RESUMEN
OBJECTIVE: To describe the utility of sleep nasendoscopy in determining the level of upper airway obstruction compared to microlaryngotracheobronchoscopy. METHODS: A retrospective observational study was conducted at a tertiary level paediatric hospital. Patients clinically diagnosed with upper airway obstruction warranting surgical intervention (i.e. with obstructive sleep apnoea or laryngomalacia) were included. These patients underwent sleep nasendoscopy in the anaesthetic room; microlaryngotracheobronchoscopy was subsequently performed and findings were compared. RESULTS: Twenty-seven patients were included in the study. Sleep nasendoscopy was able to induce stridor or stertor, and to detect obstruction at the level of palate and pharynx, including tongue base collapse, that was not observed with microlaryngotracheobronchoscopy. Only 47 per cent of patients who had prolapse or indrawing of arytenoids on sleep nasendoscopy had similar findings on microlaryngotracheobronchoscopy. However, microlaryngotracheobronchoscopy was better in diagnosing shortened aryepiglottic folds. CONCLUSION: This study demonstrates the utility of sleep nasendoscopy in determining the level and severity of obstruction by mimicking physiological sleep dynamics of the upper airway.
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Broncoscopía/estadística & datos numéricos , Endoscopía/estadística & datos numéricos , Obstrucción Nasal/diagnóstico , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Anestesia/métodos , Anestesia/estadística & datos numéricos , Broncoscopía/métodos , Niño , Diagnóstico Diferencial , Endoscopía/métodos , Femenino , Humanos , Laringoscopía/métodos , Laringoscopía/estadística & datos numéricos , Masculino , Microcirugia/métodos , Microcirugia/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/métodos , Estudios Retrospectivos , Traqueotomía/métodos , Traqueotomía/estadística & datos numéricosRESUMEN
BACKGROUND: Sinusitis complications are potentially lethal conditions that generally require extensive treatment and thus place a significant burden on the health-care system. The purpose of this study was to assess the impact of surgery on hospital utilization associated with treatment of sinusitis complications. METHODS: Retrospective cohort study using a national hospital database. The 2012 to 2013 National Inpatient Sample was queried for adult patients with sinusitis and complications. Patients were grouped based upon the presence or absence of sinus procedures. Patient demographics and health status, hospital characteristics, length of stay (LOS), and charges were determined. RESULTS: Of 1645 patients with sinusitis and associated complications, 232 (14%) underwent sinus procedures. These patients had higher LOS (8.0 ± 7.3 days vs 4.3 ± 5.2 days; P < .001) and charges (US$96 107 ± 108 089 vs US$30 661 ± 47 138; P < .001) than nonprocedure patients. Increased time to procedure in one operation patients (n = 209) of more than 2 days increased total LOS (11.4 ± 9.3 days vs 6.2 ± 5.5 days; P < .001) and charges (US$120 306 ± 112 748 vs US$76 923 ± 81 185; P = .005). Patients with multiple sinus procedures (n = 23) versus one had increased LOS and charges, despite no time difference from admission to first procedure (P = .35). On regression analysis, sinus procedure patients had excess LOS of 0.827 days and charges of US$36 949. CONCLUSION: Although often necessary, sinus procedures lead to increased LOS and charges. As prolonged time to sinus procedure and revision operations also increase charges, shorter trials of medical therapy and earlier surgical intervention may improve outcomes and reduce costs.
