Usama Waqar, A. Arif, A. Hameed, S. M. A. Zaidi, Muhammad Hamza, H. Iftikhar, Huma Naz, S. A. Abbas
Racial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors.This retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian.A total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity.Black patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.
{"title":"Racioethnic disparities in comorbidities and outcomes following head and neck oncologic surgery","authors":"Usama Waqar, A. Arif, A. Hameed, S. M. A. Zaidi, Muhammad Hamza, H. Iftikhar, Huma Naz, S. A. Abbas","doi":"10.1002/wjo2.178","DOIUrl":"https://doi.org/10.1002/wjo2.178","url":null,"abstract":"Racial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors.This retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian.A total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity.Black patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141000204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeremy P. Tervo, Patricia T. Jacobson, Brandon J. Vilarello, Tiana M. Saak, Francesco F. Caruana, Liam W Gallagher, Joseph B. Gary, D. Gudis, Paule V. Joseph, D. P. Devanand, Terry E. Goldberg, J. Overdevest
Persistent olfactory dysfunction (OD) following loss of smell associated with SARS‐CoV‐2 infection is a major feature of long COVID. Perspectives on the prevalence of persistent OD predominantly rely on self‐reported olfactory function. Few studies have tracked longitudinal rates of recovery using psychophysical assessment among patients presenting for evaluation of persistent OD beyond a window of acute recovery. Data anchored in standardized testing methods are needed to counsel patients who fail to acutely regain their sense of smell. This study aims to quantify the degree of persistent OD in post‐COVID‐19 patients who experience subjective and psychophysical OD.We grouped participants presenting for OD evaluation into cohorts based on both subjective and psychophysical olfactory status at a baseline assessment and assessed their olfactory abilities with a visual analogue scale and the Sniffin' Sticks extended test at baseline and 1‐year time points. Participants had confirmed a history of COVID‐19 by lab evaluation or clinical diagnosis if lab evaluation was not available.Baseline olfactory evaluation was completed by 122 participants, 53 of whom completed the 1‐year follow‐up assessment. Among participants presenting with perceived OD, 74.5% had confirmed psychophysical OD at baseline, with 55.1% at 1‐year follow‐up. Participants had reliable trends in self‐rated versus psychophysically tested olfactory function at both time points. The total threshold, discrimination, and identification (TDI) score improved by +3.25 points in the cohort with psychophysical OD (p = 0.0005), with this improvement largely attributable to an increase in median threshold scores (+2.75 points; p = 0.0004).OD persists in a significant number of patients who fail to acutely recovery their sense of smell after COVID‐19, with many demonstrating lingering deficits at 1‐year. Improvements in threshold, but not discrimination or identification, most significantly mediate improvement of total TDI score at follow‐up.
{"title":"Recovery rates of persistent post‐COVID‐19 olfactory dysfunction using psychophysical assessment: A longitudinal cohort study","authors":"Jeremy P. Tervo, Patricia T. Jacobson, Brandon J. Vilarello, Tiana M. Saak, Francesco F. Caruana, Liam W Gallagher, Joseph B. Gary, D. Gudis, Paule V. Joseph, D. P. Devanand, Terry E. Goldberg, J. Overdevest","doi":"10.1002/wjo2.179","DOIUrl":"https://doi.org/10.1002/wjo2.179","url":null,"abstract":"Persistent olfactory dysfunction (OD) following loss of smell associated with SARS‐CoV‐2 infection is a major feature of long COVID. Perspectives on the prevalence of persistent OD predominantly rely on self‐reported olfactory function. Few studies have tracked longitudinal rates of