المؤلفون: Shireen Samargandy, Elysia Grose, Jonathan Yip, John M. Lee

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 52, Iss 1, Pp 1-6 (2023)

مصطلحات موضوعية: Immunodeficiency, Endoscopic sinus surgery, Chronic rhinosinusitis, Revision surgery, Immune dysfunction, Nasal polyps, Surgery, RD1-811

الوصف: Abstract Background Patients with chronic rhinosinusitis (CRS) and immunoglobulin deficiencies (ID) have more recalcitrant sinonasal disease and a subset of these patients undergo surgical management for their CRS. However, there is a paucity of literature on the surgical outcomes in this patient population and appropriate treatment algorithms for CRS in patients with ID. The objective of this study was to better elucidate the outcomes of endoscopic sinus surgery (ESS) in patients with ID in terms of disease-specific quality-of-life scores and the need for revision surgery. Methods A case–control study was performed comparing adult patients with ID and healthy controls that had undergone ESS for CRS. Patients were matched based on age, sex, CRS phenotype, and preoperative Lund-Mackay score. The revision surgery rates, time to revision surgery, and changes in sinonasal outcome tests (SNOT-22) were evaluated. Results Thirteen patients with CRS and ID were matched to 26 control patients with CRS. The revision surgery rate for cases and controls was 31% and 12%, respectively, but there was no statistical difference (p > 0.05). There was a clinically meaningful reduction in SNOT-22 scores in both groups from the preoperative to postoperative period [mean of 12 points in patients with ID (p = 0.323) and 25 points in controls (p 0.05). Conclusion Our data suggests that patients with ID have clinically meaningful improvement in SNOT-22 scores after ESS but may have higher revision rates than immunocompetent patients with CRS. ID are rare disease entities, thus most attempts at studying this cohort would be limited by sample size. Further homogenous data on immunoglobulin deficient patients is required for future meta-analysis to better understand the impact of ESS in patients with ID.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/bfd68ef0b5f44af0a72491f2fc1ff624Test

المؤلفون: Andrew V. Thamboo, Melissa Lee, Mohit Bhutani, Charles Chan, Yvonne Chan, Ken R. Chapman, Christopher J. Chin, Lori Connors, Del Dorscheid, Anne K. Ellis, Richard M. Gall, Krystelle Godbout, Arif Janjua, Amin Javer, Shaun Kilty, Harold Kim, Gordon Kirkpatrick, John M. Lee, Richard Leigh, Catherine Lemiere, Eric Monteiro, Helen Neighbour, Paul K. Keith, George Philteos, Jaclyn Quirt, Brian Rotenberg, Juan C. Ruiz, John R. Scott, Doron D. Sommer, Leigh Sowerby, Marc Tewfik, Susan Waserman, Ian Witterick, Erin D. Wright, Cory Yamashita, Martin Desrosiers

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 52, Iss 1, Pp 1-36 (2023)

مصطلحات موضوعية: Chronic rhinosinusitis, Chronic rhinosinusitis with nasal polyposis, Upper airway disease, Lower airway disease, Asthma, Biologics, Surgery, RD1-811

الوصف: Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/55e88f515c324fecb00a7635d8bdad2dTest

المؤلفون: Sheila Yu, Elysia Grose, Daniel J. Lee, Vincent Wu, Mitchell Pellarin, John M. Lee

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 52, Iss 1, Pp 1-8 (2023)

مصطلحات موضوعية: Inverted papilloma, Sinonasal tumour, Endoscopic sinus surgery, Recurrence, SNOT-22, Surgery, RD1-811

