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OBJECTIVE: To propose a novel quality metric tool for retrospectively examining ESS performed on chronic rhinosinusitis (CRS) patients, ultimately to facilitate clinician self-assessment and optimize care provision within this population. DESIGN: Quality improvement study. SETTING: Multi-center. PARTICIPANTS: Observational, prospective research database of adult patients with medically recalcitrant CRS, presenting to seven North-American academic rhinology centers, who underwent ESS between 2011 and 2021. Participant characteristics, comorbidities, and preoperative study measures were collected. MAIN OUTCOMES AND MEASURES: A simple ratio of preoperative Lund-Mackay (LM) score to the number of sinus regions operated on during the course of ESS was determined for each participant and dichotomized into ratios of >1.0 or <1.0. RESULTS: 828 study participants with medically recalcitrant CRS met final study inclusion, of which 47.8 % were male with an average age of 49.0 years. Approximately 50.9 % of participants had a history of previous ESS. Overall mean ratio between preoperative LM scores and numbers of surgically addressed sinuses for all patients with CRS (n = 828) was 1.61 (range: 0.00-6.00), with a minority of subjects (n = 108; 13.0 %) found to have ratios below 1.00. Mean ratios between patients who underwent primary ESS versus revision ESS were not statistically different (2.00 [±0.83] vs 1.98 [±0.88]; 0.02 %, 95 % CI -0.10, 0.14; P = 0.76), whereas differences in mean ratios between CRSsNP patients (without nasal polyposis) and CRSwNP patients (with nasal polyposis) were statistically significant (1.78 [±0.93] vs 2.26 [±0.67]; 0.48 %, 95 % CI 0.37, 0.59; P ≤ 0.001). CONCLUSIONS AND RELEVANCE: This quality metric ratio represents a simple operational means for clinicians to integrate qualitative methodology into self-reflection when evaluating the extent of ESS performed on CRS patients. Its use as a clinical tool for retrospective self-reflection enables the surgeon to identify areas for improvement, assess situational specifics, and hone their craft.
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PURPOSE: Pott's puffy tumor (PPT) is a rare clinical entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess collection. The frequency of reported cases of PPT in the literature has increased in recent years. Previous reviews of PPT exist primarily in the form of small, retrospective case series and anecdotal case reports. Therefore, the aim of this study is to provide the literature's largest comprehensive, up-to-date review of the essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches utilized in the management of PPT, both in pediatric and adult populations. MATERIALS AND METHODS: We searched MEDLINE, PubMed, and Embase databases for English-language studies published from January 1950 through January 30, 2022. The authors reviewed all cases of PPT, focusing specifically on those describing therapeutic management of PPT. A total of 321 patients were included, consisting of 318 patients (from 216 articles) and an additional 3 adult cases from our institution. RESULTS: PPT most often results from untreated rhinosinusitis, as well as direct head trauma, substance use, and odontogenic disease. Infections are classically polymicrobial with an anaerobe-predominant microbiome. Both CT and MRI imaging modalities are commonly obtained for presurgical assessment of sinusitis and intracranial extension. The core of treatment is an early and aggressive approach to prevent long-term complications. A significant association exists between surgical management and clinical outcomes for patients with PPT. Recent literature suggests endoscopic sinus surgery is essential for successful disease resolution. CONCLUSIONS: PPT is an important and relatively morbid disease process that is often underrecognized and misdiagnosed at presentation due to its variable clinical presentation. Management of PPT includes both antimicrobial therapy and surgical intervention. Determination of the optimal approach depends on patient clinical features including age, history of prior endoscopic sinus surgery, and presence of intracranial involvement on presentation. An individualized, targeted, and interdisciplinary approach to the treatment of PPT is critical for successful disease resolution.