recovery using psychophysical assessment among patients presenting for evaluation of persistent OD beyond a window of acute recovery. Data anchored in standardized testing methods are needed to counsel patients who fail to acutely regain their sense of smell. This study aims to quantify the degree of persistent OD in post‐COVID‐19 patients who experience subjective and psychophysical OD.We grouped participants presenting for OD evaluation into cohorts based on both subjective and psychophysical olfactory status at a baseline assessment and assessed their olfactory abilities with a visual analogue scale and the Sniffin' Sticks extended test at baseline and 1‐year time points. Participants had confirmed a history of COVID‐19 by lab evaluation or clinical diagnosis if lab evaluation was not available.Baseline olfactory evaluation was completed by 122 participants, 53 of whom completed the 1‐year follow‐up assessment. Among participants presenting with perceived OD, 74.5% had confirmed psychophysical OD at baseline, with 55.1% at 1‐year follow‐up. Participants had reliable trends in self‐rated versus psychophysically tested olfactory function at both time points. The total threshold, discrimination, and identification (TDI) score improved by +3.25 points in the cohort with psychophysical OD (p = 0.0005), with this improvement largely attributable to an increase in median threshold scores (+2.75 points; p = 0.0004).OD persists in a significant number of patients who fail to acutely recovery their sense of smell after COVID‐19, with many demonstrating lingering deficits at 1‐year. Improvements in threshold, but not discrimination or identification, most significantly mediate improvement of total TDI score at follow‐up.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"62 S11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141011716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Theresa Tharakan, D. Kallogjeri, Jay F. Piccirillo
To share a single institutional experience with clinical research on COVID‐related olfactory dysfunction (OD).Narrative review of published original data and ongoing clinical trials on COVID‐related OD at Washington University from 2020 to 2023.There were three new diagnostic‐/patient‐reported outcome measures developed and tested. We report five clinical trials of interventions for COVID‐related olfactory disorders: combined Visual‐Olfactory Training (VOLT) with patient‐preferred scents versus standard olfactory training (VOLT trial), oral gabapentin versus placebo (Gabapentin for the Relief of Acquired Chemosensory Experience trial), nasal theophylline irrigations versus placebo (Smell Changes and Efficacy of Nasal Theophylline trial), stellate ganglion block (single‐arm), and mindfulness‐based stress reduction (MBSR) versus lifestyle intervention (MBSR trial).Initial intervention trials for COVID‐related OD have shown potential for improving subjective and objective olfactory outcomes. However, there remains no gold standard treatment that definitively outperforms placebo in controlled trials. Therefore, continued investigation of novel therapeutic strategies for COVID‐related OD is necessary to maximize olfactory outcomes for affected patients.
{"title":"Clinical studies in COVID‐related olfactory disorders: Review of an institutional experience","authors":"Theresa Tharakan, D. Kallogjeri, Jay F. Piccirillo","doi":"10.1002/wjo2.176","DOIUrl":"https://doi.org/10.1002/wjo2.176","url":null,"abstract":"To share a single institutional experience with clinical research on COVID‐related olfactory dysfunction (OD).Narrative review of published original data and ongoing clinical trials on COVID‐related OD at Washington University from 2020 to 2023.There were three new diagnostic‐/patient‐reported outcome measures developed and tested. We report five clinical trials of interventions for COVID‐related olfactory disorders: combined Visual‐Olfactory Training (VOLT) with patient‐preferred scents versus standard olfactory training (VOLT trial), oral gabapentin versus placebo (Gabapentin for the Relief of Acquired Chemosensory Experience trial), nasal theophylline irrigations versus placebo (Smell Changes and Efficacy of Nasal Theophylline trial), stellate ganglion block (single‐arm), and mindfulness‐based stress reduction (MBSR) versus lifestyle intervention (MBSR trial).Initial intervention trials for COVID‐related OD have shown potential for improving subjective and objective olfactory outcomes. However, there remains no gold standard treatment that definitively outperforms placebo in controlled trials. Therefore, continued investigation of novel therapeutic strategies for COVID‐related OD is necessary to maximize olfactory outcomes for affected patients.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140683018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meng‐Fan Liu, Rui‐Xia Ma, Xian‐Bao Cao, Hua Zhang, Shui‐Hong Zhou, Wei‐Hong Jiang, Yan Jiang, Jing‐Wu Sun, Qin‐Tai Yang, Xue‐Zhong Li, Ya‐Nan Sun, Li Shi, Min Wang, Xi‐Cheng Song, Fu‐Quan Chen, Xiao‐Shu Zhang, H. Wei, Shao‐Qing Yu, Dong‐Dong Zhu, L. Ba, Zhi‐Wei Cao, Xu‐Ping Xiao, Xin Wei, Zhi‐Hong Lin, Feng‐Hong Chen, Chun‐Guang Shan, Guang‐Ke Wang, J. Ye, S. Qu, Chang‐Qing Zhao, Zhen‐Lin Wang, Hua-bin Li, Feng Liu, Xiao‐Bo Cui, Sheng‐Nan Ye, Zheng Liu, Yu Xu, Xiao Cai, Wei Huang, Ru‐Xin Zhang, Yu-lin Zhao, Guo‐Dong Yu, Guang‐Gang Shi, M. Lu, Yang Shen, Yu‐Tong Zhao, Jiamin Pei, S. Xie, Longgang Yu, Ye-hai Liu, Shao‐Wei Gu, Yucheng Yang, Lei Cheng, Jian‐Feng liu
This cross‐sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID‐19 in mainland China.This study was conducted by 45 tertiary Grade‐A hospitals in mainland China. Online and offline questionnaire data were obtained from patients infected with COVID‐19 between December 28, 2022, and February 21, 2023. The collected information included basic demographics, medical history, smoking and drinking history, vaccination history, changes in olfactory and gustatory functions before and after infection, and other postinfection symptoms, as well as the duration and improvement status of olfactory and gustatory disorders.Complete questionnaires were obtained from 35,566 subjects. The overall incidence of olfactory and taste dysfunction was 67.75%. Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction. Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction. Before infection, the average olfactory and taste VAS scores were 8.41 and 8.51, respectively; after infection, they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey. The median duration of dysosmia and dysgeusia was 15 and 12 days, respectively, with 0.5% of patients having symptoms lasting for more than 28 days. The overall self‐reported improvement rate was 59.16%. Recovery was higher in males, never smokers, those who received two or three vaccine doses, and those that had never experienced dental health issues, or chronic accompanying symptoms.The incidence of dysosmia and dysgeusia following infection with the SARS‐CoV‐2 virus is high in mainland China. Incidence and prognosis are influenced by several factors, including sex, SARS‐CoV‐2 vaccination, history of head‐facial trauma, nasal and oral health status, smoking and drinking history, and the persistence of accompanying symptoms.
