S. Mahalingam, R. Green, M. Slim, A. Alatsatianos, Y. Ramakrishnan, B. Stew, C. Hopkins
Background: As elective services resumed in the aftermath of the first wave of the SARS-CoV-2 pandemic, the British Rhinology Society and Juniors Committees carried out a national prospective study in order to assess and optimise safety and efficacy of surgery. Methodology: Data from 1063 cases was collected from 111 centres in the United Kingdom (excluding Northern Ireland) within the study period (1st June – 14th August 2020), and a three week follow-up period to assess whether there were any cases of SARS-CoV-2 amongst patients and staff. Results: 89.2% of procedures took place in England. 90.6% of patients had minimal comorbidities (ASA Grade 1 or 2). 98.4% of patients were known to have a COVID negative status prior to surgery, with the majority (99.8%) investigated through Viral PCR alone. The most common form of pre-operative shielding was to self-isolate for 14 days (82.5% of cases). 32.6% of cases were performed in an alternative theatre environment, and in 5.3% the private sector was used for NHS patients. In 21.6% of procedures, unfamiliar anaesthetic teams were used, and in 19.2% unfamiliar theatre teams. There was a higher probability of unfamiliar theatre staff or anaesthetist, when operating in an alternative theatre environment. Trainees were not present in theatre in 24.2% of cases. Full PPE (Personal Protective Equipment) was worn by the operating surgeon in 64.1% of cases. No patients or staff were reported to have developed SARS-CoV-2 in the three week period following surgery. Intra-operative challenges were reported in 19.7% of cases and were primarily associated with impaired communication (8.8%) or impaired vision (6.9%). There was a higher chance of challenges reported when unfamiliar theatre teams were present. Conclusions: This data suggests that overall, the resumption of rhinological elective services has been performed safely with no cases of SARS-CoV-2 reported in patients or staff. We must consider the challenges of operating in unfamiliar environments together with surgical and/or anaesthetic teams, as well as the impact on training.
{"title":"The British Rhinology Society National COVID-19 Study: Resuming Elective Surgery","authors":"S. Mahalingam, R. Green, M. Slim, A. Alatsatianos, Y. Ramakrishnan, B. Stew, C. Hopkins","doi":"10.4193/RHINOL/21.004","DOIUrl":"https://doi.org/10.4193/RHINOL/21.004","url":null,"abstract":"Background: As elective services resumed in the aftermath of the first wave of the SARS-CoV-2 pandemic, the British Rhinology Society and Juniors Committees carried out a national prospective study in order to assess and optimise safety and efficacy of surgery. Methodology: Data from 1063 cases was collected from 111 centres in the United Kingdom (excluding Northern Ireland) within the study period (1st June – 14th August 2020), and a three week follow-up period to assess whether there were any cases of SARS-CoV-2 amongst patients and staff. Results: 89.2% of procedures took place in England. 90.6% of patients had minimal comorbidities (ASA Grade 1 or 2). 98.4% of patients were known to have a COVID negative status prior to surgery, with the majority (99.8%) investigated through Viral PCR alone. The most common form of pre-operative shielding was to self-isolate for 14 days (82.5% of cases). 32.6% of cases were performed in an alternative theatre environment, and in 5.3% the private sector was used for NHS patients. In 21.6% of procedures, unfamiliar anaesthetic teams were used, and in 19.2% unfamiliar theatre teams. There was a higher probability of unfamiliar theatre staff or anaesthetist, when operating in an alternative theatre environment. Trainees were not present in theatre in 24.2% of cases. Full PPE (Personal Protective Equipment) was worn by the operating surgeon in 64.1% of cases. No patients or staff were reported to have developed SARS-CoV-2 in the three week period following surgery. Intra-operative challenges were reported in 19.7% of cases and were primarily associated with impaired communication (8.8%) or impaired vision (6.9%). There was a higher chance of challenges reported when unfamiliar theatre teams were present. Conclusions: This data suggests that overall, the resumption of rhinological elective services has been performed safely with no cases of SARS-CoV-2 reported in patients or staff. We must consider the challenges of operating in unfamiliar environments together with surgical and/or anaesthetic teams, as well as the impact on training.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42823274","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}
A. Andrianakis, P. Kiss, U. Moser, A. Wolf, C. Holzmeister, A. Koutp, P. Grechenig, U. Pilsl, P. Tomazic
