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Objective: To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract. Methods: Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow‐up were collected. Results: One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X‐ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy‐one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p = 0.0046). Conclusion: In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa. Level of Evidence: 3 Laryngoscope, 133:1361–1366, 2023 [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the improvement in epiphora and need for surgical revision in patients with acquired nasolacrimal duct obstruction following balloon-assisted, middle meatal endoscopic dacryocystorhinostomy with chitosan-based dressing versus bioresorbable polyurethane packing versus no packing. Patients and Methods: This was a retrospective study of consecutive adult patients seen from 2015 to 2018 with follow-up evaluation of epiphora at least 3 months after balloon-assisted, middle meatal endoscopic dacryocystorhinostomy. Patients with a history of prior punctoplasty, septoplasty, sinus surgery, or dacryocystorhinostomy of any kind were excluded. Those meeting criteria were stratified by postoperative hemostatic intervention: no packing, bioresorbable packing, and chitosan-based dressing (groups 1, 2, and 3, respectively). Procedural outcomes were graded as successes or failures based on subjective report and anatomical findings at most recent visit within an 18-month postoperative window. Instances of recommendation for revision surgery were also recorded. Results: Forty-three cases (36 patients) met the abovementioned criteria. Groups 1, 2, and 3 comprised 12, 17, and 14 cases each, respectively. Average patient age was 55.3 years old, and average duration of follow-up was 6.7 months. Significant variation in outcomes was detected across the 3 groups (P =.0495), particularly between groups 1 and 3 (P =.033). Use of chitosan-based dressing trended toward reduced rates of recommendation for surgical revision (P =.203, P =.113). Conclusions: Use of chitosan-based dressing after endoscopic dacryocystorhinostomy was associated with improved subjective and anatomical outcomes. It may also contribute to less frequent need for revision surgery. Further study in a larger prospective trial is recommended. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 health crisis abruptly disrupted the practice of otolaryngology. This article aims to define the changes needed to operate an academic otolaryngology practice safely and efficiently from within the epicenter of the pandemic. We define the areas of normal patient workflow that have been affected by COVID-19, and we offer mitigation strategies with attention paid to the specific needs of subspecialties. Data Sources: The article includes data specific to the office practice metrics of the Weill Cornell Medicine Department of Otolaryngology–Head and Neck Surgery, as well as publically available data from New York Presbyterian Hospital system and the New York Times. Review Methods: Expert opinion. Conclusions: Through careful planning and execution, it is possible to reestablish safe otolaryngologic patient care during the COVID-19 pandemic. It will require a significant change from prior practice models for successful implementation. Additionally, telemedicine can be positively integrated into the treatment of otolaryngology diseases for new and established patients. Implications for Practice: The information conveyed in this review can be used as a guide by large and small otolaryngology groups to identify aspects of the patient visit that are "at risk" due to COVID-19, and it suggests sensible responses that can be made without a significant disruption to normal practice. The methods used to identify vulnerabilities with the patient visit process can be applied to future unforeseen crises, such as a resurgence of COVID-19 or a novel pandemic. [ABSTRACT FROM AUTHOR]