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Tumor de Pott , Sinusite , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/terapia , Adulto , Criança , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Tumor de Pott/complicações , Tumor de Pott/diagnóstico , Tumor de Pott/terapia , Estudos Retrospectivos , Sinusite/complicaçõesRESUMO
INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease leading to recurrent epistaxis, telangiectasias, and/or visceral arteriovenous malformations. Multiple treatment methods, including both pharmacologic and surgical, are described to be effective in managing symptomatic HHT. Few report the duration of symptom improvement for each of these treatment methods. This study aims to analyze the duration of effectiveness of coblation treatment for recurrent epistaxis in those with HHT. METHODS: Retrospective single-center chart review was completed for patients diagnosed with HHT who underwent coblation treatment by the same otolaryngologist from December 2009 to November 2021. Demographic information was collected along with whether local Bevacizumab was used during each treatment. Months between treatment coblation sessions was used as a surrogate for duration of treatment effectiveness. Descriptive statistics were used for analysis alongside quantitative statistical analysis. RESULTS: Over the course of 12 years, 57 patients (24 female, 42.11%) with HHT underwent a total number of 150 coblation treatments. The average age at initial coblation was 59 years (29-88) with an average follow-up time of 5 years (1-12 years). Of the 150 coblations, 30 treatments (20%) included bevacizumab injections into the nasal cavity. The average duration of treatment effectiveness across all 150 treatment sessions was 24.5 months (1-87 months). Of the 26 patients (46%) that underwent multiple coblation treatments, the overall average duration of coblation effectiveness was 16.4 months (1-72 mos). When Bevacizumab was utilized, the average duration of effectiveness was 18.3 months (3-62 mos), while the average duration of effectiveness for treatments without Bevacizumab was 15.7 months (1-87 mos, p > 0.251). Further, there was no correlation between duration of treatment effectiveness and age, sex, and race; yet,there was a significant negative correlation between the use of tobacco and duration of coblation effectiveness (p = 0.0202). CONCLUSIONS: Coblation is an effective treatment option for the management of epistaxis in patients with HHT with duration of benefit lasting approximately 2 years. The use of Bevacizumab did not add to the duration of treatment benefit. Further, the duration of benefit was negatively impacted by smoking history.
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Telangiectasia Hemorrágica Hereditária , Bevacizumab/uso terapêutico , Epistaxe/etiologia , Epistaxe/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Resultado do TratamentoRESUMO
OBJECTIVE: Identify the impact of demographics and social determinants of health on surgical follow-up and complications after medial orbital wall decompression (MOWD) secondary to thyroid associated orbitopathy (TAO). METHODS: Demographics and social determinants of health (age, sex, race, insurance status) for 46 patients undergoing MOWD secondary to TAO were correlated with post-operative compliance and surgical complications by chi-square analyses. RESULTS: Among 46 patients, 23 were compliant with follow-up. There was no statistically significant difference between compliance and non-compliance based on age (60.25 vs 56.4, p = .41), sex (71.9 % female vs 85.7 % female, p = .31), race (65.6 % white vs 71.4 % white, p = .70) or insurance status (59.4 % private vs 42.9 % private, p = .30). Complications were noted in 50 % of patients of which sinus infection was most common (47.8 % of complications) and epistaxis rare (4.3 % of complications). No correlation was noted between development of complications and compliance (p = .20). Likewise, age, race and insurance status did not correlate with complications. CONCLUSION: For patients undergoing MOWD, no correlations with compliance or complication rate were noted with age, sex, race, or insurance status. A larger cohort may be indicated to identify such patterns. The overall complication rate was 50 % and the increased number of visits may have economic impact. KEY POINTS: This study provides a unique chance to assess demographic correlates of compliance and complication while controlling for surgeon preference. There was no association between sociodemographics and compliance or complications.