الوصف: Abstract Background Sinonasal inverted papillomas (IP) are benign tumours arising from the mucosal lining of the nasal cavity and paranasal sinuses with a high propensity for recurrence and malignant transformation. Advances in endoscopic surgery and improved radiologic navigation have increased the role of endoscopic surgical resection in the treatment of IPs. The current study aims to evaluate the rate of IP recurrence after endoscopic endonasal resection and to evaluate factors which impact recurrence. Methods This was a single-centre retrospective chart review of all patients who underwent endoscopic sinus surgery for management of IP between January 2009 and February 2022. Primary outcomes were the rate of IP recurrence and time to IP recurrence. Secondary outcome measures were patient and tumour factors that contributed to IP recurrence. Results Eighty-five patients were included. The mean age was 55.7 and 36.5% of patients were female. The mean follow-up time was 39.5 months. Of the 85 cases, 13 cases (15.3%) had recurrence of their IP and the median time to recurrence was 22.0 months. All recurrent tumours recurred at the attachment site of the primary tumour. The univariate analysis did not identify any significant demographic, clinical, or surgical predictors of IP recurrence. There were no significant changes in sinonasal symptoms at the time IP recurrence was detected. Conclusion Endoscopic endonasal resection of IPs represents an effective surgical approach, however, the relatively high rate of recurrence and lack of symptomatic changes at the time of recurrence necessitates long term follow up. Better delineation of risk factors for recurrence can help identify high-risk patients and inform postoperative follow up strategies.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/e4202f72434c451d9f5570b731258e24Test

المؤلفون: Veeral Desai, Gianluca Sampieri, Amirpouyan Namavarian, John M. Lee

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 52, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: Rhinitis, Endoscopic sinus surgery, Chronic disease, Surgery, RD1-811

الوصف: Abstract Background ClariFix is a novel intranasal cryotherapy device developed for clinic-based cryosurgical ablation of the posterior nasal nerves region. As a relatively new technology, there is a paucity of studies within the literature assessing the efficacy and safety profile of ClariFix for chronic rhinitis. Methods A systematic review was completed in accordance with PRISMA guidelines. Databases searched included: Ovid Medline, Ovid EMBASE, Pubmed, Cochrane and Web of Science. Inclusion criteria consisted of studies investigating the use of ClariFix in chronic rhinitis (i.e., allergic and non-allergic rhinitis) in patients of all ages. Results The initial search identified 1110 studies. Final analysis consisted of 8 articles, evaluating a total of 472 patients. The data showed a significant reduction in scores post-treatment across all studies based on validated outcome measures. In all studies, at all time intervals, there was a significant improvement in outcome scores from baseline. Minor adverse effects included post-procedural pain and discomfort, headache and palate numbness. No major adverse events were identified. Conclusion ClariFix is a novel intranasal cryotherapy device that was introduced in Canada in 2021. This is the first systematic review evaluating its efficacy and safety profile. Across all studies, there was a significant reduction in validated outcome scores at multiple time intervals. Further, the treatment is safe with only minor adverse effects reported by patients. Overall, the consensus from this study highlights an apparent benefit in using this intervention for chronic rhinitis that is refractory to medical management.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/258ffa5a8c2b437b8210d0d00805ffd9Test

المؤلفون: Amr F. Hamour, John JW. Lee, Ewa Wasilewski, Eric Monteiro, John M. Lee, Allan Vescan, Lakshmi P. Kotra

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 52, Iss 1, Pp 1-8 (2023)

مصطلحات موضوعية: Animal model, Chronic rhinosinusitis, Eosinophilic chronic rhinosinusitis, Histological markers, Inflammation, Surgery, RD1-811

الوصف: Abstract Background Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the sinonasal tract. To understand this disease entity and develop targeted treatments, a reproducible animal model is paramount. Aims/objectives To optimize a murine model of eosinophilic CRS by establishing benchmark histological markers and validate its fidelity in evaluating intranasal treatments. Material and methods Forty-five Balb/c mice were included in the 7-week protocol. Experimental animals (n = 20) were induced a CRS disease state upon receiving intraperitoneal sensitization with ovalbumin (OVA), followed by intranasal OVA with Aspergillus oryzae protease. Analysis of complete blood count with differential, peripheral blood smear, and histological markers from the nasal cavity mucosa were performed. CRS mice were additionally treated with intranasal saline (n = 5) or mometasone (n = 10) and compared with control groups of untreated CRS (n = 5) and healthy (n = 5) mice after week 7. Results Histological analysis of experimental animal nasal mucosa revealed significantly higher levels of eosinophilic tissue infiltration/degranulation, hyaline droplets, Charcot–Leyden crystals, and respiratory epithelial thickness compared to healthy controls. Treatment with mometasone significantly reversed the histopathological changes observed in CRS mice. Conclusion and significance This murine model induced substantial local eosinophilic inflammation within sinonasal mucosa, that was reversible with mometasone. This model may be used to evaluate the efficacy of therapeutics designed to target CRS.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/50b8b4b6903746f49dc689ef3991f683Test

