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Purpose: Although the effectiveness of molecular antibodies has been established, evidence is still lacking on objective predictors of response. The aim of this study was to assess whether the extent of previous endoscopic sinus surgeries, assessed by means of the Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) score, may influence clinical outcomes in refractory CRSwNP patients treated with dupilumab. Materials and Methods: A consecutive sample of patients treated with dupilumab for previously operated recalcitrant CRSwNP were enrolled in the study. Every patient was required to undergo a CT scan at baseline (T0), at 3 (T1), and 12 (T2) months after treatment start. ACCESS score was calculated at baseline, whilst at every timepoint patients underwent assessment of Nasal-Polyp-Score (NPS), Lund-Kennedy-Score (LKS), and had to fill in the 22-item Sinonasal-Outcome-Test (SNOT-22) and Visual-Analog-Scales (VAS) for sinonasal symptoms. Favorable outcome was considered based on EUFOREA guidelines, namely improving at least 3 of the followings: (i) NPS; (ii) SNOT-22; (iii) VAS-olfaction; and (iv) need for systemic corticosteroids. Results: Overall favorable outcome was achieved in 69.1% (n = 38/55) of cases at T1, while in 89.1% (n = 49/55) at T2. There were no differences in baseline characteristics between responders and non-responders at both timepoints. At T1, out of all the included variables, no statistically significant predictor of favorable outcome was observed. Conversely, at T2, ACCESS score was the only confirmed independent predictive factor of response to dupilumab treatment (OR = 0.81 [95% CI = 0.67-0.92], P =.010). Conclusions: Our findings suggest that the extent of previous endoscopic sinus surgeries may have a role in influencing clinical outcomes in patients with refractory CRSwNP undergoing treatment with dupilumab. [ABSTRACT FROM AUTHOR]

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with a strong impact on the quality of life (QoL) which treatment is based on local intranasal corticosteroids (ICS) and iterative courses of systemic corticosteroids (SCS) in case of relapse. When medical treatment is insufficient, surgery is indicated. We investigated the impact of enlarged frontal sinusotomies (EFS: Draf IIb or Draf III) on QoL and annual SCS consumption of patients with severe uncontrolled CRSwNP. Methods: This is a retrospective cohort study of 38 patients, who underwent EFS at Lariboisière University Hospital (CHU) in Paris, France, between 2006 and 2020. All patients were asked to complete SNOT-22 questionnaires concerning pre- and post-op status. Patients' medical and sinus surgery history as well as the number of SCS treatments per year before and after surgery were also collected. Results: Of the 38 patients, 33 underwent a Draf III procedure and 5 a Draf IIb, with no major complications reported. Surgery resulted in a significant improvement in SNOT-22 scores (−32.7 ± 19.3, P < 0.001), with 19/22 items improving significantly. The number of annual SCS treatments decreased significantly from a mean of 4.8 ± 4.3 to 0.6 ± 1.2 (P < 0.001). During the follow-up (mean 88 months), 95% of our patients showed a satisfying disease control and only 2 patients required revision surgery for poor disease control 5 years after EFS. Conclusion: EFS appears to be an effective and durable therapeutic option to improve the QoL of patients with severe CRSwNP and to reduce their SCS consumption without major complications. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip. Material and methods: The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera's line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath. Results: The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype. Conclusions: The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons. [ABSTRACT FROM AUTHOR]

Background: Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. Objective: To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Methods: Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m2) and non-obese (18.5 kg/m2 ≤ BMI < 30 kg/m2) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). Results: A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Conclusion: Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population. [ABSTRACT FROM AUTHOR]

Objectives: Allergic fungal rhinosinusitis (AFRS) often results in expansion of disease beyond the paranasal sinuses, which may put important structures, such as the anterior ethmoid artery (AEA) or lateral lamella of the cribiform, at risk of injury during endoscopic sinus surgery (ESS). This study aims to compare the AEA to skull base (AEA-SB) length in patients with AFRS versus chronic rhinosinusitis with nasal polyps (CRSwNP), as well as additional anatomic variants. Methods: A single institutional retrospective chart review of patients undergoing ESS for AFRS and CRSwNP was performed. AEA-SB length were compared between the 2 groups. Other anatomic variants, including Keros measurement and presence of supraorbital ethmoid air cells (SOEC), concha bullosa (CB), sphenoethmoidal, and infraorbital ethmoid cells were measured and compared between the 2 groups. Results: Twenty-one patients were included in each cohort. The AFRS group was younger in age (P =.015) and had a significantly longer AEA-SB length (P =.014) compared to the CRSwNP group. No significant differences were observed between the 2 groups regarding Keros measurement, presence of concha bullosa, infraorbital ethmoid, sphenoethmoidal, or SOEC. No association was seen between AEA-SB length and Keros class in either group. Conclusions: AFRS harbors anatomical differences when compared to CRSwNP, with the former associated with a longer AEA-SB length. This key difference should be considered in preoperative planning to prevent injury to the AEA in patients undergoing ESS for AFRS. [ABSTRACT FROM AUTHOR]