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Descompressão Cirúrgica , Oftalmopatia de Graves , Descompressão Cirúrgica/efeitos adversos , Demografia , Feminino , Seguimentos , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/cirurgia , Humanos , Masculino , Órbita/cirurgia , Estudos RetrospectivosRESUMO
PURPOSE: Endodontic disease is one of the most common causes of bacterial odontogenic sinusitis (ODS). Diagnosing ODS of endodontic origin involves otolaryngologists confirming sinusitis, and dental specialists confirming endodontic sources. The purpose of this study was to conduct a multidisciplinary literature review to highlight clinical and microbiological features of ODS, and the most optimal diagnostic modalities to confirm endodontic disease. METHODS: An extensive review of both medical and dental literature was performed by rhinologists, endodontists, and an infectious disease specialist. Frequencies of various clinical and microbiological features from ODS studies were collected, and averages were calculated. Different endodontic testing and imaging modalities were also evaluated on their abilities to confirm endodontic disease. RESULTS: ODS patients most often present with unilateral sinonasal symptoms for over 3 months, purulence on nasal endoscopy, and overt dental pathology on computed tomography (CT). Subjective foul smell, and maxillary sinus cultures demonstrating anaerobes and α-streptococci (viridans group) may be more specific to ODS. For endodontic evaluations, cold pulp testing and cone-beam CT imaging are most optimal for confirming pulpal and periapical disease. CONCLUSION: Diagnosing ODS requires collaboration between otolaryngologists and dental specialists. Clinicians should suspect ODS when patients present with unilateral sinonasal symptoms, especially foul smell. Patients will generally have purulent drainage on nasal endoscopy, and both sinus opacification and overt dental pathology on CT. However, some patients will have subtle or absent dental pathology on CT. For suspected endodontic disease, endodontists should be consulted for at least cold pulp testing, and ideally cone-beam CT.
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Infecções Bacterianas , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/microbiologia , Pulpite/diagnóstico , Pulpite/microbiologia , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Estreptococos Viridans/isolamento & purificação , Estreptococos Viridans/patogenicidadeRESUMO
PURPOSE: Visualization of the surgical field is essential for patient safety during endoscopic transsphenoidal tumor surgery. In this retrospective chart review and data analysis of patients undergoing endoscopic transsphenoidal resection of pituitary tumors under general anesthesia we sought to determine if total intravenous anesthesia with propofol and remifentanil leads to decreased bleeding, surgical duration, time to extubation and/or length of stay in the recovery room compared to inhaled anesthesia with sevoflurane or desflurane. METHODS: After IRB approval, chart reviews of 193 American Society of Anesthesiologists class 1 to 3 patients were conducted who had undergone transsphenoidal, endonasal resections of pituitary tumors under total intravenous or inhaled anesthesia at an academic teaching hospital in the United States over a seven-year time period. One hundred four patients fulfilled the inclusion criteria and were further reviewed. Primary outcome was intraoperative blood loss; secondary outcomes were surgical duration, time to extubation and length of stay in the recovery room. RESULTS: Gender, age, and Lund-Mackay-Scores were equally distributed between the two anesthetic groups. We found no significant effect of the anesthetic technique, age, gender, or Lund Mackay score on any of the primary or secondary outcomes. The only significant predictor for recovery room length of stay was intraoperative blood loss. CONCLUSION: Our study shows no evidence that total intravenous anesthesia is superior to inhaled anesthesia or vice versa during endoscopic transsphenoidal sinus surgery with regard to relevant clinical outcome parameters.
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Anestesia Geral , Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Endoscopia , Neoplasias Hipofisárias/cirurgia , Propofol/administração & dosagem , Extubação , Analgésicos Opioides/administração & dosagem , Perda Sanguínea Cirúrgica , Desflurano/administração & dosagem , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Remifentanil/administração & dosagem , Estudos Retrospectivos , Sevoflurano/administração & dosagemRESUMO
OBJECTIVES: The aim of this study was to present a rare case of a venous malformation that occupied the ethmoid and sphenoid sinuses. Prior to resection, it was believed to be a hemangioma. METHODS: This study includes a case report and review of the literature. CONCLUSION: There is often confusion between "hemangiomas" and "vascular malformations," but they are important to differentiate because they have unique approaches to treatment. Venous malformations in the paranasal sinuses are very rare. To our knowledge, this is the first case report that explicitly describes a venous malformation in the ethmoid and sphenoid sinuses. It was treated using endoscopic sinus surgery with intraoperative computer-assisted stereotactic navigation.