المؤلفون: Elysia Grose, Alyssa Y. Li, John M. Lee

المصدر: Allergy, Asthma & Clinical Immunology, Vol 19, Iss 1, Pp 1-6 (2023)

مصطلحات موضوعية: Biologics, Chronic rhinosinusitis, Endoscopic sinus surgery, Sinonasal outcomes, Asthma, Immunologic diseases. Allergy, RC581-607

الوصف: Abstract Background In 2020, dupilumab became the first monoclonal antibody therapy to be approved by Health Canada for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). The primary aim of this study was to characterize the outcomes in an initial cohort of patients with CRSwNP who have undergone dupilumab therapy. Methods A retrospective study was conducted of patients with CRSwNP who were treated with dupilumab. Demographic information, comorbidities, number of previous surgeries, and insurance information were collected. The primary outcome were changes in the sinonasal outcome test (SNOT-22) scores from baseline to timepoints after receiving dupilumab. Results Forty-eight patients were considered for dupilumab therapy, and 27 (56%) received coverage or were able to fund the medication independently. Patients waited an average of 3.6 months to obtain access to the medication. The mean age of the patients was 43. Forty-one percent (11/27) of patients had aspirin exacerbated respiratory disease, and 96% (26/27) had a diagnosis of asthma. The mean length of time on dupilumab was 12.1 months. The baseline SNOT-22 score was 60.6. The mean decrease at 1 month, 3 months, 6 months, and 12 months after starting dupilumab was 8.8, 26.5, 42.8, and 33.8, respectively. There were no serious adverse events. Conclusion Patients treated with dupilumab in a Canadian tertiary care rhinology clinic demonstrated substantial clinical improvement as measured by disease-specific sinonasal outcomes. Further studies are needed to determine the longer-term effectiveness and adverse event profile of this novel therapy.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1710-1492Test

الوصول الحر: https://doaj.org/article/ab6086489e95410f842f30d7385695eaTest

المؤلفون: Amr F. Hamour, Frederick Laliberte, Vikram Padhye, Eric Monteiro, Ronit Agid, John M. Lee, Ian J. Witterick, Allan D. Vescan

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 51, Iss 1, Pp 1-8 (2022)

مصطلحات موضوعية: Complications, Endoscopic surgery, Rhinology, Skull base, Endovascular treatment, Surgery, RD1-811

الوصف: Abstract Background Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel. Methods A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff. Results After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. ‘Alert’ focusses on early communication with anesthesia and nursing staff. ‘Control’ focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, ‘Transfer’ describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres. Conclusion Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed. Graphical Abstract

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/8acffcc219ef44379cfd3fc47aa3f085Test

المؤلفون: Vincent Wu, John M. Lee, Nicholas T. Vozoris, Marie E. Faughnan

المصدر: Laryngoscope Investigative Otolaryngology, Vol 6, Iss 3, Pp 370-375 (2021)

مصطلحات موضوعية: duration, epistaxis, HHT, outcome, severity, Otorhinolaryngology, RF1-547, Surgery, RD1-811

