Search

Background/purpose: In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS).Methods: A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease.Results: Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group.Conclusion: Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively. [ABSTRACT FROM AUTHOR]

Intranasal corticosteroid drugs are widely used in chronic rhinosinusitis with nasal polyps (CRSwNP). In contrast to classical delivery with nasal pump sprays, pulsating aerosols can deliver significant doses into superior and posterior sinonasal spaces. A case–control study was designed to assess the efficacy of corticosteroid transnasal nebulization on short-term mucosal recovery and quality of life (QoL) following endoscopic sinus surgery in CRSwNP. Thirty patients were prospectively enrolled to receive either 1-month budesonide nasal pump spray or 1-month budesonide 100-Hz acoustic pulsating nebulization at the first postoperative visit (day 8). Patients were evaluated with Lund-Kennedy endoscopic score at day 8 (D8) and 1 month later (M1). CRS-related QoL questionnaires (SNOT22 and RhinoQOL) were fulfilled at M1. The Lund-Kennedy endoscopic scores compared between D8 and M1 were suggestively improved in the group treated with budesonide nebulization (mean difference between groups, − 18.28 units; 95%CI, − 31.29 to − 5.28 units, p = 0.014). QoL measurements were comparable at M1 between the groups of patients. No unexpected adverse event was described with both budesonide delivery protocols. In the early postoperative period, patients with CRswNP may benefit from pulsating nebulization. Large studies should be conducted to confirm the results. Safety profile related to systemic steroid absorption and bioavailability in chronic respiratory diseases also need to be addressed for further use. [ABSTRACT FROM AUTHOR]

Introduction: The International Frontal Sinus Anatomy Classification (IFAC) is a consensus document created to standardize and specify the naming of cells within the region of the frontal recess and frontal sinus. Aim: The aim of this study was to analyze the difficulties in identifying cells according to the IFAC in patients with diffuse primary chronic rhinosinusitis. Material and methods: Three independent reviewers examined triplanar computed tomography (CT) scans to assess the anatomy of the frontal recess using the IFAC system. CT scans were chosen randomly and divided into 3 groups: CT scans of patients not presenting sinus complaints (control group), CT scans of patients affected by diffuse primary chronic rhinosinusitis non-type 2, and CT scans of patients affected by diffuse primary chronic rhinosinusitis type 2. Results: Identification of all frontal cell types was accurate in patients not presenting sinus complaints (P-value < 0.05). Patients scoring 9 or more points in the Lund-Mackay scoring system demonstrated a statistically increased risk of improper identification of frontal recess cells (P-value < 0.0001). Conclusions: Due to a large number of possible anatomical variants and changes caused by the chronic inflammatory disease, the IFAC nomenclatura is easier to apply to non-type 2 primary diffuse CRS patients with low scores in the L-M score scale than to primary diffuse type 2 CRS patients with higher M-L scores. [ABSTRACT FROM AUTHOR]

Objective: investigate the impact of an intraoperative coding sticker (ICS) on the accuracy of coding in endoscopic sinonasal procedures. Methods: this was a two-cycle audit evaluating the accuracy (and financial impact) of intraoperative coding of sinonasal procedures at a single tertiary centre. An ICS was introduced following consultation with the coding department. The accuracy of coding was measured before (cycle 1) and after (cycle 2) the ICS was introduced to a pilot firm and compared to a control firm. The ICS was used in 35% of the pilot firm cases. Results: the accuracy of clinical coding for endoscopic sinus surgery was 60% in the first cycle. Switching to the ICS has improved the accuracy in that firm from 50% in first cycle to 70% in the second cycle (p = 0.936; Chi-squared test). The median reimbursement for endoscopic sinus surgery was equal in both cycles of £1493.00 per patient. However, inaccurate coding resulted in £109.92 excess tariff payment in first cycle and £130.96 deficiency in the second cycle. Users of ICS reported it to be easy to use for clinicians, staff and clinical coders, whilst minimizing human error. Conclusions: The integration of the ICS improves the coding in sinonasal procedures and offers low-fidelity option alternative to live coding on the computer. The accuracy was not statistically significant in the study possibly due to the low number of observations. This can allow a precise coding standard with reliable service remuneration.