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Seio Etmoidal/patologia , Hemangioma/patologia , Neoplasias dos Seios Paranasais/patologia , Seio Esfenoidal/patologia , Seio Etmoidal/irrigação sanguínea , Seio Etmoidal/cirurgia , Hemangioma/cirurgia , Humanos , Achados Incidentais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias dos Seios Paranasais/cirurgia , Radiocirurgia , Seio Esfenoidal/irrigação sanguínea , Seio Esfenoidal/cirurgia , Cirurgia Assistida por ComputadorRESUMO
OBJECTIVES: To describe potential mechanisms by which pepsin induces inflammation in refractive chronic rhinosinusitis (CRS). Our hypothesis was that pepsin induces mitochondrial damage and cytokine expression in human nasal epithelial cells (HNEpC) in vitro. METHODS: Western blot was used to detect pepsin in sinus lavages from patients with CRS and controls. The HNEpC cells were treated with pepsin (pH 7; 0.1 mg/mL) for 1 or 16 hours and routine electron microscopy (EM) and MTT assay were performed. Cytokine ELISA was performed on media collected from HNEpC cells 16 hours following a 1-hour pepsin treatment. RESULTS: Pepsin was detected in sinus lavages from 4 out of 6 CRS patients and 0 out of 3 controls. The EM showed mitochondrial damage in pepsin-treated HNEpC cells but not in control cells. The MTT assay demonstrated reduced mitochondrial activity in pepsin-treated HNEpC cells compared to controls (P < .001). Pepsin increased IL-1A (P = .003) and IL-6 (P = .04) expression in HNEpC cells. CONCLUSIONS: Pepsin in sinus lavages from patients with CRS is consistent with previous studies. This study reveals the damaging effect of pepsin on mitochondria in nasal epithelial cells in vitro. Cytokines previously associated with CRS were elevated following pepsin treatment of HNEpC cells in vitro. These results demonstrate mechanisms by which pepsin may potentiate CRS.
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Células Epiteliais/efeitos dos fármacos , Fármacos Gastrointestinais/farmacologia , Mucosa Nasal/citologia , Pepsina A/farmacologia , Idoso , Estudos de Casos e Controles , Células Cultivadas , Doença Crônica , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Feminino , Humanos , Interleucina-1alfa/metabolismo , Interleucina-6/metabolismo , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/patologia , Líquido da Lavagem Nasal , Rinite/patologia , Sinusite/patologiaRESUMO
We present a series of 4 patients with juvenile nasopharyngeal angiofibroma (JNA) who underwent Coblation-assisted endoscopic resection after preoperative embolization, and discuss the use and advantages of endoscopic Coblation-assisted resection of JNA. Our limited case series suggests that Coblation may be used in the resection of JNA after embolization in a relatively safe, efficient, and effective manner. Coblation allows for decreased bleeding, less need for instrumentation, and improved visualization. There are limited published data in the literature to date on the use of Coblation in endoscopic JNA resection. We describe its use in a more extensive tumor than those previously reported. Further studies are needed to fully define the safety and utility of Coblation technology for this application.
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Angiofibroma/cirurgia , Ablação por Cateter/métodos , Endoscopia/métodos , Neoplasias Nasofaríngeas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Adolescente , Adulto , Angiofibroma/diagnóstico por imagem , Angiofibroma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Neoplasias Nasofaríngeas/diagnóstico por imagem , Neoplasias Nasofaríngeas/patologia , Músculos Pterigoides/patologia , Fossa Pterigopalatina/patologia , RadiografiaRESUMO
We report a case of near-complete remodeling of the anterior table of the frontal sinus after treatment for an erosive Pott's Puffy Tumor. A 61-year-old male presented with progressive swelling of his left forehead. Examination showed a doughy left forehead mass, and a sinus CT showed a lateral left frontal sinus mucocele with complete anterior table erosion. Frontal trephination with marsupialization of the mucocele was performed, and at 8 month follow-up, the patient had no visible defect and only minimally palpable bony defect. The anterior table had remodeled with no additional intervention resulting in a cosmetic outcome imperceptible from the patient's baseline.
