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Objective: The recommended readability of health education materials is at the sixth‐grade level. Artificial intelligence (AI) large language models such as the newly released ChatGPT4 might facilitate the conversion of patient‐education materials at scale. We sought to ascertain whether online otolaryngology education materials meet recommended reading levels and whether ChatGPT4 could rewrite these materials to the sixth‐grade level. We also wished to ensure that converted materials were accurate and retained sufficient content. Methods: Seventy‐one articles from patient educational materials published online by the American Academy of Otolaryngology–Head and Neck Surgery were selected. Articles were entered into ChatGPT4 with the prompt "translate this text to a sixth‐grade reading level." Flesch Reading Ease Score (FRES) and Flesch‐Kincaid Grade Level (FKGL) were determined for each article before and after AI conversion. Each article and conversion were reviewed for factual inaccuracies, and each conversion was reviewed for content retention. Results: The 71 articles had an initial average FKGL of 11.03 and FRES of 46.79. After conversion by ChatGPT4, the average FKGL across all articles was 5.80 and FRES was 77.27. Converted materials provided enough detail for patient education with no factual errors. Discussion: We found that ChatGPT4 improved the reading accessibility of otolaryngology online patient education materials to recommended levels quickly and effectively. Implications for Practice: Physicians can determine whether their patient education materials exceed current recommended reading levels by using widely available measurement tools, and then apply AI dialogue platforms to modify materials to more accessible levels as needed. Level of Evidence: Level 5. [ABSTRACT FROM AUTHOR]

Objective: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic.Methods: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented.Results: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (P = .92).Discussion: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities.Implications For Practice: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays. [ABSTRACT FROM AUTHOR]

Objective: To determine if rapid implementation of simulation training for the nasopharyngeal swab procedure can increase provider confidence regarding procedure competency.Methods: A simulation training exercise was designed as a departmental initiative to improve competency performing nasopharyngeal swabs during the COVID-19 pandemic. Sixty-one health care workers attended teaching sessions led by the Department of Otorhinolaryngology on proper nasopharyngeal swab technique. After a brief lecture, participants practiced their swab technique using a high-fidelity airway simulation model. Pre- and postintervention self-evaluations were measured via standardized clinical competency questionnaires on a 5-point Likert scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent."Results: Forty-six participants in this study submitted pre- and postintervention self-assessments. Postintervention scores improved on average 1.41 points (95% CI, 1.10-1.73) out of 5 from a mean score of 3.13 to 4.54 (P < .0001). This reflects a large effect size with a Glass's delta value of 1.3.Discussion: Lecture coupled with simulation-based teaching can significantly improve health care workers' confidence in performing nasopharyngeal swabs. Proper training for frontline workers performing swabs for COVID-19 is essential to improving testing accuracy and can be achieved in a simple and timely manner.Implications For Practice: To meet the testing needs of the growing pandemic, many health care workers who are unfamiliar with nasopharyngeal swabs have been asked to perform this test. Simulation-based teaching sessions may improve health care workers' confidence and help prevent false-negative results. This intervention is easily reproducible in any setting where frequent nasopharyngeal swab testing occurs.Level Of Evidence/study Design: Prospective cohort study. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the strategic changes implemented in the departmental mission to continue safe delivery of otolaryngology care and to support the broader institutional mission during the COVID-19 pandemic response.Study Design: Retrospective assessment was performed to the response and management strategy developed to transform the clinical and academic enterprise.Setting: Large urban tertiary care referral center.Results: The departmental structure was reorganized along new clinical teams to effectively meet the system directives for provision of otolaryngology care and support for inpatient cases of COVID-19. A surge deployment schedule was developed to assist frontline colleagues with clinical support as needed. Outpatient otolaryngology was consolidated across the system with conversion of the majority of visits to telehealth. Operative procedures were prioritized to ensure throughput for emergent and time-critical urgent procedures. A tracheostomy protocol was developed to guide management of emergent and elective airways. Educational and research efforts were redirected to focus on otolaryngology care in the clinical context of the COVID-19 crisis.Conclusion: Emergence of the COVID-19 global health crisis has challenged delivery of otolaryngology care in an unparalleled manner. The concerns for preserving health of the workforce while ethically addressing patient career needs in a timely manner has created significant dilemmas. A proactive, thoughtful approach that reorganizes the overall departmental effort through provider and staff engagement can facilitate the ability to meet the needs of otolaryngology patients and to support the greater institutional mission to combat the pandemic. [ABSTRACT FROM AUTHOR]

