Christian M Meerwein, Peta-Lee Sacks, Jacqueline Ho, Christine Choy, Larry Kalish, Raewyn G Campbell, Ray R Sacks, Richard J Harvey
Objective: To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery.
Methods: A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 109/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.
Results: Eighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).
Conclusions: Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.
摘要评估过敏原免疫疗法(AIT)对手术后中央隔室特应性疾病(CCAD)和家尘螨(HDM)致敏患者的影响:对表型为 CCAD 的接受过手术治疗、对 HDM 过敏的 CRSwNP 患者进行了回顾性队列评估。根据患者是否将 AIT 作为手术治疗的一部分,将患者分为两组。所有 AIT 患者均在手术前开始接受免疫疗法。主要终点是手术后 12 个月中鼻甲水肿的恢复情况。次要终点是皮质类固醇冲洗使用量(9/L)、组织嗜酸性粒细胞增多(% > 100/HPF),同时还记录了血清 IgE(kU/L):共评估了 86 名 CCAD 患者(41 ± 14 岁,64% 为女性)。37%的患者(32 人)使用了 AIT。基线特征相似,但 AIT 组的结膜症状更严重(72 对 45%,P = 0.02)。术后 12 个月时,AIT 组的 MT 水肿较少(≥弥漫性的百分比为 15.6 vs. 52.9,p 结论:手术和药物治疗可有效缓解眼结膜水肿:手术和药物治疗对控制 CCAD 很有效,但 AIT 的加入改善了过敏现象,并允许局部治疗降级。要进一步证明免疫调节作用,还需要进行更长期的研究。
{"title":"The effect of allergen immunotherapy in patients with central compartment atopic disease post-surgery.","authors":"Christian M Meerwein, Peta-Lee Sacks, Jacqueline Ho, Christine Choy, Larry Kalish, Raewyn G Campbell, Ray R Sacks, Richard J Harvey","doi":"10.1002/alr.23459","DOIUrl":"https://doi.org/10.1002/alr.23459","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of allergen immunotherapy (AIT) on patients with central compartment atopic disease (CCAD) and house dust mite (HDM) sensitization post-surgery.</p><p><strong>Methods: </strong>A retrospective cohort of surgically treated, HDM-sensitized CRSwNP patients phenotyped as CCAD was assessed. Patients were divided into two groups based on whether they had AIT commenced as part of their surgical care. All AIT patients started immunotherapy prior to their surgery. The primary endpoint was reformation of middle turbinate (MT) edema 12 months postsurgery. Secondary endpoints were corticosteroid irrigation use (<4 times/week vs. ≥4 times/week, %) and the rhinologic domain of the 22-item sino-nasal outcome test (SNOT-22). Demographic characteristics, concomitant asthma, smoking status, history of aspirin-exacerbated respiratory disease, conjunctival symptoms, polysensitization, serum eosinophils (cell × 10<sup>9</sup>/L), tissue eosinophilia (% > 100/HPF), and serum IgE (kU/L) were also recorded.</p><p><strong>Results: </strong>Eighty-six CCAD patients were assessed (41 ± 14 yrs, 64% female). AIT was applied in 37% (n = 32). Baseline features were similar apart from greater conjunctival symptoms (72 vs. 45%, p = 0.02) in the AIT group. At 12 months post-surgery, the AIT group has less MT edema (% ≥ diffuse 15.6 vs. 52.9, p < 0.01). Patients on AIT also had less pharmacotherapy requirements at 12 months (% ≥ 4/week, 37.5 vs. 79.6%, p < 0.01). The rhinologic symptoms were similar (21.1 ± 17.1 vs. 20.1 ± 21.6, p = 0.83).</p><p><strong>Conclusions: </strong>Surgery and pharmacotherapy are effective in managing CCAD, but the addition of AIT improved allergic phenomenon and allowed de-escalation of topical therapy. Longer term studies are required to demonstrate further immunomodulation.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David K Lerner, Chau Phung, Alan D Workman, Saawan Patel, Glenn Pennington, Robert Stetson, Jennifer E Douglas, Michael A Kohanski, James N Palmer, Nithin D Adappa
Background: Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability.
Methods: We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed.
Results: A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n = 99) of nasal polyps and 31.2% (n = 69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p = 0.04), in addition to presence of nasal polyps ($531.96, p = 0.04). There was no significant association between total costs and the remaining clinical and demographic factors.
Conclusions: Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.
{"title":"Time is money: An analysis of cost drivers in ambulatory sinus surgery.","authors":"David K Lerner, Chau Phung, Alan D Workman, Saawan Patel, Glenn Pennington, Robert Stetson, Jennifer E Douglas, Michael A Kohanski, James N Palmer, Nithin D Adappa","doi":"10.1002/alr.23455","DOIUrl":"https://doi.org/10.1002/alr.23455","url":null,"abstract":"<p><strong>Background: </strong>Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability.</p><p><strong>Methods: </strong>We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed.</p><p><strong>Results: </strong>A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n = 99) of nasal polyps and 31.2% (n = 69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p = 0.04), in addition to presence of nasal polyps ($531.96, p = 0.04). There was no significant association between total costs and the remaining clinical and demographic factors.</p><p><strong>Conclusions: </strong>Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Bidwell, Dipesh Gyawali, Jonathan Morse, Vinayak Ganeshan, Thinh Nguyen, Edward D McCoul
Key points: AI-enabled augmentation of nasal endoscopy video images is feasible in the clinical setting. Edge computing hardware can interface with existing nasal endoscopy equipment. Real-time AI performance can achieve an acceptable balance of accuracy and efficiency.