Objectives Orbital apex syndrome (OAS) is characterized by visual loss, ophthalmoplegia, ptosis, and orbital pain. This study aims to analyze neuro-ophthalmologic outcomes of OAS resulting from invasive fungal rhinosinusitis (IFS). Methods This retrospective study analyzed 25 patients diagnosed with OAS resulting from IFS between January 2018 and July 2022. Patient's visual acuity, degree of ophthalmoplegia, ptosis, and orbital pain were analyzed. Poor and nonpoor visual acuity were classified based on 20/200. The study also investigated risk factors for the failure of vision restoration. Results Only 1 of 25 patients died from the progression of IFS. Among the 25 patients, 5 (20%) had initial visual acuity better than 20/200 before treatment and 20 (80%) had worse vision than 20/200. Four (80%) of five patients with better than 20/200 maintained visual acuity. Four (20%) of 20 patients with worse than 20/200 recovered to better than 20/200 but others remained or declined to worse vision after treatment. The presence of an infiltrative lesion in cavernous sinus on magnetic resonance image scans was significant in univariate but not multivariate analysis (odds ratio, 24.39; 95% confidence interval, 1.543–333.333; P -value = 0.023). Among the patients with worse than 20/200 vision, the patients whose treatment started less than 4 weeks achieved 33.3% (4/12 patients) vision recovery. In contrast, ophthalmoplegia, ptosis, and pain recovered more successfully than vision. Conclusion Although OAS caused by IFS has been reported as very rare, early pathological diagnosis and appropriate treatment can result in good survival and favorable neuro-ophthalmologic outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rhinogenic contact point headache (RCPH) is a controversial secondary headache disorder involving mucosal contact points in the nasal sinuses. The efficacy of surgical versus medical management has been debated, with some studies showing excellent long-term outcomes but others citing placebo effects. This study aimed to clarify the correlation with nasal anatomical variation detected by CT and RCPH treatment outcomes. Methods: A prospective cohort study was conducted on 90 RCPH patients undergoing surgery or medical therapy. Patients were diagnosed using CT scans, endoscopy, and lidocaine testing. The surgery group had endoscopic procedures to remove contact points. The medical group received intranasal steroids. Outcomes were measured by visual analog scale (VAS) for pain and headache frequency. Predictors like age, gender, and nasal anatomical variations were analyzed. Results: The surgery group showed significant reductions in VAS scores (6.02 to 2.51, p < 0.001) and headache frequency (9.11 to 3.04, p < 0.001). The medical group did not improve significantly. All nasal subtypes improved with surgery but concha bullosa had worse VAS outcomes (4.0) than septal deviation (1.8, p < 0.001) or spur (1.73, p < 0.001). Multivariate analysis found nasal anomalies predicted postoperative VAS scores (p < 0.001) but not headache frequency (p = 0.255). Conclusions: Surgery demonstrated superiority over medications for RCPH. This study provides new evidence that preoperative CT scans should be considered a non-invasive gold standard for analyzing nasal subtypes as they significantly influence surgical success, with concha bullosa associated with worse pain relief. Larger studies should validate these findings to optimize RCPH management. [ABSTRACT FROM AUTHOR]

INTRODUCTION It has been demonstrated that CRS significantly affects quality of life, sometimes more so than other chronic conditions such as COPD or angina. Even with the availability of efficient medical treatments, there are still certain people who may need surgery. In early investigations of endoscopic sinus surgery, objective markers of surgery, such as endoscopic appearances or changes in CT scans, were frequently reported as the main outcome. However, there has been a growing recognition that the patient's perspective on outcome is the most crucial since the development of subjective outcome measurements using validated, disease-specific instruments (PROMs [Patient Reported Outcome Measures]). The purpose of this study was to subjectively assess the effectiveness of endoscopic sinus surgery on nasal obstruction, which is a cardinal symptom of CRS. METHODS This study was performed on 33 patients diagnosed with chronic rhinosinusitis who were posted for endoscopic sinus surgery, having nasal obstruction as a symptom. NOSE (Nasal Obstruction and Symptom Evaluation) scale4 a disease-specific quality of life instrument for subjective assessment of nasal obstruction, was used to assess the efficacy of the surgery. CT NOSE and PNS findings were graded according to the Lund-Mackay System. Post-operative outcome was assessed at intervals of 2 weeks, 1 month, and 3 months. RESULTS The mean age of the patients was 49.06 +/- 13.67 years. The maximum age was 74 years, and the minimum age was 19 years. 72.7% were males and 27.3% were females. 87.9% among them had CRSwNP and 12.1% had CRSsNP. Among the study population, 15.1% of the patients had unilateral disease, whereas 84.9% had bilateral involvement. Statistically significant improvement in NOSE scores was observed postoperatively at 2 weeks, 1 month, and 3 months. There was no statistically significant change in scores depending on the extent of FESS. CONCLUSION The NOSE scoring system can serve as an accurate tool to predict postoperative subjective outcome in patients undergoing FESS (Functional Endoscopic Sinus Surgery). No statistically significant improvement in symptom score was found between full house surgeries and limited ones. [ABSTRACT FROM AUTHOR]

