Lasers in Rhinology-An Update.

OBJECTIVES: A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. METHODS: A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. RESULTS: Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. CONCLUSIONS: There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.

Innovations in Endonasal Sinus Surgery in Children.

Although there have been many advances in new tools and procedures for endonasal sinus surgery in children, the management and care for pediatric chronic rhinosinusitis has remained relatively unchanged. However, there have been advances in skull base surgery and tumor removal and new knowledge about perioperative concerns in children. This article discusses the role and risks of endoscopic sinus surgery, the use of balloon sinuplasty in children, management of complicated rhinosinusitis, and advances in skull base tumors and choanal atresia repair.

Trends in inferior turbinate surgery: analysis of patients using the Medicare database.

BACKGROUND: The aim of this study was to characterize trends in turbinate reduction procedures from 2000 to 2015. METHODS: Annual procedure data were obtained for the period 2000-2015 and detailed Medicare provider and payment data were obtained for 2012-2015. Turbinate procedures analyzed included turbinate soft tissue mucosal ablation (TMA), turbinate soft tissue submucosal ablation (TSMA), turbinate excision (TE), and turbinate submucous resection (TSR). TMA and TSMA were grouped as turbinate soft tissue ablation (TA) for analysis. From 2012 to 2015, the type and location-facility (F) or nonfacility (NF)-of the providers performing the procedures were assessed. RESULTS: From 2000 to 2015, the total number of turbinate reduction procedures increased by an average of 3.8% annually. TSR had the highest annual increase at 5.4%. TE is the only procedure to show a decrease, by an average of -2.3% annually. From 2012 to 2015, the number of turbinate reduction procedures changed by -1.6% and 107.7% at F and NF locations, respectively. NF TSMA and TSR had the largest increases at 121.6% and 260.1%, respectively. Of the NF TA procedures, there was an average annual increase of 50% by non-otolaryngologists. For TA, the average F charge was 78.0% more than the NF charge, and the average NF otolaryngologist charge 11.5% more than the non-otolaryngologist charge. CONCLUSION: The number of turbinate reduction procedures increased steadily between 2000 and 2015, with the majority being TSRs. This is consistent with previous studies demonstrating that TSR leads to better outcomes. There has been a significant increase in turbinate reduction procedures performed in outpatient/ambulatory settings by otolaryngologists, non-otolaryngologists, and midlevel providers.

The subspecialty of rhinology: a survey of otolaryngology chairmen.

BACKGROUND: The past decade has witnessed the emergence of rhinology as a distinct subspecialty within otolaryngology. A critical evaluation of this process is necessary to define the field and to determine the impact of subspecialization on residency education. METHODS: An Internet-based survey of otolaryngology residency chairmen was performed to query attitudes about the importance of various aspects of rhinologic education including didactics, presence of rhinology faculty, exposure to research, office-based rhinology, and various surgical procedures. A 7-point Likert scale was used to rate responses. RESULTS: A 30.2% response rate was noted for the chairmen survey. From the chairmen's perspective, overall high levels of importance were ascribed to rhinology education and surgical training in otolaryngology residency. Lower scores for importance were noted for basic science research, exposure to office-based allergy care, and advanced surgical procedures. High scores were noted for the importance of fellowship training in the professional development of a resident interested in pursuing a career in rhinology. CONCLUSION: Overall high levels of importance were ascribed by the participating chairmen to the importance of rhinology education in residency. As the subspecialty of rhinology continues to develop, the role of the various educational, research and clinical activities will require continued evaluation.