{"title":"Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS‐CoV‐2 Omicron strain infection in mainland China: A national multicenter survey of 35,566 individuals","authors":"Meng‐Fan Liu, Rui‐Xia Ma, Xian‐Bao Cao, Hua Zhang, Shui‐Hong Zhou, Wei‐Hong Jiang, Yan Jiang, Jing‐Wu Sun, Qin‐Tai Yang, Xue‐Zhong Li, Ya‐Nan Sun, Li Shi, Min Wang, Xi‐Cheng Song, Fu‐Quan Chen, Xiao‐Shu Zhang, H. Wei, Shao‐Qing Yu, Dong‐Dong Zhu, L. Ba, Zhi‐Wei Cao, Xu‐Ping Xiao, Xin Wei, Zhi‐Hong Lin, Feng‐Hong Chen, Chun‐Guang Shan, Guang‐Ke Wang, J. Ye, S. Qu, Chang‐Qing Zhao, Zhen‐Lin Wang, Hua-bin Li, Feng Liu, Xiao‐Bo Cui, Sheng‐Nan Ye, Zheng Liu, Yu Xu, Xiao Cai, Wei Huang, Ru‐Xin Zhang, Yu-lin Zhao, Guo‐Dong Yu, Guang‐Gang Shi, M. Lu, Yang Shen, Yu‐Tong Zhao, Jiamin Pei, S. Xie, Longgang Yu, Ye-hai Liu, Shao‐Wei Gu, Yucheng Yang, Lei Cheng, Jian‐Feng liu","doi":"10.1002/wjo2.167","DOIUrl":"https://doi.org/10.1002/wjo2.167","url":null,"abstract":"This cross‐sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID‐19 in mainland China.This study was conducted by 45 tertiary Grade‐A hospitals in mainland China. Online and offline questionnaire data were obtained from patients infected with COVID‐19 between December 28, 2022, and February 21, 2023. The collected information included basic demographics, medical history, smoking and drinking history, vaccination history, changes in olfactory and gustatory functions before and after infection, and other postinfection symptoms, as well as the duration and improvement status of olfactory and gustatory disorders.Complete questionnaires were obtained from 35,566 subjects. The overall incidence of olfactory and taste dysfunction was 67.75%. Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction. Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction. Before infection, the average olfactory and taste VAS scores were 8.41 and 8.51, respectively; after infection, they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey. The median duration of dysosmia and dysgeusia was 15 and 12 days, respectively, with 0.5% of patients having symptoms lasting for more than 28 days. The overall self‐reported improvement rate was 59.16%. Recovery was higher in males, never smokers, those who received two or three vaccine doses, and those that had never experienced dental health issues, or chronic accompanying symptoms.The incidence of dysosmia and dysgeusia following infection with the SARS‐CoV‐2 virus is high in mainland China. Incidence and prognosis are influenced by several factors, including sex, SARS‐CoV‐2 vaccination, history of head‐facial trauma, nasal and oral health status, smoking and drinking history, and the persistence of accompanying symptoms.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"75 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mihai A. Bentan, E. Reiter, R. Costanzo, Daniel H. Coelho
The aim of this study was to review findings from a large prospective national database of chemosensory disturbances associated with coronavirus disease 2019 (COVID‐19) infection.The Virginia Commonwealth University Smell and Taste Center national database of COVID‐19 chemosensory disturbances.A series of online surveys, first opened on April 10, 2020, was made accessible nationwide to any adult with sudden chemosensory dysfunction since January 2020. Participants received subsequent follow‐up surveys 14 days, 1 month, 3 months, and 6 months after enrollment. An additional survey was sent to all participants on May 28, 2022 to assess long‐term outcomes. Information pertaining to demographics, symptoms, comorbidities, treatments, and life impact was collected.Of 363 participants who reported complete smell recovery, 51.2% recovered within 1 month, 70% within 3 months, and 79% within 6 months, while 8.8% took over 1 year to completely recover. Among all participants, 7.5% had no smell recovery. Positive predictors of recovery included age <40, male gender, and the presence of nasal congestion. Negative predictors included difficulty breathing and prior head injury. Many participants reported a decrease in quality of life and the presence of potential safety hazards associated with decreased smell loss.Most subjects with COVID‐19‐related chemosensory dysfunction recover, with the majority noting complete recovery within weeks of infection. Those aged over 40 years and female gender were associated with lower rates of recovery. A considerable number of participants reported significant impact on quality of life and safety.