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Utilización de Instalaciones y Servicios/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Complicaciones Posoperatorias/terapia , Sinusitis/terapia , Adulto , Bases de Datos Factuales , Utilización de Instalaciones y Servicios/economía , Femenino , Precios de Hospital/estadística & datos numéricos , Hospitalización/economía , Hospitales , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/efectos adversos , Procedimientos Quírurgicos Nasales/economía , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Sinusitis/complicaciones , Sinusitis/economíaRESUMEN
This investigation explored the outcomes of 4 standardized treatments in patients with refractory chronic rhinosinusitis (CRS), despite recent maximal medical therapy (MMT). In a prospective observational study, we compared continued nasal steroids and irrigation (cNSI), repeated MMT (rMMT), pulsed nasal steroid inhalation (PSI), and endoscopic sinus surgery (ESS). Between November 2015 and March 2016, patients with symptomatic CRS despite having received MMT during the year prior to symptom reoccurrence were offered 1 of 4 standardized treatments. Reflecting real-world conditions, patients selected their treatment option following physician counseling. Sino-Nasal Outcome Test-22 (SNOT-22) scores were obtained before treatment, at the end of treatment, and at 2 months and 1 year following treatment. The mean (± standard deviation [SD]) duration since last MMT was 144 (±36 days). Of the 130 patients, 52 selected cNSI, 16 PSI, 19 rMMT, and 43 ESS. Mean SNOT-22 scores before treatment did not significantly differ between treatments (P = .99). Overall, SNOT-22 scores decreased from 38 ± 2 before treatment to 20 ± 2 after 1 year (P < .001), with a higher reduction for patients having CRS with nasal polyps than for those without nasal polyps (35 ± 2 to 15 ± 2 vs 41 ± 3 to 25 ± 4, respectively; both P < .001). Overall, no difference between the 3 medical treatments was observed (all P > .2). Post-treatment scores following ESS (19 ± 2) were significantly lower than for each of the 3 medical treatments (cNSI 26 ± 2, P = .004; PSI 27 ± 3, P = .026; rMMT 28 ± 3, P = .008). At 1 year following ESS, 26 of 31 patients were asymptomatic and did not require additional systemic steroids, compared to 25 of 50 patients following medical treatment (P = .002). The investigated standardized treatments significantly improved SNOT-22 scores in patients with refractory CRS under real-world conditions. Both patients having CRS with and those without nasal polyps showed significant improvement in SNOT-22 scores, although a less profound effect was found among the latter group. Patients who selected ESS were less symptomatic during the first follow-up year than patients who selected medical treatment alone. Patients with refractory CRS did not benefit from an additional course of MMT in comparison to those who were treated only with cNSI.
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Lavado Nasal (Proceso)/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Rinitis/terapia , Sinusitis/terapia , Esteroides/uso terapéutico , Adulto , Anciano , Enfermedad Crónica , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/complicaciones , Pólipos Nasales/terapia , Estudios Prospectivos , Recurrencia , Rinitis/complicaciones , Prueba de Resultado Sino-Nasal , Sinusitis/complicaciones , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Maxillary sinus squamous cell carcinoma (MSSCC) is a relatively rare head and neck cancer with poorly defined prognosis, and the present study aimed to investigate the outcomes for MSSCC according to different treatments. METHODS: Tianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2007 to 2017, and 98 patients with pathologically confirmed MSSCC were enrolled. Retrospective analysis and follow-up were performed for each patient. Multivariate analysis of prognostic factors was performed using Cox's regression model. RESULTS: For all the 98 cases of MSSCC, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 31.0% and 29.3%, respectively. Among 98 patient, 33 patients were treated with systemic treatment (NON-SUR), 19 patients underwent neoadjuvant chemotherapy and/or radiotherapy followed by surgery (CT/RT+SUR), 38 patients received surgery followed by chemotherapy and/or radiotherapy (SUR+RT/CT), and 8 patients were performed surgery alone (SUR).The OS rate for each group was 27.3%, 57.9%, 30.6% and 37.5%, respectively, while the DFS was 21.2%, 36.8%, 31.6% and 25.0%, respectively. The OS rate of CT/RT+SUR was significantly higher than that of NON-SUR and SUR+CT/RT groups (P < 0.05). Multivariate analysis revealed that smoking, low differentiation, and advanced T stage were independent risk factors for OS, while low differentiation and advanced N stage for DFS. CONCLUSIONS: Surgery-based treatment is still the first-line therapeutic strategy for MSSCC. And neoadjuvant chemoradiotherapy followed by surgery is highly recommended for MSSCC patients, especially those with advanced tumors or requesting high quality of life.