Background: The objectives of this study were to evaluate the frequency of bony dehiscences in the optico-carotid recess (OCR) area and to measure the thickness of the bony lamellas bordering the OCR, according to our previously proposed OCR classification taking into account the extent of the recess. Methodology: A total of 100 human cadaver heads (n= 200 sphenoid sinuses) were investigated. Samples were divided into groups according to the presence and extent of OCR (no OCR, sub-optical OCR, latero-optical OCR). Bony dehiscences were visually identified and bone thickness was measured by using a high-resolution micrometer. Results: A bony dehiscence in the OCR area was observed in 20%. A significant difference in bony dehiscence occurrence rate between OCR types was found. The wall thickness of the bony carotid artery- and optic nerve canals bordering the OCR were 0.25 ± 0.16 mm and 0.27 ± 0.15 mm, respectively. Significant differences between OCR groups in bony wall thickness of the carotid artery canal and optic nerve canal were found. Samples with a latero-optical OCR had a significant thinner wall of the carotid artery and optic nerve canal than samples with a sub-optical OCR and no OCR. Conclusions: The current results indicate that the presence of an extended OCR, e.g. latero-optical, is highly associated with a greater risk of bony dehiscences and thinner bony lamellas in the OCR region.
{"title":"Extent of optico-carotid recess is significantly associated with presence of bony dehiscences and bone thickness in the optico-carotid area","authors":"A. Andrianakis, P. Kiss, U. Moser, A. Wolf, C. Holzmeister, A. Koutp, P. Grechenig, U. Pilsl, P. Tomazic","doi":"10.4193/rhinol/21.014","DOIUrl":"https://doi.org/10.4193/rhinol/21.014","url":null,"abstract":"Background: The objectives of this study were to evaluate the frequency of bony dehiscences in the optico-carotid recess (OCR) area and to measure the thickness of the bony lamellas bordering the OCR, according to our previously proposed OCR classification taking into account the extent of the recess. Methodology: A total of 100 human cadaver heads (n= 200 sphenoid sinuses) were investigated. Samples were divided into groups according to the presence and extent of OCR (no OCR, sub-optical OCR, latero-optical OCR). Bony dehiscences were visually identified and bone thickness was measured by using a high-resolution micrometer. Results: A bony dehiscence in the OCR area was observed in 20%. A significant difference in bony dehiscence occurrence rate between OCR types was found. The wall thickness of the bony carotid artery- and optic nerve canals bordering the OCR were 0.25 ± 0.16 mm and 0.27 ± 0.15 mm, respectively. Significant differences between OCR groups in bony wall thickness of the carotid artery canal and optic nerve canal were found. Samples with a latero-optical OCR had a significant thinner wall of the carotid artery and optic nerve canal than samples with a sub-optical OCR and no OCR. Conclusions: The current results indicate that the presence of an extended OCR, e.g. latero-optical, is highly associated with a greater risk of bony dehiscences and thinner bony lamellas in the OCR region.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44205517","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}
BACKGROUND: Previous studies report environmental aerosolization with various endonasal procedures, but do not specifically measure intranasal levels of inhaled aerosolized particles in healthcare providers (HCP) performing such procedures. The purpose of this study is to measure the impact of various types of personal protective equipment (PPE) worn by HCP during a variety of office-based endonasal procedures. METHODOLOGY: Simulated sneeze and office-based procedures were performed in a test model and aerosol levels were quanti- fied in the middle meatus of a simulated HCP model wearing various forms of PPE by using a laser diode-based particle counter. Endoscopic exam, balloon sinus dilation, suction and irrigation, simulated tissue resection with a microdebrider, and routine debridement procedures were evaluated. The aerosol levels were evaluated with and without the use of PPE to assess HCP aerosol exposure. RESULTS: A simulated sneeze represents a worst-case aerosol generating event when compared to other common office-based procedures (approximately 1,000 times greater than baseline particle count). Common endoscopic procedures did not generate significantly greater particle counts above baseline. When compared to no mask, a surgical mask reduces particle counts experi- enced by HCP in the middle meatus by 69%, while an N95 mask significantly reduced particles by 93%. CONCLUSIONS: The levels of aerosols generated during common office-based procedures are consistent with the background aerosol levels measured at baseline. Masks are effective, with the N95 mask most effective at reducing HCP exposure to aerosols generated during a simulated sneeze.