{"title":"COVID‐19‐related chemosensory changes: Findings from a prospective national database","authors":"Mihai A. Bentan, E. Reiter, R. Costanzo, Daniel H. Coelho","doi":"10.1002/wjo2.164","DOIUrl":"https://doi.org/10.1002/wjo2.164","url":null,"abstract":"The aim of this study was to review findings from a large prospective national database of chemosensory disturbances associated with coronavirus disease 2019 (COVID‐19) infection.The Virginia Commonwealth University Smell and Taste Center national database of COVID‐19 chemosensory disturbances.A series of online surveys, first opened on April 10, 2020, was made accessible nationwide to any adult with sudden chemosensory dysfunction since January 2020. Participants received subsequent follow‐up surveys 14 days, 1 month, 3 months, and 6 months after enrollment. An additional survey was sent to all participants on May 28, 2022 to assess long‐term outcomes. Information pertaining to demographics, symptoms, comorbidities, treatments, and life impact was collected.Of 363 participants who reported complete smell recovery, 51.2% recovered within 1 month, 70% within 3 months, and 79% within 6 months, while 8.8% took over 1 year to completely recover. Among all participants, 7.5% had no smell recovery. Positive predictors of recovery included age <40, male gender, and the presence of nasal congestion. Negative predictors included difficulty breathing and prior head injury. Many participants reported a decrease in quality of life and the presence of potential safety hazards associated with decreased smell loss.Most subjects with COVID‐19‐related chemosensory dysfunction recover, with the majority noting complete recovery within weeks of infection. Those aged over 40 years and female gender were associated with lower rates of recovery. A considerable number of participants reported significant impact on quality of life and safety.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"105 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Dalfino, Andrea Ronchi, Giorgio Sileo, Luca Volpi, M. Bignami
Endoscopic resection with transnasal craniectomy (ERTC) and skull‐base reconstruction (SBR) are effective techniques for sinonasal/skull‐base malignancies treatment. Endoscopic endonasal SBR techniques are mainly based on homologue‐free grafts with excellent outcomes, but alternative techniques can be used such as regional vascularized pedicled flaps or local pedicled flap‐like Hadad–Bassagasteguy nasoseptal flap and the septal flip flap (SFF). The purpose of this article is to describe an inferiorly based septal flap aimed to promote mucosal healing and improve patients’ quality of life. We reported a clinical case of 51‐year‐old female affected by olfactory neuroblastoma, Hyams‐Ⅱ, Kadish‐INSICA‐B treated with unilateral ERTC and SBR with fascia lata, SFF, and modified reverse septal flap (mRSF). The mRSF harvesting is described in detail, to obtain a lower hinged flap with random vascularization, which can be rotated to cover the exposed bone of the nasal cavity floor. Endoscopic evaluations immediately showed rapid healing with a minimal amount of nasal crusting, despite the adjuvant treatment and the short time since the surgery. This surgical technique is a simple and viable way to boost nasal healing after endoscopic endonasal surgery and for nasal floor resurfacing after septal removal following a unilateral ERTC.
{"title":"Modified reverse septal flap: A surgical hint","authors":"G. Dalfino, Andrea Ronchi, Giorgio Sileo, Luca Volpi, M. Bignami","doi":"10.1002/wjo2.173","DOIUrl":"https://doi.org/10.1002/wjo2.173","url":null,"abstract":"Endoscopic resection with transnasal craniectomy (ERTC) and skull‐base reconstruction (SBR) are effective techniques for sinonasal/skull‐base malignancies treatment. Endoscopic endonasal SBR techniques are mainly based on homologue‐free grafts with excellent outcomes, but alternative techniques can be used such as regional vascularized pedicled flaps or local pedicled flap‐like Hadad–Bassagasteguy nasoseptal flap and the septal flip flap (SFF). The purpose of this article is to describe an inferiorly based septal flap aimed to promote mucosal healing and improve patients’ quality of life. We reported a clinical case of 51‐year‐old female affected by olfactory neuroblastoma, Hyams‐Ⅱ, Kadish‐INSICA‐B treated with unilateral ERTC and SBR with fascia lata, SFF, and modified reverse septal flap (mRSF). The mRSF harvesting is described in detail, to obtain a lower hinged flap with random vascularization, which can be rotated to cover the exposed bone of the nasal cavity floor. Endoscopic evaluations immediately showed rapid healing with a minimal amount of nasal crusting, despite the adjuvant treatment and the short time since the surgery. This surgical technique is a simple and viable way to boost nasal healing after endoscopic endonasal surgery and for nasal floor resurfacing after septal removal following a unilateral ERTC.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"123 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Barrette, William G. Cohen, Tiffany Chao, Jennifer E. Douglas, James Kearney, Erica Thaler, Michael A. Kohanski, N. Adappa, James N. Palmer, K. Rajasekaran
Enhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.A search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.Studies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.Strong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.A comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.
