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Background: Olfactory dysfunction (OD) is associated with both post‐viral and inflammatory etiologies such as COVID‐19 and chronic rhinosinusitis/rhinitis (CRS/R) respectively, to result in reduced quality of life (QoL). However, the former typically induces a sudden‐onset OD while the latter has a gradual presentation. This study aims to establish and compare health utility values (HUVs) and olfactory‐specific QoL measurements between patients with COVID‐19 and CRS/R related OD. Methods: This prospective study surveyed COVID‐19 and CRS/R patients with self‐reported OD using HUV assessments (EuroQol‐visual analog scale [EQ‐VAS], EuroQol‐5 dimension [EQ‐5D], time trade‐off [TTO]) and olfactory and sinonasal QoL measures (questionnaire of olfactory disorders –negative and positive statements [QOD‐NS + PS] and sino‐nasal outcome test [SNOT‐22]). A subgroup of subjects completed objective olfactory testing. Intergroup mean scores were compared using Mann–Whitney U tests. Results: One hundred eleven subjects were enrolled: mean age ± SD (43.0 ± 15.4 years), 55.9% female. CRS/R was associated with lower HUVs as measured by EQ‐VAS (CRS/R: 0.67 ± 0.18 vs. COVID‐19: 0.74 ± 0.19, p =.03) and worse SNOT‐22 scores in both overall (CRS/R: 49.03 ± 21.04 vs. COVID‐19: 27.58 ± 18.45, p <.001) and subgroup analysis of objectively confirmed OD subjects (CRS/R: 52.40 ± 22.78 vs. COVID‐19: 29.84 ± 21.10, p =.01). On the other hand, COVID‐19 has greater burden on olfactory‐specific QoL (QOD‐NS + PS, COVID‐19: 23.19 ± 13.73 vs. CRS/R: 17.25 ± 11.38, p =.04). Both groups demonstrated a similar decrease in health using the EQ‐5D assessment. Conclusion: CRS/R associated OD has a more severe impact on general health and sinonasal specific QoL outcomes, while COVID‐19 associated OD has a greater burden on olfactory‐specific QoL. Level of evidence: Level 2c. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: A subset of patients will undergo revision endoscopic sinus surgery (ESS) with a different otolaryngologist than the one who performed their primary surgery. The purpose of this study is to report the incidence of and clinicodemographic factors associated with a change in surgeon for revision ESS. Study Design: Retrospective cohort study. Methods: Adult patients who underwent at least two outpatient ESS procedures between 2009 and 2014 using the State Ambulatory Surgery Database for Florida were included in the study. Change in surgeon was defined by a change in a unique provider identifier for the revision procedure. Multivariable regression analysis was used to determine characteristics associated with a change in surgeon. Results: A total of 2,963 patients were included. For the revision procedure, 47.7% of patients changed their surgeon. On multivariable logistic regression, a medium‐ (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.53‐0.77) or high‐volume (OR: 0.50; 95% CI: 0.42‐0.61) surgeon performing the index surgery and advanced age (≥65 years) (OR: 0.79; 95% CI: 0.63‐0.99) were associated with decreased odds of surgeon change for revision ESS. Longer time elapsed between index and revision surgery (OR: 1.15; 95% CI: 1.13‐1.17) was associated with increased odds of surgeon change. Conclusions: Nearly half of patients who undergo revision ESS select a surgeon other than the one who performed their primary procedure. Surgeon volume, age, and time between surgeries affect the likelihood of a change in surgeon for revision ESS. These findings may provide introductory insights into patient preferences and decision making in the surgical management of recalcitrant chronic rhinosinusitis. Level of Evidence: 4 Laryngoscope, 131:E1049–E1053, 2021 [ABSTRACT FROM AUTHOR]

Background: In locally advanced sinonasal squamous cell carcinoma (SNSCC), management of the clinically node‐negative (cN0) neck is variable and elective neck dissection (END) remains controversial. Methods: Patients with surgically treated T3/T4 cN0 M0 SNSCC were identified using the NCDB. Overall survival (OS) was assessed by Cox proportional hazard analysis in propensity score‐matched cohorts. Factors associated with END were evaluated with logistic regression. Results: Two hundred twenty patients underwent END (19.6%). END did not correlated with OS in propensity score‐matched cohorts (HR 0.971, 95% CI 0.677‐1.392), a maxillary sinus tumor subgroup (HR 1.089, 95% CI 0.742‐1.599), or by radiation status [radiation: (HR 0.802, 95% CI 0.584‐1.102); no radiation: (HR 0.852, 95% CI 0.502‐1.445)]. The occult metastasis rate in the END cohort was 12.7%. Conclusion: END did not significantly improve OS in this study. Further information on disease‐free survival is necessary to determine its role in advanced‐stage SNSCC. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative correlations of Twitter and Google Search user trends concerning smell loss with daily coronavirus disease 2019 (COVID-19) incidence in the United States, compared to other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. To describe the effect of mass media communications on Twitter and Google Search user trends.Study Design: Retrospective observational study.Setting: United States.Subjects and Methods: Google Search and "tweet" frequency concerning COVID-19, smell, and nonsmell symptoms of COVID-19 generated between January 1 and April 8, 2020, were collected using Google Trends and Crimson Hexagon, respectively. Spearman coefficients linking each of these user trends to COVID-19 incidence were compared. Correlations obtained after excluding a short timeframe (March 22 to March 24) corresponding to the publication of a widely read lay media publication reporting anosmia as a symptom of infection was performed for comparative analysis.Results: Google searches and tweets concerning all nonsmell symptoms (0.744 and 0.761, respectively) and COVID-19 (0.899 and 0.848) are more strongly correlated with disease incidence than smell loss (0.564 and 0.539). Twitter users tweeting about smell loss during the study period were more likely to be female (52%) than users tweeting about COVID-19 more generally (47%). Tweet and Google Search frequency pertaining to smell loss increased significantly (>2.5 standard deviations) following a widely read media publication linking smell loss and SARS-CoV-2 infection.Conclusions: Google Search and tweet frequency regarding fever and shortness of breath are more robust indicators of COVID-19 incidence than anosmia. Mass media communications represent important confounders that should be considered in future analyses. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Socioeconomic and demographic factors have a significant impact on healthcare utilization and surgical outcomes. The effect of these variables on baseline symptom severity and quality of life (QOL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is not well established. Our goal was to investigate the association of sociodemographic factors on QOL before and after ESS, as reflected by the 22-item Sino-Nasal Outcome Test (SNOT-22) score.Study Design: Retrospective case series.Methods: From October 2016 to August 2018, 244 patients with chronic rhinosinusitis who underwent ESS were included. Socioeconomic and demographic data, surgical characteristics, and baseline and postoperative SNOT-22 scores were recorded. Univariate and multivariate regression were performed to identify determinants of baseline symptom severity and improvement following ESS.Results: Nonwhite patients reported worse baseline symptoms severity (SNOT-22, 52.06 vs. 43.76, P = .021) compared to white patients, yet lower CRS symptoms at follow-up (SNOT-22, 23.38 vs. 28.63, P = .035). Relative improvement was higher in nonwhite patients as well (41.2% vs. 36.5%, Mann-Whitney U = 1,747, P = .015). In an adjusted multivariate logistic regression model, below-median income ($71,805 [California]) was associated with worse baseline symptom severity (β = 7.72; 95% confidence interval [CI]: 1.10, 14.26). Nonmarried patients (β = 6.78; 95% CI: 2.22, 13.48) and white patients (β = 8.45; 95% CI: 0.40, 13.97) had worse QOL at follow-up.Conclusions: Nonwhite patients and those with below-median income present with more severe CRS symptoms at baseline. However, a greater degree of absolute and relative QOL improvement was found in nonwhite and married patients following ESS. Improved understanding of the significance of socioeconomic and demographic factors and attention to cultural differences/marital status could have a substantial impact on ESS outcomes.Level Of Evidence: 4 Laryngoscope, 130:297-302, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Minimum clinically important differences (MCIDs) for the 22-item SinoNasal Outcomes Test (SNOT-22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS.Study Design: Prospective observational cohort study.Methods: One hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT-22 survey responses were collected. Four distribution-based methods for calculating MCIDs (e.g., half-standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT-22 total and domain scores.Results: The average MCID value for SNOT-22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT-22 total scores following CAMT exceeded the MCID, none of the average SNOT-22 domain score improvements surpassed their respective MCID thresholds.Conclusions: MCID values for SNOT-22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT-22 domain scores.Level Of Evidence: 2c Laryngoscope, 129:31-36, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Appropriateness criteria to determine surgical candidacy for chronic rhinosinusitis (CRS) have recently been described. This study stratified patients who underwent endoscopic sinus surgery (ESS) according to these new appropriateness criteria and evaluated postoperative improvements among appropriateness categories.Methods: Adult patients with uncomplicated CRS electing ESS