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Seio Frontal/cirurgia , Mucocele/patologia , Tumor de Pott/cirurgia , Testa/patologia , Seio Frontal/diagnóstico por imagem , Seio Frontal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucocele/diagnóstico por imagem , Tomografia Computadorizada por Raios X , TrepanaçãoRESUMO
INTRODUCTION: Children sustain dentoalveolar trauma and lose teeth at the same rate regardless of socioeconomic status; however, debate surrounds these rates in adults. It is known socioeconomic status plays a major role in access and treatment in health care. This study aims to clarify the role of socioeconomic status as a risk factor for dentoalveolar trauma in adults. METHODS: A single center retrospective chart review took place from January 2011 through December 2020 for patients requiring oral maxillofacial surgery consultation in the emergency department, due to either dentoalveolar trauma (Group 1) or other dental condition (Group 2). Demographic information including age, sex, race, marital status, employment status, and type of insurance were collected. Odds ratios were calculated by chi-square analysis with significance set at P < 0.05. RESULTS: Over the course of 10 years, 247 patients (53% female) required an oral maxillofacial surgery consultation, with 65 (26%) sustaining dentoalveolar trauma. Within this group, there were significantly more subjects who were Black, single, insured with Medicaid, unemployed, and 18 - 39 years old. In the nontraumatic control group, there were significantly more subjects who were White, married, insured with Medicare, and 40 - 59 years old. CONCLUSIONS: Among those seen in the emergency department requiring an oral maxillofacial surgery consultation, those with dentoalveolar trauma have an increased likelihood of being single, Black, insured with Medicaid, unemployed, and 18 - 39 years old. Further research is needed to determine causality and the most critical/influential socioeconomic status factor in sustaining dentoalveolar trauma. Identifying these factors can assist in developing future community-based prevention and educational programs.
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Medicare , Classe Social , Idoso , Criança , Adulto , Humanos , Feminino , Estados Unidos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores SocioeconômicosRESUMO
PURPOSE: Fulminant invasive fungal sinusitis (IFS) is an aggressive disease seen in patients who are severely neutropenic. The use of granulocyte transfusions to address neutropenia-associated IFS has been described for almost 2 decades. The objectives are to provide our experience using granulocyte transfusions in patients with IFS and to provide a current review of the literature. MATERIALS AND METHODS: A retrospective chart review was performed at the Medical College of Wisconsin to identify patients who received granulocyte transfusions for IFS. Data collected included age, original diagnosis, IFS pathogen, dates, transfusion number, reason for discontinuation, additional therapies, last known follow-up, and status at last known follow-up. A Medline search and manual review of citations within bibliographies was also performed. RESULTS: A total of 20 patients received granulocyte transfusions at the Medical College of Wisconsin between October 2003 and June 2009; 3 of these patients received granulocyte transfusions for fulminant IFS. A total of 22 reported cases of IFS treated with granulocyte transfusions exist in the current literature. CONCLUSIONS: Although limitations to the use of granulocyte transfusions exist, they still represent a viable treatment option in individuals who fail to respond to more conventional therapies.
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Transfusão de Leucócitos/métodos , Micoses/terapia , Sinusite/terapia , Doença Aguda , Adolescente , Adulto , Feminino , Seguimentos , Granulócitos , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/microbiologia , Estudos Retrospectivos , Sinusite/diagnóstico , Sinusite/microbiologia , Resultado do Tratamento , Adulto JovemRESUMO
Injuries after blunt and penetrating trauma to the face are a common occurrence and are managed by specialists from several disciplines. After short-term care and immediate recovery, long-term complications can develop including cosmetic deformity, unsightly scarring, problems with soft tissue healing, malunion or nonunion of bony segments, diplopia or other visual complaints, malocclusion, hardware failure, and mucocele formation. Here, we present a report of 2 late complications recognized and treated in a patient 40 years after an episode of craniofacial trauma: epistaxis with symptomatic nasal congestion from fixation wires and mucocele formation. Management of this patient accompanied by endoscopic photographs and computed tomographic images is presented, and discussion of these complications along with review of the literature is provided.