{"title":"Modelling effectiveness of PPE on aerosol exposure for healthcare workers during typical ENT procedures","authors":"B. Senior, R. Schlosser, P. Lesch","doi":"10.4193/RHINOL/20.072","DOIUrl":"https://doi.org/10.4193/RHINOL/20.072","url":null,"abstract":"BACKGROUND: Previous studies report environmental aerosolization with various endonasal procedures, but do not specifically measure intranasal levels of inhaled aerosolized particles in healthcare providers (HCP) performing such procedures. The purpose of this study is to measure the impact of various types of personal protective equipment (PPE) worn by HCP during a variety of office-based endonasal procedures. METHODOLOGY: Simulated sneeze and office-based procedures were performed in a test model and aerosol levels were quanti- fied in the middle meatus of a simulated HCP model wearing various forms of PPE by using a laser diode-based particle counter. Endoscopic exam, balloon sinus dilation, suction and irrigation, simulated tissue resection with a microdebrider, and routine debridement procedures were evaluated. The aerosol levels were evaluated with and without the use of PPE to assess HCP aerosol exposure. RESULTS: A simulated sneeze represents a worst-case aerosol generating event when compared to other common office-based procedures (approximately 1,000 times greater than baseline particle count). Common endoscopic procedures did not generate significantly greater particle counts above baseline. When compared to no mask, a surgical mask reduces particle counts experi- enced by HCP in the middle meatus by 69%, while an N95 mask significantly reduced particles by 93%. CONCLUSIONS: The levels of aerosols generated during common office-based procedures are consistent with the background aerosol levels measured at baseline. Masks are effective, with the N95 mask most effective at reducing HCP exposure to aerosols generated during a simulated sneeze.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48631596","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}
Pub Date : 2021-01-01Epub Date: 2021-08-13DOI: 10.4193/rhinol/21.034
Daniel R Bacon, Princess Onuorah, Alexander Murr, Christopher A Wiesen, Jonathan Oakes, Brian D Thorp, Adam M Zanation, Charles S Ebert, David Wohl, Brent A Senior, Adam J Kimple
Background: Evidence regarding prevalence of COVID-19 related Olfactory dysfunction (OD) among ambulatory patients is highly variable due to heterogeneity in study population and measurement methods. Relatively few studies have longitudinally investigated OD in ambulatory patients with objective methods.
Methods: We performed a longitudinal study to investigate OD among COVID-19 ambulatory patients compared to symptomatic controls who test negative. Out of 81 patients enrolled, 45 COVID-19 positive patients and an age- and sex-matched symptomatic control group completed the BSIT and a questionnaire about smell, taste and nasal symptoms. These were repeated at 1 month for all COVID-19 positive patients, and again at 3 months for those who exhibited persistent OD. Analysis was performed by mixed-effects linear and logistic regression.
Results: 46.7% of COVID-19 patients compared to 3.8% of symptomatic controls exhibited OD at 1-week post diagnosis (p<0.001). At 1 month, 16.7%, (6 of 36), of COVID-19 patients had persistent OD. Mean improvement in BSIT score in COVID-19 patients between 1-week BSIT and 1 month follow-up was 2.0 (95% CI 1.00 - 3.00, p<0.001). OD did not correlate with nasal congestion (r= -0.25, 95% CI, -0.52 to 0.06, p=0.12).
Conclusions: Ambulatory COVID-19 patients exhibited OD significantly more frequently than symptomatic controls. Most patients regained normal olfaction by 1 month. The BSIT is a simple validated and objective test to investigate the prevalence of OD in ambulatory patients. OD did not correlate with nasal congestion which suggests a congestion-independent mechanism of OD.