were prospectively enrolled in a multi-institutional cohort study between March 2011 and June 2015 to assess outcomes. Subsequently, appropriateness criteria that consider preoperative medical therapy, 22-item SinoNasal Outcome Test (SNOT-22) scores, and Lund-Mackay computed tomography scores were retrospectively applied.Results: A total of 92.6% (436 of 471) were categorized as "appropriate" ESS candidates, 3.8% (18 of 471) as "uncertain," and 3.6% (17 of 471) as "inappropriate." Among uncertain patients, two-thirds (12 of 18) had identifiable reasons for undergoing ESS, most commonly oral corticosteroid intolerance (n = 6). Postoperative follow-up was available for 79% (n = 372). Clinically significant SNOT-22 improvements occurred in both appropriate and uncertain groups (all P < 0.050) but not among the inappropriate group. The inappropriate group reported less mean improvement in SNOT-22 total score compared to appropriate (P = 0.008) and uncertain (P = 0.006) groups.Conclusion: The vast majority of patients (∼93%) who underwent ESS in a multi-institutional research program were identified as appropriate candidates for surgical intervention, as defined by current appropriateness criteria. Valid considerations frequently exist for offering ESS to patients categorized as uncertain. Appropriate and uncertain candidates report similar, clinically significant SNOT-22 improvements following surgery. Patients classified as inappropriate reported significantly less improvement following ESS. Surgical appropriateness criteria may assist in predicting outcomes of ESS.Level Of Evidence: 2b. Laryngoscope, 2448-2454, 2018. [ABSTRACT FROM AUTHOR]

The association of smell and taste loss with COVID-19 has been well demonstrated with high prevalence rates. In certain cases, chemosensory loss may be the only symptom of COVID-19 and may linger while other symptoms have resolved. The significance of persistent smell and taste loss and its relationship to ongoing viral shedding has yet to be investigated. In this cross-sectional study, of the 316 laboratory test–confirmed COVID-19 cases at our institution, 46 had subsequent test-based confirmation of viral clearance with 2 consecutive negative RT-PCR test results (reverse transcriptase polymerase chain reaction). Olfactory dysfunction was reported by 50% of the patients (23 of 46), with 78% (18 of 23) having subjective persistent smell loss despite negative RT-PCR test results. These preliminary data demonstrate the persistence of self-reported smell loss despite otherwise clinical resolution and undetectable nasal viral RNA. [ABSTRACT FROM AUTHOR]

Objective: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may "cross over" to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality.Study Design: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics.Methods: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality.Results: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02-1.11; P = 0.003).Conclusion: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover.Level Of Evidence: 2c. Laryngoscope, 128:304-310, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Endoscopic sinus surgery (ESS) is performed for patients with chronic rhinosinusitis (CRS) that have failed maximal medical therapy. This study seeks to determine the prevalence of revision surgery and factors predicting the need for revision after ESS using a large statewide surgery database.Study Design: Large retrospective cohort study using the State Ambulatory Surgery Database for the state of California between 2005 and 2011.Methods: We identified over 61,000 patients with CRS who underwent ESS, determined by Current Procedural Terminology code. We identified which patients underwent a repeat surgery, and performed multivariable modeling to determine which factors (nasal polyps, age, gender, insurance, hospital setting, ethnicity) predicted the need for revision. Adjusted odds ratios (AOR) and 95% confidence intervals are presented.Results: Of 61,339 patients who underwent ESS, 4,078 (6.65%) returned for revision ESS during the time period investigated. In a multivariable logistic regression model, positive predictors of revision were a diagnosis of nasal polyps (AOR: 1.20, 95% CI: 1.11-1.29, P < .001) and female gender (AOR: 1.20, 95% CI: 1.11-1.29, P < .001); public insurance was marginally predictive of increased reoperation (AOR: 1.10, 95% CI: 1.00-1.21, P = .048). Patients of Hispanic ethnicity were less likely to have revision surgery (AOR: 0.86, 95% CI: 0.77-0.97, P = .011). Age, income, and hospital setting were not significant predictors.Conclusions: A minority of patients with CRS who undergo ESS will have a revision surgery. This likelihood is increased in female patients and those with nasal polyps, and decreased in patients of Hispanic ethnicity, even when controlling for income, insurance, and hospital setting.Level Of Evidence: 4. Laryngoscope, 128:31-36, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disease