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to validate a method for successful frontal sinus surgery. The method classifies the frontal sinus drainage pathway (FSDP) into five categories based on three bony walls of the anterior ethmoid sinus, including the uncinate process (UP), accessory uncinate process (UPa), and basal lamella of the ethmoid bulla (BLEB), which was tested in actual surgical procedures. Methods: This study analyzed 53 sides of 48 patients who underwent frontal sinus surgery between October 2022 and March 2023. We classified the FSDPs using preoperative computed tomography (CT) and multiplanar reconstruction (MPR). During surgeries for FSDPs located anterior to the BLEB, we used a two-step method involving resection of the turbinal UP, followed by upward resection from the lower edge of the ethmoidal UP. For FSDPs located posterior to the BLEB, we resected the BLEB at the superior semilunar recess. Results: We confirmed the origin of each of the five types of FSDP during surgery. These origins, which were located at the lowest part of the anterior ethmoid, could be identified in the early stages of ethmoid sinus surgery before proceeding to the frontal recess area. Conclusion: The origins of the five types of FSDP, classified based on the bony walls, can be clearly and accurately identified during surgery. This provides a reliable method for preoperatively predicting and locating the inferior end of the FSDP (origin), without extensive manipulation of the cells formed in the frontal fossa. [ABSTRACT FROM AUTHOR]

Background: Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50 °C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure. Methods and materials: This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50 °C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml. Results: The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60 min with comparatively less bleeding (mean bleeding = 221.83 ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67 ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50 °C. Conclusion: Normal saline heated up to 50 °C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery. [ABSTRACT FROM AUTHOR]

Purpose: Anatomical associations between the frontal sinus and anterior skull base must be carefully understood in preoperative imaging to minimize surgical complications. This study aims to investigate the relationship between frontal sinus volume and lateral lamella angle. Methods: 150 computed tomography scans of paranasal sinuses (300 sides) were retrospectively reviewed. Pneumatization patterns were classified according to volume using a three-dimensional reconstruction analysis of the frontal sinuses. The angle formed between the lateral lamella and the horizontal plane in continuation with the cribriform plate was measured and grouped according to Gera classification based on the hypothetical risk of iatrogenic injury. Analysis of these measurements was conducted. Results: A positive correlation was found between frontal sinus volume and lateral lamella angle. Hyperplastic frontal sinuses were the most prevalent followed by middle-sized sinuses. 5% of the frontal sinuses were aplastic. Lateral lamella angles ranging from 45 to 80 degrees (Gera class II) were the most common. Aplastic and hypoplastic frontal sinuses were common in subjects with less than 45 degrees lateral lamella angles (Gera class III). Males had significantly higher frontal sinus volumes and lateral lamella angles than females, while the influence of age was insignificant. Lateral lamella angles were significantly higher on the left side. Conclusion: The frontal sinus volume affects the lateral lamella angle. Larger frontal sinuses are associated with higher lateral lamella angles and vice versa. Understanding this anatomical relationship can help prevent surgical complications. [ABSTRACT FROM AUTHOR]

Introduction The uncinate process (UP) is the most important and constant landmark in the ostiomeatal complex and the middle meatus. Objective To identify the UP variations that have not been published before and establish a categorization using computed tomography (CT). Methods The current study was carried out on 110 paranasal CT scans (220 sides). Axial images were acquired with multiplanar reformats to capture delicate details in other planes. Results Out of 120 CT scans (220 sides), the UP was found to be of type 1 in 84.5%, type 2 in 12.3%, and type 3 in 3.2%, without significant diferences between genders, and it was found to be medialized in 81.9%, vertical in 16.3%, lateralized in 0.9%, and absent in 0.9%, without significant differences between genders. A total of 8.63% of the UPs were pneumatized. Conclusion The present study improves surgeons' and radiologists' knowledge of the UP, while creating a standard classification and description to be used as a common language between otorhinolaryngologists and radiologists, which could also be used for training. [ABSTRACT FROM AUTHOR]

Isolated maxillary fungal pathologies involve a variety of clinical entities. These include invasive and non-invasive variants, where each has a unique pathogenesis, clinical manifestation, and approach for management. The aim of this case series is to investigate the several ways that fungal infections of the maxillary sinus might present, with the approach to diagnose and manage these conditions. Several discrete maxillary fungal diseases were studied, including fungal ball, acute fulminant invasive fungal sinusitis, allergic fungal sinusitis, and chronic invasive fungal sinusitis at a hospital. For every condition, several treatment options, clinical manifestations, and diagnostic strategies were investigated, which are greatly influenced by the degree of invasiveness as well as the patient's immunological status. Optimizing patient outcomes, especially in more aggressive types of the disease, requires an early and proper diagnosis. Understanding the various symptoms of these fungal infections is critical for a timely management. [ABSTRACT FROM AUTHOR]

Introduction: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique. Methods: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization for quantitative assessment of TRE (q-TRE). Results: We performed 98 localizations in 20 patients. The ROI in the sinuses were ethmoid (33 sites), maxillary (28 sites), frontal (17 sites), and sphenoid (22 sites). For localizations, mean qTRE and eTRE were 0.93 and 0.84 mm (P =.56). Notably, 80% of qTRE and 81% of eTRE were 1 mm or less. Mean qTRE and eTRE were less for attending-performed registrations at the maxillary, frontal and sphenoid. Conclusion: Surgical navigation accuracy, as measured by qTRE and eTRE, approaches 1 mm or better at all sinus sites in a real-world setting for 80% of localizations. The qTRE method provides a unique approach for assessing TRE. Surgeons underestimate TRE (overstate navigation accuracy), but this difference does not seem to be statistically significant. Registration performed by trainees yields higher TRE than registration performed by attendings. These data may be used to guide navigation optimization. [ABSTRACT FROM AUTHOR]

