The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease

Abstract Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking. Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis. Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP. Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline (p = 0.002126) but significant improvement of symptoms after undergoing BSP (p < 0.0001). Conclusions The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease.

Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking. Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis. Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP. Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline ( p = 0.002126) but significant improvement of symptoms after undergoing BSP ( p < 0.0001). Conclusion The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

Home Away From Home: Mentorship and Research in Private Practices for Students Without Home Programs.

As the competitiveness of matching to an otolaryngology residency continues to climb, students are encouraged to seek mentorship and research within their home institution. This notion, however, does not account for students without a home otolaryngology program or department. Here, we present a research model where medical students conduct clinical research and gain experience and mentorship within a local otolaryngology private practice. Over the span of 6 years, rotating students produced an average of 3 research projects per year. Fourth-year medical students within the practice had an average of 20.5 publications, exceeding the 2020 National Residency Match Program's metrics for matched otolaryngology applicants. Private practices may provide research and mentorship for students with limited resources. Similarly, physicians who oversee such students may gain added help to conduct research within their practice. This symbiotic relationship may serve in advancing evidence-based clinical practice while amplifying the diverse voices of students otherwise seldom heard.

Does Mask Usage Worsen Symptoms in Patients With Rhinosinusitis Balloon Sinuplasty Amid the COVID-19 Pandemic?

With the onset of the COVID-19 pandemic, social distancing guidelines have reshaped the way that we live our lives. Perhaps the most common and strictly adopted measure has been mask wearing. Mask wearing, whether it be cloth, surgical, or N95, has quickly become the new norm in the ongoing struggle against this pandemic and has been proven to be effective in curbing its high infection rate. There has, however, been growing opposition to these policies by a substantial part of the general population who claims that masks are ineffective and can worsen breathing. To some, the choice to use or not use a mask has morphed into a point of political contention, rather than a choice rooted in concerns for public health. This commentary attempts to investigate the validity of these claims and explore how clinicians can encourage the usage of masks despite the fears and confusion against them.

Telemedicine in Minority and Socioeconomically Disadvantaged Communities Amidst COVID-19 Pandemic.

In the wake of the COVID-19 pandemic, many otolaryngology practices worldwide have chosen to shift their consultations from in-person to telemedicine. The addition of the telemedicine model has allowed many physicians to resume their clinical duties while maintaining social distancing. Access to telemedicine generally relies on the patient's ability to obtain and use technology-factors that are usually dictated by age, education, and socioeconomic status. The Rio Grande Valley, the home of the South Texas Sinus Institute, is a border community situated on the southern tip of Texas. The population is predominantly Hispanic, Spanish speaking, and of a lower socioeconomic level. The aim of this commentary is to describe the effects of the transition to telemedicine in a vulnerable community and the possible improvements that could be made to facilitate access to this resource.