{"title":"COVID-19 related olfactory dysfunction prevalence and natural history in ambulatory patients.","authors":"Daniel R Bacon, Princess Onuorah, Alexander Murr, Christopher A Wiesen, Jonathan Oakes, Brian D Thorp, Adam M Zanation, Charles S Ebert, David Wohl, Brent A Senior, Adam J Kimple","doi":"10.4193/rhinol/21.034","DOIUrl":"https://doi.org/10.4193/rhinol/21.034","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding prevalence of COVID-19 related Olfactory dysfunction (OD) among ambulatory patients is highly variable due to heterogeneity in study population and measurement methods. Relatively few studies have longitudinally investigated OD in ambulatory patients with objective methods.</p><p><strong>Methods: </strong>We performed a longitudinal study to investigate OD among COVID-19 ambulatory patients compared to symptomatic controls who test negative. Out of 81 patients enrolled, 45 COVID-19 positive patients and an age- and sex-matched symptomatic control group completed the BSIT and a questionnaire about smell, taste and nasal symptoms. These were repeated at 1 month for all COVID-19 positive patients, and again at 3 months for those who exhibited persistent OD. Analysis was performed by mixed-effects linear and logistic regression.</p><p><strong>Results: </strong>46.7% of COVID-19 patients compared to 3.8% of symptomatic controls exhibited OD at 1-week post diagnosis (p<0.001). At 1 month, 16.7%, (6 of 36), of COVID-19 patients had persistent OD. Mean improvement in BSIT score in COVID-19 patients between 1-week BSIT and 1 month follow-up was 2.0 (95% CI 1.00 - 3.00, p<0.001). OD did not correlate with nasal congestion (r= -0.25, 95% CI, -0.52 to 0.06, p=0.12).</p><p><strong>Conclusions: </strong>Ambulatory COVID-19 patients exhibited OD significantly more frequently than symptomatic controls. Most patients regained normal olfaction by 1 month. The BSIT is a simple validated and objective test to investigate the prevalence of OD in ambulatory patients. OD did not correlate with nasal congestion which suggests a congestion-independent mechanism of OD.</p>","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"4 4","pages":"131-139"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415759/pdf/nihms-1732007.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39387182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Debry, L. Fath, Laura Nakhleh, G. Trau, I. Djennaoui, Pierre Mahaudeau, N. Bawazeer, P. Pâris, Sait Ciftci
Objective: To assess safety and efficacy of an asymmetrical balloon in the treatment of epistaxis in adult patients (≥18 years) managed in an emergency setting. Methodology: Pilot, open label, monocenter, prospective, interventional non comparative study in adult patients. The patients were hospitalized for 48h, timepoint at which the device was removed. Primary endpoints were the assessment of bleeding arrest and pain score evaluated on a Visual Analogic Scale. Secondary endpoints were the nature and number of adverse events reported and patient quality of life evaluated with the RhinoQoL questionnaire. Results: Ten patients were included, and nine were treated. In Intent to Treat (ITT), bleeding was stopped upon positioning in 9/10 patients. Efficacy was maintained in 8/10 patients during treatment. Pain was moderate at insertion, inflation and during treatment and mild upon and post-removal. Minor bleeding recurrence occurred in two patients during the post-treatment period. The reported adverse events considered device-related were consistent with the ones observed with other intranasal devices. The mean and median RhinoQoL impact scores tend to decrease upon the different control visits. Conclusion: This pilot study provides promising preliminary safety and efficacy data for CAVI-TTM in the management of epistaxis in an emergency setting.