Background: Preoperative review of computed tomography (CT) imaging assists with endoscopic sinus surgery (ESS) planning, where trainees may benefit from a systematic approach. We have previously developed an optimized preoperative checklist for sinus CT imaging using an iterative modified Delphi method. Objective: In this study, we assess the utility of an optimized preoperative checklist for residents performing ESS. Methods: Resident sinus CT scan education consisted of a preintervention questionnaire, an 18-min video outlining the optimized preoperative checklist, and a delayed postintervention questionnaire; these were distributed via Qualtrics to otolaryngology residents across 5 training programs in the NY metro area. The preintervention questionnaire contained 25 survey questions and a 225-point quiz on sinus CT anatomy; the delayed postintervention questionnaire contained the same 25 survey questions and a second, distinct 225-point quiz. Results: In total, 74 residents completed the preintervention questionnaire, 47 completed the postintervention questionnaire, and 36 completed both. Among residents completing both questionnaires, the average preintervention quiz score was 136.8 ± 24.0 and the average postintervention quiz score was 156.0 ± 23.5 (P <.001). Resident habitual utilization of a systematic preoperative CT imaging checklist increased significantly from 21.6% to 72.9% as a result of the curriculum intervention. Conclusion: We find that an educational program centered on an iteratively optimized preoperative checklist for ESS improves the ability of trainees to identify critical sinus CT structures. Further integration of checklists and educational curricula may enhance rhinology education efforts and improve surgical anatomy competency. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

After endoscopic sinus surgery (ESS), nasal packing is often used to stop bleeding and promote wound healing. Because maintaining a moist environment is important to enhance wound healing, hydrogel-based wound dressings are effective to promote wound healing. Chitosan is used in the medical field because of its high hemostatic and wound healing properties. We developed a pH-neutral and non-toxic chitosan hydrogel, which was difficult to achieve using conventional methods. In this study, we show in animal experiments that the chitosan hydrogel (hydrogel particles) had higher wound healing properties than a commercially available solid wound dressing (dry state) composed of the same polymer. Additionally, we applied the injectable chitosan hydrogel particles as nasal packing materials to patients with bilateral chronic sinusitis undergoing ESS in a pilot clinical study. Concerning symptom scores, though the results narrowly missed statistical differences (p < 0.05), the average scores of our chitosan hydrogel were superior to those of a commercially available wound dressing (especially p = 0.09 for nasal bleeding). These findings suggest that the injectable chitosan hydrogel could be a viable option as a packing material following ESS. [ABSTRACT FROM AUTHOR]

In 2018, Medicare introduced new codes to the Endoscopic Sinus Surgery (FESS) and balloon sinus dilation (BSD) families of Current Procedural Terminology (CPT) codes. Using the Medicare Part B National Summary Data File from 2010 to 2022, an interrupted time‐series analysis examined trends in volume and reimbursements before and after 2018. Prior to 2018, volume and reimbursements for FESS grew at a mean rate of 2.5% ± 2.2% per year and 6.9% ± 6.6% per year, respectively, before reimbursements decreased significantly in 2018 by −13.9% (P =.014), leading to a stabilization of volume (growth of 0.72%, P =.602). Volume and reimbursements for BSD saw rapid growth from 2011 to 2015 which plateaued prior to the introduction of bundled codes and did not appear to change significantly in 2018 (−0.6%, P =.306 and 11.9%, P =.392, respectively). In addition to concurrent devaluation of FESS and BSD codes, bundling appears to have further contributed to falling reimbursements in rhinology. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic rhinosinusitis (CRS) is a frequent chronic heterogeneous inflammatory disease of the upper airways and paranasal sinuses persistent for ≥ 12 weeks causing considerable healthcare expenses and reduction of patients’ quality of life due to severe tiredness and disappointment as well as diminished cognitive function. CRS is commonly associated with eustachian tube (ET) dysfunction. Aim of the study To evaluate the effect of endoscopic sinus surgery on ET function in the form of (tympanogram, Valsalva maneuver, and total ET dysfunction questionnaire score), in adult patients with CRS. Method This non-randomized clinical trial study was conducted at the Otorhinolaryngology department, the Faculty of Medicine, Cairo University, on 40 patients > 18 years old, suffering from CRS with or without sinonasal polyposis who are indicated for endoscopic sinus surgery (ESS) and were recruited from Otorhinolaryngology department’s outpatient clinic in the period from November 2022 to June 2023. All selected patients were subjected to a full history taken, a full general examination, and a local otorhinolaryngology examination. Routine preoperative laboratory investigation including complete blood count (CBC), liver and kidney function tests, and coagulation profile. An electrocardiogram (ECG) examination was done routinely for all patients above 40 years old. Radiological examination included the following: preoperative CT nose and paranasal sinus, axial and coronal soft tissue cuts, and bone windows. Assessment of ET function was done using the ET dysfunction questionnaire (ETDQ-7), Valsalva maneuver, and tympanogram. ET function was reevaluated 6 weeks post-operative in the form of an ETDQ-7, Valsalva maneuver, and tympanogram. Results The ages of selected patients ranged from 21 to 45 years old with mean ± SD = 30.98 ± 10.24 years old. 52.5% of patients were males. Our results showed a statistically significant postoperative improvement in the Valsalva maneuver and the tympanogram type of both ears compared to preoperative with a p-value