process that is driven, in part, by intrinsic mucosal inflammation. Surgery plus continued medical therapy is commonly elected by medically recalcitrant, symptomatic patients. The objective was to evaluate the prevalence of nasal polyp recurrence up to 18 months after endoscopic sinus surgery (ESS) with congruent continuing medical management.Study Design: Prospective, multicenter cohort of adult patients undergoing ESS for medically recalcitrant CRSwNP performed between August 2004 and February 2015.Methods: All patients received baseline nasal endoscopy quantified using Lund-Kennedy grading. All patients included for final analysis provided at least 6 months of postoperative endoscopy examinations. Multivariate analysis was used to identify risk factors for polyp recurrence.Results: Three hundred sixty-three CRSwNP patients having undergone ESS involving polypectomy were enrolled. A total of 244 (67%) participants had graded postoperative endoscopies with average of follow-up of 14.3 ± 7.0 months. Surgery plus postoperative medical management significantly improved endoscopy total scores at 6 months (P < .001). The recurrence of nasal polyposis 6 months after ESS was 35% (68/197), compared to 38% (48/125) after 12 months, and 40% (52/129) after 18 months. Multivariate analysis identified both prior ESS (odds ratio [OR]: 2.6, 95% confidence interval [CI]: 1.5-4.6; P = .001) and worse preoperative polyposis severity (OR: 1.4, 95% CI: 1.1-1.8; P = .016) as risk factors for recurrent polyposis.Conclusions: Polyp recurrence is common after ESS with control of polyps up to 18 months found in approximately 60% to 70% of patients. Investigation into both surgical and medical management strategies is warranted to improve upon the observed prevalence of recurrence.Level Of Evidence: 2c. Laryngoscope, 127:550-555, 2017. [ABSTRACT FROM AUTHOR]

Background Diagnostic nasal endoscopy is a routine measure of sinonasal inflammation in patients with chronic rhinosinusitis (CRS). Although multiple staging systems have been proposed and evaluated, evidence of association between concurrent symptoms and endoscopic findings remains discordant. The goal of this study is to identify the relevant endoscopic attributes associated with symptom burden, and to systematically derive a weighted endoscopic scale that optimizes prediction of concurrent symptoms. Methods Reported baseline symptom (22-item Sino-Nasal Outcome Test [SNOT-22]) and endoscopic evaluation scores (Lund-Kennedy [LK]) were obtained from patients with CRS enrolled in a prospective cohort study. Canonical correlation analysis of the SNOT-22 subdomains and LK variables was completed. Results A total of 629 patients were included in analysis including 343 with prior endoscopic sinus surgery. Significant canonical correlations outperformed aggregate correlations in explaining variance of the data (33% vs 3%, respectively). The first canonical correlation was dominated by the rhinologic symptom domain and the endoscopic polyp score ( r = 0.54; p < 0.05) whereas additional significant canonical correlation was found between the extra-rhinologic symptom subdomain and the edema score in patients without prior ESS ( r = 0.21; p < 0.05), and discharge in patients with prior ESS ( r = 0.22; p < 0.05). All other domains and endoscopic variables did not significantly contribute to the canonical correlation. Conclusion Although aggregate symptoms and endoscopic scores demonstrate minimal correlation, a weighted combination of symptom domains and endoscopic attributes greatly improves this correlation. A simple approximation of the weights of each of the endoscopic variables of polyps, edema, discharge, scarring, and crusting, is an approximate ratio of 4:2:1:0:0, respectively. [ABSTRACT FROM AUTHOR]

Background: Cognitive dysfunction and its relationship to both pain and disease-specific quality of life (QOL) in chronic rhinosinusitis (CRS) have not been investigated previously. We sought to analyze the correlations of pain and disease-specific QOL with cognitive function in CRS. Methods: Adults with CRS were prospectively enrolled in a cross-sectional study. Participants' cognitive function was assessed using the Cognitive Failures Questionnaire. Pain was characterized using the Short-Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory Short Form. Disease-specific QOL was ascertained using the Rhinosinusitis Disability Index (RSDI) and 22-item Sinonasal Outcome Test (SNOT-22). Disease severity was assessed using nasal endoscopy and computed tomography. Bivariate correlations of pain and cognitive dysfunction, diseasespecific QOL, and clinical measures of disease severity were ascertained. Results: In patients with CRS (n = 70) there was a significant correlation between cognitive dysfunction and pain severity scores (Spearman's correlation [Rs] = 0.321, p < 0.01). A similar correlation was identified with pain interference (Rs = 0.317, p < 0.01) and cognitive dysfunction scores. This ismirrored by a significant correlation between another measure of pain severity, the SF-MPQ and cognitive dysfunction (Rs = 0.498, p < 0.01). In patients with CRS there was a significant correlation between diseasespecific QOL scores and cognitive function scores as measured by the SNOT-22 (Rs = 0.395, p < 0.01) and the RSDI (Rs = 0.528, p < 0.01). Conclusion: In patients with CRS, increasing pain and worseQOL are associated with cognitive dysfunction. Possiblemechanisms for this cognitive dysfunction include differential neural activation secondary to chronic pain and/or the sequela of a chronic inflammatory state. [ABSTRACT FROM AUTHOR]