Background: Aspirin-exacerbated respiratory disease (AERD) is an aggressive inflammatory disorder of the upper and lower respiratory tract. Corticosteroids, leukotriene modifiers, endoscopic sinus surgery (ESS), aspirin (ASA) desensitization, and biological immunomodulators are currently used to treat the disorder. Objective: The objective of this study was to determine the psychosocial impact of ESS and ASA desensitization on AERD patients. Methods: All AERD patients who underwent complete ESS were divided into two cohorts based on ASA desensitization status. The psychosocial metrics of the SNOT-22 were collected and analyzed at the following time points: pre-operative, 1-month, 3-month, 6-month, and 12-month after ESS. Results: One hundred and eighty-four AERD patients underwent ESS from November 2009 to November 2018. From this group, 130 patients underwent ASA desensitization (AD cohort) and 54 patients remained non-desensitized (ND cohort). AD patients showed a significantly greater reduction in total SNOT-22 scores over the study period compared to ND patients (p = 0.0446). Analysis of SNOT-22 psychosocial metrics showed a significantly greater improvement in patient productivity in the AD cohort when compared to the ND cohort (p = 0.0214). Further, a sub-group analysis accounting for subject attrition showed a significantly greater improvement in both productivity and concentration in AD patients when compared to the ND cohort (productivity: p = 0.0068; concentration: p = 0.0428). Conclusions: ESS followed by ASA desensitization decreases the overall psychosocial burden in AERD patients with a significant improvement in perceived productivity and concentration. This has significant implications given the psychosocial impact of chronic diseases.

Objective  Computed tomography (CT) is a powerful tool for delineating the anatomy of the anterior skull base. The goal of this study is to further characterize the relevant anatomical features of this area, along with other parameters important for endoscopic sinus surgery. Design  Retrospective case review. Setting  Tertiary care hospital. Participants  Thirty patients who had CT scans of the paranasal sinuses. Main Outcome Measures  The following features were assessed using image analysis software: olfactory fossa depth, the length and angle of the lateral lamella, fovea ethmoidalis length and shape, ethmoid roof height and slope, and the position and course of the anterior ethmoid artery. Statistical analysis was performed assessing for differences in the above parameters. Results  The mean olfactory fossa depth of the anterior and posterior skull base was 3.4  ± 1.1 and 2.4  ± 0.9 mm, respectively (p  < 0.05). The mean lateral lamella length was 3.6  ± 0.9 mm, which did not demonstrate significant variability. The angle of the lateral lamella varied significantly by skull base position, measuring 63.1 ± 17.8 degrees anteriorly, and 39.1 ± 17.9 degrees posteriorly (p  < 0.05). In scans classified as a Keros type I, 25.3% had lateral lamellae longer than 4 mm. Furthermore, 43.7% had lateral lamellae with angles less than 45 degrees. Moving anteriorly, the posterior skull base sloped downward in 46.7% of patients. Conclusion  Thorough preoperative assessment of CT scans is crucial to understanding the inherent variability of skull base anatomy. Even "safe" anatomy can still contain features such as long and acutely angled lateral lamella, which may predispose patients to iatrogenic injury. [ABSTRACT FROM AUTHOR]

Purpose: Endoscopic sinus surgery (ESS) is typically guided under preoperative computed tomography (CT), which increasingly diverges from actual patient anatomy as the surgery progresses. Studies have reported that the revision surgery rate in ESS ranges between 28 and 47%. This paper presents a method that can update the preoperative CT in real time to improve surgical completeness in ESS. Approach: The work presents and compares three novel methods that use instrument motion data and anatomical structures to predict surgical modifications in real time. The methods use learning techniques, such as nonparametric filtering and Gaussian process regression, to correlate surgical modifications with instrument tip positions, tip trajectories, and instrument shapes. Preoperative CT image sets are updated with modification predictions to serve as a virtual intraoperative CT. Results: The three methods were compared in eight ESS cadaver cases, which were performed by five surgeons and included the following representative ESS operations: maxillary antrostomy, uncinectomy, anterior and posterior ethmoidectomy, and sphenoidotomy. Experimental results showed accuracy metrics that were clinically acceptable with dice similarity coefficients > 86%, with F-score > 92% and precision > 89.91% in surgical completeness evaluation. Among the three methods, the tip trajectory-based estimator had the highest precision of 96.87%. Conclusions: This work demonstrated that virtually modified intraoperative CT scans improved the consistency between the actual surgical scene and the reference model, and could lead to improved surgical completeness in ESS. Compared to actual intraoperative CT scans, the proposed method has no impact on existing surgical protocols, does not require extra hardware, does not expose the patient to radiation, and does not lengthen time under anesthesia. [ABSTRACT FROM AUTHOR]