Abstract Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that often requires surgical intervention. Despite advances in endoscopic sinus surgery (ESS), recurrence rates remain significant. Platelet-rich plasma (PRP), known for its regenerative properties, has been suggested to reduce inflammation and promote healing. Methodology This prospective randomized controlled clinical trial was carried out on 40 patients which aims to evaluate the effectiveness of PRP in reducing the recurrence and healing of sinonasal polyps after functional endoscopic sinus surgery (FESS) after 6 months follow-up. Patients aged over 18 years and under 60 years old, with more than 3 months of CRS symptoms with endoscopic evidence of polyps and/or mucosal changes on a CT scan were included in our study. Previous sinus surgery, systemic vasculitis, immune deficiency, allergic fungal rhinosinusitis, patients with uncontrolled systemic diseases or coagulopathy, history of asthma, aspirin sensitivity, cystic fibrosis, and congenital mucociliary problems were excluded from our study. Results Both groups showed improvement in Lund-Kennedy scores and SNOT-22 scores postoperatively. However, Group 1 demonstrated significantly greater improvement at 3 months (median Lund-Kennedy score: 4.0 vs. 6.0, p

Context: The anterior skull base (ASB) and the paranasal sinuses are known for anatomical variations. Therefore, a preoperative assessment for the assessment of these variations is a necessity. This study aims to determine the profile of variations of the ASB using computed tomography of the paranasal sinuses (CT-PNS) scans. Settings and Design: Observational Study. Materials and Methods: Forty CT-PNS scans were studied with measurement of different parameters. Statistical Analysis: Observational study analysis – Descriptive stats, t-tests, Chi-square, nonparametric tests, analysis of variance, regression, P < 0.05 significance level. A significance level of P < 0.05 was used for all tests. Results: Seventeen male and 23 female CT-PNS scans were studied. Different measurements on the right and left sides, as well as between genders, were examined and compared. The supraorbital ethmoidal cell is the most often seen anatomical variation. Variations in the ASB are equally visible on both sides in men and on the right in females (Type-II > Type-1). Type I was more common among female, whereas Type II was more common. The existence of the anterior ethmoidal foramen is a dependable marker for the anterior ethmoidal artery. In the group under investigation, there was no lamina papyracea abnormality. Conclusion: This study aims to assess anatomical variations in the Indian population undergoing ASB surgeries, contributing to the current understanding of Indian paranasal sinuses and skull base dynamics.

Abstract Objectives This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Methods We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation. Results Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow‐up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48–1.25). Similarly, no difference was seen at either 8–12 weeks of follow‐up, with an RR of 0.68 (95% CI: 0.42–1.20). Nasal congestion was reported to be less on the packed side on the follow‐up in one of the trials. Conclusions Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long‐term sequelae.

Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively rare disease that commonly occurs in the olfactory cleft, followed by the posterior nasal septum within the nasal cavity. We herein report a case of REAH on the nasal floor, which is an extremely rare anatomical site for the occurrence of REAH. A 63-year-old man was referred to our department because he had developed right epistaxis. Endoscopic examination revealed a protruding lesion on the floor of the right nasal cavity. The tumor was endoscopically removed and histopathological examination revealed that the tissue was characterized by proliferation of glandular duct structures composed of multiciliated cells and glandular cells, consistent with isolated REAH. No evidence of recurrence was observed endoscopically 14 months after surgery. The findings indicate that REAH can occur in the nasal cavity at sites covered by the respiratory mucosa that have not been previously reported and should be treated with caution.

Abstract Background Paranasal sinus mucoceles are benign cystic lesions characterized by mucous accumulation that can lead to significant complications due to erosion of sinus walls and compression of adjacent structures. This retrospective study aims to compare the clinical characteristics and treatment outcomes of primary and secondary mucoceles. Methods We reviewed medical records of 68 patients treated for mucoceles at the Ear, Nose, and Throat Hospital in Ho Chi Minh City, Vietnam, from June 2022 to June 2024. Advanced diagnostic imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), were utilized in the management of these lesions. Statistical analysis was conducted using chi-square and t-tests to compare the characteristics and outcomes between the two groups. Results The study found that primary mucoceles often presented with less severe symptoms compared to secondary mucoceles, which occur post-surgery or post-trauma and are associated with more severe symptoms and complications. Primary mucoceles were most frequently located in the frontal-ethmoid region (47.4%), while secondary mucoceles had a similar distribution but were more prevalent following previous surgical interventions. Endoscopic sinus surgery was the primary treatment for both groups, with secondary mucoceles frequently requiring more complex surgical interventions. Postoperative improvement was significant in both groups, though secondary mucoceles exhibited slower recovery and higher rates of residual minor visual impairments. Conclusion The comparison between primary and secondary paranasal sinus mucoceles reveals critical differences in clinical profiles and treatment outcomes. Understanding these differences is essential for optimizing management strategies and improving prognosis for patients with these challenging conditions. Further research is needed to explore long-term treatment effects and the efficacy of different surgical approaches.