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Quimioradioterapia Adyuvante/estadística & datos numéricos , Neoplasias del Seno Maxilar/terapia , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Terapia Neoadyuvante/estadística & datos numéricos , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Seno Maxilar/patología , Seno Maxilar/cirugía , Neoplasias del Seno Maxilar/mortalidad , Neoplasias del Seno Maxilar/patología , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/efectos adversos , Terapia Neoadyuvante/efectos adversos , Estadificación de Neoplasias , Pronóstico , Calidad de Vida , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Adulto JovenRESUMEN
BACKGROUND: Excess opioid use after surgery contributes to opiate misuse and diversion. Understanding opioid prescribing and utilization patterns after sinonasal surgery is critical in designing effective practice protocols. In this study we aim to identify factors associated with variable opioid usage and further delineate optimal prescription patterns for sinonasal surgery. METHODS: All patients undergoing sinonasal surgery within a single health-care system from March 2017 to August 2018 were sent electronic postoperative surveys. Data were collected on the amount of opioid required, pain control, presurgical opiate use, and narcotic disposal. Additional data collected from the electronic medical record included demographics, type of surgery performed, and total amount of opioid prescribed, including refills. RESULTS: Three-hundred sixty four patients were included. A mean number of 25.3 tablets were prescribed per patient, yet the mean taken was just 11.8 tablets. Excess opioids were prescribed 84.9% of the time with a mean excess narcotic in oral morphine equivalents of 152.5. Among patients, 11.8% reported using no opioids, whereas 52.1% used <50% and 36.1% used >50% of their narcotic prescription. Patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery (p > 0.05). The addition of septoplasty and/or turbinoplasty was associated with variation in opioid usage (p < 0.001). A total of 76.1% of patients incorrectly discarded/stored excess opiates. CONCLUSION: Opioids are overprescribed after sinonasal surgery. The amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed. Improved patient education regarding disposal of excess narcotics may help to curtail future opioid diversion.
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Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Almacenaje de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Periodo Perioperatorio , Encuestas y CuestionariosRESUMEN
The aim of the present study was to evaluate the clinical practice patterns in maximal medical therapy (MMT) before endoscopic sinus surgery for chronic rhinosinusitis (CRS) by Chinese otolaryngologists. An anonymous web-based survey of MMT was performed. This survey assessed types of therapies, the frequency of use, duration of use, and demographic data of respondents. A total of 134 (26.8%) questionnaires were completed and returned. The majority (62.69%) of respondents would consider surgery less than 3 months after commencing MMT, 33.58% would wait 3 to 6 months. Intranasal corticosteroid sprays, saline irrigation, oral antibiotics, oral mucolytics, and oral Chinese herbals were the most commonly used therapies and listed as "often (>70%)". Macrolides were most commonly antibiotics prescribed among the clinicians surveyed (51.49%). Intranasal corticosteroid sprays, oral antibiotics, oral mucolytics, nasal saline irrigations, and oral Chinese herbals are most commonly prescribed by the majority of Chinese otolaryngologists as MMT for CRS. Current practice patterns of MMT among Chinese otolaryngologists are not uniformly based on evidence-based guidelines.
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Otorrinolaringólogos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Rinitis/terapia , Sinusitis/terapia , Administración Intranasal , Corticoesteroides/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , China , Enfermedad Crónica , Endoscopía/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Lavado Nasal (Proceso)/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricosAsunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Complicaciones Posoperatorias/inducido químicamente , Adulto , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway. MATERIALS AND METHODS: A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18â¯years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma. RESULTS: 73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer. CONCLUSIONS: Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.
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Vías Clínicas , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Epistaxis/terapia , Otolaringología , Transferencia de Pacientes , Mejoramiento de la Calidad , Cauterización , Vías Clínicas/normas , Femenino , Departamentos de Hospitales , Humanos , Masculino , Procedimientos Quírurgicos Nasales/métodos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Seguridad del Paciente , Estudios Retrospectivos , Tampones QuirúrgicosRESUMEN
OBJECTIVES/HYPOTHESIS: Balloon sinuplasty has become an increasingly popular option for patients undergoing surgical treatment of sinusitis. This study analyzes utilization and growth of these procedures across a large cohort of patients over a 5-year period. STUDY DESIGN: Retrospective data review. METHODS: This was a retrospective review of Medicare utilization and billing data. Utilization and payment values were obtained from Medicare claims data using Centers for Medicare and Medicaid Services datasets. All Medicare claims were analyzed from 2012 to 2016. Data were extracted for balloon sinuplasty and endoscopic sinus surgery claims. Procedure location, total submitted claims, charges, and payments were compared. RESULTS: From 2012 to 2016, the number of balloon procedures increased from 5,603 to 25,640. Traditional endoscopic sinus surgery procedures increased from 15,509 to 18,164. Aggregate Medicare payments to otolaryngologists for endoscopic sinus surgery have remained relatively stable, whereas there has been a 450% increase in total payments to providers of balloon sinuplasty. In 2016, total payments to providers of balloon procedures ($40.5 million) were substantially higher than payments to providers of non-balloon-based endoscopic sinus surgery ($4.7 million). The number of providers performing balloon procedures has increased 277% versus 17% for traditional sinus surgery. CONCLUSIONS: There has been a rapid expansion in the number of sinus procedures in the Medicare population from 2012 to 2016. Office-based balloon procedures account for the overwhelming majority of the increases in procedures and payments. Per procedure and aggregate payments are now higher for sinuplasty procedures than for traditional sinus surgery. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2224-2229, 2019.