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Traumatismos Craniocerebrais/etiologia , Diplopia/etiologia , Mucocele/etiologia , Traumatismos Craniocerebrais/diagnóstico , Diplopia/diagnóstico , Endoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Mucocele/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Extranasopharyngeal angiofibromas (ENA) arising from the nasal septum or nasal septal angiofibromas are extremely rare; only 13 such cases have been reported in the international literature. Our objective is to describe the presentation, workup, and surgical management of these lesions. STUDY DESIGN: Case reports were done. SETTING: The setting was a tertiary care referral center and the Veterans Affairs Medical Center. PATIENTS, INTERVENTIONS, AND RESULTS: We present 2 cases of extranasopharyngeal angiofibroma occurring on the nasal septum. CONCLUSIONS: In this report, we discuss the occurrence, the histopathologic findings, and the treatment of nasal septal angiofibroma.
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Angiofibroma/diagnóstico , Angiofibroma/cirurgia , Septo Nasal/patologia , Neoplasias Nasais/diagnóstico , Angiofibroma/patologia , Diagnóstico Diferencial , Endoscopia , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgiaRESUMO
Current treatment of severe epistaxis in patients with hereditary hemorrhagic telangiectasia is not durable in reducing the frequency and severity of bleeds. Recent reports have demonstrated marked improvement of epistaxis with administration of either intravenous or topical bevacizumab. We present the long-term outcome of a patient who received repeated treatments of intravenous bevacizumab followed by maintenance intranasal bevacizumab. We demonstrate durable control of epistaxis with intranasal bevacizumab. This allows delivery of bevacizumab effectively, reduces cost, and obviates the risk of systemic adverse effects related to bevacizumab.
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Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Telangiectasia Hemorrágica Hereditária/tratamento farmacológico , Administração Intranasal , Bevacizumab , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Contagem de Plaquetas , Telangiectasia Hemorrágica Hereditária/sangue , Telangiectasia Hemorrágica Hereditária/diagnóstico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
INTRODUCTION: The risk of adverse events, specifically avascular necrosis (AVN), associated with corticosteroid use is not well reported. The aim of this study was to evaluate the prevalence of AVN among patients with prior oral corticosteroid administration. METHODS: An institutional database query recognized 113,734 adult patients with oral corticosteroid administration between January 2006 and May 2017. A temporal query performed on this cohort determined that 789 had a diagnosis of AVN following oral corticosteroids. A retrospective review was performed on this cohort. Data collected included demographics, comorbidities, date of initial oral corticosteroid exposure, and time to diagnosis of AVN. Records without radiographic confirmation of AVN were excluded from analysis. Patients with cumulative lifetime dosages greater than 10,000 mg prednisone were excluded from analysis. RESULTS: A total of 789 patients with oral corticosteroid use prior to diagnosis of AVN were identified. Five hundred and seventy-two patients were excluded due to insufficient documentation of oral corticosteroid dosage, no radiographic evidence supporting the diagnosis of AVN, insufficient data confirming the temporal relationship between oral corticosteroids and AVN, and/or a cumulative dosing of >10,000 mg prednisone. This left 217 patients included in the analysis. The mean duration of use prior to diagnosis of AVN was 219 (± 374) days, and mean cumulative dose was 3314 (± 2908) mg prednisone equivalents. Mean time between diagnosis of AVN and onset of pathologic fracture was 379 (± 1046) days. CONCLUSION: For patients receiving low cumulative doses of oral corticosteroids, corticosteroids pose a small risk of development of AVN. More studies are required to better characterize risk.
