Seeking an optimal dose of preoperative corticosteroids in chronic rhinosinusitis with nasal polyposis: A randomized controlled trial.

Background: Preoperative corticosteroids have been shown to improve surgical visibility and intraoperative blood loss for chronic rhinosinusitis with nasal polyposis (CRSwNP) patients undergoing endoscopic sinus surgery (ESS). However, there is no consensus on the optimal dosing regimen.

Methods: A randomized, controlled trial was conducted to compare low, medium, and high dose corticosteroids prior to ESS.

Are nonsteroidal anti-inflammatory drugs effective enough for postoperative pain control after functional endoscopic sinus surgery and septoplasty? A randomized, controlled study.

Background: Endoscopic sinus surgery (ESS) and septoplasty are commonly performed procedures without standardized postoperative pain regimens. There is reluctance to prescribe opioids for postoperative pain given their potential for abuse. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been demonstrated to reduce or even obviate the need for opioid pain medications after otolaryngologic surgeries, but prospective validation is lacking.

The role of doxycycline in the management of chronic rhinosinusitis with nasal polyps.

Introduction: Many theories on the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRSwNP) exist. The most effective management of CRSwNP has not been elucidated. Doxycycline, which has anti-inflammatory and anti-bacterial properties, has shown durable effects; however, its efficacy in combination with standard therapy has not been examined.

Office-Based Sinus Surgery.

Office-based rhinologic procedures have seen a dramatic rise in incidence over the last decade. It is crucial to select appropriate patients and understand which pathologies may be amenable to in-office procedures. It behooves the otolaryngologist to be familiar with the array of technologic advances that are expanding the limits of office-based rhinology and to have a solid understanding of the technical nuances of using these technologies in the clinic.

Cutting-edge endonasal surgical approaches to thyroid ophthalmopathy.

Objective: Thyroid orbitopathy is a poorly understood extrathyroidal manifestation of Graves' disease that can cause disfiguring proptosis and vision loss. Orbital decompression surgery for Graves' orbitopathy (GO) can address both cosmetic and visual sequelae of this autoimmune condition. Endonasal endoscopic orbital decompression provides unmatched visualization and access to inferomedial orbital wall and orbital apex.

Evaluation and Decision Making in Frontal Sinus Surgery.

Management of frontal sinusitis can be challenging for even the most experienced otolaryngologists. A thorough understanding of the anatomy and pathophysiology of the frontal sinus is essential to properly manage disease affecting the frontal sinus. Being able to distinguish acute viral from acute bacterial and acute from chronic sinusitis is crucial because these distinctions guide appropriate management.

Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer.

Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51 year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS.

Sociodemographic disparities in choice of therapy and survival in advanced laryngeal cancer.

Purpose: To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S.

Design/setting/subjects/methods: Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992-2009.

Merkel cell carcinoma of the head and neck: pathogenesis, current and emerging treatment options.

Merkel cell carcinoma (MCC) is a relatively uncommon, neuroendocrine, cutaneous malignancy that often exhibits clinically aggressive features and is associated with a poor prognosis. It typically presents as a painless, rapidly enlarging, dome-shaped red or purplish nodule in a sun-exposed area of the head and neck or upper extremities. Our understanding of MCC has increased dramatically over the last several years and the pathogenesis continues to be an area of active research.

Tonsillectomy on rivaroxaban.

Objective: The objective of this case report is to increase awareness regarding a new category of drugs, new direct oral anticoagulants (specifically, rivaroxaban), which are increasingly being used instead of the more traditional vitamin K antagonists, to highlight the current recommendations for perioperative management of rivaroxaban, and to demonstrate a clinical scenario where a tonsillectomy was successfully performed in a patient requiring anticoagulation with rivaroxaban.

Methods: A literature review and a case report are presented. PubMed was reviewed for evidence based recommendations regarding the perioperative management of rivaroxaban and the recommendations for reversal in the event of a hemorrhagic complication.