Side-Firing Intraoperative Ultrasonograhy for Resection of Giant Pituitary Adenomas.

Background: Suprasellar extension, cavernous sinus invasion, and involvement of intracranial vascular structures and cranial nerves are among the challenges faced by surgeons operating on giant pituitary macroadenomas. Intraoperative tissue shifts may render neuronavigation techniques inaccurate. Intraoperative magnetic resonance imaging can solve this problem, but it may be costly and time consuming.

Side-firing intraoperative ultrasound applied to resection of pituitary macroadenomas and giant adenomas: A single-center retrospective case-control study.

Introduction: Multiple intraoperative navigation and imaging modalities are currently available as an adjunct to endoscopic transsphenoidal resection of pituitary adenomas, including intraoperative CT and MRI, fluorescence guidance, and neuronavigation. However, these imaging techniques have several limitations, including intraoperative tissue shift, lack of availability in some centers, and the increased cost and time associated with their use. The side-firing intraoperative ultrasound (IOUS) probe is a relatively new technology in endoscopic endonasal surgery that may help overcome these obstacles.

Feasibility of Implementing Opioid Stewardship Recommendations for Sinonasal Surgery.

Objective: The objective of our study was to review the current literature pertaining to perioperative opioids in sinus surgery and to determine the effects of implementing opioid stewardship recommendations in the setting of endoscopic sinonasal surgery.

Study Design: Single-institution retrospective case-control study.

Setting: Academic medical center outpatient area.

Is weight a predictive risk factor of postoperative tonsillectomy bleed?

Objective: To determine if a correlation exists between weight-for-age percentile and post-tonsillectomy hemorrhage in the pediatric population.

Study Design: Retrospective study.

Methods: 1418 patients under the age of 15 who underwent tonsillectomy with or without adenoidectomy at a tertiary children's hospital between June 2012 and March 2015 were included in this retrospective study.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

Objectives/hypothesis: The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management.

Study Design: Literature review and cost-effectiveness analysis.

Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review.

Background: The use of prophylactic systemic antibiotics with nasal packing has been a controversial topic. There are few evidence-based studies to determine the need for prophylactic systemic antibiotics. We performed a systematic literature review to determine the role of prophylactic systemic antibiotics with nasal packing in the prevention of toxic shock syndrome and local nasal infections.

Correlation of frontal sinus recess anatomy with ethnicity, gender, and pathology.

Purpose: Research on frontal sinus cells has been conflicting regarding relationship between frontal sinus cells and frontal sinus disease. There are no published studies regarding gender differences in frontal sinus disease. No comparisons between African Americans and Caucasians and frontal sinus disease have been published.

Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction.

Objective: To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction.

Methods: An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established.

Strategies for decreasing contamination of homemade nasal saline irrigation solutions.

Background: Saline nasal irrigations (SNI) are an important adjunct in the treatment of rhinosinusitis, and many patients prepare and store these solutions in their homes without an awareness of the potential for contamination. The objectives of this study were to determine if such contamination occurs and the effect of preparation methods on contamination.

Methods: Stock solutions of various tonicities and pHs were prepared using boiled, bottled, and distilled water (n = 57).

Clival chordoma of the nasal septum secondary to surgical pathway seeding.

Educational Objective: At the conclusion of this presentation, the participants should be able to recognize seeding as a form of treatment failure in transseptal resection of clival chordomas.

Objectives: The purpose is to present a case of implanted metastases in the nasal septum after a transseptal approach for resection of clival chordoma and to compare it with other reported cases in the literature.

Study Design: Case report and literature review.

Atrophic rhinosinusitis: progress toward explanation of an unsolved medical mystery.

Purpose Of Review: Atrophic rhinosinusitis is a chronic condition associated with considerable morbidity and decreased quality of life. This review describes progress in the characterization of primary and secondary atrophic rhinosinusitis and the development of diagnostic criteria for both syndromes.

Recent Findings: Primary atrophic rhinitis usually develops as a consequence of an acute febrile illness in members of lower socioeconomic groups in developing areas of the world.

Going to the next level: health care's evolving expectations for evidence.

Rhinologic literature has historically relied on lower levels of evidence to make prescriptive recommendations for use of new technology and procedures. However, as the medical profession has moved to embrace the principles of evidence-based medicine, expectations for minimum standards of evidence have risen. The resulting high-quality efficacy outcomes data have become the linchpin of informed decision making by physicians, payers, and health care systems.