Objective: To develop a clinical consensus statement on the use of balloon dilation of the eustachian tube (BDET).Methods: An expert panel of otolaryngologists was assembled with nominated representatives of general otolaryngology and relevant subspecialty societies. The target population was adults 18 years or older who are candidates for BDET because of obstructive eustachian tube dysfunction (OETD) in 1 or both ears for 3 months or longer that significantly affects quality of life or functional health status. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus.Results: After 3 iterative Delphi method surveys, 28 statements met the predefined criteria for consensus, while 28 statements did not. The clinical statements were grouped into 3 categories for the purposes of presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes.Conclusion: This panel reached consensus on several statements that clarify diagnosis and perioperative management of OETD. Lack of consensus on other statements likely reflects knowledge gaps regarding the role of BDET in managing OETD. Expert panel consensus may provide helpful information for the otolaryngologist considering the use of BDET for the management of patients with OETD. [ABSTRACT FROM AUTHOR]

Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices. Conclusion Expert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the utility of intrathecal fluorescein (IF) for intraoperative localization and successful repair of cerebrospinal fluid (CSF) leaks. Study Design: Case series with chart review. Setting: Tertiary-care medical center. Subjects and Methods: Subjects included those undergoing endoscopic CSF leak repair with or without the use of IF. Informed consent was obtained from all patients undergoing the administration of IF (total dose 10 mg). Results: A total of 103 patients underwent CSF leak repair, and in 47 cases (45.6%), IF was used. Patients who were administered IF were more likely to have spontaneous CSF leak etiology (61.7% vs 16.1%; P < 0.001). Of the 47 cases with IF use, fluorescein was visualized at the skull base in 31 cases (66.0%), 11 (23.4%) had visible CSF leak without fluorescein coloration, and five (10.6%) had neither clear nor fluorescein-colored CSF visualized. Sensitivity and specificity for fluorescein detection was 73.8 percent (95% confidence interval [CI] 57.7%-85.6%) and 100 percent (95% CI 46.3%-100%), respectively. The false-negative rate was 26.2 percent (95% CI 15.8%-43.5%). Localization of the leak site was greater when fluorescein-colored CSF was visualized (100% vs 81.3%; P = 0.035). When fluorescein-colored CSF was not visualized intraoperatively, recurrence rates were 31.3 percent versus 9.7 percent when fluorescein coloration was seen, although this finding was not statistically significant (P = 0.10). Conclusion: The use of IF facilitates the accurate localization of CSF leaks and may assist the surgeon in confirming a watertight closure. The lack of intraoperative fluorescein visualization should not rule out the presence of CSF leak, as evidenced by a false-negative rate of 26.2 percent. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate optical rhinometry (ORM) as an objective evaluation of nasal patency using nasal provocation testing with Dermatophagoides farinae (Df) as compared with acoustic rhinometry. Study Design: Prospective pilot. Setting: Academic rhinologic practice. Subjects and Methods: Five adult healthy controls and five adult subjects with allergic rhinitis (AR) underwent nasal provocation testing with increasing concentrations of Df while undergoing ORM. The minimum concentration of Df causing a positive reading was recorded. Nasal cross-sectional area was measured before and after testing using acoustic rhinometry. Nasal patency was assessed subjectively after each challenge with the visual analogue scale. Results: The median amount of Df causing a positive response on ORM was less in AR patients as compared to healthy controls, at 5000 AU/mL and greater than 10,000 AU/mL, respectively. There was a statistically significant correlation between the change in optical density in ORM and subjective nasal congestion after increasing Df challenges (r = 0.63; P = 0.0007). Similarly, there was a statistically significant correlation between change in optical density by ORM and both minimum cross-sectional areas as measured by acoustic rhinometry (r = −0.60, P = 0.03; and r = −0.64, P = 0.02, respectively). Conclusion: This is the first study to show a correlation between optical rhinometry and acoustic rhinometry during nasal provocation testing with Df. In addition, the data support a correlation of optical rhinometry to subjective symptoms of nasal congestion. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with Df. [Copyright &y& Elsevier]

