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Objective: Commonly used endoscopic grading scales, such as the nasal polyp scale, inadequately describe the degree of polyposis found postoperatively in the paranasal sinus cavities. The purpose of this study was to create a novel grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities, the Postoperative Polyp Scale (POPS). Methods: A modified Delphi method was utilized to establish the POPS using consensus opinion among 13 general otolaryngologists, rhinologists, and allergists. Postoperative endoscopy videos from 50 patients with chronic rhinosinusitis with nasal polyps were reviewed by 7 fellowship‐trained rhinologists and scored according to the POPS. Videos were rated again 1 month later by the same reviewers, and scores were assessed for test–retest and inter‐rater reliability. Results: Overall inter‐rater reliability for the first and second reviews of the 52 videos was Kf = 0.49 (95% CI 0.42–0.57) and Kf = 0.50 (95% CI 0.42–0.57) for the POPS. Intra‐rater reliability showed near‐perfect test–retest reliability for the POPS with Kf = 0.80 (95% CI 0.76–0.84). Conclusion: The POPS is an easy‐to‐use, reliable, and novel objective endoscopic grading scale that more accurately describes polyp recurrence in the postoperative state which will be useful in the future for measuring the efficacy of various medical and surgical interventions. Level of Evidence: 5 Laryngoscope, 133:2885–2890, 2023 [ABSTRACT FROM AUTHOR]

Objective: Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically-refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost-effectiveness of dupilumab versus ESS for patients with CRSwNP.Study Design: Cohort-style Markov decision-tree economic model with a 36-year time horizon.Methods: A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS-24 and SINUS-52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT-22 instrument in both cohorts. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed.Results: The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One-way sensitivity analyses showed ESS to be cost-effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855.Conclusions: The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost-effective manner.Level Of Evidence: 2C Laryngoscope, 131:E26-E33, 2021. [ABSTRACT FROM AUTHOR]