{"title":"Pilot clinical trial of an asymmetrical balloon in the treatment of epistaxis in adult patients","authors":"C. Debry, L. Fath, Laura Nakhleh, G. Trau, I. Djennaoui, Pierre Mahaudeau, N. Bawazeer, P. Pâris, Sait Ciftci","doi":"10.4193/rhinol/20.039","DOIUrl":"https://doi.org/10.4193/rhinol/20.039","url":null,"abstract":"Objective: To assess safety and efficacy of an asymmetrical balloon in the treatment of epistaxis in adult patients (≥18 years) managed in an emergency setting. Methodology: Pilot, open label, monocenter, prospective, interventional non comparative study in adult patients. The patients were hospitalized for 48h, timepoint at which the device was removed. Primary endpoints were the assessment of bleeding arrest and pain score evaluated on a Visual Analogic Scale. Secondary endpoints were the nature and number of adverse events reported and patient quality of life evaluated with the RhinoQoL questionnaire. Results: Ten patients were included, and nine were treated. In Intent to Treat (ITT), bleeding was stopped upon positioning in 9/10 patients. Efficacy was maintained in 8/10 patients during treatment. Pain was moderate at insertion, inflation and during treatment and mild upon and post-removal. Minor bleeding recurrence occurred in two patients during the post-treatment period. The reported adverse events considered device-related were consistent with the ones observed with other intranasal devices. The mean and median RhinoQoL impact scores tend to decrease upon the different control visits. Conclusion: This pilot study provides promising preliminary safety and efficacy data for CAVI-TTM in the management of epistaxis in an emergency setting.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44804496","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}
T. Radulesco, J. Lechien, C. Chiesa-Estomba, L. Sowerby, C. Hopkins, S. Saussez, J. Michel
{"title":"Copper enhanced nasal saline irrigations: a safe potential treatment and protective factor for COVID-19 infection?","authors":"T. Radulesco, J. Lechien, C. Chiesa-Estomba, L. Sowerby, C. Hopkins, S. Saussez, J. Michel","doi":"10.4193/rhinol/20.050","DOIUrl":"https://doi.org/10.4193/rhinol/20.050","url":null,"abstract":"","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46401969","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}
Background: Sinonasal hemangiomas are rare, especially hemangiomas of the sphenoid sinus, for which very few cases have been reported. Observation: We report the case of a 20-year-old patient who had consulted for epistaxis associated with headache. A CT scan of the nose and sinuses revealed a heterogeneous tumor process filling the sphenoid sinus. A minimally invasive endonasal surgery under endoscopic guidance allowed complete removal of the tumor. The histological study of the surgical specimen had revealed capillary hemangioma. After 27 months of decline, no recurrence was noted. Conclusion: Capillary hemangioma is very rare in its sphenoidal location. Endonasal endoscopic excision allows optimal control, after a good pre-operative evaluation.
{"title":"Capillary hemangioma of the sphenoid sinus excision through the endonasal endoscopic approach","authors":"H. Younes, A. Tall, M. Diouf, Fabrice Senghor","doi":"10.4193/rhin20.038","DOIUrl":"https://doi.org/10.4193/rhin20.038","url":null,"abstract":"Background: Sinonasal hemangiomas are rare, especially hemangiomas of the sphenoid sinus, for which very few cases have been reported. Observation: We report the case of a 20-year-old patient who had consulted for epistaxis associated with headache. A CT scan of the nose and sinuses revealed a heterogeneous tumor process filling the sphenoid sinus. A minimally invasive endonasal surgery under endoscopic guidance allowed complete removal of the tumor. The histological study of the surgical specimen had revealed capillary hemangioma. After 27 months of decline, no recurrence was noted. Conclusion: Capillary hemangioma is very rare in its sphenoidal location. Endonasal endoscopic excision allows optimal control, after a good pre-operative evaluation.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44019432","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}
Background: In prior phase 3, randomized, placebo-controlled trials, fluticasone propionate exhalation delivery system (EDS-FLU) over 24 weeks showed significant reduction in total polyp score compared with EDS-placebo. The goal of this study was to observe nasal endoscopy improvement(s) along with patient-reported symptoms associated with EDS-FLU administration over 24 weeks. Methods: This open-label, multicenter study enrolled adults with bilateral nasal polyp grade of ≥3 (out of 6), 22-Item Sino-Nasal Outcome Test (SNOT-22) scores ≥20, and previous sinus surgery. All patients received EDS-FLU 186 μg BID for 24 weeks. Nasal endoscopy was performed, and disease-specific quality of life and sense of smell were assessed with SNOT-22 and “Sniffin’ Sticks” at baseline, 3 months, and 6 months. An independent reviewer evaluated videos and performed blinded polyp grading and Lund-Kennedy (LK) assessments. Results: Eleven patients were enrolled. At baseline, mean polyp grade was 3.1/6. SNOT-22 scores were 48.8, and Sniffin’ Sticks measurements were 11.8/48. A clinically meaningful reduction in SNOT-22 was noted at 24 weeks. Olfaction improved by 4.7 points. The mean polyp grade was reduced from 3.1 to 2.4 at week 24. LK edema scores were reduced by 2.2. Conclusion: EDS-FLU 186 μg BID given over 24 weeks resulted in clinically meaningful reduction in SNOT-22 scores and polyp grade improvement in most subjects. Endoscopic documentation showed reduced inflammation and edema not adequately captured with polyp-scoring methodology.