Abstract: Objective: Optical rhinometry is a new method that quantifies light extinction in optical density to assess nasal blood volume as a measure of nasal patency. The purpose of this study is to evaluate optical rhinometry as an objective evaluation of nasal patency using nasal provocation testing with histamine and oxymetazoline. Study Design: Prospective pilot. Setting: Academic tertiary rhinologic practice. Subjects and Methods: Convenience sample of five adult subjects with allergic rhinitis and five adult normal subjects who underwent challenge with histamine and oxymetazoline. Patients underwent challenge with increasing concentrations of histamine to determine the amount of histamine needed to cause a positive optical rhinometry reading. The same subjects then underwent histamine challenge with this amount followed by oxymetazoline. Nasal patency was assessed subjectively after each challenge with the visual analog scale. Results: The median histamine amount needed to cause a positive response was statistically lower in allergic rhinitis as compared with nonallergic subjects at 150 μg and 300 μg, respectively (P = 0.04). When comparing the optical rhinometry with subjective nasal congestion after histamine and oxymetazoline challenges, there was a statistically significant correlation with r = 0.79 (P = 0.00003). Conclusion: This initial study demonstrates a correlation between subjective symptoms of nasal patency and objective measurements with the optical rhinometer. Less histamine amount necessary to incite nasal congestion in allergic rhinitis suggests that these patients may be primed to the effects of histamine. These preliminary data suggest that optical rhinometry is able to assess changes in nasal patency during challenges with histamine and oxymetazoline. [Copyright &y& Elsevier]

Abstract: Objective: The objectives of this study were to 1) evaluate anatomical relationships and 2) develop technical correlates for endoscopic anterior skull base (ASB) surgery. Study Design: Cadaver study. Setting: Minimally invasive surgery laboratory. Subjects and Methods: Ten adult fresh-frozen cadaver heads were dissected from December 2006 to December 2007. The endoscopic trans-cribriform, trans-ethmoid approach to the anterior cranial base was refined over these consecutive dissections. Endoscopic orientation along the ventral axis was assessed with 0°, 30°, and 70° rigid telescopes. Anatomical dimensions of the ASB window were measured in the anteroposterior (posterior table of frontal sinus to planum sphenoidale) and transverse (orbit-to-orbit) dimensions at the anterior ethmoid artery (AEA) and posterior ethmoid artery (PEA). Results: Endoscopic cadaveric dissections confirmed technical feasibility of ASB surgery and greatly enhanced understanding of ASB anatomical concepts. The 30° rigid endoscope provided the most optimal view from the frontal sinus to the planum sphenoidale with the least distortion, relative to 0° and 70° scopes. Careful identification of the AEA and PEA was requisite for proper orientation at the ASB. The posterior one third of the ASB was thickest and always required drilling for resection. The mean boundaries of the ASB window were 33.7 mm (anterior to posterior) and 23.5 and 19.1 mm at the AEA and PEA (orbit to orbit), respectively. Conclusion: This prospective cadaveric study outlined key correlates for endoscopic ASB surgery. It serves to highlight the requisite technical steps and anatomical dimensions when the trans-nasal endoscopic route is employed for ASB pathology. [Copyright &y& Elsevier]