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Endoscopía/estadística & datos numéricos , Reembolso de Seguro de Salud/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Sinusitis/cirugía , Anciano , Endoscopía/instrumentación , Endoscopía/métodos , Femenino , Humanos , Masculino , Medicare , Procedimientos Quírurgicos Nasales/instrumentación , Procedimientos Quírurgicos Nasales/métodos , Senos Paranasales/cirugía , Estudios Retrospectivos , Estados UnidosRESUMEN
Importance: Nasal endoscopy is the most highly reimbursed routine clinical procedure in otolaryngology by Medicare. To our knowledge, the economic and demographic characteristics of nasal endoscopy have not been characterized at a population level. Objective: To quantify trends in use of nasal endoscopy among Medicare recipients at a national and state level. Design, Setting, and Participants: Cross-sectional study of procedure and beneficiary data from January 1, 2000, to December 31, 2016, and available health care provider data from 2015 obtained from the Centers for Medicare & Medicaid Services for all diagnostic nasal endoscopies categorized as Current Procedural Terminology code 31231. Exposures: Diagnostic nasal endoscopy. Main Outcomes and Measures: Nasal endoscopies were analyzed by state, medical or surgical specialty, mean reimbursement, health care provider density, and type of health care practitioner performing the procedure. Results: The Centers for Medicare & Medicaid Services reimbursed $86.3 million for 559â¯547 nasal endoscopies in 2016. The total number of nasal endoscopies increased 313%, from 135â¯494 in 2000 to 559â¯547 in 2016 (9.3% average annual rate of increase). The mean reimbursement rate per nasal endoscopy varied by state, from $114.25 in Puerto Rico to $189.53 in New York. The percentage of Medicare beneficiaries receiving nasal endoscopy per state ranged from 0.1% in Alaska to 1.7% in New York. Almost all nasal endoscopies were performed by physicians (97.3%), with otolaryngologists (97.2%) being the most common specialty. Reimbursement rates (r = 0.60) and density of health care providers (r = -0.56) were correlated with higher utilization in a state's Medicare population. Conclusions and Relevance: Utilization of nasal endoscopy by otolaryngologists in the Medicare population appears to have increased substantially over the past 2 decades. Practice patterns and reimbursement appeared to vary across the United States.
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Endoscopía/estadística & datos numéricos , Medicare , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Otolaringología , Anciano , Humanos , Pautas de la Práctica en Medicina , Utilización de Procedimientos y Técnicas , Estados UnidosRESUMEN
OBJECTIVES/HYPOTHESIS: To evaluate the impact of age on patient-reported quality of life (QOL) following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective cohort study. METHODS: Six hundred thirty-six patients with CRS were recruited from 11 otolaryngologic practices and completed the sinonasal-specific, 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and general health-related EuroQol 5-Dimension (EQ-5D) questionnaires at baseline and 12 and 24 months after ESS. Patients were grouped chronologically to determine whether age at time of ESS was associated with clinical outcomes. RESULTS: Ages ranged from 18 to 80 years (mean ± standard deviation = 48.5 ± 14.4). Improvement was observed in postoperative SNOT-22 scores at 12 and 24 months for all decades of life. Similar improvements were observed for EQ-5D-based health utility value (HUV) scores in all decades of life, except for the eldest cohort (ages 70-80, N = 33), who did not exceed the minimal clinically important difference at either 12 or 24 months following ESS. In regression analysis, age was not associated with sinonasal-specific outcomes (change in SNOT-22 scores) at 12 (P = .507) or 24 months (P = .955). In general health-related outcomes, however, age was significantly associated with change in EQ-5D-based HUV scores from baseline to 12 months following ESS after adjusting for patient demographics, comorbidities, and surgical history (P = .049). CONCLUSIONS: This study demonstrates that ESS for adult CRS sufferers offers improved QOL outcomes through the eighth decade of life. The impact of comorbidities on QOL needs to be carefully considered when assessing older patients for sinus surgery. LEVEL OF EVIDENCE: 2b Laryngoscope, 128:2681-2687, 2018.