Background : Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that often requires surgical intervention. Despite advances in endoscopic sinus surgery (ESS), recurrence rates remain significant. Platelet-rich plasma (PRP), known for its regenerative properties, has been suggested to reduce inflammation and promote healing. Methodology: This prospective randomized controlled clinical trial was carried out on 40 patients which aims to evaluate the effectiveness of PRP in reducing the recurrence and healing of sinonasal polyps after functional endoscopic sinus surgery (FESS) after 6 months follow-up. Patients aged over 18 years and under 60 years old, with more than 3 months of CRS symptoms with endoscopic evidence of polyps and/or mucosal changes on a CT scan were included in our study. Previous sinus surgery, systemic vasculitis, immune deficiency, allergic fungal rhinosinusitis, patients with uncontrolled systemic diseases or coagulopathy, history of asthma, aspirin sensitivity, cystic fibrosis, and congenital mucociliary problems were excluded from our study. Results: Both groups showed improvement in Lund-Kennedy scores and SNOT-22 scores postoperatively. However, Group 1 demonstrated significantly greater improvement at 3 months (median Lund-Kennedy score: 4.0 vs. 6.0, p < 0.001) and 6 months (median Lund-Kennedy score: 4.5 vs. 6.0, p < 0.001) compared to Group 2. Additionally, the percent change in Lund-Kennedy scores was significantly higher in Group 1 (median 40.18% vs. 14.29%, p < 0.001). Group 1 also exhibited a substantial reduction in SNOT-22 scores at 6 months (median score: 7.0 vs. 45.0, p < 0.001) with a higher median percent change (90.91% vs. 43.65%, p < 0.001). Notably, relapse rates were lower in Group 1 (15.0%) compared to Group 2 (50.0%) at 6 months (p = 0.018). Conclusions: PRP injection during FESS significantly reduces the recurrence of sinonasal polyps and improves clinical outcomes in patients with CRSwNP. These findings suggest PRP as a promising adjunctive treatment to enhance surgical outcomes and reduce healthcare burdens associated with recurrent sinonasal polyposis. [ABSTRACT FROM AUTHOR]

Key points CRS patients with asthma show differential nasal mucus cytokine signatures based on endotype. IL‐7 concentration is positively associated with higher %FEV1 and %FVC in CRS patients with asthma. [ABSTRACT FROM AUTHOR]

Trigeminal schwannomas are rare tumours comprising 0.2% of all intracranial tumours and 0.5% of all head and neck tumours. Patients with trigeminal schwannomas presented with facial hypoesthesia and pain. We presented a case with left bulging oropharynx. The CT scan showed a 3.8x2.6x4.9cm left parapharyngeal tumour compressed to the oropharynx and middle cranial fossa. We performed 3 ways in two times of operation to excise the whole tumour. We chose the transoral approach for parapharyngeal space, trans-parotid approach for deep parotid part and the endoscopic endonasal trans-pterygoid approach and trans-maxillary with Canine fossa trephination for intracranial lesions. The pathology showed schwannoma. A huge schwannoma extended from intracranial to several spaces is difficult to resect just by one approach. We should separate the tumour to several parts by clinical image before the operation and design a plan to remove the whole tumour in different approach. The different space of tumour involvement had several ways to access. We needed to choose the less harm but with better surgical field. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and adverse events of different oral corticosteroids (OCSs) withdrawal methods for chronic rhinosinusitis with nasal polyp after endoscopic sinus surgery (ESS). Methods: This was a randomized prospective study conducted from Oct 2019 to Jan, 2021. 35 patients who underwent ESS were randomly divided into 2 groups. Regular group (n = 18) received 0.4mg/kg/day of methylprednisolone orally for 10 days, tapering group (n = 17) received 0.4mg/kg/day of methylprednisolone orally for 7 days, followed by progressive reduction of 8 mg of methylprednisolone per week for 3 weeks. The visual analogue scale (VAS) score, the Lund-Kennedy endoscopy (LKE) score, and the E score were assessed preoperatively and at half and 1, 2, and 12 months postoperatively. Statistical analyses were performed using SPSS. Results: There was no statistical difference in the baseline characteristics between the 2 groups. The postoperative VAS scores and LKE scores of patients were significantly improved from those preoperatively (P-values < 0.05). There was no statistical difference in the LKE score, E score, and VAS score between the 2 groups both preoperatively and postoperatively (P-values > 0.05). There was no statistical difference in adverse events between the 2 groups (P-values > 0.05). Conclusions: The combination of OCSs and ESS can improve the clinical symptoms of patients and the recovery of nasal mucosa. There was no difference between the 2 drug withdrawal methods in efficacy and adverse events. Drug withdrawal gradually is more complicated therefore, in clinical practice, OCSs withdrawal directly would be the better option for patients. [ABSTRACT FROM AUTHOR]

Background: The inability of topical medications to reach sinus cavities is a potential reason for lack of efficacy in chronic rhinosinusitis (CRS). One purpose of endoscopic sinus surgery (ESS) is to enable delivery of medications into the sinus cavities. The exhalation delivery system with fluticasone (EDS‐FLU; XHANCE) creates unique biomechanics that enable deposition of intranasal corticosteroid into sinuses and sinus drainage pathways but may have differing efficacy in operated versus unoperated sinuses. Two 24‐week randomized trials (ReOpen1/2) evaluated EDS‐FLU versus EDS‐placebo in patients with CRS, stratified by surgical status. Methods: Surgery‐naive (n = 332) and prior‐surgery (n = 215) patient groups were analyzed as pooled data from ReOpen1/2. Outcome measures (least‐squares mean change from baseline) included combined symptom score (CSS) and congestion score at weeks 4, 8, and 12 and average of percentages of opacified volume (APOV) of ethmoid/maxillary sinuses on CT and Sinonasal Outcome Test 22 (SNOT‐22) total score at week 24. Results: Baseline scores suggested moderate–severe disease: mean CSS = 5.8; APOV = 67.2%. EDS‐FLU produced significant improvement versus placebo (p < 0.05): CSS (surgery‐naive, −0.68 vs. −1.42; prior ESS, −0.70 vs. −1.87); congestion (surgery‐naive, −0.24 vs. −0.59; prior ESS, −0.24 vs. −0.69); and SNOT‐22 (surgery‐naive, −7.56 vs. −18.30; prior ESS, −10.72 vs. −18.74). Similar results were observed for APOV (p < 0.05). No statistically significant difference was observed between surgery subgroups with either EDS‐FLU dose. Conclusion: EDS‐FLU improved symptoms, sinus opacification, and quality of life in patients with CRS with or without prior ESS, suggesting a role for EDS‐FLU in both populations. [ABSTRACT FROM AUTHOR]