{"title":"VISUALIZE: a 24-week,open-label study using nasal endoscopy video to evaluate the efficacy and safety of EDS-FLU 186 μg twice daily in adults with bilateral nasal polyps","authors":"W. Yao, V. Ramakrishnan, A. Luong, M. Citardi","doi":"10.4193/rhinol/20.008","DOIUrl":"https://doi.org/10.4193/rhinol/20.008","url":null,"abstract":"Background: In prior phase 3, randomized, placebo-controlled trials, fluticasone propionate exhalation delivery system (EDS-FLU) over 24 weeks showed significant reduction in total polyp score compared with EDS-placebo. The goal of this study was to observe nasal endoscopy improvement(s) along with patient-reported symptoms associated with EDS-FLU administration over 24 weeks. Methods: This open-label, multicenter study enrolled adults with bilateral nasal polyp grade of ≥3 (out of 6), 22-Item Sino-Nasal Outcome Test (SNOT-22) scores ≥20, and previous sinus surgery. All patients received EDS-FLU 186 μg BID for 24 weeks. Nasal endoscopy was performed, and disease-specific quality of life and sense of smell were assessed with SNOT-22 and “Sniffin’ Sticks” at baseline, 3 months, and 6 months. An independent reviewer evaluated videos and performed blinded polyp grading and Lund-Kennedy (LK) assessments. Results: Eleven patients were enrolled. At baseline, mean polyp grade was 3.1/6. SNOT-22 scores were 48.8, and Sniffin’ Sticks measurements were 11.8/48. A clinically meaningful reduction in SNOT-22 was noted at 24 weeks. Olfaction improved by 4.7 points. The mean polyp grade was reduced from 3.1 to 2.4 at week 24. LK edema scores were reduced by 2.2. Conclusion: EDS-FLU 186 μg BID given over 24 weeks resulted in clinically meaningful reduction in SNOT-22 scores and polyp grade improvement in most subjects. Endoscopic documentation showed reduced inflammation and edema not adequately captured with polyp-scoring methodology.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49474674","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}
R. Kamel, A. Ragab, H. Abdelghaffar, A. Kaled, A. Elfarouk Abdel Fattah, M. Abdelaziz, B. Hamdy Abdelhak, N. Abdullah, Rashid Al-Abri, M. Alfalasi, S. Alnawaiseh, M. Aloulah, H. Al-reefy, M. Al-Sihan, A. Alzubiadi, M. Baban, K. Bofares, M. N. Dandachli, M. El-Sharnouby, H. Elsherif, T. Ghannoum, A. Ghiţă, M. Ghonim, U. Hadi, M. Hassab, S. Sahtout Jouini, Z. Soliman, M. Youssef
COVID-19’s rapid sweep across the world has caused an extraordinary disruption to the otorhinolaryngology (ORL) profession and its subspecialties including the rhinology section. The present pandemic forced our specialty practitioners to make quick clinical and practice management decisions. Staff safety must receive the highest prioritization along with strategies to provide the highest quality care. The purpose of the present manuscript is to provide a narrative review of the current knowledge and committee practices regarding ORL (including rhinology) professionals' safe practice during COVID-19 pandemic and after reopen process. The present review findings will allow the clinical practitioners to understand the factors involved in reducing the risk of transmission of COVID-19 in the ORL and rhinology settings, personal protective equipment (PPE) for different ORL and rhinology practices and criteria of practice in outpatient clinic (OPC), emergency operations and ORL surgeries. The emerging evidence based on COVID-19 is rapidly changing. Further updates may be needed to this review as new details or evidence emerge. ORL including rhinology doctors should consider the specific conditions of each individual place of work and comply with all applicable legislations.
