Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery.

Background: Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture-inappropriate postoperative antibiotic therapy was associated with less quality-of-life (QOL) improvement following functional endoscopic sinus surgery (FESS).

Methods: This retrospective cohort study recruited 376 adult CRS patients undergoing FESS between October 1, 2007 to December 31, 2011.

The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome.

Background: Patients with diabetes mellitus (DM) are known to be prone to infection. However, the association between diabetes and chronic rhinosinusitis (CRS) has not been well studied. We sought to determine the effects of DM on CRS culture results and quality of life (QOL) after functional endoscopic sinus surgery (FESS).

Exome sequencing identifies BRAF mutations in papillary craniopharyngiomas.

Craniopharyngiomas are epithelial tumors that typically arise in the suprasellar region of the brain. Patients experience substantial clinical sequelae from both extension of the tumors and therapeutic interventions that damage the optic chiasm, the pituitary stalk and the hypothalamic area. Using whole-exome sequencing, we identified mutations in CTNNB1 (β-catenin) in nearly all adamantinomatous craniopharyngiomas examined (11/12, 92%) and recurrent mutations in BRAF (resulting in p.

Spontaneous sphenoid lateral recess cerebrospinal fluid leaks arise from intracranial hypertension, not Sternberg's canal.

Background: Spontaneous cerebrospinal fluid (CSF) leaks/encephaloceles are proven to be associated with intracranial hypertension by objective measurements of CSF pressure during or following endoscopic repair. A common area of involvement is a pneumatized lateral recess of the sphenoid (LRS) sinus, where prolonged intracranial pressures lead to arachnoid pits and subsequent development of skull-base defects. Even though the LRS is never present at birth, a "congenital" cause of these leaks due to a persistent Sternberg's (lateral craniopharyngeal) canal continues to be erroneously perpetuated in the literature.

The bitter taste receptor T2R38 is an independent risk factor for chronic rhinosinusitis requiring sinus surgery.

Background: The bitter taste receptor T2R38 was recently described to play a role in upper airway innate mucosal defense. When activated by bacterial quorum-sensing molecules, T2R38 stimulates the ciliated epithelial cells to produce nitric oxide (NO), resulting in bactericidal activity and an increase in mucociliary clearance (MCC). Polymorphisms within the T2R38 gene (TAS2R38) confer variability in activation of the receptor yielding dramatic differences in upper airway defensive responses (NO production and accelerated MCC) to microbial stimulation based on genotype.

Educational value of a preoperative CT sinus checklist: a resident's perspective.

Objective: The objective of this study is to evaluate the educational value and effectiveness of a preoperative computed tomography (CT) sinus anatomy checklist as a teaching method from the perspective of otolaryngology residents.

Design: Between 2009 and 2011, 15 otolaryngology residents completed a CT sinus anatomy checklist prior to the start of sinus surgery cases. A cross-sectional brief Likert-type questionnaire assessed the resident experience with the checklist.

A catecholamine-secreting skull base sinonasal paraganglioma presenting with labile hypertension in a patient with previously undiagnosed genetic mutation.

Sinonasal paragangliomas are very uncommon neuroendocrine tumors that can present as skull base lesions. Functional paragangliomas are exceedingly rare. They can be associated with genetic mutations that have been associated with increased risk of head and neck paragangliomas.

Vasoactive intestinal peptide regulates sinonasal mucociliary clearance and synergizes with histamine in stimulating sinonasal fluid secretion.

Mucociliary clearance (MCC) is the primary physical airway defense against inhaled pathogens and particulates. MCC depends on both proper fluid/mucus homeostasis and epithelial ciliary beating. Vasoactive intestinal peptide (VIP) is a neurotransmitter expressed in the sinonasal epithelium that is up-regulated in allergy.

18-FDG-PET in the initial staging of sinonasal malignancy.

Objectives/hypothesis: The utility of fluorine-18 fluorodeoxyglucose-positron emission tomography (PET) has been gradually defined for most head and neck cancers, However, its utility in the initial diagnosis of sinonasal malignancy has not been extensively studied. The aim of this study was to determine if PET scanning accurately diagnoses and stages malignant sinonasal lesions and if maximum standard uptake value (SUV max) correlates with clinically advanced disease.

Study Design: Retrospective chart review.

Surfactants in the management of rhinopathologies.

Background: Surfactants are a class of amphiphilic surface active compounds that show several unique physical properties at liquid-liquid or liquid-solid surface interfaces including the ability to increase the solubility of substances, lower the surface tension of a liquid, and decrease friction between two mediums. Because of these unique physical properties several in vitro, ex vivo, and human trials have examined the role of surfactants as stand-alone or adjunct therapy in recalcitrant chronic rhinosinusitis (CRS).

Methods: A review of the literature was performed.

Suprasellar pediatric craniopharyngioma resection via endonasal endoscopic approach.

Purpose: Purely endoscopic endonasal approaches to surgical resection of pediatric suprasellar craniopharyngiomas are uncommonly performed. The aim of the study is to assess the feasibility and to describe the short-term outcomes of endonasal endoscopic approaches for the gross total resection of suprasellar craniopharyngiomas in the pediatric population.

Methods: A combined neurosurgical-otolaryngologic team performed gross total resection of craniopharyngiomas in seven pediatric patients (mean age 9.

Sphenoid sinus anatomy and suprasellar extension of pituitary tumors.

Object: As tumors enlarge, they generally grow along paths of least resistance. For pituitary macroadenomas, extrasellar extension into the suprasellar region, cavernous sinus, or sphenoid sinus may occur. The sphenoid sinus is known to have a variable anatomical configuration, and the authors hypothesize that certain anatomical factors may resist tumor expansion into the sphenoid sinus, thereby directing tumor growth into the suprasellar space.