Background Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused postobstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multifactorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention. Methods Participants with CRS were prospectively enrolled into an ongoing, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone 'complete' surgery, whereas all other participants were categorized as receiving 'targeted' surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (B-SIT). Results A total of 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, acetylsalicylic acid (ASA) sensitivity, nasal polyposis, and a history of prior sinus surgery ( p ≤ 0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1 ± 21.9 vs 21.9 ± 20.6; p = 0.011) and B-SIT (0.8 ± 3.1 vs 0.2 ± 2.4; p = 0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9 ± 2.5 greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches ( p = 0.016). Conclusion Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent. [ABSTRACT FROM AUTHOR]

Background Prior investigations into facial pain associated with chronic rhinosinusitis (CRS) have yielded important results, but have yet to use pain-specific outcome measures. This study seeks to characterize facial pain associated with CRS using validated pain-specific instruments. Methods Adults with CRS were enrolled into a prospective, cross-sectional study along with control participants presenting with non-CRS diagnoses. Facial pain was characterized in both groups using the Brief Pain Inventory Short Form (BPI-SF) and the Short-Form McGill Pain Questionnaire (SF-MPQ). CRS-specific measures of disease were measured including the 22-item Sino-Nasal Outcome Test-22 (SNOT-22), nasal endoscopy, and computed tomography scoring. Results The patients comprised of CRS with nasal polyposis (CRSwNP; n = 25), CRS without nasal polyposis (CRSsNP; n = 30), and control participants (n = 8). Subjects with CRSwNP and CRSsNP were less likely to be pain free than controls (16.0%, 6.7%, and 62.5% respectively, p = 0.001) and carried greater burden of pain as measured by the BPI-SF and SF-MPQ than controls ( p = 0.002 and p = 0.017, respectively). Pain in CRS was most commonly located around the eyes and characterized as 'throbbing' and 'aching.' Nasal polyp status was not associated with differences in character, severity, or location of pain. Conclusion Subjects with CRS have a greater burden of facial pain relative to control subjects across several standardized pain measures. Further, facial pain in CRS significantly correlated to quality of life and CRS-specific disease severity measures. Study across larger cohorts using standardized pain measures is warranted to clarify the association of facial pain with CRS. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The purpose of this study is to improve patient understanding of surgical outcomes while they make a preference-sensitive decision regarding electing endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Study Design: Prospective observational cohort study. Methods: Patients with CRS who elected ESS were prospectively enrolled into a multi-institutional, observational cohort study. Patients' were categorized into 10 preoperative Sino-Nasal Outcome Test (SNOT-22) groups based on 10-point increments beginning with a score of 10 and ending at 110. The proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) (9 points) and the percentage of relative improvement (%) for each preoperative SNOT-22 group were calculated. A subgroup analysis based on polyp status was performed. Results: A total of 327 patients were included in this study. Patients with a SNOT-22 score between 10 and 19 had the lowest chance of achieving an MCID (37.5%) and received a relative mean worsening of their quality of life (QoL) after ESS (+18.8%). Patients with a SNOT-22 score greater than 30 obtained a greater than 75% chance of achieving an MCID, and there was a relative improvement of 45% in QoL (all < -44.9%) after ESS. Outcomes from the polyp status subgroup analysis were similar to the findings from the overall cohort. Conclusion: Outcomes from this study suggest that patients with a preoperative SNOT-22 score higher than 30 points receive a greater than 75% chance of achieving an MCID and on average obtain a 45% relative improvement in their QoL after ESS. Patients with SNOT-22 score of less than 20 did not experience improved QoL from ESS. [ABSTRACT FROM AUTHOR]