الوصف: Abstract Objectives There is great interest in developing and studying novel therapies for epistaxis in hereditary hemorrhagic telangiectasia (HHT) given its associated morbidity and impact on patients' quality of life. Several recent randomized controlled trials (RCTs) have been negative, likely attributed to poorly characterized outcome measures. This study reported on and evaluated an epistaxis outcome measure, weekly epistaxis duration (WED) in an ongoing RCT, with the aim of better characterizing the measurement of epistaxis for clinical trials. Materials and methods Patients were recruited to an ongoing phase II, double‐blind, cross‐over RCTs of oral doxycycline for HHT‐associated epistaxis. Patients were included for the epistaxis measures analysis if they had already completed the initial 3‐month run‐in period, and had received treatment of either study drug doxycycline or placebo for a minimum of 6 months. The primary measure of interest was patient‐reported outcome (PRO)‐WED, captured from prospective daily diaries. Epistaxis severity score (ESS) was collected as a secondary outcome. Results Seven patients were included for analysis, with 98% completion of the daily diary. The average PRO‐WED across all patients was 85.0 minutes, SD 93.2 at baseline, and 65.6 minutes, SD 59.5 during treatment/placebo. Coefficient of variance for PRO‐WED at baseline and during treatment/placebo was 0.49, SD 0.1 and 0.58, SD 0.2, respectively. Statistically significant changes in the mean PRO‐WED from baseline to treatment/placebo was noted in six patients (86%). Only two patients (29%) had a significant change in ESS, with both reporting decreased (improved) scores after treatment/placebo as compared to baseline. Conclusions PRO‐WED was a feasible clinical trials measure, was reasonably stable during baseline measurement, and appeared to be variable with treatment state, suggesting it may provide a sensitive clinical trials PRO in HHT.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2378-8038Test

الوصول الحر: https://doaj.org/article/53b4f16de00b466ca1bac3e34288a951Test

المؤلفون: Elysia M. Grose, Connor P. Holmes, Kaishan A. Aravinthan, Vincent Wu, John M. Lee

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 50, Iss 1, Pp 1-8 (2021)

مصطلحات موضوعية: Septoplasty, Nasal septum deviation, Quality assessment, Readability assessment, Patient education, Internet-based education, Surgery, RD1-811

الوصف: Abstract Background Given that nasal septoplasty is a common procedure in otolaryngology – head and neck surgery, the objective of this study was to evaluate the quality and readability of online patient education materials on septoplasty. Methods A Google search was performed using eight different search terms related to septoplasty. Six different tools were used to assess the readability of included patient education materials. These included the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning-Fog Index, Simple Measure of Gobbledygook Index, Coleman-Liau Index, and Automated Readability Index. The DISCERN tool was used to assess quality and reliability. Results Eighty-five online patient education materials were included. The average Flesch-Reading Ease score for all patient education materials was 54.9 ± 11.5, indicating they were fairly difficult to read. The average reading grade level was 10.5 ± 2.0, which is higher than the recommended reading level for patient education materials. The mean DISCERN score was 42.9 ± 10.5 and 42% (36/85) of articles had DISCERN scores less than 39, corresponding to poor or very poor quality. Conclusion The majority of online patient education materials on septoplasty are written above the recommended reading levels and have significant deficiencies in terms of their quality and reliability. Clinicians and patients should be aware of the shortcomings of these resources and consider the impact they may have on patients’ decision making.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/ff7e3f1d97654db58c755bad6812428aTest

المؤلفون: Yvonne Chan, Sarfaraz M. Banglawala, Christopher J. Chin, David W. J. Côté, Dustin Dalgorf, John R. de Almeida, Martin Desrosiers, Richard M. Gall, Artur Gevorgyan, A. Hassan Hassan, Arif Janjua, John M. Lee, Randy M. Leung, Bradford D. Mechor, Dominik Mertz, Eric Monteiro, Smriti Nayan, Brian Rotenberg, John Scott, Kristine A. Smith, Doron D. Sommer, Leigh Sowerby, Marc A. Tewfik, Andrew Thamboo, Allan Vescan, Ian J. Witterick

المصدر: Journal of Otolaryngology - Head and Neck Surgery, Vol 49, Iss 1, Pp 1-22 (2020)

مصطلحات موضوعية: Surgery, RD1-811

الوصف: Abstract Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1916-0216Test

الوصول الحر: https://doaj.org/article/b93d3afd167c4011898824cc0cfff1cbTest