Search

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is associated with a significant disease burden. The optimal use of and administration route for intranasal corticosteroids (INCS) when managing CRSwNP are unclear.We systematically synthesized the evidence addressing INCS for CRSwNP.We searched studies archived in Medline, Embase, and Central from database inception until September 1, 2021, for randomized controlled trials comparing INCS using any delivery method to placebo or other INCS administration types. Paired reviewers screened records, abstracted data, and rated risk of bias (CLARITY revision of Cochrane Risk of Bias version 1 tool) independently and in duplicate. We synthesized the evidence for each outcome using random effects network meta-analyses. We critically appraised the evidence following the GRADE (Grades of Recommendation Assessment, Development, and Evaluation) approach.We analyzed 61 randomized controlled trials (7176 participants, 8 interventions). Sinusitis-related quality of life might improve with INCS rinse (mean difference [MD] -6.83, 95% confidence interval [CI] -11.94 to -1.71) and exhalation delivery system (EDS) (MD -7.86, 95% CI -14.64 to -1.08) compared to placebo (both low certainty evidence). Nasal obstruction symptoms are likely improved when receiving INCS via stent/dressing (MD -0.31, 95% CI -0.54 to -0.08), spray (MD -0.51, 95% CI -0.61 to -0.41), and EDS (MD -0.35, 95% CI -0.51 to -0.18) (all moderate to high certainty) compared to placebo. We found no important differences in adverse effects among interventions (moderate certainty for INCS spray, very low to low certainty for others).Multiple delivery forms of INCS are viable therapeutic options for CRSwNP, resulting in improvement of patient-important outcomes. INCS via stent, spray, and EDS appear to be beneficial across the widest range of considered outcomes.

The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), latest version EPOS2020, and the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS), latest version ICAR-RS-2021, assimilate thousands of articles on the topic of rhinosinusitis. Encompassing scores of subtopics and relying on the perspectives of many international experts, EPOS2020 and ICAR-RS-2021 reduce the existing data into consumable formats and create evidence-based recommendations. The approaches and findings are similar in many respects but have significant differences. This clinical commentary, authored by some of the principal authors of these documents, compares and contrasts EPOS2020 and ICAR-RS-2021, examining methodology, diagnostic and treatment recommendations, and each document's emphases. This commentary demonstrates that, through somewhat differing methodologies, the 2 documents arrive at largely similar conclusions. Those who care for patients suffering from rhinosinusitis will find the documents complementary and valuable in their differences as much as in their similarities.

The article reviews the anatomy and imaging evaluation of the sellar and parasellar regions. Both common and uncommon sellar and suprasellar masses are reviewed, focusing on a systematic approach to analysis and when appropriate, differential creation.

This article defines chronic rhinosinusitis (CRS) and shares contemporary principles for its diagnosis and management, focusing on practical considerations for rhinoplasty surgeons. Nasal obstruction, the most common symptom of CRS, is frequently the chief complaint of patients seeking functional rhinoplasty surgery. Because correcting sites of anatomic obstruction to nasal airflow alone is unlikely to adequately treat CRS, rhinoplasty surgeons must have a firm understanding of the origin, diagnosis, and management of this disease process. With no single cause identified, CRS is likely an umbrella diagnosis or syndrome encompassing numerous causative factors, with the common end point of chronic sinonasal inflammation.

Epistaxis is a common occurrence. The estimated lifetime incidence of epistaxis is approximately 60% and it ranges in severity from a minor nuisance to a life-threatening hemorrhage. Evaluation of recurrent or severe cases includes a search for underlying causes, such as bleeding disorders and neoplasia. Many techniques, materials, and procedures treat nasal bleeding effectively and sometimes more than one treatment must be used. Otolaryngologists must be prepared to deal with severe or refractory bleeding through the use of medications, packing materials, and radiologic or surgical interventions. This article reviews nasal vascular anatomy, common causes of epistaxis, and treatments, including biomaterials and minimally invasive surgical techniques.

Successful outcomes in rhinologic surgery require careful endoscopic interventions, not only in the operating room, but also in the perioperative setting. In particular, meticulous postoperative care is essential to successful outcomes. This article reviews aspects of wound healing and perioperative care that can optimize surgical patency and clinical outcome.

The chemical senses of taste and smell are important to survival and quality of life. Both senses rely on the binding of odorant molecules to receptors located on the receptor cells. Olfaction and gustation have complex systems of coding, but they display differing methods for coding the receptor stimulus. Both have numerous central projections that allow for the perception and interpretation of these important sensory inputs.

Image-guided surgery (IGS) of the paranasal sinuses has steadily grown as an important tool in the rhinologist’s armamentarium. In a relatively short time IGS has evolved from a novelty, with limited use, into a technology with broad applications in the fields of rhinology and minimally invasive skull base surgery. As a result of this rapid advance in technology, many issues have surfaced that present challenges to the universal application of this technology. There remains a learning curve for the user to master, and decreased surgical complications and improved patient outcomes with the use of IGS have yet to be clearly established. Moreover, the large capital investment required makes economic justification illusive, and issues of standard of care remain unresolved and acutely debated. Thus, despite the increasing availability of image-guidance systems, the proper role of this new technology remains to be defined. Nonetheless, IGS of the sinuses and skull base seems have become an important adjunctive tool, and its future growth seems certain. This article reviews these issues as they pertain to the current and future use of IGS in the field of rhinology.

Frontal sinusitis following functional endoscopic sinus surgery may represent persistent, recurrent, or iatrogenic disease. The narrow frontal recess is unforgiving of technical errors, and surgery within its confines requires ample training, skill, and patience. Revision surgery in this area, compromised by scarring and long-standing mucosal disease, demands even more of the endoscopic sinus surgeon. While successful treatment of this condition is a formidable task, strict attention to principles of proper medical and surgical therapy can increase the chances of a favorable outcome.

Several options exist for the treatment of posterior epistaxis, ranging from posterior packing through transantral internal maxillary artery ligation to endovascular embolization. As otolaryngologists have become increasingly familiar and comfortable with nasal endoscopy, the range of techniques performed by using this tool has expanded. This expansion has recently encompassed the treatment of posterior epistaxis by using endoscopic ligation of the sphenopalatine artery. This technique is readily mastered by the experienced rhinologic surgeon and provides prompt and successful treatment of posterior epistaxis. The anatomic landmarks will be described, and the technique and its results presented.