Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study.

BACKGROUND: Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. METHODS: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1-9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures-kappa coefficient ([Formula: see text]) value > 0.61. RESULTS: After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. CONCLUSION: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years.

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic.

Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

Sinonasal endoscopy reporting format: emphasis on chronic rhinosinusitis.

The role of nasal endoscopy has been well characterized in terms of diagnosis and treatment, the methods of performing the endoscopy, and the findings that can be visualized within the nasal cavities. The reporting format of such findings has not been the subject of such detailed popularity. A structured format would create a common language between otolaryngologists, potentially facilitating outcomes assessment and/or research by providing an objective tool for recording findings. More so, professional associations might use a structured format for government or billing negotiations and justifications. The following sinonasal endoscopy reporting format represents a synthesis of clinical experience from three rhinologists in attempting to document endoscopic findings in the nose and sinuses. Our primary objective was limited to establishing a standardized format that will be suitable for objective outcomes assessment and communication between endoscopic sinus surgeons. It is also hoped that this reporting format can be correlated with patients' subjective quality of life outcomes.

Evaluation of static thermal and near-infrared hyperspectral imaging for the diagnosis of acute maxillary rhinosinusitis.

Although acute maxillary rhinosinusitis may be confidently diagnosed based on a history and physical examination by trained specialists, its diagnosis by primary health workers is less dependable, with a tendency for overdiagnosis, often resulting in inappropriate treatment. It is commonly perceived among the otolaryngology community that a new and objective diagnostic tool would be beneficial, facilitating the widespread and reliable diagnosis of rhinosinusitis. Numerous merits of thermal imaging make it an attractive modality to fulfill this role. Although modern systems possess ample sensitivity to detect small thermal abnormalities that accompany various physiologic conditions, reservations remain over whether a rhinosinusitis-induced thermal response in the overlying tissues is dominant enough to yield reliable diagnostic information in a normal clinical setting. Hence, a small preliminary study was conducted with the objective of testing the hypothesis that acute maxillary rhinosinusitis results in hyperthermia over the affected site and subsequent contralateral thermal asymmetry that is clearly distinguished from the normal population. The complementary yet distinct modality of near-infrared hyperspectral imaging, which detects changes in tissue perfusion, was assessed concurrently. We have not found a diagnostic test based on static thermal imaging or near-infrared hyperspectral imaging as viable options for the widespread and routine diagnosis of human sinus conditions. The presence and prevalence of visually inconspicuous epidermal features have been identified as representing a major confounding factor for facial thermal imaging. This article also serves as an overview of diagnostic imaging techniques employed in the detection of maxillary rhinosinusitis.

Image-guided sinus surgery.

Image-guided sinus surgery is a relatively new technology used to track the position of endoscopic instruments placed within the nose or sinus cavities. The different types of image-guided technologies are reviewed. A review of our experience with 55 patients in whom this technology was used over a 10-month period is presented. Our interpretation of the usefulness and limitations of this technology is described.

Control of bleeding in endoscopic sinus surgery: use of a novel gelatin-based hemostatic agent.

OBJECTIVE: To determine whether FloSeal Matrix Hemostatic Sealant is a safe and effective means of controlling bleeding post-endoscopic sinus surgery (ESS) and to assess postoperative healing. DESIGN: Prospective clinical study. SETTING: University of Toronto. METHODS: Eighteen patients with FloSeal placed on a total of 30 operative sites post-ESS. Time to cessation of bleeding was assessed intraoperatively. Patients had the operative sites assessed at 30 days postoperatively. MAIN OUTCOME MEASURES: Effectiveness of FloSeal in controlling bleeding and aiding in healing of the operative site. RESULTS: FloSeal adequately controls postoperative bleeding in patients post-ESS. Healing was also not adversely affected. CONCLUSIONS: FloSeal is a safe and effective treatment for controlling blood loss after EES. It may also provide support to the middle meatus as well as improve healing of the operative site compared with the use of traditional nasal packing. However, randomized clinical trials are needed to further evaluate this.