Background/Objective: Complicated acute rhinosinusitis in the pediatric population is an uncommon problem that may affect the orbit or brain and is life‐threatening. This condition requires surgical intervention with endoscopic sinus surgery for source control, and prior studies have demonstrated the safety of balloon sinuplasty in chronic frontal sinusitis. Methods/Results: We present our approach with a balloon sinus dilation hybrid procedure to resolve four distinct types of complicated acute frontal sinusitis in pediatric patients, including intracranial manifestations, intraorbital complications, and recurrent disease. All four patients were able to be managed operatively with frontal balloon sinuplasty. Conclusions: Prior efficacy has been demonstrated for chronic frontal sinusitis in the pediatric population. We demonstrate that frontal balloon sinuplasty is also feasible in the proper clinical setting for acute frontal sinusitis, even in the presence of regional complications or recurrent disease. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background: Although pediatric rhinosinusitis is a commonly encountered clinical entity, the diagnostic approach and treatment algorithm are constantly evolving. In addition to anatomic and allergic etiologies, immunologic deficiencies have been implicated in the pathogenesis of rhinosinusitis; however, the prevalence of immunologic disease in pediatric rhinosinusitis is poorly defined. Objective: To inform the approach to the evaluation of pediatric patients with rhinosinusitis, this retrospective pilot study examined the prevalence of abnormal results detected on immunologic testing in pediatric patients with chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis (RARS). Methods: Patients between 2008 and 2018 were identified using International Classification of Diseases 9/10 codes. Imaging, endoscopy findings, and clinical criteria were used to diagnose CRS and RARS (n = 27). We reviewed available results, including quantitative immunoglobulins (Igs), thyroid evaluation, complete blood count, and titers to Streptococcus, Haemophilus influenzae type B (HiB), Diphtheria, and Tetanus. Statistical analyses were performed with the Mann–Whitney U test and Fisher's exact test. Results: Our initial search yielded 140 patients, of which 27 met diagnostic criteria for CRS (17) or RARS (10). Eight patients (29.6%) underwent adenoidectomy and 5 (18.5%) underwent endoscopic sinus surgery. The most common Ig deficiencies were IgM, 13.0%, and IgA, 11.1%. Four (23.5%) of the 17 patients had significantly elevated IgE levels, indicating a possible allergic etiology. Within this cohort, there was an increased incidence of insufficient protective titers to polysaccharide vaccines. HiB titers were not protective in 35% of our cohort. Insufficient pneumococcal protection was more common in patients >10 years, while deficient IgM was more common in those <10 years. Conclusion: High-yield testing in pediatric rhinosinusitis should include titers to polysaccharide antigens, specifically Streptococcus pneumoniae and H. influenzae. Low-yield tests that may be deferred during initial testing include thyroid studies and Tetanus and Diphtheria antibodies. Prospective, high-volume studies are required to further elucidate the role of immunologic testing in this population. [ABSTRACT FROM AUTHOR]

Background: Respiratory epithelial adenomatoid hamartomas (REAH) are benign nose neoplasms found in the nasal cavity and sinuses. Symptoms include anosmia, nasal obstruction, facial pressure, and rhinorrhea. Although previously thought to be rare, these tumors are being increasingly recognized on pathology in patients undergoing endoscopic sinus surgery. However, REAH is difficult to diagnose before surgery because it may mimic other entities, such as nasal polyps or inverted papilloma, and is often found incidentally only after surgery. Objective: The aims of this study were to (1) add an additional case series of REAH to the literature, (2) report unique imaging findings on computed tomography and magnetic resonance imaging, and (3) pool and summarize all available data from existing publications. Methods: Retrospective chart review from years 2004 to 2015 and a literature review Results: Twenty-three cases were found in our case series, which included 12 men (52%) and 11 women (48%), with a mean age of 59 years. No cases were found before 2007. Lund-Mackay scores were comparable with those found in chronic rhinosinusitis without nasal polyposis. Imaging consistently demonstrated a discoid-shaped mass at the olfactory cleft. Fifty previous publications were found (4 prospective, 11 retrospective studies, 9 case series, 26 cases reports), which included 660 patients diagnosed with REAH. Pooled data revealed a mean age of 54 years (range, 9-86 years) and a male to female ratio of 3:2. Conclusion: The results of our study further refined the average age at which REAH diagnosis occurs as 54 years old, although it may occur at any age. There is a clear male-to-female predominance (3:2). In addition, olfactory cleft widening and discoid soft tissue at the olfactory cleft are hallmark radiographic findings. The vast majority of published cases occurred during the past 4 years, which indicated increased recognition of REAH. [ABSTRACT FROM AUTHOR]

Background: Chronic lymphocytic leukemia (CLL) is an indolent B-lineage neoplasm responsible for 30% of all leukemias. The median age of onset is 67 years with a male predominance of 2:1. Localized infiltration in the oropharynx and paranasal sinuses is exceptionally rare. The aims of this study were (1) to add an additional case series of CLL with involvement of the oropharynx and paranasal sinuses to the literature and (2) to determine incidence and demographic data. Methods: Retrospective chart review from 1990 to 2014. Results: Five cases were found in our case series, representing 0.74% of the total number of cases analyzed (5/680). Sixteen additional cases were identified through literature review, resulting in a total of 21 cases of CLL (13 men, 8 women) with involvement of the oropharynx (n = 15) and paranasal sinuses (n = 6). The average age of patients with CLL in the oropharynx was 62 years whereas in the paranasal sinuses it was 52 years (p = 0.16). The average age of female cases was 62 years and the average age of male cases was 58 years (p = 0.63). Almost 85% (84.6%) of men had oropharynx invasion vs 50% of females (p = 0.15), which suggests a nonsignificant trend. Conclusion: The results of our study indicate that CLL infiltrates the oropharynx or paranasal sinuses in less than 1% of CLL cases. Although there seems to be no age bias between invasion in the oropharynx and the paranasal sinuses, there is a trend whereby women appear more likely to experience invasion of the paranasal sinuses. [ABSTRACT FROM AUTHOR]