Evaluation of a polysaccharide gel for laser-assisted skull base repair.

Background: Endoscopic reconstruction of skull base defects remains a challenge. Laser tissue welding (LTW) is a technique in which a laser-activated solder is used to create instantaneous repairs of skull base defects with burst strengths far exceeding intracranial pressure (ICP). This study was designed to define the thermal and inflammatory profile of a novel polysaccharide soldering gel, to assess the burst strength of the repair, and to determine the time required for solder resorption.

Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base.

Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies.

Isolated sinonasal posttransplantation lymphoproliferative disorder: a clinical and radiographic invasive fungal sinusitis look-a-like.

Posttransplantation lymphoproliferative disorder (PTLD) is a known complication of solid organ transplantation with chronic immunosuppression. We present a unique case that illustrates PTLD mimicking invasive fungal sinusitis both clinically and radiographically. This report addresses the critical diagnostic evaluation and management of PTLD arising from the paranasal sinuses.

Genetics of the taste receptor T2R38 correlates with chronic rhinosinusitis necessitating surgical intervention.

Background: We recently demonstrated the bitter taste receptor T2R38 upregulates sinonasal mucosal innate defense in response to gram-negative quorum-sensing molecules through increased nitric oxide production and mucociliary clearance. T2R38 was initially identified in the quest to understand the variability in bitter taste perception to the compound phenylthiocarbamide (PTC) and demonstrated to have polymorphisms generating diplotypes dividing people into PTC supertasters, heterozygotes (with variable PTC detection), and nontasters. We have further demonstrated that sinonasal epithelial cultures derived from supertasters significantly increase innate defenses in response to gram-negative quorum-sensing molecules compared with sinonasal cultures derived from heterozygotes and nontaster individuals.

Planum, tubercular, sellar and clival defects.

Transsphenoidal and extended transsphenoidal approaches have provided improved surgical access to numerous intradural and extradural tumors from the retrosellar area to the craniovertebral junction. The evolution in reconstruction of planum, tubercular and clival skull base defects has progressed from the use of free tissue grafts alone to the use of free tissue grafts in combination with vascularized flaps. Sellar floor reconstruction is usually necessary only if intraoperative CSF leaks, prolapse of the suprasellar cistern, or bleeding from the medial aspect of the cavernous sinus occur.

MR imaging evaluation of endoscopic cranial base reconstruction with pedicled nasoseptal flap following endoscopic endonasal skull base surgery.

Introduction: Postoperative CSF leak is the most common complication of endoscopic endonasal approach (EEA) to skull base lesions. Endoscopic multilayer closure of skull base defect using pedicled nasoseptal flaps (NSF) based off the sphenopalatine artery reduces CSF leaks. EEA robustly expands in surgical arena, yet postoperative imaging evaluation remains poorly studied.

Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis.

Background/aims: Tuberculum sellae meningiomas (TSMs) are challenging tumors for surgical resection. Endoscopic endonasal (EE) approaches to these lesions have not been directly compared to open craniotomy in a controlled trial.

Methods: We searched Medline and Embase online databases for English-language articles containing key words related to TSMs.

Clinical consensus statement: appropriate use of computed tomography for paranasal sinus disease.

Objective: To develop a consensus statement on the appropriate use of computed tomography (CT) for paranasal sinus disease.

Subjects And Methods: A modified Delphi method was used to refine expert opinion and reach consensus by the panel.

Results: After 3 full Delphi rounds, 33 items reached consensus and 16 statements were dropped because of not reaching consensus or redundancy.

T2R38 taste receptor polymorphisms underlie susceptibility to upper respiratory infection.

Innate and adaptive defense mechanisms protect the respiratory system from attack by microbes. Here, we present evidence that the bitter taste receptor T2R38 regulates the mucosal innate defense of the human upper airway. Utilizing immunofluorescent and live cell imaging techniques in polarized primary human sinonasal cells, we demonstrate that T2R38 is expressed in human upper respiratory epithelium and is activated in response to acyl-homoserine lactone quorum-sensing molecules secreted by Pseudomonas aeruginosa and other gram-negative bacteria.

Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study with 1-year follow-up.

Background: This study evaluated 1-year outcomes in patients with chronic rhinosinusitis (CRS) who were considered surgical candidates by study criteria and elected either medical management or endoscopic sinus surgery (ESS). In addition, some patients initially enrolled in the medical treatment arm crossed over to the surgery arm during the study period and their respective outcomes are evaluated.

Methods: Adult subjects with CRS who failed initial medical therapy were prospectively enrolled into a nonrandomized, multi-institutional cohort.

Angiomatosis of the paranasal sinuses.

Angiomatosis is a rare benign lesion of the head and neck that can be mistaken for either a vascular malformation or malignant disease as a result of its infiltrative nature. The recurrence rate of angiomatosis requiring surgery is reported to be >90%, and as such the otolaryngologist treating this condition should endeavor to remove all disease during the first operation while maintaining a high level of suspicion for recurrence during postoperative surveillance. This case represents the first report of angiomatosis involving the nose and/or paranasal sinuses, and extends the differential diagnosis of sinonasal tumors, of which the otolaryngologist must be aware.

Molecular basis of tobacco-induced bacterial biofilms: an in vitro study.

Objective: To evaluate changes in the expression of biofilm-related genes when exposed to tobacco smoke and oxidative stress.

Study Design: Experimental, in vitro. Setting Laboratories of Rhinology and Microbiology, University of Pennsylvania.