内窥镜鼻窦手术（ESS）的术后强化恢复（ERAS）方案尚未广泛实施，对ERAS建议的批判性回顾和对支持性文献的全面分析也尚未开展。我们介绍了一种ESS ERAS方案，包括对接受ESS手术的患者进行关键的围手术期干预，并对现有证据进行了评估。我们使用Medline（通过PubMed）和Scopus检索了耳鼻喉科、麻醉科和外科领域所有相关的ERAS文献。关键词包括每个干预领域的 "内窥镜鼻窦手术"、"鼻窦手术"、"FESS "和 "ESS"。根据牛津循证医学中心（Oxford Centre for Evidence-Based Medicine）的标准，这些研究的证据质量分为 "低"、"中 "或 "高 "三个等级。根据现有证据，每项干预措施被分为 "强"、"弱 "或 "有条件 "三个等级。"强 "建议包括全面的患者教育和咨询、尽量减少术前禁食、使用局部/局部麻醉剂和血管收缩剂、使用全静脉麻醉、避免咽部包装以及术后鼻腔冲洗和多模式镇痛。有条件的建议包括抗生素预防。针对ESS的综合ERAS方案可包括各种高收益、循证干预措施，这些措施可能会改善手术效果和患者满意度。
{"title":"Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care","authors":"L. Barrette, William G. Cohen, Tiffany Chao, Jennifer E. Douglas, James Kearney, Erica Thaler, Michael A. Kohanski, N. Adappa, James N. Palmer, K. Rajasekaran","doi":"10.1002/wjo2.166","DOIUrl":"https://doi.org/10.1002/wjo2.166","url":null,"abstract":"Enhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.A search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.Studies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.Strong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.A comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":" 53","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140221223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Kim, John B. Finlay, Tiffany Ko, Bradley J. Goldstein
An acute loss of smell emerged as a striking symptom present in roughly half of the people infected with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus in the early phases of the COVID‐19 pandemic. In most COVID‐19 patients, olfaction recovers over the course of a few weeks. However, a lasting partial or complete loss of smell, often associated with distorted olfactory perceptions termed parosmia, has emerged as a widespread problem impacting at least 5%–10% of those who experience anosmia due to COVID‐19. Our inability to offer effective therapies to this hyposmic or anosmic population, comprising millions of patients, highlights an enormous unmet need for the medical system. Here, we summarize the current understanding of the pathobiology causing acute olfactory loss due to SARS‐CoV‐2 infection, focusing on how the virus interacts with the peripheral olfactory system, a major site of viral infection. We also explore the problem of long‐COVID olfactory dysfunction, which may accompany other persistent systemic disorders collectively termed postacute sequelae of COVID‐19. Specifically, we discuss an emerging model focused on unresolved immune cell activity driving ongoing dysfunction. Finally, we review current and future therapeutic approaches aimed at restoring olfactory function.
