Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhea without lumbar drains.

Objective: Lumbar drains (LD) are commonly used during endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea, either to facilitate graft healing or to monitor CSF fluid dynamics. However, the indications and necessity of LD placement remains controversial. The current study sought to evaluate endoscopic CSF leak repair outcomes in the setting of limited LD use.

Differential effect of omalizumab on pulmonary function in patients with allergic asthma with and without chronic rhinosinusitis.

Background: Omalizumab, an anti-immunoglobulin E monoclonal antibody, is approved by the U.S. Food and Drug Administration for the management of patients with allergic asthma and with refractory disease, and has also proven beneficial in the management of selected patients with chronic rhinosinusitis (CRS).

Early Practice: External Sinus Surgery and Procedures and Complications.

External approaches to the paranasal sinuses are rarely used in the endoscopic era. However, their indications for use have not changed, and in every surgeon's career those indications may present themselves. For residents training in the endoscopic era, these procedures are also very rarely seen.

Practical aspects of integrating allergy and pulmonology management into a rhinology practice: the Vanderbilt ASAP experience.

Purpose Of Review: In the aftermath of reforms in healthcare laws, there is a focused conversation concerning healthcare delivery with an increasing emphasis on quality, cost containment, improved outcomes and access. Concurrently, providers are experiencing pressure as patient volume escalates yet while funding levels fail to keep pace. Addressing these issues is imperative to the medical practices.

Five 'nontraditional' techniques for use in patients with recalcitrant sinusitis.

Purpose Of Review: Although endoscopic sinus surgery remains the mainstay of surgical approaches to treating paranasal sinus disease, some disease may require alternative approaches. We review here five techniques: endoscopic middle turbinectomy, maxillary sinoscopy, the Caldwell-Luc procedure, intranasal inflammatory polyp steroid injection, and frontal sinus trephine.

Recent Findings: Recent findings suggest that endoscopic sinus surgery is limited in certain cases to access particular anatomic sites that may contain disease.

Malpractice in head and neck surgery: a review of cases.

Objective: To examine the sources of litigation related to the practice of head and neck surgery.

Study Design: Analysis of malpractice claims directly related to the diagnosis and treatment of head and neck disease provided by 16 medical liability insurance companies.

Setting: Not applicable.

Impact of chronic rhinosinusitis on work productivity through one-year follow-up after balloon dilation of the ethmoid infundibulum.

Background: Although multiple clinical trials have demonstrated that balloon dilation of sinus ostia in patients diagnosed with chronic rhinosinusitis (CRS) results in sustained symptomatic improvement, less data are available to measure the effects of sinusitis on worker productivity. The objective of our research was to analyze work and activity impairment before and after transantral, endoscopically-guided balloon dilation of the maxillary sinus ostia and ethmoid infundibulum.

Methods: Subjects diagnosed with CRS and computed tomography (CT) evidence of disease in the maxillary sinuses alone, or maxillary and anterior ethmoid sinuses, completed the Work Productivity and Activity Impairment (WPAI) questionnaire and the Work Limitation Questionnaire (WLQ) before treatment and at 3, 6, and 12 months postprocedure.

First clinic experience: patient selection and outcomes for ostial dilation for chronic rhinosinusitis.

Background: To report outcomes for subjects undergoing balloon dilation in either the operating room (OR) or the clinic and define criteria to identify suitable candidates for local anesthesia procedures.

Methods: Subjects with medically refractory chronic rhinosinusitis (CRS) underwent de novo surgery via transantral balloon dilation of the maxillary sinus ostium and ethmoid infundibulum. Concomitant nasal or endoscopic sinus surgeries were contraindicated.

Comparison of maxillary sinus specimens removed during Caldwell-Luc procedures and traditional maxillary sinus antrostomies.

The cases of 80 patients who underwent Caldwell-Luc surgery for the treatment of chronic rhinosinusitis between 2002 and 2007 at Vanderbilt University Medical Center's Department of Otolaryngology were reviewed. Data on demographics, comorbidities, details of surgery, surgical pathology, and histology were collected. These data were compared with those of 40 patients who underwent standard functional endoscopic sinus surgery in 2007.

Proton pump inhibitor therapy improves symptoms in postnasal drainage.

Background & Aims: Gastroesophageal reflux is common among patients with postnasal drainage. We investigated whether proton pump inhibitor therapy improved symptoms in patients with postnasal drainage without sinusitis or allergies.

Methods: In a parallel-group, double-blind, multi-specialty trial, we randomly assigned 75 participants with continued symptoms of chronic postnasal drainage to groups that were given 30 mg of lansoprazole twice daily or placebo.

A review of malpractice cases after tonsillectomy and adenoidectomy.