The aim of this work was to present a practical management algorithm for orbital and brain complications of sinusitis. According to the inclusion criteria, a sample of 68 patients was collected between 2008 and 2018 (39 males and 29 females). Among them, 44 were adults, with a mean age of 50.46 years, and 24 were pediatric patients, with a mean age of 10.33 years. Oral or intravenous antibiotic therapy was administered to all patients. Pharmacological resolution was observed in 14 cases. Early surgical treatment within 48 hours was necessary in 10 cases. Surgery consisted of abscess drainage, associated or not with functional endoscopic sinus surgery. Delayed surgery within 15–30 days was performed in 44 patients. The core procedure was functional endoscopic sinus surgery. Subsidiary procedures were abscess drainage, tooth extraction or cranial base repair. The combination of two or more of these procedures was case selected. Median follow-up was of 46.36 months. Sinusitis complications necessitate rapid diagnosis and prompt treatment. Antibiotic therapy alone is enough for mistreated rhinosinusitis with no anatomical predisposing factor. Surgery is mandatory for altered nasal and paranasal sinus anatomy or odontogenic infections. [ABSTRACT FROM AUTHOR]

The present case of angioleiomyoma of the nasal cavity in a 59-year-old male is unique, being the first case from North India and also because of its unique area of origin. The patient was referred to the Ear, Nose and Throat Outpatient Department with a diagnosis of an asymptomatic nasal mass. Biopsy done on the mass in another hospital reported angiofibroma. Excision was done after all relevant investigations. Histopathology revealed diagnosis of angioleiomyoma. Immunohistochemistry revealed desmin, SMA, and H-caldesmon positivity, consistent with the diagnosis of angioleiomyoma. Our case report thus highlights the im­portance of including this diagnosis in the differential diagnoses of nasal masses.

Abstract Objective The purpose of this study is to determine if removal of ethmoid cell septations as commonly performed in endoscopic sinus surgery leads to a change in orbital wall fracture patterns and the force required to create them. Methods Six fresh-frozen cadaveric heads were acquired and underwent endoscopic uncinectomy, maxillary antrostomy, and anterior and posterior ethmoidectomy on one, randomized, side. The contralateral sinuses were used as intra-specimen control. Hyaluronic acid gel globe injections were performed to simulate normal intra-ocular pressure. Post-op CT scans confirmed no orbital fractures or violation of the lamina papyracea prior to trauma testing. Orbital trauma was induced using a guided weight-drop technique. Both orbits were tested in random order, and sequentially higher drops were performed until both the test and control side demonstrated an orbital fracture on CT scan. Results In all six heads, the post-sinus surgery side incurred a medial orbital wall fracture, and no orbital floor fractures were identified. On the other hand, on the control side, all six heads incurred orbital floor fractures at drop heights equal to, or higher than, the surgical side. Fisher’s exact test demonstrated a significant difference in fracture pattern (p

The lateral recess of a well-pneumatized sphenoid sinus is challenging to access surgically. Traditional methods require the use of multiple angled endoscopes and curved instruments which may limit visualization. We describe a prelacrimal-transpterygoid/maxillary approach which offers direct access to this region with a 0° endoscope. Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Aim: The aim of this study was to evaluate the safety and efficacy of the piezoelectric knife as a new tool for frontal beak surgery in patients with chronic rhinosinusitis (CRS) both in terms of imaging and perception of symptoms' outcomes., Materials and Methods: The study involved 28 patients with CRS who underwent endoscopic sinus surgery (ESS) using a piezoelectric knife in the frontal recess region. Assessment of sinus imaging and patients' quality of life (QoL) was performed before and after surgery with the Lund-Kennedy and Lund-Mackay systems and the 22-item Sino-Nasal Outcomes Test (SNOT-22)., Results: Median scores on the Lund-Kennedy and Lund-Mackay systems decreased within 24 weeks after surgery with piezo knife assistance by 4 and 5 points, respectively. QoL improved with SNOT-22 scores decreasing by 35.5 points., Conclusions: ESS with the piezoelectric knife used for frontal beak reduction turned out to be a safe procedure. In the studied group of patients, the improvement was observed in terms of imaging, patients' perceptions of symptoms, and QoL outcomes. Therefore, the piezoelectric knife might be a valuable supporting tool in ESS in patients with CRS, although further observation is needed.

