The efficacy of surgery for upper airway resistance syndrome: A systematic review, meta-analysis and case series.

PURPOSE: Upper airway resistance syndrome (UARS) is a sleep related breathing disorder that was first described in 1993. This goal of this study is to determine the efficacy of surgical intervention for UARS. MATERIALS AND METHODS: Systematic review of the literature and a case series of UARS patients at a large integrated healthcare system. Meta-analysis was performed. RESULTS: For the systematic review, 971 abstracts were reviewed and 3 articles were included, yielding 49 subjects. All of the included studies were of level 3 or 4 evidence. Significant improvement in Epworth Sleepiness Scale (ESS) score was noted after surgery in two level 4 studies. No significant change in ESS was noted in one level 3 study. Our retrospective chart review of eleven UARS patients compared preoperative and postoperative ESS scores, as well as sleep study data. Patients underwent a variety of surgical procedures. Our findings show a significant improvement in mean ESS scores after surgery, from 11.0 (±3.5) to 7.0 (±4.8) with p = 0.01, though no difference in apnea hypopnea index (AHI) and respiratory disturbance index (RDI) were identified. Meta-analysis was performed on 2 studies from the systematic review and our cases series data. UARS surgery showed a mean change in ESS of -5.89 (95% CI, -8.29 to -3.50). CONCLUSIONS: This systematic review, meta-analysis and retrospective case series indicate that surgery may improve ESS scores in patients with UARS. AHI and RDI are unlikely to be impacted by surgery.

Shortcomings in the diagnosis of chronic rhinosinusitis: evaluating diagnosis by otolaryngologists and primary care physicians.

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent illness in the United States that accounts for 18-22 million physician visits annually. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has defined diagnostic criteria, but a recent study demonstrated that nearly all patients diagnosed by nonspecialists did not meet these criteria. In this study we aimed to evaluate the diagnostic rate of CRS by primary care physicians and otolaryngologists. METHODS: We retrospectively reviewed a random sample of adult patients diagnosed with CRS in 2016, based on ICD-10 codes from primary care and otolaryngology departments. Patients with previous CRS diagnosis, previous sinus surgery, and related comorbidities were excluded. RESULTS: A total of 502 patients with a new CRS diagnosis were analyzed (308 from primary care, 194 from otolaryngology). The percentage of diagnoses meeting the criteria was significantly higher from otolaryngology (28.9% vs 0.97%, p < 0.0001), but was low in both cohorts. Symptom duration <12 weeks was higher in primary care (81.6% vs 53.6%, p < 0.0001), as was lack of evidence of inflammation (97.4% vs 50.0%, p < 0.0001). Having <2 of the required symptoms was significantly higher in otolaryngology (63.8% vs 50.8%, p = 0.013). The most commonly unevaluated symptom was decreased sense of smell (97.7% in primary care, 69.1% in otolaryngology encounters). CONCLUSION: CRS diagnoses commonly do not meet the diagnostic criteria outlined by the AAO-HNS in both primary care and otolaryngology. As a specialty, we should aim to improve our adherence to the guidelines and educate our primary care colleagues to better identify patients with CRS and initiate appropriate treatment.

Herpes Simplex Virus Laryngitis Presenting as Airway Obstruction: A Case Report and Literature Review.

OBJECTIVES: Herpes simplex virus (HSV) laryngitis is rare in adults. We add a case report to the literature and perform a literature review to further delineate the clinical presentation, course, and treatment of HSV laryngitis in adults. METHODS: Case report and literature review using PubMed and Ovid databases. RESULTS: Ten cases of diagnosed HSV laryngitis in adults were reported in the literature. It is more common in immunocompromised patients. The mean patient age was 51 years with a male to female ratio of 1:1. The clinical presentation and course of HSV laryngitis is variable. Patients may have mild chronic symptoms, such as dysphonia, or a fulminant course with rapid airway compromise. On laryngoscopic exam, the most common findings are a white exudate or ulceration. The most common treatment is with antiviral medication, such as acyclovir, which tends to be highly effective. CONCLUSIONS: Herpes simplex virus laryngitis is rare. Clinical presentation of HSV laryngitis is variable, and its course may be indolent or fulminant. Treatment with antiviral medication tends to be highly effective.

Pharmacologic treatment for postviral olfactory dysfunction: a systematic review.

BACKGROUND: Postviral olfactory dysfunction (PVOD) is the most common cause of olfactory dysfunction. Several treatments have been presented in the literature. The objective of this study is to systematically review the existing literature on the effectiveness of pharmacologic treatments for PVOD. METHODS: We performed a literature search of PubMed, Ovid, and ScienceDirect from 1966 to 2014. Inclusion criteria included English-language articles containing original data on pharmacologic treatment of PVOD with ≥5 subjects, measurable outcomes, and readily available treatments. Data was collected regarding study design, subject demographic information, clinical outcomes, and level of evidence. Two investigators reviewed all articles independently. RESULTS: Of 445 abstracts identified, 8 articles were included, yielding 563 patients. Treatments investigated included oral corticosteroids, local injections of corticosteroids, zinc sulfate, alpha lipoic acid, caroverine, vitamin A, Ginkgo biloba, and minocycline. Outcome measures were determined by symptom scores and objective olfactory test methods-the most common being Sniffin' Sticks. Improvement was noted in subjects receiving oral corticosteroid therapy, local injections of corticosteroid, alpha lipoic acid, and caroverine, whereas vitamin A, zinc sulfate, Ginkgo biloba, and minocycline groups did not show significant improvement. CONCLUSION: The majority of therapies investigated that show benefit in treating PVOD are of poor quality. Although caroverine therapy showed benefit and is a level 1b study, etiologies of olfactory dysfunction other than PVOD were included as well, which clouds the results. Overall, there is no strong evidence for any pharmacologic treatment of PVOD in the literature.

Block method of human temporal bone removal: a technical modification to permit rapid removal.

OBJECTIVES/HYPOTHESIS: To describe a technical modification to the block method (BM) of harvesting human cadaveric temporal bones for otolaryngology resident education and training. STUDY DESIGN: Human cadaveric study. METHODS: Human cadavers previously dissected by medical students in a professional health science program were identified as potential candidate specimens for temporal bone removal. Cadaveric heads were prepared for temporal bone harvesting by excising the calvarium and brain via standard techniques. A reciprocating saw was used to make four bone cuts to harvest two temporal bone specimens. RESULTS: Temporal bone specimens could be harvested using only four bone cuts to release both temporal bones from one human cadaver as opposed to four bone cuts for a single temporal bone per the traditional BM. All temporal bones were inspected and found to have all the anatomical landmarks necessary for resident education and training intact. CONCLUSIONS: The modified BM for temporal bone removal is a rapid, efficient, and reproducible method of harvesting two complete and intact temporal bones per cadaver with fewer bone cuts as compared to the traditional BM.