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Background: Drug‐eluting implants are becoming increasingly popular in the treatment of chronic rhinosinusitis (CRS). A previous attempt to make an evidence‐based recommendation was hindered by limited evidence and experience with these implants. Since that time, the body of literature discussing drug‐eluting implants has grown rapidly. The objective of this study was to review drug‐eluting implants designed for use in the sinonasal cavity through an evidence‐based review with recommendations. Methods: A systematic review of the literature was performed using PubMed, EMBASE, Cochrane Review, and gray literature databases from January 1990 through February 2019 to examine drug‐eluting implants used in CRS. Benefit‐harm assessments, value judgments, and recommendations were made based on the available evidence. Study exclusion criteria included studies unavailable in English and non‐endoscopic sinus surgeries. All authors agreed on recommendations through an iterative process. Results: Thirty‐one studies were included in the final analysis. Absorbable drug‐eluting implants achieved a high aggregate grade of evidence (A), with a recommendation for their use to be considered in carefully selected patients. Nonabsorbable drug‐eluting implants were recommended against due to minimal evidence supporting clinical efficacy. Antibiotic and alternative drug‐eluting implants lack sufficient evidence for recommendations. Conclusion: Absorbable steroid‐eluting implants are recommended for carefully selected patients with CRS. Additional research to define appropriate patient selection is needed. [ABSTRACT FROM AUTHOR]

Background: Despite the significant morbidity associated with chronic rhinosinusitis (CRS) in individuals with asthma (CRSwA), there is a paucity of codified, evidence‐based management strategies for CRS in this population. Methods: Using PubMed, Embase, and Cochrane Review Databases, a systematic review was performed covering management strategies for CRSwA. A total of 5903 articles were screened, and 70 were included for full‐text analysis. After application of exclusion criteria, 53 articles comprised the qualitative synthesis. The level of evidence was graded and benefit‐harm assessments, as well as value judgment and recommendations, were provided Results: Strong evidence confirms the benefit of oral and topical medications on sinonasal‐specific outcomes in individuals with CRSwA; there is low‐grade evidence demonstrating that these agents improve lung function and/or asthma control. Moderate to strong evidence suggests that endoscopic sinus surgery (ESS) improves both sinonasal‐ and asthma‐specific quality of life. Although there is insufficient to low evidence to indicate that ESS improves pulmonary function in this population, data indicate a positive impact of this intervention on asthma control. Biologic medications strongly improve both subjective and objective sinonasal‐ and asthma‐specific outcomes. Conclusion: Evidence supports managing CRS in individuals with CRSwA in a stepwise fashion, starting with traditional nonbiologic oral and topical medication, and escalating to second‐line treatments, such as ESS and biologics. Optimal treatment of individuals who have CRSwA often requires concurrent, directed management of asthma, as not all CRS interventions impact asthma status. [ABSTRACT FROM AUTHOR]

Background: Surgeons commonly prescribe prophylactic antibiotics after endoscopic sinus surgery (ESS), yet minimal data exist to support this practice. In this study we aimed to assess the impact of post‐ESS antibiotics on infection, quality of life (QOL), and endoscopic scores. Methods: This was a randomized, double‐blind, placebo‐controlled, noninferiority trial comparing amoxicillin‐clavulanate vs placebo after ESS (NCT01919411, ClinicalTrials.gov). Adults (N = 77) with chronic rhinosinusitis (CRS) refractory to appropriate medical therapy who underwent ESS were randomized to antibiotics (N = 37) or placebo (N = 40) and followed clinically (mean ± standard deviation: 1.3 ± 0.3 and 8.8 ± 3.9 weeks postoperatively). At baseline and follow‐up, QOL was measured with 22‐item Sino‐Nasal Outcome Test questionnaires and Lund‐Kennedy endoscopic scores were evaluated. Outcomes were analyzed with repeated‐measures analysis of variance and analysis of covariance and z tests for proportions. Results: Placebo was noninferior to antibiotic prophylaxis with regard to postoperative SNOT‐22 scores (β = 0.18, 2‐tailed p < 0.05). There were no significant differences between the antibiotic and placebo groups in LK score trajectories over time (p = 0.63) or in postoperative infection rates (2.6% vs 2.4%, respectively; p = 0.96). The rate of diarrhea was significantly higher in the antibiotic group (24.3% vs 2.5%; relative risk = 10.8; p = 0.02). Conclusion: Although statistically underpowered, the results suggest placebo was noninferior to prophylactic antibiotics after ESS for CRS regarding postoperative sinonasal‐specific QOL. There were no significant differences in postoperative endoscopic scores or rates of infection, but the rate of diarrhea was significantly higher in the antibiotic group. These findings add to the growing evidence that routine use of prophylactic postoperative antibiotics does not improve outcomes post‐ESS and significantly increases the rate of diarrhea. [ABSTRACT FROM AUTHOR]