Objective: To examine sources of litigation following tonsillectomy and/or adenoidectomy.

Study Design: Analysis of malpractice claims filed after tonsillectomy or adenoidectomy provided by 16 medical liability insurance companies.

Setting: Not applicable.

Malpractice claims in nasal and sinus surgery: a review of 15 cases.

Otolaryngologists may encounter claims of medical malpractice during the course of their careers. A sample of 15 cases involving patient claims of medical malpractice relating to care delivered for problems of the nose and paranasal sinus is presented. A short summary of each case is provided, which may be useful to practicing otolaryngologists.

Prevention and management of complications in maxillary sinus surgery.

This article is divided into six sections that are related to six commonly used operations for surgery on the maxillary sinus. The authors discuss maxillary sinoscopy, the Caldwell-Luc procedure, extended middle meatus antrostomy, endoscopic maxillary sinus antrostomy, minimally invasive sinus technique, and balloon sinus procedures. In each of these procedures, the authors discuss potential complications and address prevention and management strategies.

Endoscopic endonasal repair of difficult-to-access cerebrospinal fluid leaks of the frontal sinus.

Background: Cerebrospinal fluid (CSF) leaks located within the frontal sinus can be difficult to repair effectively. Additional challenges arise from the need to simultaneously repair the leak or defect and to ensure the future patency of the sinus itself.

Methods: The cases of two patients who underwent surgical repair of CSF leaks and skull base defects located in difficult to access locations within their frontal sinuses were reviewed.

The ethmo-frontal angle: a new anatomic and radiologic landmark for use in sinus surgery.

Objective: To identify anatomic and radiologic landmarks to assist with frontal sinus surgery.

Study Design: Retrospective review.

Subjects And Methods: Sinus CT scans of 50 patients were evaluated with respect to a new radiologic and anatomic landmark, the ethmo-frontal angle (EFA).

Surgery of the inferior and middle turbinates.

For over a century, surgical management of the inferior and middle turbinates has been an ongoing topic of discourse and disagreement. Treatment, either medical or surgical, of the inferior turbinate is required in cases of turbinate hypertrophy where the goals of therapy are to maximize the nasal airway, to preserve nasal mucosal function, and to minimize complications. Middle turbinate management, more controversial than inferior turbinate management, still lacks definitive consensus.

Balloon sinuplasty for the surgical management of immunocompromised and critically ill patients with acute rhinosinusitis.

Objective: The purpose of this study was to review use of balloon sinuplasty for surgical treatment in critically ill patients with acute sinusitis.

Study Design: Case series with chart review.

Subjects And Methods: Patients who underwent balloon sinuplasty between October 2007 and March 2008 were identified.

Revisiting the interpretation of positive sinus CT findings: a radiological and symptom-based review.

Objective: It is widely believed that a high percentage of normal, healthy patients without sinusitis symptoms have abnormal findings on sinus CT. Experiences of the authors of this study suggest otherwise.

Study Design: Cross-sectional survey.

Current issues in the management of sinonasal methicillin-resistant Staphylococcus aureus.

Purpose Of Review: Staphylococcus aureus is an important pathogen, contributing to both pediatric and adult infections in the USA. In recent years, methicillin-resistant Staphylococcus aureus (MRSA) has become a source of public fear and outcry. In this article, we review facts and fiction of sinonasal MRSA.

The role of steroid injection in the management of sinonasal polyps.

Purpose Of Review: To review treatment options for sinonasal polyps, focusing on the role of steroids and, specifically, intrapolyp steroid injection. History of steroid injections, comparison to other medical and surgical treatments, as well as the risks and safety of injections are all discussed.

Recent Findings: A panoply of methods exists to treat sinonasal polyps.

Current value of nasal nitric oxide measurement in rhinology.

Purpose Of Review: Since the first description of nitric oxide in the exhaled breath of humans by Gustafsson et al., there has been enormous interest in the study of nitric oxide and its role in the nose and paranasal sinuses. The aim of this review is to present the current knowledge about nasal NO: its physiology, novel methods of detection and measurement, and implications in sinonasal disease, focusing on the recent data from the literature.

Results of Caldwell-Luc after failed endoscopic middle meatus antrostomy in patients with chronic sinusitis.

Objectives/hypothesis: The Caldwell-Luc operation for treatment of medically refractory chronic maxillary sinusitis has largely been replaced by functional endoscopic sinus surgery. Despite this change, the Caldwell-Luc procedure still has well documented indications including treatment of both failed endoscopic middle meatus antrostomy and irreversible mucosal changes. The purpose of the study was to review the authors' experience and results of Caldwell-Luc procedure after failed endoscopic middle meatus antrostomy in patients clinically deemed to have irreversible mucosal changes.