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Background: Critical review of computed tomography (CT) imaging is essential in preoperative planning for endoscopic sinus surgery. In this study, we used a systematic review and a modified Delphi method to develop a comprehensive checklist that facilitates preoperative review of sinus CT imaging., Methods: We performed a systematic review of PubMed, Embase, CINAHL, Cochrane, and Web of Science databases to identify existing checklists developed to evaluate sinus CT imaging. An inclusive list of items from these checklists was compiled and a modified Delphi methodology was used to assign ranked priority. The Delphi process involved 14 rhinologists and had three phases: an initial survey with Likert priority (scale of 1-9) and two rounds of live discussions followed by survey to confirm consensus., Results: Ninety-seven possible checklist items were identified from a systematic review and panelist input. On initial survey, 63 items reached a consensus score of 7+, and 13 items had near consensus scores between 6 and 7; two of these 13 borderline items were retained after subsequent panelist discussion. The resulting items were consolidated into an 11-item disease checklist and a 24-item anatomical checklist; the anatomical checklist was further divided into six subsections: nasal cavity, maxillary, ethmoid, sphenoid, frontal, skull base, and orbit. Additionally, panelists identified six core aspects of patient history to consider prior to surgery., Conclusions: After establishing content validity through a systematic literature review and a modified Delphi method, we developed a comprehensive checklist for preoperative sinus CT imaging review; implementation and evaluation of validity among trainees will suggest overall utility., (© 2022 ARS-AAOA, LLC.)

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.)

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.

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]

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]