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Corticosteroides , Osteonecrose , Corticosteroides/efeitos adversos , Adulto , Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/diagnóstico , Osteonecrose/epidemiologia , Prednisona/efeitos adversos , Estudos Retrospectivos , Fatores de RiscoRESUMO
Absorbable steroid-eluting sinus implants provide targeted corticosteroid release over a sustained period and are designed to prevent both undesirable adhesion formation and sinus ostia restenosis. Here, we highlight the key evidence of these implants to date and query a group of experts via a Delphi process on the indications and optimal timing for intraoperative or in-office placement of these implants. Six of a total of 12 statements reached consensus and were accepted. Overall, experts largely agree that intraoperative or in-office use of steroid-eluting stents could be considered for patients: (1) who are diabetic or intolerant of oral steroids, (2) undergoing extended frontal sinus surgery, and (3) with recurrent stenosis. Given the lack of expert consensus on other key statements, clinicians should carefully consider these treatment options on a case-by-case basis after shared decision-making.
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Rinite , Sinusite , Implantes Absorvíveis , Corticosteroides , Doença Crônica , Técnica Delphi , Endoscopia , Humanos , Rinite/cirurgia , Sinusite/cirurgia , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. DATA SOURCES: PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. REVIEW METHODS: Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell's palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19-specific findings. CONCLUSIONS: Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell's palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. IMPLICATIONS FOR PRACTICE: SCS use for SSNHL, Bell's palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.
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Paralisia de Bell , COVID-19 , Paralisia Facial , Otolaringologia , Criança , Humanos , Paralisia de Bell/tratamento farmacológico , Vacinas contra COVID-19 , SARS-CoV-2 , Otolaringologia/métodosRESUMO
OBJECTIVES: The aim of the study was to present a case of small cell carcinoma arising from the tonsil with metastasis to the external auditory canal (EAC) and associated facial nerve paralysis. METHODS: This study includes a case report and review of the literature. CONCLUSIONS: Extrapulmonary small cell carcinoma from the head and neck is rarely described and carries a poor prognosis. It often presents with widely metastatic disease. To our knowledge, this is the first case report describing extrapulmonary small cell carcinoma from the tonsil with metastatic disease to the EAC. Irregular lesions in the EAC must be considered suspicious for metastasis in a patient with a history of cancer.
Assuntos
Carcinoma de Células Pequenas/secundário , Meato Acústico Externo/patologia , Neoplasias da Orelha/secundário , Paralisia Facial/etiologia , Neoplasias de Cabeça e Pescoço/patologia , Biópsia , Carcinoma de Células Pequenas/complicações , Carcinoma de Células Pequenas/diagnóstico , Diagnóstico Diferencial , Neoplasias da Orelha/complicações , Neoplasias da Orelha/diagnóstico , Paralisia Facial/patologia , Evolução Fatal , Seguimentos , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The objective of this study was to determine the impact of patient demographics and socioeconomic factors on the utilization of tertiary rhinology care services in an upper Midwestern academic medical center. STUDY DESIGN: Retrospective review of electronic health records. SETTING: Academic medical center. METHODS: The electronic health record of our academic center was interrogated for the demographics and diagnosis of chronic rhinosinusitis (CRS) among adult patients seen by fellowship-trained rhinologists from 2000 to 2019. Patient characteristics (age, sex, race, insurance status) and population-level data (median income and education level) were compared with utilization of tertiary rhinology services for CRS. Utilization rates were calculated for each regional zip code and correlated with census data for median income and education. The association between determinants of health and tertiary rhinology utilization was assessed by multivariate regression analyses. RESULTS: A total of 8325 patients diagnosed with CRS used tertiary rhinology services. Patients were older (median, 58.9 years) and more likely to be female (57.6%), White (85%), and privately insured (60%) when compared with patients seen across our hospital system (P < .001). Adjusted analyses showed median income, education level, and White race to be independently correlated with tertiary care utilization. Private insurance alone was not an independent contributing factor to access. CONCLUSION: Utilization of tertiary rhinology services correlated with income, race, and education level. Private insurance was not an independent factor. These results highlight social differences in determinants of access to tertiary otolaryngologic care.