Abstract: Objective: To characterize the endoscopic anatomy of the sphenoid sinus and the adjacent clivus and cavernous sinus, and to review patient outcomes for neoplasms in this region. Study Design: Cadaver dissection and chart review. Setting: Cadaver laboratory and tertiary care center. Subjects and Methods: Fresh-frozen cadaver heads were dissected to study the endoscopic anatomy of the sphenoclival region. Retrospective chart review of patients undergoing endoscopic resection of sphenoclival neoplasms between 2000 and 2008 was performed. Results: Transnasal endoscopic access to the sphenoid sinus was obtained in 10 cadaver heads. A clival window with mean dimensions of 1.4 cm × 1.7 cm was created. Through the clival window, identification and dissection of the basilar and vertebral arteries, mamillary bodies, third ventricle, cranial nerves III through VI, and cervical rootlets were possible. Nineteen patients with mean age of 56.2 years were treated. The most common pathologies were inverted papilloma (5), chordoma (4), squamous cell carcinoma (2), and adenoid cystic carcinoma (2). None of the patients required adjunct craniotomies. Nine patients received adjuvant therapies. Thirteen (68.4%) patients had no evidence of disease, five (26.3%) patients were alive with disease, and one (5.3%) patient died of disease at mean follow-up of 32.6 months. Conclusion: The sphenoclival region poses a significant surgical challenge given its central location at the skull base and proximity to critical structures. This study demonstrates that transnasal endoscopic access to the sphenoclival region is technically feasible and allows successful surgical extirpation of tumors with a low complication rate and acceptable patient outcomes. [Copyright &y& Elsevier]

Abstract: Rhinologic literature has historically relied on lower levels of evidence to make prescriptive recommendations for use of new technology and procedures. However, as the medical profession has moved to embrace the principles of evidence-based medicine, expectations for minimum standards of evidence have risen. The resulting high-quality efficacy outcomes data have become the linchpin of informed decision making by physicians, payers, and health care systems. While many challenges remain in this transition to higher evidence expectations, none are insurmountable. It has become the responsibility of the organized medical profession to play a role in influencing and supporting production of high-quality outcomes research. [Copyright &y& Elsevier]

Objective: The objective of this study was to review the management of paranasal sinus mucoceles with skull-base and/or orbital erosion in the endoscopic era. Study Design: A retrospective data analysis. Methods: A chart review was performed on 57 patients treated from January 2001 to March 2007. Results: The average age at the time of presentation was 50.6 years with a 1:1 male: female ratio. The most common site was the frontal sinus (54.4%), followed by frontoethmoid (29.8%) and sphenoid (8.8%). Areas of erosion included skull base (40.4%), orbit (50.9%), and both orbit and skull base (8.8%). Endoscopic drainage using image guidance was used in all 57 patients without complications. Fifty-six cases (98.2%) had a functionally patent mucocele opening with a median follow-up of 15 months. Conclusions: The endoscopic approach can be safely used for the management of mucoceles with skull-base and/or orbital erosion. Open adjunct approaches can be avoided in most cases. [Copyright &y& Elsevier]

Background: Nebulized budesonide (Pulmicort Respules, AstraZeneca, Wilmington, DE) provides control of respiratory tract inflammation in asthmatic patients. The Mucosal Atomization Device (MAD; Wolfe-Tory Medical, Salt Lake City, UT) is a novel sinonasal atomization device. Methods: Uncontrolled case series of postoperative patients with chronic rhinosinusitis (CRS) who received budesonide via MAD was performed. Results: A total of 44 patients with a mean age of 53.5 years met inclusion criteria. The average follow-up was 31.5 weeks (SD 17.55; range, 8 to 80 weeks). Overall, patient and physician global assessments demonstrated moderate to significant improvement. Average daily oral prednisone usage among patients who took systemic steroids (n = 27) was reduced from 7.96 to 1.94 mg/day without relapse of polyps, mucosal edema, and nasal discharge. Prednisone use was reduced to zero in 16 patients and reduced or stabilized in 10 other patients. Conclusion: Topical budesonide via MAD may reduce the need for systemic prednisone and improve both physician and patient global assessment scores in postoperative CRS patients. Additional investigation is warranted to exclude placebo effect, spontaneous resolution, and regression to the mean as responsible factors for the reported findings. [Copyright &y& Elsevier]

