What is the robustness of randomized controlled trials supporting rhinosinusitis guidelines?

Purpose: To determine the robustness of randomized controlled trials (RCTs) supporting the current rhinosinusitis guideline; International Consensus Statement on Allergy and Rhinology: rhinosinusitis (ICAR-RS).

Materials & Methods: RCTs referenced by ICAR-RS with primary dichotomous outcomes were analyzed. The Fragility Index (FI) was calculated for trials with statistically significant findings.

I'm Getting a Migraine: A Comparative Evaluation of Patient and Clinician Interpretations of Migraine Symptoms.

Patients and providers vary in how they describe common otolaryngology-related complaints. These differences can lead to miscommunication and frustration that may affect patient outcomes and satisfaction. The aim of this cross-sectional survey-based study was to explore the differences in migraine symptom selection by otolaryngology patients and clinicians.

Perioperative Use of Systemic Steroids Within Otolaryngology-Head and Neck Surgery: Evidence-Based Guidance for Clinicians.

Objective: To review and synthesize the available evidence for use of perioperative systemic steroids for otolaryngologic surgical procedures.

Data Sources: A comprehensive literature review with evidence-informed recommendations.

Review Methods: Databases were queried for medical subject heading terms and keywords related to perioperative systemic corticosteroids use for comprehensive otolaryngology and subspecialty procedures including otologic, sinonasal, sleep, laryngeal, head and neck, facial plastics, and pediatric surgery.

Viral infection as an inciting event for development of chronic rhinosinusitis: A population-based study.

Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year. Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes.

Nasal endoscopy score thresholds to trigger consideration of chronic rhinosinusitis treatment escalation and implications for disease control.

Background: In the absence of direct evidence supporting how to use nasal endoscopy findings to judge chronic rhinosinusitis (CRS) disease control, experts' practice patterns could provide guidance.

Methodology: Participants consisted of a diverse group of twenty-nine rhinologists. Participants were presented with every possible combination of bilateral nasal endoscopy findings represented by the modified Lund-Kennedy (MLK; range: 0-12) endoscopic scoring system and Nasal Polyp Score (NPS; range: 0-8).

Redundancy of Pharmacologic Ingredients in Over-the-Counter Nasal Sprays.

Objective: To evaluate and determine the prevalence of ingredients in over-the-counter (OTC) nasal sprays.

Study Design: Cross-sectional.

Setting: Retail pharmacies.

Real-time augmentation of diagnostic nasal endoscopy video using AI-enabled edge computing.

AI-enabled augmentation of nasal endoscopy video images is feasible in the clinical setting. Edge computing hardware can interface with existing nasal endoscopy equipment. Real-time AI performance can achieve an acceptable balance of accuracy and efficiency.

Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework.

Objective: Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies.

Study Design: A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations.

Nasal endoscopy: What have we been missing?

Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability. However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus.

Gender differences in outcomes following endoscopic sinus surgery: a systematic review and meta-analysis.

Background: The extent to which gender affects outcomes in chronic rhinosinusitis (CRS) is unclear. The objective of this study was to examine differential outcomes between genders following endoscopic sinus surgery (ESS) among CRS patients.

Methods: PubMed/Ovid, Embase and Cochrane databases were queried.

Enhancing nasal endoscopy: Classification, detection, and segmentation of anatomic landmarks using a convolutional neural network.

A convolutional neural network (CNN)-based model can accurately localize and segment turbinates in images obtained during nasal endoscopy (NE). This model represents a starting point for algorithms that comprehensively interpret NE findings.

Guaifenesin: The Ubiquitous Orphan.

Guaifenesin, a widely used ingredient in over-the-counter cough and cold medications, has been a subject of debate regarding its efficacy in treating respiratory conditions. Despite its historical use and US Food and Drug Administration approval, recent studies have questioned its claimed expectorant effect and its effectiveness in managing symptoms. This article examines the available evidence, highlighting the lack of significant benefits over placebo for upper respiratory disease.