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Factores de Edad , Endoscopía/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Rinitis/cirugía , Sinusitis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Endoscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: Endoscopic sinus surgery (ESS) is a common operation typically performed due to chronic rhinosinusitis (CRS). There are limited data on the nationwide ESS rate and factors contributing to its regional variation. The aim was to evaluate factors causing variation of ESS rate. DESIGN: Cross-sectional nationwide observational study. SETTING: A ll patients undergoing ESS in Finland 2013-2015. POPULATION: Nationwide Finnish population aged 15 years or over. MAIN OUTCOME MEASURES: ESS rate per 1000 inhabitants between 2013 and 2015 in all 21 hospital districts and independent factors for multilevel model analyses. METHODS: We used the Finnish register data of all patients with CRS who underwent ESS in 2013-2015. Patients aged under 15 years and those with ESS due to neoplasia were excluded. The age and gender standardised ESS rates were calculated, and multilevel Poisson regression models were used to evaluate variation in ESS in the 21 hospital districts. The likelihood ratio test was applied to assess the statistical significance of random components in the models. RESULTS: The nationwide annual rate of ESS is 0.71 per 1000 people in Finland. Hospital district rates varied from 0.25/1000 (95% CI 0.18 to 0.32) to 1.15/1000 (95% CI 1.09 1.21). Compared with males, females undergo ESS significantly more frequently (57% of the procedures), more often due to CRS without nasal polyps, and at a younger age (mean age 44.2 and 46.2 years, correspondingly). Multilevel analyses showed that lower age (between 24 years and 45 years) and availability/ease of medical services were independently associated with higher ESS rates. CONCLUSIONS: This study confirms marked regional variation in the ESS rate in Finland, explained only in part by patients' age and differing availability of medical services. To analyse ESS across different CRS phenotypes or to compare quality registers on ESS properly, more research on regional variation is needed.
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Endoscopía , Pólipos Nasales/complicaciones , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Rinitis/cirugía , Sinusitis/cirugía , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Estudios Transversales , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Tabique Nasal/cirugía , Evaluación de Resultado en la Atención de Salud , Distribución de Poisson , Sistema de Registros , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to characterize trends in turbinate reduction procedures from 2000 to 2015. METHODS: Annual procedure data were obtained for the period 2000-2015 and detailed Medicare provider and payment data were obtained for 2012-2015. Turbinate procedures analyzed included turbinate soft tissue mucosal ablation (TMA), turbinate soft tissue submucosal ablation (TSMA), turbinate excision (TE), and turbinate submucous resection (TSR). TMA and TSMA were grouped as turbinate soft tissue ablation (TA) for analysis. From 2012 to 2015, the type and location-facility (F) or nonfacility (NF)-of the providers performing the procedures were assessed. RESULTS: From 2000 to 2015, the total number of turbinate reduction procedures increased by an average of 3.8% annually. TSR had the highest annual increase at 5.4%. TE is the only procedure to show a decrease, by an average of -2.3% annually. From 2012 to 2015, the number of turbinate reduction procedures changed by -1.6% and 107.7% at F and NF locations, respectively. NF TSMA and TSR had the largest increases at 121.6% and 260.1%, respectively. Of the NF TA procedures, there was an average annual increase of 50% by non-otolaryngologists. For TA, the average F charge was 78.0% more than the NF charge, and the average NF otolaryngologist charge 11.5% more than the non-otolaryngologist charge. CONCLUSION: The number of turbinate reduction procedures increased steadily between 2000 and 2015, with the majority being TSRs. This is consistent with previous studies demonstrating that TSR leads to better outcomes. There has been a significant increase in turbinate reduction procedures performed in outpatient/ambulatory settings by otolaryngologists, non-otolaryngologists, and midlevel providers.