{"title":"Real-time augmentation of diagnostic nasal endoscopy video using AI-enabled edge computing.","authors":"Jonathan Bidwell, Dipesh Gyawali, Jonathan Morse, Vinayak Ganeshan, Thinh Nguyen, Edward D McCoul","doi":"10.1002/alr.23458","DOIUrl":"https://doi.org/10.1002/alr.23458","url":null,"abstract":"<p><strong>Key points: </strong>AI-enabled augmentation of nasal endoscopy video images is feasible in the clinical setting. Edge computing hardware can interface with existing nasal endoscopy equipment. Real-time AI performance can achieve an acceptable balance of accuracy and efficiency.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correspondence for article titled “The relationship between survey-based subjective olfactory awareness and objective olfactory function”","authors":"Hyun Jin Min MD,PhD","doi":"10.1002/alr.23456","DOIUrl":"10.1002/alr.23456","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 10","pages":"1673-1674"},"PeriodicalIF":7.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew M Chu, Jack T Garcia, Ahmad R Sedaghat, George A Scangas, Katie M Phillips
Background: The management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost-effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost-effective strategy for the initial management of AECRS.
Methods: The study design consisted of a decision-tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost-effectiveness ratio < $50,000/quality-adjusted life year (QALY) or equivalently < $137/quality-adjusted life day (QALD) were considered cost-effective.
Results: Observation was the most cost-effective strategy at a willingness to pay of $137 per QALD. One-way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost-effective.
Conclusion: Observation is the most cost-effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost-effective strategy.
{"title":"A cost utility analysis for the management of acute exacerbations of chronic rhinosinusitis.","authors":"Matthew M Chu, Jack T Garcia, Ahmad R Sedaghat, George A Scangas, Katie M Phillips","doi":"10.1002/alr.23452","DOIUrl":"https://doi.org/10.1002/alr.23452","url":null,"abstract":"<p><strong>Background: </strong>The management of acute exacerbations of chronic rhinosinusitis (AECRS) is understudied and the most cost-effective management of AECRS has not been previously investigated. The aim of this study is to determine the most cost-effective strategy for the initial management of AECRS.</p><p><strong>Methods: </strong>The study design consisted of a decision-tree economic model comparing three different initial strategies for managing a patient perceived AECRS: observation, upfront rescue medications, or clinic visit with diagnostic nasal endoscopy (DNE). The primary study outcome was the disease burden of a single AECRS, which was determined by the health utility value and the duration of symptoms. Strategies with an incremental cost-effectiveness ratio < $50,000/quality-adjusted life year (QALY) or equivalently < $137/quality-adjusted life day (QALD) were considered cost-effective.</p><p><strong>Results: </strong>Observation was the most cost-effective strategy at a willingness to pay of $137 per QALD. One-way sensitivity analysis demonstrated that observation was more effective than upfront rescue medications when the probability of bacterial infection as the cause of AECRS was <24.0%. Upfront rescue medications wer more cost effective than observation when the probability of bacterial infection exceeded 49.0%. Clinic visit with DNE was the most effective strategy to manage an AECRS, but it was not considered cost-effective.</p><p><strong>Conclusion: </strong>Observation is the most cost-effective strategy for the initial management of AECRS when there is a low likelihood of bacterial infection. When the probability of bacterial etiology of AECRS exceeds 49.0%, upfront rescue medications proved to be the most cost-effective strategy.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martin Stampe, Ida Skovgaard Christiansen, Vibeke Backer, Kasper Aanæs, Anne-Sophie Homøe, Jens Tidemandsen, Emilie Neumann Nielsen, Sigrid Louise Hjorth Rasmussen, Rasmus Hartvig, Katalin Kiss, Thomas Hartvig Lindkær Jensen
Key points: Eosinophilic granulocytes have characteristic morphological features. This makes them prime candidates for utilization of a single cell binary classification network. Single cell binary classification networks can reliably help quantify eosinophils in nasal polyps.
{"title":"Quantitative characterization of eosinophilia in nasal polyps with AI-based single cell classification.","authors":"Martin Stampe, Ida Skovgaard Christiansen, Vibeke Backer, Kasper Aanæs, Anne-Sophie Homøe, Jens Tidemandsen, Emilie Neumann Nielsen, Sigrid Louise Hjorth Rasmussen, Rasmus Hartvig, Katalin Kiss, Thomas Hartvig Lindkær Jensen","doi":"10.1002/alr.23454","DOIUrl":"https://doi.org/10.1002/alr.23454","url":null,"abstract":"<p><strong>Key points: </strong>Eosinophilic granulocytes have characteristic morphological features. This makes them prime candidates for utilization of a single cell binary classification network. Single cell binary classification networks can reliably help quantify eosinophils in nasal polyps.</p>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":" ","pages":""},"PeriodicalIF":7.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aurelia S. Monk BA, Shreyas Pyati BS, Meredith Lamb DO, Nicholas Melott MS, Ezer H. Benaim MD, Christopher Wiesen PhD, Cristine Klatt-Cromwell MD, Brian D. Thorp MD, Charles S. Ebert Jr. MD, Adam J. Kimple MD, PhD, Brent A. Senior MD
{"title":"Reply to correspondence regarding the article “The relationship between survey-based subjective olfactory awareness and objective olfactory function”","authors":"Aurelia S. Monk BA, Shreyas Pyati BS, Meredith Lamb DO, Nicholas Melott MS, Ezer H. Benaim MD, Christopher Wiesen PhD, Cristine Klatt-Cromwell MD, Brian D. Thorp MD, Charles S. Ebert Jr. MD, Adam J. Kimple MD, PhD, Brent A. Senior MD","doi":"10.1002/alr.23457","DOIUrl":"10.1002/alr.23457","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"14 10","pages":"1676-1677"},"PeriodicalIF":7.2,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}