Objective: To characterize the pre- and post-operative findings in patients undergoing endoscopic dacryocystorhinostomy (eDCR) performed jointly by ophthalmologists and otolaryngologists. Methods: Retrospective case series consisting of all the patients who underwent eDCR for nasolacrimal duct obstruction at New York Presbyterian Hospital/Weill Cornell Medical College between the 2009-2012 academic years. Patients were followed post-operatively for at least six months. The primary endpoint assessed in this study was symptom recurrence (epiphora). Results: A total of 20 patients (25 total cases) underwent eDCR within the study interval. Of the 25 cases, 7 (28.0%) represented reoperations due to recurrent symptoms. All 20 patients in the study exhibited sinus pathology, as determined during a pre-operative otolaryngology assessment. As a result, 16 of these patients (80.0%) underwent concurrent sinonasal surgery at the time of eDCR. The success rate in cases without prior DCR was 83.3% (15/18). Only 57.1% of revision cases (4/7) reported resolution of epiphora following surgery. Conclusion: While a joint approach to eDCR did not appear to significantly improve efficacy, it offered the advantage of having an otolaryngologist assess and treat concurrent sinonasal pathology, which was seen in every patient in our series. Given our findings, as well as the technical difficulty often associated with the procedure, there may be great utility in performing eDCR in conjunction with an otolaryngologist. [ABSTRACT FROM AUTHOR]

Background: The effect of comorbid conditions such as asthma and atopy on the severity of chronic rhinosinusitis (CRS) and the presence of nasal polyps (NPs) remains an area of investigation. We sought to elucidate the relationship among these entities. Methods: The study population included 106 consecutive patients who were referred to a multidisciplinary, university-based allergy and sinus clinic that underwent computed tomography (CT) scan, skin-prick testing, and had CRS. Data were analyzed to determine Lund-MacKay score (LMS), presence of NPs, asthma status, and sensitivity to seven classes of aeroallergens. Results: Skin tests were positive in 52 cases and negative in 54 cases. Although, there was no statistical relationship between LMS and atopic status in the entire group, among the asthmatic subgroup, mean LMS was greater in nonatopic asthmatic patients than in atopic asthmatic patients. Asthmatic patients had a higher LMS than nonasthmatic patients (p < 0.0001). Asthmatic patients were more likely than nonasthmatic patients to have NPs (57.6% versus 25%; p = 0.0015), regardless of atopic status. Mean LMS was higher in NP patients compared with nonpolyp patients (p < 0.0001), independent of atopic status. Mean LMS was not affected by sensitivity to any particular allergen, with the exception of cockroach-allergic patients who were more likely to have an LMS of >10 (p = 0.0236) and had more severe maxillary sinus involvement (p = 0.0391). Conclusion: These data indicate a strong relationship between CRS severity, as measured by LMS, and chronic airway inflammatory diseases, asthma, and NPs. The association between LMS and atopic status appears weak. The present study suggests that CRS is an inflammatory disease that occurs independently of systemic IgE-mediated pathways. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the improvement in epiphora and need for surgical revision in patients with acquired nasolacrimal duct obstruction following balloon-assisted, middle meatal endoscopic dacryocystorhinostomy with chitosan-based dressing versus bioresorbable polyurethane packing versus no packing., Patients and Methods: This was a retrospective study of consecutive adult patients seen from 2015 to 2018 with follow-up evaluation of epiphora at least 3 months after balloon-assisted, middle meatal endoscopic dacryocystorhinostomy. Patients with a history of prior punctoplasty, septoplasty, sinus surgery, or dacryocystorhinostomy of any kind were excluded. Those meeting criteria were stratified by postoperative hemostatic intervention: no packing, bioresorbable packing, and chitosan-based dressing (groups 1, 2, and 3, respectively). Procedural outcomes were graded as successes or failures based on subjective report and anatomical findings at most recent visit within an 18-month postoperative window. Instances of recommendation for revision surgery were also recorded., Results: Forty-three cases (36 patients) met the abovementioned criteria. Groups 1, 2, and 3 comprised 12, 17, and 14 cases each, respectively. Average patient age was 55.3 years old, and average duration of follow-up was 6.7 months. Significant variation in outcomes was detected across the 3 groups ( P = .0495), particularly between groups 1 and 3 ( P = .033). Use of chitosan-based dressing trended toward reduced rates of recommendation for surgical revision ( P = .203, P = .113)., Conclusions: Use of chitosan-based dressing after endoscopic dacryocystorhinostomy was associated with improved subjective and anatomical outcomes. It may also contribute to less frequent need for revision surgery. Further study in a larger prospective trial is recommended.