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Medicare/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Procedimientos Quírurgicos Nasales/tendencias , Otolaringología/tendencias , Cornetes Nasales/cirugía , Atención Ambulatoria , Bases de Datos Factuales , Costos de la Atención en Salud , Personal de Salud , Humanos , Otolaringología/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVES: The main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved. METHODS: We performed a systematic review searching PubMed and MEDLINE databases including English-language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children. RESULTS: We included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0-20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0-8.0) compared with FESS 17.7% (95% CI: 12.8-23.4) or SP 50% (95% CI:15.7-84.3) (pâ¯<â¯.05) but no significant differences with CWL 9.1% (95% CI: 1.1-29.2) and others surgical approaches (pâ¯>â¯.05). The analysis of the possible risk factors involved in recurrences are inconclusive. CONCLUSION: Recurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.
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Pólipos Nasales/cirugía , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Adolescente , Niño , Bases de Datos Factuales , Endoscopía , Femenino , Humanos , Masculino , Pólipos Nasales/patología , Senos Paranasales , Recurrencia , Factores de RiesgoRESUMEN
BACKGROUND: The Sino-Nasal Outcome Test (SNOT)-22 has multiple items that reflect how nasal disease affects quality of life. Currently, no validated Arabic version of the SNOT-22 is available. OBJECTIVE: . To develop an Arabic-validated version of SNOT-22. DESIGN: Prospective. SETTING: Tertiary care center. PATIENT AND METHODS: This single-center validation study was conducted between 2015 and 2017 at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. The SNOT-22 English version was translated into Arabic by the forward and backward method. The test and retest reliability, internal consistency, responsiveness to surgical treatment, discriminant validity, sensitivity and specificity all were tested. MAIN OUTCOME MEASURES: Validated Arabic version of the SNOT-22. RESULTS: Of 265 individuals, 171 were healthy volunteers and 94 were chronic rhinosinusitis patients. The Arabic version showed high internal consistency (Cronbach's of 0.94), and the ability to differentiate between diseased and healthy volunteers (P < .001). The translated versions demonstrated the ability to detect the change scores significantly in response to intervention (P < .001). CONCLUSION: This is the first validated Arabic version of SNOT-22. The instrument can be used among the Arabic population. LIMITATIONS: No subjects from other Arab countries.
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Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Calidad de Vida , Rinitis/diagnóstico , Sinusitis/diagnóstico , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Psicometría , Reproducibilidad de los Resultados , Rinitis/epidemiología , Rinitis/psicología , Rinitis/cirugía , Arabia Saudita/epidemiología , Sensibilidad y Especificidad , Sinusitis/epidemiología , Sinusitis/psicología , Sinusitis/cirugía , TraducciónRESUMEN
This article presents the results of the study designed to determine the concentration of the neuromediator serotonin in the blood serum and tissue homogenates prepared from the polypous tissue harvested in the patients presenting with chronic polypous rhinosinusitis (CPR). The study included 51 patients with this pathology while 11 patients with chronic maxillary rhinosinusitis (CMR) and deflection of the nasal septum (DNS) made up the group of comparison. The serum serotonin levels were measured and compared in the patients of the main and both control groups. The results obtained give evidence of the significant inverse correlation between serotonin levels in the sera and tissue homogenates on the one hand and the history of allergic diseases in individual patients on the other hand.