Background: Odontogenic sinusitis (ODS) can present a therapeutic dilemma because multiple treatment strategies have been reported. ODS review articles have been published, but they have lacked multidisciplinary collaboration and an evidence‐based methodology. The purpose of this article was to perform an evidence‐based review of ODS management options, and develop a multidisciplinary consensus statement on ODS management options. Methods: An evidence‐based review of dental and medical literature on ODS management was performed using PubMed, EMBASE, and Cochrane Review Databases up to December 2019. Exclusion criteria included non‐English‐language articles, case series with fewer than 10 patients, fungal sinusitis, and studies that did not report treatment success rates. Because aggregate levels of evidence for recommendations were no higher than level C, a clinical consensus statement was conducted using a modified Delphi method. Results: Sixteen articles met inclusion criteria for the evidence‐based review on the following ODS management options: dental treatment alone or combined with ESS for various dental pathologies, and endoscopic sinus surgery (ESS) alone for dental implant‐related ODS. Strong consensus was achieved for 9 of the 10 clinical statements, the strongest being the use of shared decision‐making for selecting management strategies. No consensus was reached for determining the extent of ESS necessary for uncomplicated ODS. Conclusion: Strong consensus was reached that ODS management should involve shared decision‐making between the otolaryngologist, dental provider, and patient, where the benefits and risks of dental treatment and ESS are discussed. Higher‐quality studies are necessary to develop evidence‐based treatment recommendations for ODS. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the impact of bilateral inferior turbinate reduction (BITR) on patient‐reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods: This was a prospective cohort study. Patients with CRS, who were recruited from 10 different otolaryngologic practices between 2011 and 2014, completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Chronic Sinusitis Survey (CSS), and EuroQol 5 Dimension (EQ‐5D) survey at baseline, and at 12, 24, 36, and 48 months after ESS. A total of 113 patients who underwent ESS with BITR were compared to 788 patients who underwent ESS without BITR. Results: Significant demographic and comorbid differences between BITR and non‐BITR cohorts included age (41 vs 49 years, p < 0.0001), presence of asthma (19% vs 36%, p < 0.0001), prior sinus surgery (22% vs 53%, p < 0.0001), and concurrent septoplasty (80% vs 53%, p < 0.0001), respectively. On univariate analysis, patients who underwent ESS with or without BITR were found to have statistically significant improvement in disease‐specific (SNOT‐22 and CSS) and general (EQ‐5D) QOL scores at years 1 through 4 (p < 0.05). On multivariate regression, however, the performance of BITR was not associated with any improvements in these outcome measures. Conclusion: Patients undergoing ESS achieve similar long‐term improvement in both disease‐specific and general QOL regardless of the performance of concurrent BITR. [ABSTRACT FROM AUTHOR]

Background Industry outreach promotes awareness of novel technologies. However, concerns have been raised that such relationships may also unduly impact medical decision-making. Our objective in this study was to evaluate industry relationships among practitioners who frequently employ balloon dilation (BD), characterizing whether there is any association between financial relationships and BD utilization. Methods Provider utilization data (FY-2014) was accessed for individuals billing BD procedures to Medicare, the largest healthcare payor in the United States. The names of individuals included in these data sets were cross-referenced with the Centers for Medicare and Medicaid Services Open Payment site to determine the extent of industry relationships during this same year. Individuals included in this analysis were organized by those with 'significant' ($1,000 to $10,000) and 'major' (> $10,000) industry relationships. Practice setting, training, and experience were also evaluated. Results Of the 302 otolaryngologists who billed enough BDs for inclusion in this data set, 99.3% were in private practice, 89.7% were board-certified, 8.3% had facial plastic and reconstructive fellowship training, and 1.3% had rhinology fellowship training. There was a significant increase in BDs performed with increasing BD company financial contributions (analysis of variance, p = 0.0003). Individuals without 'significant' relationships with BD companies billed fewer BDs than those with at least 'significant' (>$1,000) relationships (57.0 ± 4.3 vs 87.7 ± 10.0, p = 0.001). Conclusion There is an association between receiving money from industry and the frequency with which otolaryngologists employ BD. Although our analysis demonstrates an association, these results in no way imply causation. Further analysis exploring the reasons for this association may be necessary. [ABSTRACT FROM AUTHOR]

Background The need for objective assessment of patient outcomes is becoming an essential component of clinical practice for both private and academic otolaryngologists. The purpose of this study is to describe the implementation of an online model for collection of clinical outcomes data in patients with chronic rhinosinusitis (CRS). Methods Patients completed the Sinonasal Outcome Test (SNOT-22), Chronic Sinusitis Survey (CSS), and EuroQol 5-dimension assessment (EQ-5D), before and after sinus surgery. One year after initial patient enrollment, an online tool was developed to facilitate collection of postoperative data. Response rates preimplementation and postimplementation of online data collection were compared. Results A total of 520 sinus surgery patients provided outcomes data from the practices of 7 private practice (n = 308) and 4 academic otolaryngologists (n = 212). With implementation of the online collection instrument, the response rate at 3 months increased from 67% to 78.8% ( p = 0.004). The overall follow-up rate at 3 months was higher in patients recruited from private as compared to academic practices (77.9% vs 69.8%, respectively, p = 0.04). Conclusion Quality of life data can be effectively collected from CRS patients in both the private and academic practice setting. The addition of an online data collection tool can significantly increase response rates, and allow a comprehensive capture of meaningful clinical outcomes. Such a model is not difficult to implement and has increasing relevance as payers begin to request outcome data from providers. [ABSTRACT FROM AUTHOR]