Background Patients with chronic rhinosinusitis (CRS) have significant quality-of-life (QOL) improvements following endoscopic sinus surgery (ESS). These improvements remain stable and persist between 6 months and 20 months as measured by the Rhinosinusitis Disability Index and the Chronic Sinusitis Survey. There has yet to be an evaluation of the longitudinal stability of the 22-item Sino-Nasal Outcome Test (SNOT-22) after ESS in patients with CRS. Methods Adults with medically recalcitrant CRS who were considered surgical candidates were enrolled in a prospective, multicenter, observational cohort study from February 2011 to February 2013. Baseline evaluation of subjects included assessment of clinical characteristics, measures of CRS-specific disease severity, and QOL evaluation using the SNOT-22. Subjects were then re-evaluated at approximately 6-month, 12-month, and 18-month intervals postoperatively. Data was analyzed using repeated measures analysis of variance (ANOVA) with Bonferroni corrections for matched pairwise comparisons. Results A total of 110 patients completed baseline evaluations and follow-up for all 3 postoperative time points. Significant improvement in SNOT-22 scores was seen between baseline and 6 months across both SNOT-22 total and subdomain scores ( p < 0.001). There was no statistically significant difference between the 6-month, 12-month, and 18-month time points in the total SNOT-22 score or its domains ( p ≥ 0.125) for both the entire cohort or subgroups ( p ≥ 0.077). Conclusion Postoperative improvement in CRS-specific QOL and symptom severity, as measured by the SNOT-22, suggest stability and durability between 6 months and 18 months. Further study on the longitudinal stability of the SNOT-22 past the 18-month time frame will help further refine clinical study of CRS and provide further understanding of temporal improvements following ESS. [ABSTRACT FROM AUTHOR]

Background Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more 'cardinal symptoms' that include: (1) nasal obstruction; (2) thick nasal discharge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to ongoing medical therapy. Methods Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 questions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up. Results A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely ( p ≤ 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026). Conclusion Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste. [ABSTRACT FROM AUTHOR]

Background Prior study demonstrated that baseline 22-item Sino-Nasal Outcome Test (SNOT-22) aggregate scores accurately predict selection of surgical intervention in patients with chronic rhinosinusitis (CRS). Factor analysis of the SNOT-22 survey has identified five distinct domains that are differentially impacted by endoscopic sinus surgery (ESS). This study sought to quantify SNOT-22 domains in patient cohorts electing both surgical or medical management and postinterventional change in these domains. Methods CRS patients were prospectively enrolled into a multi-institutional, observational cohort study. Subjects elected continued medical management or ESS. SNOT-22 domain scores at baseline were compared between treatment cohorts. Postintervention domain score changes were evaluated in subjects with at least six-month follow-up. Results A total of 363 subjects were enrolled with 72 (19.8%) electing continued medical management, whereas 291 (80.2%) elected ESS. Baseline SNOT-22 domain scores were comparable between treatment cohorts in sinus-specific domains (rhinologic, extranasal rhinologic, and ear/facial symptoms; p > 0.050); however, the surgical cohort reported significantly higher psychological (mean ± standard deviation [SD]: 16.0 ± 8.4 vs 12.0 ± 7.1; p < 0.001) and sleep dysfunction (13.7 ± 6.8 vs 10.5 ± 6.2; p < 0.001) than the medical cohort. Effect sizes for ESS varied across domains with rhinologic and extranasal rhinologic symptoms experiencing the greatest gains (1.067 and 0.997, respectively), whereas psychological and sleep dysfunction experiencing the smallest improvements (0.805 and 0.818, respectively). Patients experienced greater mean improvements after ESS in all domains compared to medical management (p < 0.001). Conclusion Subjects electing ESS report higher sleep and psychological dysfunction compared to medical management but have comparable sinus-specific symptoms. Subjects undergoing ESS experience greater gains compared to medical management across all domains; however, these gains are smallest in the psychological and sleep domains. [ABSTRACT FROM AUTHOR]