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Hipersensibilidad/metabolismo , Obstrucción Nasal , Pólipos Nasales , Rinitis , Serotonina , Sinusitis , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Hipersensibilidad/complicaciones , Masculino , Persona de Mediana Edad , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/etiología , Obstrucción Nasal/cirugía , Pólipos Nasales/etiología , Pólipos Nasales/metabolismo , Pólipos Nasales/patología , Pólipos Nasales/cirugía , Procedimientos Quírurgicos Nasales/métodos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Rinitis/sangre , Rinitis/complicaciones , Rinitis/diagnóstico , Rinitis/metabolismo , Serotonina/sangre , Serotonina/metabolismo , Sinusitis/sangre , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sinusitis/metabolismo , Estadística como AsuntoRESUMEN
Evaluation of endoscopic ethmoidectomy performed as a day-case in terms of security, quality, and satisfaction of the patient. This prospective observatory bi-centric study over 1 year included 74 patients undergoing an ethmoidectomy respecting the eligibility criteria of ambulatory care. We recorded patients' demographic data, operative details, satisfaction, postoperative course, and follow-up results. Nasal symptoms were evaluated by SNOT-22 on preoperative appointment and postoperatively at D30. No non-absorbable nasal packing was used, eventually in the case of preoperative-bleeding absorbable gelatine packing. The postoperative follow-up took place at D1 by phone call and at D10 and D30 to assess complications, Visual Analogue Scale, and state of ethmoidal corridors by endoscopic exam. Patients benefited of bilateral ethmoidectomy in 82.4 % cases associated with septoplasty in 42 %. The majority (95 %) was discharged on the same day. Only one patient had bleeding at D0 and was kept in standard hospitalization, such as three other patients for medical or organizational reasons not related to surgery. At D1, 23 % described postoperative light bleeding but needed no revisit and pain was estimated at 1.3 (VAS). No readmission was observed, and no major complication was noted. SNOT-22 decreased successfully by 56 %, statistically related to postoperative treatment of corticosteroids and in the case of Samter triad. 97 % of patients were satisfied of the ambulatory care. These results suggest that within an experienced and dedicated day-case medical and paramedical team, ethmoidectomy can be safely performed on a day-case basis with high quality of taking care and satisfaction of patients.
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Procedimientos Quirúrgicos Ambulatorios , Epistaxis , Senos Etmoidales/cirugía , Hemostasis Quirúrgica , Procedimientos Quírurgicos Nasales , Complicaciones Posoperatorias , Adulto , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Epistaxis/diagnóstico , Epistaxis/etiología , Epistaxis/prevención & control , Femenino , Francia , Hemostasis Quirúrgica/métodos , Hemostasis Quirúrgica/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quírurgicos Nasales/efectos adversos , Procedimientos Quírurgicos Nasales/métodos , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Cirugía Endoscópica por Orificios Naturales/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Prioridad del Paciente , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Rinoplastia , Resultado del TratamientoRESUMEN
Conclusion Nasal obstruction can aggravate the psychological status of OSA patients, and nasal surgery should reduce this aggravation. Nasal surgery significantly improved sleep latency and ameliorated several polysomnographic characteristics. Background The aim of this study was to investigate the psychological status of patients with obstructive sleep apnea (OSA) and nasal obstruction and to evaluate the effects of nasal surgery on the psychological symptoms and polysomnographic (PSG) parameters of these patients. Methods The study was designed as a prospective comparative study. This study compared 30 patients (all male) with nasal obstruction and 30 matched patients without nasal obstruction using the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Check List 90 (SCL-90). All of the patients had been previously diagnosed with OSA (apnea hypopnea index [AHI] ≥ 5 events/h) via a whole-night polysomnographic examination. Nasal obstruction was assessed using a visual analogue scale (VAS). The patients with nasal obstruction underwent nasal surgery, and their weight, VAS, nocturnal PSG characteristics, and psychological symptoms at baseline and 3 months after surgery were compared. Results The OSA patients with nasal obstruction suffered from significantly longer sleep latency on the PSQI and higher somatization and anxiety scores on the SCL-90 than the subjects without nasal obstruction (p < 0.05). The nasal obstruction symptoms significantly improved after surgery (VAS decreased from 6.18 ± 1.85 to 1.87 ± 1.76, p < 0.01). The assessments also showed a significant reduction in weight (from 84.60 ± 11.30 kg to 82.27 ± 9.87 kg, p < 0.05) between the pre-operative and post-operative values. Although there was significant reduction in the AHI (from 49.67 ± 19.49/h to 43.07 ± 21.86/h, p < 0.01) and a significant improvement in lowest oxygen saturation (LSpO2, from 73.83 ± 8.49% to 75.97 ± 9.86%, p < 0.05), only 23.3% of patients achieved a response of nasal surgery that met Sher's criteria. Remarkable reductions were observed in the sleep latency scores, daytime dysfunction scores on the PSQI, anxiety and hostility scores, and the number of positive symptoms on the SCL-90 (p < 0.05). There was a strong positive correlation between PSQI total score and some psychosomatic symptoms on the SCL-90, including inter-personal sensitivity, depression, hostility, paranoid ideation, psychoticism, global symptom index, and the number of positive symptoms (r > 0.3, p < 0.05).