Objective: Studies have demonstrated improvement in Eustachian tube dysfunction (ETD) symptomatology after functional endoscopic sinus surgery (FESS); however, factors associated with ETD symptom alteration have not been elucidated. This study evaluated factors associated with improvement and normalization of ETD symptoms after FESS. Methods: A case‐control study was performed of FESS patients who had clinically significant ETD symptoms based on the Eustachian Tube Dysfunction Questionnaire‐7 (ETDQ‐7 ≥ 2.1) without middle ear effusion (MEE) preoperatively. Study patients were identified as those with a normalized ETDQ‐7 at 2 months postoperatively. Controls were patients whose ETDQ‐7 did not normalize at 2 months. Demographics, surgery characteristics, chronic rhinosinusitis phenotype, Lund‐Mackay score, temporomandibular joint dysfunction (TMJD), preoperative ETDQ‐7 and SNOT‐22 scores, and tympanograms were analyzed. Univariate and multivariate analyses were performed comparing study cases and controls. Results: Data were collected on 165 patients, with 46% patients having clinically significant preoperative ETD and 60 patients meeting final study inclusion/exclusion criteria. FESS was associated with both SNOT‐22 and ETDQ‐7 improvement (P < 0.001). Nasal polyposis was associated with a higher probability of ETDQ‐7 normalization (OR 4.429, P = 0.035). Factors associated with failure of ETDQ‐7 normalization included TMJD (OR 0.086, P < 0.001, 95% CI 0.019–0.391) and high preoperative ETDQ‐7 (OR 0.140, P = 0.006, 95% CI 0.032–0.613). Conclusion: In patients with clinically significant ETD symptoms without MEE, FESS was associated with ETDQ‐7 improvement. Nasal polyposis was associated with an increased probability of normalization of ETD symptoms postoperatively, whereas TMJD had a negative association. Level of Evidence: 3b Laryngoscope, 2019 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess the face, content, construct, and concurrent validity of the PHACON Sinonasal Surgery Simulator (SNSS). Study Design: Prospective cohort study. Methods: A total of 12 otolaryngology residents were recruited to perform sinonasal surgery on the simulator followed by cadaveric heads. Resident performances were recorded and de‐identified. Face and content validities were evaluated based on 5‐point Likert scale questionnaires. The recordings were evaluated by extramural expert rhinologists based on a validated Global Rating Scale (GRS). These results were analyzed and compared to assess construct and concurrent validity. Results: The appearance of anatomic structures was rated as realistic by 75% of all participants, while only 30% and 41.7% rated the mucosal and bony tissues as realistic, respectively. A total of 91.7% of participants found the model useful for teaching anatomy, while 66.7% said it was useful for teaching operative technique. Construct validity was confirmed by showing significant differences in performance between the novice and experienced groups. Concurrent validity was confirmed by showing significant correlation between performance on the model and gold standard (i.e. cadaver head). Conclusions: This study demonstrates the face, content, concurrent, and construct validity of a 3D‐printed SNSS. Although this model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents, improvements are required with respect to the quality of simulated mucosal tissue as well as the simulated anatomy of the fronto‐ethmoid compartment Level of Evidence: NA Laryngoscope, 2019 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Ear fullness and pressure is a common complaint seen in otolaryngology clinics and frequently is attributed to eustachian tube dysfunction (ETD). In addition to traditional tympanometry and physical examination, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) has recently been used to aid in the diagnosis of ETD and to assess its severity. Temporomandibular joint disorder (TMJD) is a common condition that causes similar symptoms to ETD and has been recognized as a potential confounding condition in patients presenting with ETD symptoms. We sought to determine the cross-sectional prevalence of ETD symptoms in patients with TMJD using the ETDQ-7.Study Design: Prospective cross-sectional analysis.Methods: An analysis was performed of ETDQ-7 scores in patients diagnosed with TMJD.Results: A total of 21 patients with confirmed TMJD completed the ETDQ-7 at routine consult or follow-up for their TMJD. The mean ± standard deviation ETDQ-7 score for the cohort was 24.5 ± 12.5. Two-thirds of patients had an ETDQ-7 score of >14.5, which has been used in the literature to denote clinically significant ETD. No single question was scored significantly higher than the others.Conclusions: Symptoms of ETD are highly prevalent among patients with TMJD determined by patient-reported outcome measures. It is not clear if these symptoms reflect true derangement of eustachian tube function in these patients or whether there is only clinical similarity between ETD and TMJD. However, future research efforts may resolve this dilemma.Level Of Evidence: 4 Laryngoscope, 130:E233-E236, 2020. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To compare by meta-analysis the effect of recurrent laryngeal nerve (RLN) monitoring versus RLN identification alone on true vocal fold palsy rates after thyroidectomy. Study Design: Systematic review and meta-analysis. Methods: A search of MEDLINE (1966-July 2008), EMBASE (1980-July 2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases was performed. References from retrieved articles, presentation data, and correspondence with experts was also included. All authors used a detailed list of inclusion/exclusion criteria to determine articles eligible for final inclusion. Two authors independently extracted data including study criteria, methods of vocal fold function assessment, laryngeal nerve monitor type, and surgical procedure. Odds ratios (OR) were pooled using a random-effects model. Associations with patient and operative characteristics were tested in subgroups. Results: One randomized clinical trial, seven comparative trials, and 34 case series evaluating 64,699 nerves-at-risk were included. The overall incidence of true vocal fold palsy (TVFP) was 3.52% for intraoperative nerve monitoring (IONM) versus 3.12% for nerve identification alone (ID) (OR 0.93; 95% confidence interval [CI], 0.76-1.12]. No statistically significant difference in transient TVFP (2.74% IONM vs. 2.49% ID [OR 1.07, 95% CI, 0.95-1.20]), persistent TVFP (0.75% IONM vs. 0.58% ID [OR 0.99, 95% CI, 0.79-1.23]), or unintentional RLN injury (0.12% IONM vs. 0.33% ID [OR 0.50, 95% CI, 0.15-1.75]) was found. Conclusions: This meta-analysis demonstrates no statistically significant difference in the rate of true vocal fold palsy after using intraoperative neuromonitoring versus recurrent laryngeal nerve identification alone during thyroidectomy. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to systematically review the literature and examine the safety for the use of topical vasoconstrictors in endoscopic sinus surgery. Study Design: Systematic review clinical trials. Method: A systematic literature search was performed in MEDLINE, EMBASE, The Cochrane Library, and National Guideline Clearinghouse, and references in the selected articles. Results: The search criteria captured 42 manuscripts with relevant titles. A systematic review on the topical use of phenylephrine was found; however, no other systematic review, meta-analyses, or clinical guidelines were identified. Six randomized clinical trials or comparative studies, as well as multiple case reports and review articles were also identified. The literature supports the safety of oxymetazoline and epinephrine when used judiciously in carefully selected patients undergoing endoscopic sinonasal surgery; however, topical phenylephrine is not recommended because of its risk profile. Conclusion: In sinus or nasal surgery, topical vasoconstrictors should be used in a manner that minimizes the risk of cardiovascular morbidity [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To perform a systematic pooled-data analysis of literature data involving laryngeal mucous membrane pemphigoid (MMP). Study Design: A systematic review and pooled-data analysis. Methods: We conducted a systematic literature search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the National Guideline Clearinghouse databases without language restriction for studies including combinations of relevant terms. All authors independently screened the abstracts of the search results, identified articles eligible for review, and critically appraised the full-text studies. Pooled-data analyses and Kaplan-Meier survival analyses were conducted using SPSS version 16.0 software (SPSS Inc., Chicago, IL). Results: Of the 2,524 citations reviewed, the included articles consisted of 63 case reports and 10 case series reporting on 141 patients with laryngeal MMP. No clinical trials or comparative trials were found. The overall calculated prevalence of laryngeal MMP was 12.2% (95% confidence interval [CI], 11.5-12.9%) of cases of MMP or one in 10 million persons in the general population. Mean age at laryngeal MMP onset was 59.7 years (95% CI, 57.9-61.1 years), and the supraglottis was the most commonly affected site (84.8%, 95% CI, 82.5-87.2%). Distribution among genders was equivalent ( P = .655). The presence of antiepiligrin autoantibodies was associated with increased laryngeal involvement (Odds ratio 7.9, 95% CI, 3.9-16.0). The overall 5-year relative survival rate was 92.4% (standard error, 8.4) with a follow-up range of 1 to 221 months. Standard medical therapy alone occasionally improved the condition; however, relapses were frequent, and 10.5% eventually required tracheostomy. Laryngeal surgical interventions seemed to be effective in severe cases. Conclusions: Laryngeal MMP is a rare condition that can be life threatening without proper treatment and frequent follow-up. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

The article offers information on research on imaging modality for investigating olfactory dysfunction in the setting of normal endoscopy. Olfactory dysfunction may divided into conductive and sensorineural and its examples of include sinonasal inflammatory disease and post-upper respiratory infections. Based on the studies and expert advice, the choice of imaging modality for evaluation of olfactory dysfunction patients, depends on the patient demographics and history.