Objectives: To evaluate outcomes for patients with esthesioneuroblastoma treated at a single institution during a 25-year period. Design: Eighteen patients with pathologic diagnosis of esthesioneuroblastoma between 1980 and 2004 were retrospectively identified. Results: Two patients had Kadish A, seven had Kadish B, and nine had Kadish C disease. The mean follow-up was 71 months. Treatment regimens consisted of surgery alone (four patients), surgery followed by postoperative radiation (six patients), surgery followed by postoperative chemoradiotherapy (three patients), preoperative radiotherapy (two patients), preoperative chemoradiotherapy (one patient), chemoradiotherapy (one patient), and surgery plus chemotherapy (one patient). Surgical approaches (n = 17) consisted of 13 traditional craniofacial resections, one endoscopic-assisted cranionasal resection, and three minimally invasive endoscopic resections. The 10-year disease-specific survival was 80%. The overall recurrence-free survival at five and 10 years was 62% and 46%, respectively. Positive surgical margins and TNM staging predicted survival. Conclusion: Both endoscopic and open surgical approaches have been successful in treating a small number of esthesioneuroblastoma patients with high survival and low rate of surgical complications. [Copyright &y& Elsevier]

Objectives: 1) To compare epicutaneous testing (ET) from four skin subsites (forearm, upper arm, upper back, lower back) and 2) to compare ET to modified RAST (mRAST) for inhalant allergens. Study Design: Prospective clinical trial. Subjects and Methods: Fifty one patients underwent ET at four skin subsites and mRAST to six antigens and positive and negative controls. Results: The forearm and upper back showed best sensitivity to positive controls and all subsites demonstrated similar specificity to negative controls. The forearm and upper back demonstrated best sensitivity and specificity for most antigens. No statistically significant differences were noted for antigen sensitivity and specificity for the four subsites. ET and mRAST agreed best on D. farinae and timothy grass and least on short ragweed and dog epithelium. Conclusion: This study confirms that forearm and upper back demonstrate very good sensitivity and specificity for positive and negative controls and most tested antigens. This has important diagnostic implications for clinical practice of inhalant allergy. [Copyright &y& Elsevier]

Objective: Image fusion software creates composite images from computed tomography (CT) and magnetic resonance (MR) images. Study design and setting: CT-MR fusion studies between August 2004 to July 2005 were reviewed. CT scan images (1-mm axial) were obtained on a multi-detector CT scanner. MR images (1-mm axial) were obtained with a T1-weighted, volume acquisition technique. CT-MR fusion images were created on the Instatrak 3500 Plus or CBYON Suite. Results: A total of 25 patients had 27 CT-MR image fusion studies. CT-MR fusion accuracy was 2 mm or better. During preoperative planning and intraoperative navigation, CT-MR fusion facilitated the delineation of the anatomic relationships between the lesion and the skull base. Conclusions: CT-MR image fusion yields composite images that combine features of each component imaging modality. Image fusion, when combined with surgical navigation, further enhances potential skull base applications for minimally invasive endoscopic surgery. [Copyright &y& Elsevier]

Introduction: Topical nasal medications are frequently employed for persistent sinonasal symptoms after functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis patients. The optimal means for the delivery of these medications is unclear. In this study, the efficacy of the vertex to floor (VF) position compared to atomizer spray was evaluated in post-FESS patients. Methods: Three trials were performed: two trials in which patients maintained the VF position for 1 and 5 minutes, respectively, after nasal drop administration were compared to a third trial utilizing an atomizer spray in the upright position. Two independent observers rated the distribution of fluorescein-dyed dexamethasone drops at 5 sinonasal sites: maxillary sinus (MS), ethmoid cavity (EC), frontal recess (FR), sphenoid sinus (SS), and olfactory cleft (OC). Results: VF position consistently delivered nasal drops to the MS, EC, SS, and OC. The atomizer distributed drops to the MS, EC, SS, and FR. The greatest difference was noted with the nasal drops in the olfactory cleft in the VF position; statistical significance was achieved with ANOVA testing (P = 0.012). Student’s paired t test comparing trial 1 to 2, 1 to 3, and 2 to 3 demonstrated greater distribution in the OC at 5 minutes compared with 1 minute and spray (P = 0.042 and 0.003). Conclusions: The VF position and atomizer spray were both effective in delivery of the dexamethasone drops to the paranasal sinuses. This has significant implications for management of patients suffering from recalcitrant chronic rhinosinusitis and/or sinonasal polyposis through the delivery of topical medications to the paranasal sinuses and olfactory cleft. EBM rating: C. [Copyright &y& Elsevier]