{"title":"Long‐term olfactory loss post‐COVID‐19: Pathobiology and potential therapeutic strategies","authors":"Sarah Kim, John B. Finlay, Tiffany Ko, Bradley J. Goldstein","doi":"10.1002/wjo2.165","DOIUrl":"https://doi.org/10.1002/wjo2.165","url":null,"abstract":"An acute loss of smell emerged as a striking symptom present in roughly half of the people infected with the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus in the early phases of the COVID‐19 pandemic. In most COVID‐19 patients, olfaction recovers over the course of a few weeks. However, a lasting partial or complete loss of smell, often associated with distorted olfactory perceptions termed parosmia, has emerged as a widespread problem impacting at least 5%–10% of those who experience anosmia due to COVID‐19. Our inability to offer effective therapies to this hyposmic or anosmic population, comprising millions of patients, highlights an enormous unmet need for the medical system. Here, we summarize the current understanding of the pathobiology causing acute olfactory loss due to SARS‐CoV‐2 infection, focusing on how the virus interacts with the peripheral olfactory system, a major site of viral infection. We also explore the problem of long‐COVID olfactory dysfunction, which may accompany other persistent systemic disorders collectively termed postacute sequelae of COVID‐19. Specifically, we discuss an emerging model focused on unresolved immune cell activity driving ongoing dysfunction. Finally, we review current and future therapeutic approaches aimed at restoring olfactory function.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140223177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. C. Pang, Lauren Michelle, K. Roman, A. Abiri, Theodore V. Nguyen, B. Bitner, F. P. Hsu, E. C. Kuan
Hospital‐acquired catheter‐associated urinary tract infections (UTIs) have been regarded as preventable adverse events, yet their risk in endoscopic skull base surgery (ESBS) has not been well described despite common use. We determine the incidence of UTI following ESBS and identify contributing clinical factors.Retrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program. Postoperative UTI comprised the primary outcome. Independent variables included patient demographics, use and length of urinary catheterization, and pre‐existing genitourinary conditions.Nosocomial UTIs were identified in 1.3% (3/229) of patients, occurring on postoperative days 2, 9, and 14, respectively; all were catheter‐associated. Overall, 86.0% (197/229) of patients received urinary catheters (mean duration 2.2 ± 1.8 days). Compared to those without, patients with UTI were older (70.0 ± 15.4 vs. 52.2 ± 16.8 years, p = 0.034), had lengthier stays (94.7 ± 126.8 vs. 5.9 ± 8.4 days, p < 0.001), and had prolonged catheterizations (9.3 ± 5.5 vs. 2.1 ± 1.5 days, p < 0.001). Preoperative genitourinary conditions were also associated with UTI development, namely, chronic urinary retention/obstruction (66.7% vs. 4.0%, p = 0.006), urinary incontinence (66.7% vs. 6.2%, p = 0.013), prostate disease (100.0% vs. 17.8%, p = 0.035), and renal dysfunction (100.0% vs. 9.7%, p = 0.001). Among intraoperative cerebrospinal fluid leak patients, postoperative CSF leak incidence was not associated with catheter use versus nonuse (3.3% vs. 12.5%, p = 0.276).Although UTIs are uncommon in ESBS patients, advanced age, length of stay, duration of indwelling urinary catheterization, and comorbid genitourinary conditions may elevate risk.
医院获得性导管相关性尿路感染（UTI）一直被认为是可预防的不良事件，然而，尽管内窥镜颅底手术（ESBS）被广泛使用，但其风险却没有得到很好的描述。我们对 2018 年 7 月至 2022 年 6 月期间在一家三级学术性颅底外科项目中接受内窥镜颅底手术治疗任何颅底病变的 229 例连续成年患者进行了回顾性回顾。术后UTI是主要结果。自变量包括患者人口统计学特征、导尿管使用情况和使用时间以及术前存在的泌尿生殖系统疾病。1.3%（3/229）的患者发现术后UTI，分别发生在术后第2天、第9天和第14天；所有UTI均与导尿管相关。总体而言，86.0%（197/229）的患者使用了导尿管（平均持续时间为 2.2 ± 1.8 天）。与无尿道炎患者相比，尿道炎患者年龄更大（70.0 ± 15.4 岁 vs 52.2 ± 16.8 岁，p = 0.034），住院时间更长（94.7 ± 126.8 天 vs 5.9 ± 8.4 天，p < 0.001），导尿时间更长（9.3 ± 5.5 天 vs 2.1 ± 1.5 天，p < 0.001）。术前泌尿生殖系统疾病也与UTI的发生有关，即慢性尿潴留/梗阻（66.7% vs. 4.0%，p = 0.006）、尿失禁（66.7% vs. 6.2%，p = 0.013）、前列腺疾病（100.0% vs. 17.8%，p = 0.035）和肾功能障碍（100.0% vs. 9.7%，p = 0.001）。虽然UTI在ESBS患者中并不常见，但高龄、住院时间长、留置导尿时间长以及合并泌尿生殖系统疾病可能会增加风险。
