Postoperative Oral Antibiotics and Sinonasal Outcomes Following Endoscopic Transsphenoidal Surgery for Pituitary Tumors Study: A Multicenter, Prospective, Randomized, Double-Blinded, Placebo-Controlled Study.

BACKGROUND: Postoperative prophylactic antibiotics are commonly used in pituitary surgery, but evidence supporting their use is lacking, which has implications for antibiotic stewardship. OBJECTIVE: To evaluate whether receipt of postoperative oral antibiotics results in superior sinonasal quality of life (QOL) compared with placebo among patients who undergo endoscopic endonasal transsphenoidal pituitary surgery. METHODS: Patients were randomized to receive either oral placebo or cefdinir (trimethoprim-sulfamethoxazole in patients intolerant to cefdinir) for 7 d after surgery. They were monitored for 12 wk. The primary outcome measure was sinonasal QOL at 2 wk on the Anterior Skull Base Nasal Inventory-12. Supplementary end points included sinonasal QOL reported on the Sinonasal Outcome Test-22 and objective endoscopy scores to assess nasal healing according to the Lund-Kennedy method. RESULTS: A total of 461 patients were screened, 131 were randomized, and 113 (placebo arm: 55; antibiotic arm: 58) were analyzed. There was no clinically meaningful or statistically significant difference in sinonasal QOL at any measured time point (P ≥ .24) using either instrument. Nasal cavity endoscopy scores were not significantly different at 1 to 2 wk after surgery (P = .25) or at 3 to 4 wk after surgery (P = .08). CONCLUSION: Postoperative prophylactic oral antibiotics did not result in superior sinonasal QOL compared with placebo among patients who underwent standard endoscopic transsphenoidal surgery.

Assessment of the Validity of the Sinonasal Outcomes Test-22 in Pituitary Surgery: A Multicenter Prospective Trial.

OBJECTIVES/HYPOTHESIS: Sinonasal Outcomes Test-22 (SNOT-22) is used widely as a patient-reported sinonasal quality-of-life (QOL) instrument for endoscopic endonasal pituitary surgery. However, it has never been validated in this population. This study explores the psychometric validity of SNOT-22 to determine if it is a valid scale in patients undergoing endoscopic pituitary surgery. STUDY DESIGN: Multicenter prospective trial. METHODS: Adult patients (n = 113) with pituitary tumors undergoing endoscopic surgery were enrolled in a multicenter study. Patient-reported QOL was assessed using SNOT-22 and the Anterior Skull Base Nasal Inventory-12. Face validity, internal consistency, responsiveness to clinical change, test-retest reliability, and concurrent validity were determined using standard statistical methods. RESULTS: Internal consistency using Cronbach's alpha at baseline and 2 weeks postoperatively were 0.911 and 0.922, indicating SNOT-22 performed well as a single construct. Mean QOL scores were significantly worse at 2 weeks than baseline (16.4 ± 15.1 vs. 23.1 ± 16.4, P < .001), indicating the scale is responsive to clinical change. However, only 11/22 items demonstrated significant changes in mean scores at 2 weeks. Correlation between scores at 2 and 3 weeks was high, suggesting good test-retest reliability, r(107) = 0.75, P < .001. Factor analysis suggests the five-factor solution proposed for the SNOT-22 in rhinosinusitis patients is not valid in pituitary surgery patients. CONCLUSIONS: The SNOT-22 is a valid QOL instrument in patients undergoing endoscopic pituitary surgery. However, because it includes 22 items, can be applied only as a single construct, 50% of the items do not demonstrate changes after surgery, and is not as sensitive to change as other scales, shorter instruments developed specifically for this patient population may be preferable. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2757-E2763, 2021.

Use of image-guided systems in the reconstruction of the periorbital region.

The conflict in the Middle East has led to an increase in the incidence and severity of facial trauma evaluated at tertiary military medical facilities. The Naval Medical Center San Diego, San Diego, Calif, has treated 5 patients with penetrating injuries to the orbit with associated comminuted fractures. We have used the technology of image-guided surgery to assist in reconstructing these injuries. Image-guided surgery has many applications in the head and neck. This review consists of a series of traumatic applications of the image-guided system with a focus on orbital and midfacial trauma. We will discuss the benefits and drawbacks of this technique compared with previously described techniques.

Teleotolaryngology: a retrospective review at a military tertiary treatment facility.

OBJECTIVE/HYPOTHESIS: The use of real-time telemedicine in providing quality health-care in multiple specialties has been demonstrated in several small studies; however, a review of the literature reveals no large-scale prospective or retrospective telemedicine studies in otolaryngology. The telemedicine office at Naval Medical Center San Diego (NMCSD) acquired a large otolaryngology telemedicine patient database, and this study reviews the otolaryngology telemedicine experience at NMCSD over an 18-month period. STUDY DESIGN: We conducted a retrospective and reviewed new patient consults for the NMCSD otolaryngology telemedicine clinic from April 1, 2001, until November 6, 2002. RESULTS: During the study period, a total of 883 patients received new patient evaluations. Of 883 patients, 568 (64.3%) received a preliminary diagnosis and were treated accordingly. Telemedicine resulted in the avoidance of 22.7% consults. Only 115 (13.0%) of 883 patients required traditional face-to-face otolaryngology consultation. In addition, only 30 (4.3%) of 705 patients who underwent flexible nasopharyngoscopy, otomicroscopy, or nasal endoscopy received incomplete examinations. CONCLUSIONS: Our study demonstrates the ability of telemedicine to function in an general otolaryngology setting.

Chronic inspiratory stridor secondary to a retained penetrating radiolucent esophageal foreign body.

Although foreign body ingestions are common in infants and young children, penetration of the esophagus is a relatively rare event. Timely diagnosis is impeded by the absence of classical symptoms and by the ingestion of radiolucent foreign bodies. The authors present a 17-month-old girl with a 6-month history of inspiratory stridor. An extensive workup found a penetrating radiolucent foreign body at the thoracic inlet.