Objective: To evaluate the diagnosis and management of isolated sphenoid sinus disease by using the current rhinologic standard of care. Study design: Retrospective chart review. Results: Fifty sequential, symptomatic patients were studied. Presenting symptoms included headache or facial pain (88%), rhinorrhea (46%), and nasal congestion (26%). All patients underwent CT imaging, demonstrating bony changes or dehiscences (42%), a mass (24%), or complete opacification of the sphenoid sinus (22%). Eighty percent required surgical intervention. The most frequent diagnoses were as follows: sinusitis (38%), fungal ball (20%), neoplasm (16%), and mucocele (12%). Treatment resulted in clinical or endoscopic improvement or resolution in 87% of the patients. Conclusion: The presenting symptoms of isolated sphenoid sinus disease can be nonspecific and may result in an inordinate delay in diagnosis. Nasal endoscopy and radiologic imaging are central to making an accurate and timely diagnosis. Medical treatment or minimally invasive surgical techniques can successfully manage the majority of patients with persistent or refractory symptoms. [Copyright &y& Elsevier]

Objective: Delineate the relationships among the optic nerve (CN II), the sphenoid sinus, and the sphenoethmoid cell. Study Design: High-resolution CT scans of 64 frozen human cadavers were obtained on a Siemens VolumeZoom CT scanner (Munich, Germany) and transferred to a CBYON Suite Doctor Station version 2.6 (CBYON, Mountain View CA) for standardized review. Results: Pneumatization around CN II was categorized into 5 types: no adjacent pneumatization (type 0), pneumatization adjacent to CN II (type 1), adjacent pneumatization with indentation (type 2), pneumatization of <50% CN II circumference (type 3), and pneumatization of >50% CN II circumference (type 4). The prevalence of types 0 to 4 CN II position relative to the sphenoid sinus was 4.7%, 25.8%, 39.8%, 14.1%, and 15.6%, respectively. The prevalence of sphenoethmoid cells was 28.1%. The prevalences of types 0, 1, 2, 3, and 4 CN II positions relative to the sphenoethmoid cell was 5.6%, 58.3%, 25%, 2.8%, and 8.3% respectively. Conclusions: Software-enabled CT review facilitated precise study of the anatomic relationships of CN II. Caution must be exercised during sinonasal surgery to minimize the risk of inadvertent CN II injury. Ebm Rating: D. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of the study was to evaluate intraoperative management of the orbit during endoscopic resection of benign and malignant sinonasal tumors. Methods: Retrospective chart review and prospective imaging assessment was performed of 215 cases managed at a tertiary care referral center between July 2009 and December 2012. Results: A total of 41 patients met predetermined criteria for inclusion. Squamous cell carcinoma (17.1%) and inverted papilloma (31.7%) were the most common malignant and benign pathologies, respectively. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) most commonly demonstrated lamina papyracea erosion (78.1%), followed by extension into the periorbita (43.9%), lacrimal system (24.4%), orbit (14.6%), and orbital apex (7.3%). Procedures performed to address orbital involvement included endoscopic resection of lamina papyracea (85.3%), dacryocystorhinostomy (DCR) (26.8%), optic nerve decompression (7.3%), and orbital exenteration (4.8%). Ophthalmologic involvement was required in 31.7% of cases; anterior orbitotomy (26.8%) and open DCR (17.1%) were the most common adjunct open procedures. Orbital complications most commonly included epiphora (7.3%) and diplopia (5.1%), with no cases of change in visual acuity or orbital hematoma. CT reliably predicted invasion of the lamina papyracea and lacrimal system (P <. 05), while MRI reliably predicted invasion of the periorbita (P <. 05). Irregular tumor margin along the periorbita on MRI was statistically significant (P <. 05) for ophthalmologic involvement. Conclusions: CT and MR imaging provide complementary information for assessment of tumor extension to the orbit. This typically requires endoscopic and adjunct open approaches for effective tumor extirpation and can be achieved safely with low rate of complications. [ABSTRACT FROM AUTHOR]