Background Evidence comparing the impact of medical and surgical management of chronic rhinosinusitis on olfactory function is limited. This study evaluates olfactory outcomes in patients who failed initial medical management and elect either continued medical management or endoscopic sinus surgery (ESS) followed by medical management. Methods Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics, quality-of-life and objective clinical findings were collected along with 2 quality-of-life disease-specific measures, the Rhinosinusitis Disability Index (RSDI) and Sinonasal Outcome Test (SNOT-22). The primary outcome measure was the posttreatment change (≥6 months) in the Brief Smell Identification Test (B-SIT). Bivariate and multivariate analyses compared B-SIT changes by treatment type while controlling for baseline cofactors. Results Subjects (n = 280) were enrolled between March 2011 and May 2013. Baseline B-SIT scores (mean ± standard deviation) were comparable between medical and surgical treatment groups (8.8 ± 3.2 vs 9.0 ± 3.2; p = 0.703). Subjects with baseline impaired olfaction (n = 83; 29.6%) experienced B-SIT improvement in both the medical (n = 17; 2.3 ± 2.8; p = 0.005) and surgical (n = 66; 2.1 ± 3.0; p < 0.001) cohort. A total of 38.6% of subjects with impaired olfaction return to normal olfaction at follow-up with no difference identified between treatment modalities ( p = 0.803). Multivariate analyses identified prior surgery as a predictor of less improvement regardless of treatment modality in patients with baseline impaired olfaction. Average changes in B-SIT scores were comparable between treatment groups ( p > 0.050). Conclusion Subjects electing ESS experienced gains in olfaction comparable to subjects electing continued medical management. Further study with larger sample size and more sensitive measures of olfaction are needed to determine differences between treatment groups. [ABSTRACT FROM AUTHOR]

Background Chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) are common entities that overlap in patient demographics. The pathophysiologic role of GERD has yet to be elucidated, but it is postulated that extraesophageal reflux may contribute to worsening symptoms of CRS. This study seeks to investigate whether patients with CRS with and without a history of GERD experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS). Methods An adult cohort (n = 229) with medically refractory CRS was prospectively assessed following ESS using 3 disease-specific QOL constructs. A patient subset with a history of comorbid GERD was retrospectively identified (n = 72) and preoperative and postoperative QOL were compared to patients without GERD (n = 157). Results Patients with comorbid GERD and CRS were comparable across all baseline patient characteristics ( p > 0.050) with the exception of patients with a history of GERD; those patients were less likely to have undergone allergy testing ( p < 0.002) and were older (53.8 years vs 47.6; p < 0.002). Similarly, baseline objective and subjective measures of disease were comparable between patients with CRS with and without GERD ( p > 0.050). Both groups experienced significant QOL improvement across all QOL constructs ( p ≤ 0.021), and no difference was detected in the magnitude of that improvement between patients with and without a history of GERD ( p > 0.050). Similarly, patients on active medical therapy for GERD (n = 49) had QOL gains comparable to patients not reporting GERD medical therapy ( p > 0.050). Conclusion Patients electing ESS for CRS with and without comorbid GERD have comparable baseline characteristics and QOL outcomes following surgery. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology, yet little research exists that investigates the intersection of the two. This study seeks to investigate whether patients with CRS--with and without a migraine history--experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS). Study Design: Retrospective analysis of a prospective cohort. Methods: An adult population (n = 229) with medically refractory CRS was prospectively evaluated following ESS using disease-specific QOL surveys: the Rhinosinusitis Disability Index (RSDI), the Chronic Sinusitis Survey (CSS), and the Sinonasal Outcome Test-22 (SNOT-22). History of comorbid migraine was identified (n = 46), and preoperative and postoperative QOL was compared to patients without migraine (n = 183). Results: Patients migraine and CRS were more likely to be female (P = 0.023); experience allergies (P = 0.024), fibromyalgia (P = 0.009), and depression (P = 0.010); and be less likely to have nasal polyposis (P = 0.003). Objective measures of disease (endoscopy and computed tomography scores) were significantly lower in patients with migraine (P = 0.027 and P = 0.002, respectively), yet these patients scored lower on baseline RSDI and SNOT-22 scores (P = 0.025 and P = 0.019, respectively). QOL in both patients with and without migraine improved significantly after ESS (P = 0.003) and by comparable magnitudes (P ≥ 0.062). Conclusion: Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse preoperative baseline QOL scores. This may imply that comorbid migraine disorder, in the setting of CRS, compels these patients to seek surgical management earlier in the disease process. Regardless, ESS provides comparable improvement for both patients with and without comorbid migraine. [ABSTRACT FROM AUTHOR]