Posterior Nasal Nerve Ablation as a Viable Treatment Option for the Primary Symptom of Postnasal Drip.

Background: Postnasal drip (PND) syndrome is a prevalent complaint encountered in otolaryngology practices. PND may be refractory to medical therapy, and surgical treatments are complicated by side effects.

Objective: While posterior nasal nerve (PNN) ablation has demonstrated efficacy for chronic rhinitis overall, we sought to examine the effect of PNN ablation for patients with PND as their primary complaint.

How Do Patients and Otolaryngologists Define Dizziness?

Objective: To assess for differences in how patients and otolaryngologists define the term dizziness.

Methods: Between June 2020 and December 2022, otolaryngology clinicians and consecutive patients at 5 academic otolaryngology institutions across the United States were asked to define the term "dizziness" by completing a semantics-based questionnaire containing 20 common descriptors of the term within 5 symptom domains (imbalance-related, lightheadedness-related, motion-related, vision-related, and pain-related). The primary outcome was differences between patient and clinician perceptions of dizzy-related symptoms.

Are you congested? A comparison of definitions between otolaryngologists and their patients.

Objective: To assess for differences of intended meaning in the description of congestion-related symptoms among otolaryngology patients and clinicians.

Materials And Methods: Between June 2020 and October 2022, a questionnaire consisting of 16 common descriptors of congestion-related symptoms within four domains (obstructive-related, pressure-related, mucus-related, and other symptoms) was completed by patients and otolaryngologists at five tertiary otolaryngology practices. The primary outcome was to assess differences in patient and clinician perceptions of congestion-related symptoms.

Layperson Perception of Reflux-Related Symptoms.

Objective: To assess for differences of intended meaning in the description of reflux-related symptoms among otolaryngology patients and clinicians.

Study Design: Cross-sectional survey-based study.

Setting: Five tertiary, academic otolaryngology practices.

Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists.

A patient-reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin-E (IgE)-mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs.

Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control.

Background: We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient-reported CRS control).

Methods: Fifteen rhinologists were provided with real-world data from 200 CRS patients. Participating rhinologists first classified patients' CRS control as "controlled," "partly controlled," and "uncontrolled" using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient-reported CRS control.

Layperson Perception of Symptoms Caused by the Sinuses.

Objective: To assess the perceived symptoms caused by the sinuses as defined by otolaryngology patients and clinicians.

Study Design: Multi-institutional cross-sectional study.

Setting: Six academic outpatient otolaryngology practices.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023.

Background: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated.

Avoiding bias in artificial intelligence.

Artificial intelligence (AI) is ubiquitous and expanding, and the healthcare industry has rapidly adopted AI and machine learning for numerous applications. It is essential to understand that AI is not immune to the biases that impact our clinical and academic work, and in fact may inadvertently amplify rather than reduce them. As we harness the power of AI, it is our obligation to our patients to ensure that we address these concerns.

Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction.

Objective: To evaluate the predictive ability of symptom self-localization to distinguish obstructive eustachian tube dysfunction from non-obstructive salpingitis.

Methods: Adult (age ≥18 years) patients with a primary complaint of aural discomfort who underwent diagnostic nasal endoscopy and tympanometry at a tertiary academic center were enrolled. Symptoms were self-localized by using a single finger on the affected side.

Increased Prevalence of Eosinophilic Esophagitis in Patients With Chronic Rhinosinusitis.

Background: Chronic rhinosinusitis (CRS) and eosinophilic esophagitis (EoE) are immune-mediated inflammatory conditions that share common histopathologic features. Once considered two separate pathologies, preliminary data has suggested that a higher prevalence of EoE may exist in patients with CRS.

Objectives: We aimed to expand the base of evidence across geographic regions and investigate the association between EoE and CRS, including CRS with nasal polyposis (CRSwNP).