Program Description: Balloon catheter technology was introduced to otolaryngology in 2005 for management of paranasal sinus inflammatory disease. Since its introduction, it has engendered considerable controversy with proponents for and against adoption of the technology. Over time, alternate balloon devices have been advocated for office‐based sinus ostia dilatation. Balloon technology has been promoted to be less invasive resulting in reduced pain and quicker recovery, generating significant press and interest by the lay public looking for new solutions for sinonasal problems. Thus, proper vetting of the balloon devices is essential to elucidate their proper role in the surgical paradigm for management of chronic rhinosinusitis. This miniseminar will objectively evaluate the currently available operative suite and office‐based balloon catheter technology. Rhinologists with considerable experience without commercial conflicts on balloons will assess the frank advantages and limitations of the current balloon devices. Evidence‐based review will be incorporated to assess the strengths and weaknesses of the existing peer‐review literature. The potential complications unique to balloon catheters will be reviewed. The concerns of radiation exposure from fluoroscopy will be discussed. Current coding dilemmas and socioeconomic issues will also be addressed. At the conclusion of the miniseminar, participants should have a better understanding of the potential strengths and weaknesses of the balloon catheter technology in the context of management of paranasal sinus disease. This information will also serve as the foundation for better evaluation of new technologies that are introduced to our specialty. The miniseminar will be presented in a multimedia powerpoint format with video demonstrations, when applicable. Audience participation will be encouraged to stimulate discussion through the course of the miniseminar. Educational Objectives: 1) Review currently available balloon catheter technologies and to explore implications on the FESS paradigm. 2) Critically appraise the existing peer‐review literature and address potential complications and radiation exposure. 3) Assess socioeconomic implications and CPT coding issues related to balloons. [ABSTRACT FROM AUTHOR]

Program Description: Although our understanding of chronic rhinosinusitis (CRS) has improved, patients prove to be a diagnostic and therapeutic challenge. The variability in presentation contributes to the difficulty in providing effective medical and/or surgical therapy for each patient, and straightforward, all‐encompassing guidelines are lacking. As more innovative treatments arise, choices available to otolaryngologists become overwhelming. The purpose of this miniseminar is to provide a stepwise approach to the overall management of CRS patients. The panelists will cover aspects of patient care including evaluation and diagnosis, tailored medical management, surgical choice and optimization, and postoperative management. Educational Objectives: (1) Evaluate patients presenting with CRS and provide medical/surgical management recommendations for specific categories of CRS. (2) Discuss methods for improving surgical outcomes and recommend appropriate use of surgical devices/products for CRS. (3) Provide recommendations for effective postoperative management, use of subsequent in‐office procedures, and continued medical treatments for CRS. [ABSTRACT FROM AUTHOR]

Program Description: There are significant technological advances occurring in different otolaryngology subspecialties. In addition, there are many opportunities for cross‐pollenization of ideas to envision novel ways to use these technologies. In this miniseminar, the participant will learn about novel technologies being applied in a selected number of technology‐heavy areas of otolaryngology. The panel and audience will engage in an interactive discussion about the different technologies and where else these could be employed or changed to solve other clinical problems. Topics include intraoperative computed tomography advances, vascular injury and control, frontiers in robotic surgery, computer‐assisted surgery, middle ear gels, 3‐dimensional printing, and biomaterials. Educational Objectives: (1) Discuss new technologies being applied in different fields within otolaryngology. (2) Review where these technologies have inherent strengths and limits in their current application. (3) Synthesize new and unique applications for these technologies in otolaryngology. [ABSTRACT FROM AUTHOR]