Background Total intravenous anesthesia (TIVA) has been shown in some studies to impact visual field, blood loss, and cardiovascular parameters during endoscopic sinus surgery when compared to inhalational anesthesia (IA). These variables are critical in endoscopic sinus surgery. A systematic review and meta-analysis was undertaken to discern the impact of TIVA vs IA in endoscopic sinus surgery. Methods MEDLINE (1950 to October 20, 2012) was searched using a search strategy designed to include all randomized controlled trials (RCTs) that discussed TIVA, IA, and endoscopic sinus surgery. An abstract search was then used to identify RCTs directly comparing TIVA and IA in endoscopic sinus surgery. All articles selected then underwent full-text review. Data on visual field scores, blood loss, and cardiovascular parameters was then extracted, compared, and analyzed. Results There were 42 articles identified by the search strategy. Full-text review identified 9 articles that met eligibility criteria and contained extractable data. Although inconsistently reported, preoperative characteristics (Lund-Mackay scores and history of nasal polyps) were similar ( p > 0.05) between the 2 groups. No difference was found between heart rate, mean arterial pressure, anesthesia time, operative time, or estimated blood loss. Only 7 studies reported a visibility score, but overall favored the TIVA group ( p < 0.001). Conclusion Current evidence supporting TIVA is limited to a handful of inconsistently controlled and reported studies. Standardized grading of visibility scores and preoperative characteristics would better establish the role of TIVA in endoscopic sinus surgery. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To test the osteoregenerative potential and dosing of bone morphogenetic protein-2 (BMP-2)-impregnated biomimetic scaffolds in a rat model of a mandibular defect. Study Design Prospective study using an animal model. Methods Varied doses of BMP-2 (0.5, 1, 0.5, 0.5 in microspheres, 5, and 15 μg) were absorbed onto a biomimetic scaffold. Scaffolds were then implanted into marginal mandibular defects in rats. Blank scaffolds and unfilled defects were used as negative controls. Two months postoperatively, bone healing was analyzed with microcomputerized tomography (microCT). Results MicroCT analysis demonstrated that all doses of BMP-2 induced successful healing of marginal mandibular defects in a rat mandible. Increasing doses of BMP-2 on the scaffolds produced increased tissue healing, with 15 μg demonstrating significantly more healing than all other dosing ( P < .01). Conclusions BMP-2-impregnated biomimetic scaffolds successfully induce bone healing in a marginal mandibular defect in the rat. Percentage healing of defect, percentage of bone within healed tissue, and total bone volume are all a function of BMP-2 dosing. There appears to be an optimal dose of 5 μg beyond which there is no increase in bone volume. Level of Evidence NA [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the radiographic incidence of heterotopic ossification and the clinical incidence of neck masses secondary to heterotopic ossification in a series of patients who underwent fibula free flap oromandibular reconstruction. Study Design: Retrospective review at a university medical center. Methods: Patient database of 520 consecutive fibula free flaps from 1995 to 2010 was reviewed to identify patients who had postoperative computed tomography (CT) scans of the neck to further investigate the radiologic presence of heterotopic ossification. Patient chart review was also performed to identify patients who had clinical evidence of neck masses consistent with heterotopic ossification. Results: Of the 66 patients who had postoperative CT scans available for radiologic assessment, 43 (65%) showed heterotopic ossification of the fibula periosteum. Clinically, 14 of 520 patients (2.6%) presented with firm, level I or II neck masses that proved to be secondary to heterotopic ossification. Conclusions: Development of a firm neck mass after treatment of head and neck cancer often indicates recurrent tumor. Heterotopic ossification has not been previously reported as a potential etiology of neck masses after fibula free flap oromandibular reconstruction in the head and neck surgery literature. The radiographic incidence of this phenomenon is high, and the clinical incidence of neck masses secondary to heterotopic ossification is low. Heterotopic ossification can be distinguished from recurrent tumor on the basis of physical examination, radiographic assessment, and/or fine-needle aspiration biopsy. Awareness of heterotopic ossification should be included in the differential diagnosis of patients with a neck mass who have undergone fibula free flap reconstructions. [ABSTRACT FROM AUTHOR]