{"title":"Safe practice guidance: a review for otorhinolaryngologists during COVID-19 pandemic and after reopen process","authors":"R. Kamel, A. Ragab, H. Abdelghaffar, A. Kaled, A. Elfarouk Abdel Fattah, M. Abdelaziz, B. Hamdy Abdelhak, N. Abdullah, Rashid Al-Abri, M. Alfalasi, S. Alnawaiseh, M. Aloulah, H. Al-reefy, M. Al-Sihan, A. Alzubiadi, M. Baban, K. Bofares, M. N. Dandachli, M. El-Sharnouby, H. Elsherif, T. Ghannoum, A. Ghiţă, M. Ghonim, U. Hadi, M. Hassab, S. Sahtout Jouini, Z. Soliman, M. Youssef","doi":"10.4193/rhinol/20.014","DOIUrl":"https://doi.org/10.4193/rhinol/20.014","url":null,"abstract":"COVID-19’s rapid sweep across the world has caused an extraordinary disruption to the otorhinolaryngology (ORL) profession and its subspecialties including the rhinology section. The present pandemic forced our specialty practitioners to make quick clinical and practice management decisions. Staff safety must receive the highest prioritization along with strategies to provide the highest quality care. The purpose of the present manuscript is to provide a narrative review of the current knowledge and committee practices regarding ORL (including rhinology) professionals' safe practice during COVID-19 pandemic and after reopen process. The present review findings will allow the clinical practitioners to understand the factors involved in reducing the risk of transmission of COVID-19 in the ORL and rhinology settings, personal protective equipment (PPE) for different ORL and rhinology practices and criteria of practice in outpatient clinic (OPC), emergency operations and ORL surgeries. The emerging evidence based on COVID-19 is rapidly changing. Further updates may be needed to this review as new details or evidence emerge. ORL including rhinology doctors should consider the specific conditions of each individual place of work and comply with all applicable legislations.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45577831","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}
E. Batista Fontes, A. Wady Debes Felippu, B. Belchior de Oliveira, D. da Silva Rico Junior, F. Cascio, M. Goldchmit, A. Felippu
Background: Medial rectus muscle (MRM) injury is an uncommon complication of endoscopic sinus surgery (ESS). The main objective of this study is to report a systematized surgical technique in the reconstruction of the MRM after EES injury. Case presentation: The present study consists of a retrospective review of three cases of MRM injuries after ESS based on intraoperative observation with clinical and radiologic follow up. Three patients presented with total rupture of MRM after ESS and were surgically treated. To treat the lesion a multidisciplinary team composed by an ENT surgeon and an ophthalmologist used a combined approach that consisted of external and endonasal accesses. Results: All three patients presented with clinical and radiological satisfactory outcomes in their follow-ups with the resolution of the diplopia and strabismus. Discussion: In this series of cases, all ruptured MRMs were successfully retrieved by combined approaches. Early intervention, and identification of both stumps allowed a muscle-to-muscle anastomosis. The technique described provided a satisfactory aesthetic result. Conclusion: Although the present study consists of a small sample supply, we describe a feasible surgical technique in the reconstruction of an MRM total rupture after ESS.
{"title":"Surgical reconstruction technique of medial rectus muscle after endoscopic sinus surgery iatrogenic rupture – report of three cases","authors":"E. Batista Fontes, A. Wady Debes Felippu, B. Belchior de Oliveira, D. da Silva Rico Junior, F. Cascio, M. Goldchmit, A. Felippu","doi":"10.4193/rhinol/20.066","DOIUrl":"https://doi.org/10.4193/rhinol/20.066","url":null,"abstract":"Background: Medial rectus muscle (MRM) injury is an uncommon complication of endoscopic sinus surgery (ESS). The main objective of this study is to report a systematized surgical technique in the reconstruction of the MRM after EES injury. Case presentation: The present study consists of a retrospective review of three cases of MRM injuries after ESS based on intraoperative observation with clinical and radiologic follow up. Three patients presented with total rupture of MRM after ESS and were surgically treated. To treat the lesion a multidisciplinary team composed by an ENT surgeon and an ophthalmologist used a combined approach that consisted of external and endonasal accesses. Results: All three patients presented with clinical and radiological satisfactory outcomes in their follow-ups with the resolution of the diplopia and strabismus. Discussion: In this series of cases, all ruptured MRMs were successfully retrieved by combined approaches. Early intervention, and identification of both stumps allowed a muscle-to-muscle anastomosis. The technique described provided a satisfactory aesthetic result. Conclusion: Although the present study consists of a small sample supply, we describe a feasible surgical technique in the reconstruction of an MRM total rupture after ESS.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46043668","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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