The text discusses the comparison between surgery and biologics as treatments for chronic rhinosinusitis with nasal polyposis (CRSwNP). Biologics like dupilumab, mepolizumab, and omalizumab have emerged as powerful therapies for CRSwNP, with dupilumab showing strong performance in various endpoints. However, the data comparing surgery and biologics remain mixed, with surgery showing better improvement in nasal congestion score and polyp size. Cost-effectiveness is a significant factor, with surgery being more cost-effective than biologics like dupilumab. The text concludes that surgery should be considered before biologic therapy for most CRSwNP patients, with treatment decisions guided by individual patient needs and shared decision-making. [Extracted from the article]

Key points: Penetrating orbital trauma from marine creatures, especially needlefish, should be considered after injuries sustained in open water.Advances in endoscopic sinus surgery have enabled surgeons to remove certain orbital foreign bodies through endoscopic endonasal approaches.3D segmentation is a valuable pre‐operative tool in complex endoscopic orbital cases. [ABSTRACT FROM AUTHOR]

Although technical causes of endoscopic sinus surgery (ESS) failure have long been reported, we were curious about the quality of contemporary sinus surgery. The electronic health database of Mayo Clinic, Arizona was scrutinized to identify adult patients with diffuse chronic rhinosinusitis (CRS) who underwent revision ESS between January 2019 and September 2023 with a history of bilateral full-house ESS. Anatomical features on preoperative radiology and intraoperative endoscopy were cataloged: residual uncinate tissue, maxillary antrostomy with a non-incorporated natural os, residual ethmoidal septations (three septations > 3 mm), and inadequate sphenoid osteotomy (os size < 6 mm). Sixty-nine subjects were identified. A deviated nasal septum was present in 53.6%. Residual uncinate tissue was noted in 50.7% of patients associated with missed natural maxillary os in 39.13% of antrostomies. An inadequate os diameter was noted in 63.8% of sphenoidotomies. Significant residual septations were seen in posterior ethmoidal cells in 66.7% and anterior ethmoidal cells in 62.3% of patients. Residual frontoethmoidal cells were noted in 72.4% of patients. Although the extent of ESS must be individualized, a high prevalence of features reflecting suboptimal surgery that could limit the success of ESS was identified. These findings merit further consideration for focused training during residency and continuous professional development activities. [ABSTRACT FROM AUTHOR]

Maxillary sinusitis is a recognized complication following dental procedures, but its occurrence after orthognathic surgery, such as Le Fort osteotomies, remains less documented. This case report presents a 58‐year‐old female who developed unilateral maxillary sinusitis 23 years post‐orthognathic surgery. The patient was asymptomatic, aside from occasional cacosmia, and was incidentally found to have sinus opacification on a computed tomography (CT) scan performed for implant‐prosthetic rehabilitation. Nasal endoscopy revealed purulence and mucosal edema, prompting endoscopic sinus surgery (ESS). Intraoperatively, purulent material and fungal debris were removed from the maxillary sinus, confirming bacterial sinusitis with a concurrent fungal ball. S. salivarius and Klebsiella species were identified from the cultures. The patient's condition improved following the removal of both the sinus contents and the retained titanium plates and screws. This case underscores the potential for maxillary sinusitis to develop long after orthognathic surgery, particularly in the presence of retained dental hardware. It highlights the importance of thorough imaging and endoscopic evaluation in patients with a history of dental or facial surgeries presenting with sinonasal symptoms. Additionally, it raises questions about the role of retained hardware in the persistence or recurrence of infection and the possible association with fungal ball formation. The need for further research to establish guidelines for the management of sinusitis in such contexts, particularly regarding the removal of facial hardware, is emphasized. [ABSTRACT FROM AUTHOR]

The article from Clinical & Experimental Allergy highlights the high prevalence of asthma in patients with uncontrolled chronic rhinosinusitis with nasal polyps undergoing endoscopic sinus surgery. The study found that half of these patients may have undiagnosed or uncontrolled asthma preoperatively. The research emphasizes the importance of systematically evaluating both upper and lower airway diseases in patients with uncontrolled CRSwNP before surgery. The study was conducted as part of a larger multicenter trial and suggests that asthma and uncontrolled asthma are common in this patient population. [Extracted from the article]

Due to the close relationship between the maxillary sinus and the posterior maxillary tooth apices, oro-antral fistula and maxillary sinusitis may occur after interventional procedures performed in this region. In this case, a 53-year-old male patient placed an implant for his left second premolar tooth 7 months ago, but migration of the implant into the maxillary sinus has been detected. Nasal endoscopic examination revealed edema and hyperemia at the level of the left maxillary sinus ostium, but no foreign body was observed. A hyperdense image was reported on paranasal sinus tomography, narrowing the left maxillary sinus ostium and creating obstruction in the osteomeatal unit. Surgical intervention was planned for the patient, implant material was removed, and the maxillary sinus was cleared of inflamed tissues by the functional endoscopic sinus surgery was performed under general anesthesia. With this case that we present to the literature, we aimed to draw attention to odontogenic factors in the etiology of maxillary sinusitis and to raise awareness for the diagnosis and treatment of the disease. [ABSTRACT FROM AUTHOR]