Background: The advent of 3D navigation imaging has opened new borders to the endoscopic surgical approaches of naso-sinusal inflammatory and neoplastic disease. This technology has gained in popularity among otolaryngologists for endoscopic sinus and skull base surgeries in both adults and children. However, the increased tissue radiation required for data acquisition associated with 3D navigation protocols CT scans is a source of concern because of its potential health hazards. We aimed to compare the effective doses of radiation between 3D navigation protocols and standard protocols for sinus computed tomography (CT) scans for both the adult and pediatric population. Methods: We performed a retrospective cohort study through electronic chart review of patients undergoing sinus CT scans (standard and 3D navigation protocols) from May 2019 to December 2019 using a Siemens Drive (VA62A) CT scanner. The effective dose of radiation was calculated in mSv for all exams. Average irradiation doses were compared using a Student's T-Test or a Kruskall–Wallis test when appropriate. Results: A total of 115 CT scans were selected for analysis, of which 47 were standard protocols and 68 were 3D navigation protocols CT scans. Among these, 31 exams were performed on children and 84 exams on adults. For the total population, mean effective dose in the non-navigation CT scans was 0.37 mSv (SD: 0.16, N = 47) and mean effective dose in the 3D navigation sinus CT group was 2.33 mSv (SD: 0.45, N = 68). The mean difference between the two groups was statistically significant 1.97 mSv (CI 95% − 2.1 to − 1.83; P < 0.0001). There was a sixfold increase in radiation with utilization of 3D navigation protocols. The ratio was identical when the pediatric as well as the adult subset of patients were analyzed. Conclusion: In our center, utilization of 3D navigation sinus CT protocols significantly increases radiation exposure. Otolaryngologists should be aware of this significant increase and should attempt to decrease the radiation exposure of their patients by limiting unnecessary scan orders and by evaluating 3D acquisition protocols locally with radiation physicists. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Background: Chronic rhinosinusitis (CRS) is one of the most commonly reported chronic diseases. Refractory CRS represents a subgroup of patients who continue to be symptomatic even after adequate medical and surgical therapy. These patients started to form a significant portion of patients with CRS. Food elimination as a therapeutic method to control symptoms of different chronic diseases, such as eosinophilic esophagitis, asthma, and atopic dermatitis, has been described in the literature with variable success rates. Objectives: To evaluate the effectiveness of food elimination therapy as adjuvant treatment in refractory patients having CRS with positive food sensitization. Design: Prospective open-label study. Setting: Tertiary academic center. Methods: Consecutive adult patients with refractory nonobstructive CRS (patients who had persistent sinonasal symptoms despite endoscopic sinus surgery and patent sinuses ostia with adequate medical treatment) with positive food sensitization were included. Subjects were asked to eliminate the sensitized food from their diet. Clinical outcome was assessed using the Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores. Results: Twenty-two patients were initially enrolled in the study. Six patients were excluded; 4 were lost to follow-up, and 2 did not eliminate the causal food for the required period. The average age of the patients was 36 years old. There were 10 female and 6 male patients. Nasal discharge and facial pressure were the most common presenting symptoms. Shellfish, egg, and meat mix were the most common eliminated foods. There was a significant difference in the patients' Lund-Kennedy symptom and Lund-Kennedy endoscopic appearance scores at 6 and 12 weeks after food elimination therapy. Conclusions: Food elimination in refractory CRS is an effective adjuvant treatment and should be considered in the treatment algorithm of patients with persistent symptoms after successfully performed sinus surgery. [ABSTRACT FROM AUTHOR]