Purpose: The purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR)., Methods: A retrospective review of consecutive patients who underwent eDCR and were followed up for at least 6 months at our institution from January 2010 to December 2017 was performed., Results: 47 cases(39 patients) of eDCR met the inclusion and exclusion criteria during this time period. Mean follow up after the surgery was 12.5 ± 8 months. In 45 out of 47 (96%) cases post-operative improvement in epiphora within 2 weeks of surgery, or lack thereof, correlated with long-term success or failure of the procedure. There were only 2 cases in which the patients felt improvement in tearing at the initial post-operative visit and the tearing recurred in the late post-operative period (>6 months)., Conclusions: There is a strong association between the early initial post-operative assessment of tearing resolution and the long-term result of eDCR., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose of Review: Rhinosinusitis is one of the most common medical complaints, affecting nearly 31 million US citizens annually. Multiple medical professionals including emergency medicine, internal medicine, allergy, and otolaryngology treat rhinosinusitis, resulting in high-practice variability. This review will discuss recommendations of the 2007 American Academy of Otolaryngology - Head and Neck Surgery's multispecialty panel on evidence based clinical practice guidelines for diagnosis and treatment of rhinosinusitis., Recent Findings: The task force for recommendations defines rhinosinusitis as follows: acute bacterial, viral, chronic, or recurrent acute rhinosinusitis. For acute rhinosinusitis three symptoms are required: purulent nasal discharge with nasal obstruction and/or facial pain-pressure-fullness lasting between 10 days and 4 weeks. For viral rhinosinusitis, imaging is not recommended and treatment is symptomatic. For acute bacterial rhinosinusitis in an otherwise healthy patient, symptomatic relief is recommended including pain control. Amoxicillin is the first-line antibiotic of choice if needed. Radiographic imaging should be considered if an infectious complication is suspected. Chronic rhinosinusitis is likely when symptoms persist for greater than 12 weeks, with computed tomography being the gold standard for diagnostic testing. Nasal endoscopy and allergy/immune testing are also considered., Summary: Accurate diagnosis of rhinosinusitis with recommended treatments should standardize management. However, these recommendations are guidelines and the clinician's judgment is highly important.

Background: The management of cerebrospinal fluid (CSF) leaks can be challenging. Acellular dermal grafts derived from human cadavers can be used as a replacement material when autogenous materials are unavailable. Fibrin tissue adhesive (FTA) is a wound support product that has been used for hemostatic and tissue fixation purposes. The combined use of acellular dermis in conjunction with FTA for dural repair remains a subject of study. The aim of this study was to evaluate wound healing and tissue compatibility characteristics of acellular dermal substitute material when used both with and without FTA, for repair of a dural tear in a chinchilla model., Methods: Forty-nine chinchillas were included in this randomized case-control study. The squamous portion of the temporal bone was removed to expose the tegmen. A 2 x 2 mm dural defect was removed to create an iatrogenic CSF leak. Then, animals were randomly assigned to one of three treatment groups: group 1, acellular dermis alone; group 2, acellular dermis with FTA; group 3, fibrinogen, acellular dermis, and FTA. Surgical sites were examined grossly at 1- and 2-week intervals. Temporal bones were examined histologically., Results: Grossly, groups 2 and 3 had significantly less visible CSF leak and brain herniation noted at both 1- and 2-week intervals when compared with group 1. Histological results confirmed the gross results showing the best seal in group 2 and 3., Conclusion: Acellular dermis combined with FTA provided superior support compared with acellular dermis alone in repair of induced dural defects.