Background: Aside from the obvious negative effects on patients and society's financial well-being, chronic rhinosinusitis (CRS) can lead to absenteeism, decreased productivity, and impaired respiratory function, all of which have a major influence on patients and society's overall quality of life. Endoscopic sinus surgery is an option for patients who have not responded to other treatments, and there are several objective and subjective ways to evaluate the success of the procedure, even if there is little level 1 evidence. We summarize the available outcome metrics and provide a thorough evaluation of the published results up to this point. Also covered is research suggesting that endoscopic sinus surgery may improve asthma patients' respiratory performance. Conclusion: There has been a shift in the last 20 years toward using patient-reported outcomes rather than objective data as the main result in sinus disease, especially CRS. The variety of instruments at our disposal enables us to assess the efficacy of surgery in relation to health-specific and general quality of life, burden of illness, healthcare utilization, and pulmonary function. [ABSTRACT FROM AUTHOR]

Extended endoscopic sinus surgery (EESS) can reduce the recurrence rate of chronic rhinosinusitis (CRS). The purpose of this study was to investigate the effect of the application of modified "protective middle turbinate-EESS" (mEESS) on patients with CRS with nasal polyps (CRSwNP) and allergic rhinitis (AR). Forty-three patients with CRSwNP and AR were classified into 2 groups, the mEESS group (n=23) and the functional endoscopic sinus surgery (FESS) group (n=20), and were followed up for 6 months and 1 year after surgery. The disease severity was assessed by the Lund-Mackay score, the Lund-Kennedy score, and the visual analog scale (VAS) score. The patency rate of the frontal sinus was evaluated by endoscopy. Patient satisfaction was also followed up. No preoperative differences or postoperative complications were found between the 2 groups. The VAS score and Lund-Kennedy score of the 2 groups were lower at 6 months and 1 year after surgery. The olfactory function of the mEESS group was significantly better than that of the FESS group at 6 months post-operative. The patency rate of the frontal sinus orifice in the mEESS group was significantly higher than that in the FESS group at 6 months and 1 year post-operative. Patient satisfaction in the mEESS group was relatively higher than that in the FESS group. mEESS improves frontal sinus drainage, olfactory sense, and patient satisfaction in the short term. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery (FESS) is a common procedure for the treatment of chronic sinusitis and minimal bleeding inside the narrow surgical field affects the surgical visualization, prolongs operative time, and increases ocular and intracranial injuries. Our study aims to evaluate and compare the effectiveness of oral versus intravenous Tranexamic acid on surgical field bleeding in endoscopic sinus surgery. Methods: A prospective, randomized, controlled trial enrolled 159 participants (ASA I-II, both sex and age 18–40 years) undergoing FESS who were equally randomized into 3 groups. Group O received 2 gm of TXA orally 2 hours before surgery, Group I received 15 mg/kg of IV TXA slowly after induction of anesthesia, and Group C didn't receive any. Intraoperative surgical field bleeding was assessed by the Wormald grading scale and Surgeon satisfaction on a 5-point Likert scale. At 24 hours post-operatively, the incidence of nasal bleeding, PONV, and D-dimer level were recorded. Results: Showed significantly higher surgical field score, duration of surgery, recovery time, and postoperative (24 hours) D-dimer in group-C (p-value <0.001) with no difference between groups-I and O, while surgeon satisfaction was significantly lower in group-C (p-value <0.001) with no difference between groups-I and O. No differences regarding hemodynamic parameters, postoperative bleeding, pain, and PONV were found. Conclusions: Oral TXA was safe, cheap, and as effective as IV TXA regarding surgical field visualization, surgeon satisfaction, and operative time during FESS; with limited adverse effects and no evidence of thromboembolic complications. [ABSTRACT FROM AUTHOR]

Objective: Paranasal sinus mucoceles are benign cystic lesions resulting from mucus accumulation, which can cause severe complications, including sinus wall erosion and compression of surrounding structures. This study aims to evaluate and compare the clinical features and treatment outcomes of primary versus secondary mucoceles Methods: We reviewed the medical records of 76 mucoceles treated at the Ear, Nose, and Throat Hospital in Ho Chi Minh City, Vietnam, between June 2022 and June 2024. This study emphasizes the role of advanced diagnostic imaging and endoscopic sinus surgery in effectively managing these lesions. Results: Primary mucoceles were most frequently located in the frontal-ethmoid region, accounting for 47.4% of cases. Primary mucoceles often present with less severe symptoms compared to secondary mucoceles, which occur post-surgery or post-trauma and are associated with more severe symptoms and complications. Treatment primarily involved endoscopic sinus surgery, with secondary mucoceles frequently requiring more complex surgical interventions. Conclusion: This study demonstrates key differences in the clinical presentation and treatment outcomes of primary and secondary paranasal sinus mucoceles. Effective management requires distinguishing between the two types, with secondary mucoceles often needing more complex surgical interventions. [ABSTRACT FROM AUTHOR]