Background: Injury to the internal carotid artery (ICA) is a potentially devastating complication of endoscopic endonasal surgery (EES) that as many as 20% of skull base surgeons will experience at least once during their careers. Managing these injuries is difficult given the small operative field and poor visibility created by high-flow hemorrhage, and, at present, there is no consensus regarding best practices. Objective: This study seeks to consolidate the practices and opinions of experienced skull base surgeons from high-volume tertiary care centers into a single consensus statement regarding the best practices for managing ICA injuries during EES. Methods: A panel of 23 skull base surgeons (15 neurosurgeons and 8 otolaryngologists) completed a 3-round Delphi survey that assessed experiences and opinions regarding various aspects of ICA injury management. Mean (SD) years since fellowship completion was 15.6 (8.1) and all but 3 surgeons had experienced an ICA injury at least once. Results: The final consensus statement included 36 guidelines all of which were grouped under 1 of 4 categories: 11 statements concerned preoperative management and equipment for high-risk patients; 14 statements concerned hemorrhage control; 4 statements concerned definitive management; 7 statements concerned pharmacologic treatment, blood pressure, and neurophysiologic monitoring. Conclusions: There are numerous decisions that a surgeon must make when facing a carotid artery injury. In our estimation, many questions can be grouped under 1 of the 4 categories outlined in our consensus statement and can be addressed by these findings. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery is a standard procedure for the treatment of chronic sinusitis. This surgery is usually conducted under general anesthesia and it is better to be performed under controlled hypotensive technique to improve surgical field and to decrease the operation time. Routine analgesic treatment is usually based on non-opioid analgesics with rescue opioids. Objective: The aim of this study was to compare opioid free versus opioid based general anesthesia in functional endoscopic sinus surgeries regarding hypotension, surgical field, operation time and postoperative pain. Patients and methods: Patients were divided into 2 equal groups: Group 1: Opioid free group: (Group OFA) 22 participants, Group 2: Opioid based group: (Group OBA) 22 participants. All participants were subjected to medical history taking, complete clinical examination and premedication and routine laboratory investigations. Results: There was no statistical significant difference between the studied groups regarding the mean arterial pressure, oxygen saturation and need for analgesia. Duration of stay in post anesthesia care unit was significantly shorter in OFA group than OBA group. OBA Group was significantly associated with higher VAS score at 6-, 10- and 12-hours postoperatively. Conclusion: OFA provided satisfactory intraoperative analgesia and control of surgery-induced pressor reflexes. Also, the perioperative safety and efficacy of the opioid-free anesthesia techniques provided for functional endoscopic sinus surgeries had good postoperative analgesia and other postrecovery criteria. There is a need for wider-scale comparative studies with large number of patients with long period in multi-center studies to confirm our finding. [ABSTRACT FROM AUTHOR]

Summary: Current methods of creating sinus drainage and allowing egress of a sinus pack at the end of surgery create significant haemorrhage. Given that haemorrhage is already a concern in some sinus surgeries, the method described allows for a significant reduction in blood loss. The objective was to describe a method of enlarging the nasomaxillary aperture in horses to allow egress of a sinus pack, and subsequent endonasal treatment, without incurring significant haemorrhage. The bulla of the maxillary septum is depressed using a gloved finger (through a sinus flap or trephine hole) or using a long curved Peine instrument under sinoscopic control before fenestration. No major operative or post‐operative complications have been encountered. Satisfactory widening of the nasomaxillary aperture has been accomplished in all cases, although at times, when the bulla is under the floor of the dorsal conchal sinus, it can be difficult to compress. It is imperative that this procedure be performed before fenestration. If performed after fenestration, the most rostral edge of the fenestration can be difficult to identify, and this becomes an impediment to widening the nasomaxillary aperture. Enlarging the nasomaxillary aperture with a finger or blunt instrument allows improvements in sinus drainage without the complication of severe epistaxis. Depression of the bulla of the maxillary septum, before surgical fenestration into the rostral maxillary and ventral conchal sinuses, allows opening of the nasomaxillary aperture with minimal haemorrhage. Thereafter, the sinus pack can be egressed via this route, which is also large enough to perform sinus lavage and post‐operative treatments endonasally without the risk of disturbing the external surgical site. [ABSTRACT FROM AUTHOR]