Diagnostic criteria for atrophic rhinosinusitis.

Background: Patients with atrophic rhinosinusitis have intractable upper airway symptoms that result from loss of the normal nasal epithelium. There is no consensus on how to diagnose this condition, and diagnostic criteria are not available to perform multicenter treatment trials. We sought to establish diagnostic criteria for atrophic rhinosinusitis.

Diagnostic evaluation of inhalant allergies: a cost-effectiveness analysis.

Background: The purpose of this study was to compare the cost-effectiveness of modified quantitative testing (MQT), intradermal dilutional testing (IDT), and in vitro allergy testing as diagnostic methods used in the management of patients with suspected IgE-mediated inhalant allergies.

Methods: A systematic review was conducted to determine key statistics for analysis, such as prevalence of disease, and sensitivity and specificity of each diagnostic modality. Costs were calculated based on charges from distribution companies to providers.

The evolution of surgical training: perspectives on educational models from the past to the future.

Surgical education and training have progressed through the centuries, with the most commonly used model being the apprentice model. With advances in medical knowledge and practice, the apprentice model has evolved and competing models have arisen. However, the apprentice model remains the gold standard today, but for future use, further evolutionary changes will need to be made to the apprentice model if it is to continue to remain an effective education paradigm.

Evidence-based recommendations for antimicrobial nasal washes in chronic rhinosinusitis.

Background: Chronic rhinosinusitis (CRS) refractory to medical and surgical therapy is a difficult problem for patients and physicians. Topical antimicrobial nasal irrigations are commonly used for treatment with great variation in methodology and without clear scientific support for current treatment formulations. The purpose of this study was to develop a scientific rationale for creating standardized recommendations for clinical practice in the use of topical antimicrobial washes for CRS.

Economic analysis of the use of limited coronal computed tomography scans in the management of sinusitis.

Background: As medical costs increase, less expensive alternatives to standard diagnostic tests are sought to reduce the economic burden placed on society. One alternative is using limited, non-consecutive cut computed tomography (CT) scans for the evaluation of sinonasal disease. This study evaluates the cost-effectiveness of using limited CT scans instead of full sequence CT scans in the diagnosis and management of rhinosinusitis.

Utility of image guided surgery in the diagnosis of pterygopalatine fossa lesions.

Objectives: To describe the utility of image guided surgery in the diagnosis of pterygopalatine fossa lesions and to discuss the varied pathologic diagnoses from this area.

Study Design: Case series presentation.

Methods: Three cases of pterygopalatine fossa lesions were accessed and biopsied by way of a middle meatus antrostomy approach into the pterygopalatine fossa under image guidance for rapid localization.

Lymph nodes of patients with regional metastases from head and neck squamous cell carcinoma as a predictor of pathologic outcome: size changes at CT before and after radiation therapy.

Background And Purpose: Viable tumor in a neck dissection specimen is important in predicting prognosis and directing treatment. Our purpose was to clarify the importance of size changes of regional metastases from head and neck squamous cell carcinoma on CT scans obtained before and after radiation therapy (RT) as a predictor of pathologic outcome.

Methods: Thirty-seven heminecks in 34 patients who underwent pre-RT CT, RT, post-RT CT, and post-RT neck dissection were reviewed.

Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both.

Background: The treatment of patients with squamous cell carcinoma (SCC) of the oropharynx remains controversial. No randomized trial has addressed adequately the question of whether surgery (S), radiation therapy (RT), or combined treatment is most effective.

Methods: Treatment results from North American academic institutions that used S with or without adjuvant RT (S +/- RT) or used RT alone or followed by neck dissection (RT +/- ND) for patients with SCC of the tonsillar region or the base of tongue were compiled through a MEDLINE search (from 1970 to August, 2000) and from the references cited in each report.

Voice rehabilitation after total laryngectomy and postoperative radiation therapy.

Purpose: The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx.

Patients And Methods: Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment.

Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection.

Purpose: To present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx treated at the University of Florida and to compare these data with those obtained after conservation surgery.

Methods And Materials: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 274 patients with squamous cell carcinoma of the supraglottic larynx between 1964 and 1998. All patients had follow-up for a minimum of 2 years, and 250 (91%) had follow-up for 5 years or more.