{"title":"Short‐term urinary catheter usage in endoscopic skull base surgery and impact on urinary tract infection and reconstructive outcomes","authors":"J. C. Pang, Lauren Michelle, K. Roman, A. Abiri, Theodore V. Nguyen, B. Bitner, F. P. Hsu, E. C. Kuan","doi":"10.1002/wjo2.172","DOIUrl":"https://doi.org/10.1002/wjo2.172","url":null,"abstract":"Hospital‐acquired catheter‐associated urinary tract infections (UTIs) have been regarded as preventable adverse events, yet their risk in endoscopic skull base surgery (ESBS) has not been well described despite common use. We determine the incidence of UTI following ESBS and identify contributing clinical factors.Retrospective review was conducted for a cohort of 229 consecutive adult patients who underwent endoscopic endonasal surgery for treatment of any skull base pathology between July 2018 and June 2022 at a tertiary academic skull base surgery program. Postoperative UTI comprised the primary outcome. Independent variables included patient demographics, use and length of urinary catheterization, and pre‐existing genitourinary conditions.Nosocomial UTIs were identified in 1.3% (3/229) of patients, occurring on postoperative days 2, 9, and 14, respectively; all were catheter‐associated. Overall, 86.0% (197/229) of patients received urinary catheters (mean duration 2.2 ± 1.8 days). Compared to those without, patients with UTI were older (70.0 ± 15.4 vs. 52.2 ± 16.8 years, p = 0.034), had lengthier stays (94.7 ± 126.8 vs. 5.9 ± 8.4 days, p < 0.001), and had prolonged catheterizations (9.3 ± 5.5 vs. 2.1 ± 1.5 days, p < 0.001). Preoperative genitourinary conditions were also associated with UTI development, namely, chronic urinary retention/obstruction (66.7% vs. 4.0%, p = 0.006), urinary incontinence (66.7% vs. 6.2%, p = 0.013), prostate disease (100.0% vs. 17.8%, p = 0.035), and renal dysfunction (100.0% vs. 9.7%, p = 0.001). Among intraoperative cerebrospinal fluid leak patients, postoperative CSF leak incidence was not associated with catheter use versus nonuse (3.3% vs. 12.5%, p = 0.276).Although UTIs are uncommon in ESBS patients, advanced age, length of stay, duration of indwelling urinary catheterization, and comorbid genitourinary conditions may elevate risk.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140222480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Iftikhar, Ammaar M. A. Abbasi, K. Mustafa, Jai K. Das, Amin R. Javer
This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation.Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow‐up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48–1.25). Similarly, no difference was seen at either 8–12 weeks of follow‐up, with an RR of 0.68 (95% CI: 0.42–1.20). Nasal congestion was reported to be less on the packed side on the follow‐up in one of the trials.Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long‐term sequelae.
{"title":"Efficacy of nonmedicated middle meatal packing after endoscopic sinus surgery: A systematic review","authors":"H. Iftikhar, Ammaar M. A. Abbasi, K. Mustafa, Jai K. Das, Amin R. Javer","doi":"10.1002/wjo2.148","DOIUrl":"https://doi.org/10.1002/wjo2.148","url":null,"abstract":"This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A literature search was performed on Medline (PubMed), EBSCO CINAHL plus, CENTRAL, and Clinicaltrials.org and included randomized controlled trials in the English language only. We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool (version 2). We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment, Development and Evaluation.Our search identified 390 articles of which four met our eligibility criteria. A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils. At 4 weeks of follow‐up, there was no difference in the risk of synechia formation on either the packed side or the unpacked side, with a relative risk (RR) of 0.77 (95% confidence interval [CI]: 0.48–1.25). Similarly, no difference was seen at either 8–12 weeks of follow‐up, with an RR of 0.68 (95% CI: 0.42–1.20). Nasal congestion was reported to be less on the packed side on the follow‐up in one of the trials.Our systematic review, with limited evidence, indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS. Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long‐term sequelae.","PeriodicalId":510563,"journal":{"name":"World Journal of Otorhinolaryngology - Head and Neck Surgery","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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