Introduction: Pneumatization of the sphenoid sinus (SS) varies widely among different ethnic groups. Information regarding the prevalence and significance of SS variants among Hispanic groups is limited. This study aims to describe and analyze pneumatization and septation patterns of the SS in a Hispanic population. Methods: A total of 160 paranasal sinus computed tomographies were reviewed by a head and neck-specialized radiologist and 2 otolaryngologists. Results: The postsellar and sellar types were the most frequent patterns of pneumatization observed, with a prevalence of 52.5 and 40%, respectively. Accessory septations were present in 59.4% of the patients. Septa were inserting over the internal carotid artery (ICA) in 43.8% and over the optic nerve in 17.5% of the population. No significant association (p > 0.05) was observed when comparing the different accessory septation patterns among the types of the SS. The frequency of septa inserting on the ICA was significantly higher in postsellar types (p < 0.001). Pneumatization of the anterior clinoid process, pterygoid processes, and greater wing was present in 20, 17.5, and 45.9% of the sinuses, respectively. Onodi cells were encountered in 40% of the sinuses. There were no significant differences in any of the pneumatization and septation variables when compared by gender and age (p > 0.05). Discussion/Conclusion: Differences regarding anatomical variants and septations of the SS were observed in our study when compared with findings reported in other ethnic groups. Preoperative assessment of the anatomical variants of the SS in Mexican patients is imperative to select the most optimal surgical approach and prevent iatrogenic injuries to related neurovascular structures. [ABSTRACT FROM AUTHOR]

Objectives: Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. Design: Retrospective review of medical records. Setting: Academic Hospital. Participants: 40 adult CF patients. Main outcome measures: Rate of lung function decline (% predicted Forced Expiratory Volume in 1 second [ppFEV1]), number of pulmonary exacerbations (IV/oral antibiotic therapy ± hospital admission) and total number days hospitalised 2‐year postoperatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. Results: Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline ppFEV1(72.5% vs. 72.7%, P =.98), 2‐year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P =.10), or Lund‐Mackay scores (12.25 vs. 11.55, P =.71). No significant difference was found in 1‐year (70.5% vs. 72.8%, P =.84) or 2‐year (70.4% vs. 72.6% P =.80) postoperative ppFEV1 and 2‐year postoperative pulmonary exacerbations (1.7 vs. 1.45, P =.87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P =.02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1, 1 year (−2.51%, P =.32) and 2 years after ESS (−3.10%, P =.51), postoperative rate of pulmonary exacerbations (−1.28, P =.11), or in total number days hospitalised (3.74, P =.14). Conclusions: In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively. [ABSTRACT FROM AUTHOR]

Summary: The goal of this American Rhinologic Society expert practice statement (EPS) is to provide clinically applicable, evidence‐based recommendations regarding pain management in sinonasal surgery. This EPS was developed following the recommended methodology and approval process as previously outlined. The topics of interest included preoperative counseling, local anesthesia, use of opioids for postoperative pain, use of nonopioid medication for postoperative pain, nonsteroidal anti‐inflammatory drugs and bleeding, and use of gabapentin for pain control. Following a modified Delphi approach, 6 statements were developed, 5 of which reached consensus and 1 that did not. These statements and accompanying evidence are summarized along with an assessment of future needs. [ABSTRACT FROM AUTHOR]

If the ARS member is not part of a committee, then the member will approach the chair of the ARS committee most relevant to the content of the proposed EPS for sponsorship (see Section 2.3 "Working group creation" for further details). These ARS Expert Practice Statements (EPS) would be endorsed by the ARS and provide guidance for clinicians on everyday topics of clinical interest in the field of rhinology. With these limitations in mind, the Quality Improvement Committee (QIC) of the ARS, under the direction of the Board of Directors (BOD), has been tasked with developing a methodology to summarize existing evidence and provide explicit summary recommendations for discrete clinical topics. CONCEPT APPROVAL AND WORKING GROUP CREATION PROCESS FOR EPS Eligible authors Any member of the ARS is eligible to submit a proposal and declaration of intent to the QIC to create an EPS. [Extracted from the article]

Keywords: endoscopic sinus surgery; healthcare economics; rhinology workforce; sinus surgery; statistics EN endoscopic sinus surgery healthcare economics rhinology workforce sinus surgery statistics 1387 1390 4 09/30/21 20210901 NES 210901 INTRODUCTION Gender-based pay gaps have been reported across industries, and unfortunately, the trend has also infiltrated medicine. Endoscopic sinus surgery, healthcare economics, rhinology workforce, sinus surgery, statistics. [Extracted from the article]