded as one-mild to five-severe), functional status, and 29 symptoms and principal component symptoms cluster analysis. The Institute of Medicine (IOM) 2015 criteria were used to determine the Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) phenotype. Findings: The median age was 47 years, 59.0% were female; 49.3% White, 17.2% Hispanic, 14.9% Asian, and 6.7% Black. Only 12.7% required hospitalization. Seventy-two (53.5%) patients had no known comorbid conditions. Forty-five (33.9%) were significantly debilitated. Themedian duration of symptoms was 285.5 days, and the number of symptoms was 12. The most common symptoms were fatigue (86.5%), post-exertional malaise (82.8%), brain fog (81.2%), unrefreshing sleep (76.7%), and lethargy (74.6%). Forty-three percent fit the criteria for ME/CFS, majority were female, and obesity (BMI > 30 Kg/m2) (P = 0.00377895) and worse functional status (P = 0.0110474) were significantly associated with ME/CFS. Interpretations: Most PASC patients evaluated at our clinic had no comorbid condition and were not hospitalized for acute COVID-19. One-third of patients experienced a severe decline in their functional status. About 43% had the ME/CFS subtype. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the effect of povidone‐iodine (PVP‐I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold (Ct) on quantitative polymerase chain reaction (qPCR) of SARS‐CoV‐2 in outpatients. Study Design: Three arm, triple blinded, randomized, placebo‐controlled clinical trial. Methods: Participants were randomized within 5 days of testing positive for COVID‐19 to receive nasal sprays containing placebo (0.9% saline), 0.5% PVP‐I, or 2.0% PVP‐I. NP swabs for qPCR analysis were taken at baseline, 1‐hour post‐PVP‐I spray (two sprays/nostril), and 3 days post‐PVP‐I spray (20 sprays/nostril). Symptom and adverse event questionnaires were completed at baseline, day 3, and day 5. University of Pennsylvania Smell Identification Tests (UPSIT) were completed at baseline and day 30. Results: Mean Ct values increased over time in all groups, indicating declining viral loads, with no statistically significant difference noted in the rate of change between placebo and PVP‐I groups. The 2.0% PVP‐I group showed statistically significant improvement in all symptom categories; however, it also reported a high rate of nasal burning. Olfaction via UPSIT showed improvement by at least one category in all groups. There were no hospitalizations or mortalities within 30 days of study enrollment. Conclusions: Saline and low concentration PVP‐I nasal sprays are well tolerated. Similar reductions in SARS‐CoV‐2 NP viral load were seen over time in all groups. All treatment groups showed improvement in olfaction over 30 days. These data suggest that dilute versions of PVP‐I nasal spray are safe for topical use in the nasal cavity, but that PVP‐I does not demonstrate virucidal activity in COVID‐19 positive outpatients. Level of Evidence: 2 Laryngoscope, 132:2089–2095, 2022 [ABSTRACT FROM AUTHOR]

Background: The literature regarding clinical olfaction, olfactory loss, and olfactory dysfunction has expanded rapidly over the past two decades, with an exponential rise in the past year. There is substantial variability in the quality of this literature and a need to consolidate and critically review the evidence. It is with that aim that we have gathered experts from around the world to produce this International Consensus on Allergy and Rhinology: Olfaction (ICAR:O). Methods: Using previously described methodology, specific topics were developed relating to olfaction. Each topic was assigned a literature review, evidence‐based review, or evidence‐based review with recommendations format as dictated by available evidence and scope within the ICAR:O document. Following iterative reviews of each topic, the ICAR:O document was integrated and reviewed by all authors for final consensus. Results: The ICAR:O document reviews nearly 100 separate topics within the realm of olfaction, including diagnosis, epidemiology, disease burden, diagnosis, testing, etiology, treatment, and associated pathologies. Conclusion: This critical review of the existing clinical olfaction literature provides much needed insight and clarity into the evaluation, diagnosis, and treatment of patients with olfactory dysfunction, while also clearly delineating gaps in our knowledge and evidence base that we should investigate further. [ABSTRACT FROM AUTHOR]

Because of the timing of patient follow-up in clinic at 1 week, depending on the specific day of the week for the surgery, the data for the last postoperative day had several missing values and was not included on the table. To clarify, formal turbinate surgery with submucus resection was performed on all patients enrolled in the study. [Extracted from the article]

Objective: Patients undergoing endoscopic transsphenoidal adenomectomy (eTSA) for pituitary tumors are at risk for postoperative complications, including rhinosinusitis. We aimed to determine if preoperative sinonasal disease is a risk factor for postoperative rhinosinusitis (PRS). Study Design: Retrospective review. Setting: Tertiary academic center in U.S. Subjects and Methods: Patients with a diagnosis of pituitary adenoma who underwent eTSA between 2007-2016. PRS patients were matched to non-PRS patients or sex, age, tumor size, skull base reconstruction with intranasal tissue grafting, and concurrent septoplasty. Groups were statistically analyzed for potential preoperative risk factors of sinonasal disease (patient-reported, radiographic, endoscopic). Results: 49 of 987 patients who underwent eTSA developed PRS (44.9% male, 71.4% Caucasian, mean age 49.3y). On analysis of individual risk factors, there was a significantly higher proportion of patients with a history of prior sinonasal surgery in the PRS group than the non-PRS group (25.5% vs. 6.5%, p = 0.01); however, this group difference became insignificant on multivariate analysis. There were no significant group differences with regard to history of sinus infections, nasal symptoms, seasonal allergies, radiographic abnormalities, or sinonasal disease on endoscopy. Conclusion: This is the first study to investigate preoperative sinonasal disease as a risk factor for PRS after eTSA. The risk factors considered did not demonstrate definitive risk for PRS, although a history of prior sinonasal surgery should be investigated further. [ABSTRACT FROM AUTHOR]