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Objectives/hypothesis: To evaluate the potential efficacy of steroid-soaked, absorbable calcium alginate nasal packing following endoscopic sinus surgery.Study Design: Prospective, randomized, single-blinded, placebo-controlled trial.Methods: Twenty-two patients (44 nostrils) who had chronic rhinosinusitis with polyps underwent bilateral endoscopic sinus surgery. Only those with an intersinus difference in Lund-Mackay severity score of 1 or less were included. In each patient, one randomly selected nostril was packed with calcium alginate soaked with 2 mL of triamcinolone (40 mg/mL) (triamcinolone group), whereas the contralateral nostril received an identical packing soaked in 2 mL of normal saline (saline group). Two independent investigators blinded to the packing allocation scored the surgical field using the validated Perioperative Sinus Endoscopy (POSE) scores 1, 4, and 8 weeks after surgery.Results: All 44 nostrils were analyzed; the Lund-Mackay scores did not differ significantly between the groups before surgery. Eight weeks after surgery, the total POSE scores were significantly lower in the triamcinolone group (P = .014). The POSE scoring parameters were then compared between groups, and the following variables were significantly different: middle turbinate synechiae with the lateral wall (P = .037), polypoid degeneration of the ethmoid cavity (P = .006), and sphenoid sinus severity (P = .036).Conclusions: This study demonstrated that steroid-soaked, absorbable nasal packing can be used to enhance wound healing after endoscopic sinus surgery and to prevent polypoid changes in the nasal mucosa.Level Of Evidence: 1b. Laryngoscope, 128:311-316, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: We aimed to evaluate the effectiveness of low-concentration hypochlorous acid (HOCl) nasal irrigation compared to isotonic normal saline for pediatric chronic rhinosinusitis.Study Design: This was a randomized, prospective, active-controlled study.Methods: This study investigated the effectiveness of 4 weeks of low-concentration hypochlorous irrigation by analyzing five categorized subjective symptoms and x-ray findings in pediatric patients with rhinosinusitis. Thirty-seven patients were enrolled, and 26 patients successfully completed the study.Results: Total symptom scores significantly improved with both HOCl and normal saline nasal irrigation, but there was no difference between the two groups. X-ray scores also improved in both groups; improvement was much greater in the HOCl group than the placebo group.Conclusions: Nasal irrigation with HOCl is an effective adjuvant treatment compared to isotonic normal saline for pediatric sinusitis.Level Of Evidence: 1b. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The objective of this study was to determine the potential role of a surgical robotic system in nasopharyngeal surgery using bilateral transantral or combined endonasal/transantral port. Study Design The da Vinci robot (Intuitive Surgical Inc., Sunnyvale, CA) was used to perform dissection of the skull base on a whole fresh-frozen cadaver. Methods Bilateral mega-antrostomy was done with the usual endoscopic sinus surgery equipment. To obtain an accessible bilateral working space, posterior septectomy was performed. Next, bilateral anterior maxillary windows were created through a gingivobuccal incision. The 8.5-mm-diameter 0° or 30° three-dimensional camera arm was introduced into a nostril. The two 5-mm-diameter articulating EndoWrist arms entered through the transantral or endonasal port. For the dissection, Maryland articulated forceps, needle driver, and monopolar spatula- or hook-type electrocauterizer were used. Results The 8.5-mm diameter of the camera arm was easily inserted into the nostril. Excellent access to the nasopharyngeal area from the level of the palate up to the skull base crossing the sphenoid prow was possible. Bilateral robotic arms were able to move inside the nasopharyngeal space, and the target dissection area could be accessed fully via the transantral or endonasal port. Conclusions This is the first report about the feasibility of bilateral transantral or combined transantral/endonasal port for robotic nasopharyngectomy. Robotic removal of the entire nasopharyngeal area was successfully achieved without transpalatal or facial skin incision. These new approaches may be applied to selected patients with nasopharyngeal carcinoma or other pathologic tumors involving the nasopharynx. Level of Evidence NA Laryngoscope, 125:1839-1843, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Saline irrigation would be more effective for chronic sinusitis patients if it had bactericidal effects. Low concentrations of hypochlorous acid may be used as a nasal irrigation solution. First, we developed a 0.85% NaCl solution by adding NaCl to tap water (pH 7.0 and 8.4) and measuring the concentration of free chlorine and hypochlorous acid after giving the solution a short electrical impulse of 20 seconds. Then we investigated whether the derived hypochlorous acid had a toxic effect on human primary nasal epithelial cells, if and what effect it had on the expression of mucin genes, and, finally, if it had bactericidal, fungicidal, or virucidal effects. Study Design: In vitro biochemical experiment. Methods: We treated human primary nasal epithelial cells with 3.5 ppm of hypochlorous acid and then examined the cells for cytotoxicity. We also investigated the bactericidal, fungicidal, and virucidal effects by challenging the cells with the following microorganisms Aspergillus fumigatus, Haemophilus influenzae, Klebsiella pneumoniae, Rhizopus oryzae, Candida albicans, Methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. To study the virucidal effects of HOCl, we used the human influenza A virus to challenge the cells. Results: In the cytotoxicity assay and in the morphological examination, the cells did not show anytoxicity at 30 minute or 2 hours after treatment with HOCl. More than 99% of bactericidal or fungicidal activity was noted for all species, except for Candida albicans, in tap water at either pH 7.0 or 8.4. In addition, a 3.2-log10 reduction was achieved in cells challenged with the human influenza A virus. Conclusions: A low concentration HOCl solution can be used as an effective nasal irrigation solution. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Improved Outcomes After Low-Concentration Hypochlorous Acid Nasal Irrigation in Pediatric Chronic Sinusitis," in the April 2016 issue, is presented.