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Obstrucción Nasal/cirugía , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Apnea Obstructiva del Sueño/cirugía , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Nasal/complicaciones , Obstrucción Nasal/psicología , Polisomnografía , Estudios Prospectivos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/psicología , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: Much of the epidemiological data on chronic rhinosinusitis (CRS) are based on large administrative databases and health surveys. The accuracy of CRS identification with these methods is unknown. METHODS: A systematic review was performed to identify studies that measured the accuracy of CRS diagnoses in large administrative databases or within health surveys. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess study quality. RESULTS: Of 512 abstracts initially identified, 122 were selected for full-text review; only three studies (2.5%) measured the accuracy of CRS patient identification. In a single, large administrative database study with a CRS prevalence of 54.8%, a single International Classification of Diseases-9th Revision diagnostic code for CRS had a positive predictive value (PPV) of only 34%. A diagnostic code algorithm identified CRS patients with a PPV of 91.3% (95% confidence interval [CI], 85.3-95.1); in a population with a CRS prevalence of 5%, this algorithm had a PPV of 31%. In health survey studies having an estimated CRS prevalence of 25% to 46%, self-reported symptom-based CRS diagnosis had a PPV of 62% (95% CI, 50.2-72.1) when nasal endoscopy was the gold standard for CRS diagnosis, and 70% (95% CI, 57.4-80.8) when otolaryngologist-based CRS diagnosis (after interview and nasal endoscopy) was the gold standard. CONCLUSION: Most health administrative data and health surveys examining CRS did not consider the accuracy of case identification. For unselected populations, administrative data and health surveys using self-reported diagnoses inaccurately identify patients with CRS. Epidemiological results based on such data should be interpreted with these results in mind. Laryngoscope, 126:1303-1310, 2016.
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Bases de Datos Factuales/estadística & datos numéricos , Encuestas Epidemiológicas/estadística & datos numéricos , Rinitis/diagnóstico , Sinusitis/diagnóstico , Algoritmos , Enfermedad Crónica , Exactitud de los Datos , Endoscopía/estadística & datos numéricos , Humanos , Clasificación Internacional de Enfermedades , Procedimientos Quírurgicos Nasales/estadística & datos numéricos , Valor Predictivo de las Pruebas , Prevalencia , Rinitis/epidemiología , Sinusitis/epidemiologíaRESUMEN
OBJECTIVES/HYPOTHESIS: The Sinonasal Outcomes Test-20 (SNOT-20) is a validated tool to assess treatment outcomes in patients with chronic rhinosinusitis (CRS). In the clinic, we observed that patients who responded with a positive score on all 20 items of the SNOT-20 questionnaire (pan-positive patients) often did not have evidence of CRS upon workup. Many of these patients had other underlying diseases contributing to their complaints. METHODS: Analysis of prospectively collected data was performed to identify SNOT-20 pan-positive patients and compare them to 100 consecutive non-pan-positive patients who served as the control group. The following parameters were compared between the two patient groups: presence or absence of chronic diseases such as obstructive sleep apnea, depression, anxiety, fibromyalgia, chronic pain, headaches, temporomandibular joint disease, and arthritis--in addition to sinus computed-tomography Lund-McKay scores and nasal endoscopy Lund-Kennedy scores. We also reviewed the medication list of each patient to look for the possible presence of mental illness. Statistical analysis was performed using the chi-squared and Student t test. RESULTS: One hundred twenty-two pan-positive patients were identified in our database collected from 2003 to 2011. Pan-positive patients had higher incidence of depression, fibromyalgia, anxiety, pain, headache, and use of depression medications--and they also had higher SNOT-20 and endoscopy scores when compared to controls (P < 0.05). Pan-positive patients were more likely female (P < 0.05), but age and race differences did not reach statistical significance. CONCLUSION: The SNOT-20 questionnaire assists clinicians to monitor outcomes in patients treated for CRS. However, clinicians should suspect other underlying chronic conditions in SNOT-20 pan-positive patients. LEVEL OF EVIDENCE: 3B.