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Background: Nasal endoscopes have transformed and improved the safety of intranasal and transnasal surgery. The heat they can produce may, however, reach dangerous levels for surgeons. Studies have not previously assessed the temperature of the nasal endoscope light post/ocular assembly (LP/OA)—where the surgeon usually holds the endoscope. Objective: This study aims to understand the effect of different nasal endoscopes, light sources, and light cords on the LP/OA temperature. Methods: We measured the temperature at the LP/OA of various rigid nasal endoscopes at multiple time intervals over 30 minutes, as well as after turning off the light source and irrigating the LP/OA with 10 mL of saline. Results: The highest temperature recorded was 67.37°C at the LP/OA at 30 minutes, using a new light cord, older endoscope, and 184-hour xenon light bulb. In every trial, the temperature of the LP/OA continually increased until 30 minutes when the light source was turned off. Statistically significant (P <.001) temperature differences were seen in trials using the older xenon light sources. The light-emitting diode light source was significantly cooler with an older light cord regardless of the age of the scope (P =.003). Conclusion: Endoscope temperatures during sinus surgery may reach potentially dangerous levels at the LP/OA region. These temperatures may be sufficient to cause second-degree burns during normal usage. Factors associated with higher endoscope temperatures include longer times with the light source on and xenon light bulbs. [ABSTRACT FROM AUTHOR]

Objective To determine the effectiveness and safety of sialendoscopy for the treatment of juvenile recurrent parotitis (JRP). The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data Sources A comprehensive search strategy in MEDLINE, EMBASE, the Cochrane library, and Google Scholar was completed and limited to studies published in English. Relevant reference lists were reviewed. Study Selection Two independent reviewers selected prospective or retrospective studies of pediatric patients treated with interventional sialendoscopy for the management of JRP. Outcome measures included rates of successful treatment (no further episodes of parotid swelling or need for further sialendoscopy) and complications, Data Extraction Two reviewers appraised the level of evidence using the Oxford Clinical Evidence-based Medicine (OCEBM) guidelines, extracted data, and resolved discrepancies by consensus. Weighted pooled proportion, 95% confidence interval (CI), and test results for heterogeneity and publication bias are reported. Results Seven studies were included. Levels of evidence varied from OCEBM level 3 to 4. The weighted pooled proportion of success rates for no further episodes by patient (n = 120) was 73% (95% CI: 64%-82%) and by gland (n = 165) 81% (95% CI: 75%-87%). The weighted pooled proportion of success rates for no further sialendoscopy by patient was 87% (95% CI: 81%-93%). Heterogeneity was low, and publication bias was not detected. There were no major complications reported. Surgical techniques and endoscopic findings are summarized. Conclusions The results from this analysis suggest that sialendoscopy is effective and safe for the treatment of JRP and may be offered to appropriate patients. Level of Evidence NA Laryngoscope, 125:1472-1479, 2015 [ABSTRACT FROM AUTHOR]

Background: Although rare, sinogenic intracranial epidural frontal abscesses remain a serious and potentially life-threatening complication of sinusitis. Traditional therapy involves a combination of intravenous antibiotics, sinus surgery, and neurosurgical drainage through an external approach. Objective: In this report, we present a technique in which a purely endoscopic transnasal approach was used to treat both the sinusitis and the intracranial abscess. Four cases are discussed illustrating the technique and its outcomes. Methods: In all cases, endoscopic sinus surgery was performed to treat underlying sinus disease. Next, under image guidance, an endoscopic, intranasal opening through the skull base was performed for intracranial access and abscess drainage. Results: Our patients tolerated this procedure well and fully recovered with resolution of all presenting neurologic features. Conclusion: This approach may offer a safe and effective alternative to frontal craniotomy for selected cases and can result in lower postoperative morbidity than traditional approaches. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To assess the efficacy of a novel high-fidelity epistaxis simulator in teaching epistaxis management to junior otolaryngology head and neck surgery residents.Study Design: Prospective cohort study.Methods: A novel high-fidelity epistaxis task trainer was developed using a cadaver head, intravenous tubing, and a food coloring-filled saline bag to emulate blood. Learners were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis using the task trainer. Learners were videotaped attempting to pack the nose of the task trainer pre- and postintervention (verbal instruction, and practice time with task trainer). Five board-certified otolaryngologists (blinded to pre- and postintervention status) evaluated the packing technique using standardized subjective outcome measures.Results: There were 13 junior otolaryngology residents enrolled in the study. This cohort showed a statistically significant increase in global rating scores (P < 0.05) in all items measured for both packing methods.Conclusion: This novel cadaveric epistaxis simulator has been successful in teaching and the practical application of various skills in epistaxis management. This task trainer appears to confer an educational benefit in technical skills acquisition in novice learners. Further studies are needed to determine long-term skill retention. Simulation is a promising educational adjunct that effectively enhances epistaxis management skills acquisition while maximizing patient safety.Level Of Evidence: NA. Laryngoscope, 126:1501-1503, 2016. [ABSTRACT FROM AUTHOR]

Introduction: The purely endoscopic approach to sellar tumors is thought to offer improved visualization and decreased complications compared to the endoscopic assisted approach. Methods: This retrospective study was approved by the Research Ethics Board (REB) of McMaster University. Seventy-one consecutive patients who underwent sellar surgery at our institution from January 2003 to October 2005 were reviewed. 40 patients underwent an endoscopic assisted (microscope) approach, while 31 underwent a purely endoscopic approach. Populations were compared for differences in demographics, OR times, outcome measures, and complication rates. Results: The groups were demographically equivalent. The pathology was similar across both groups. Both groups had a reduction of volume and invasion post operatively. There was a trend toward greater reduction in tumour volume and a significant decrease in turnout invasion in the purely endoscopic group. Both groups demonstrated similar improvements in visual fields. The purely endoscopic group had an improvement of 0.33 axes (p<0.051 in pituitary function. Overall, complications were reduced in the purely endoscopic group. A trend toward shorter operative times (128 minutes vs 135 minutes) and length of hospital stay (3.6 days (p<0.05) vs 5.4 days) in the purely endoscopic group. Conclusion: Our purely endoscopic group demonstrated a trend, as skill and confidence increased so did the size and invasiveness of the tumours being resected. Overall, the purely endoscopic technique showed improved total tumour resection, improved pituitary function, similar visual field outcomes, less post operative complications, decreased operative times and reduced hospital stay when compared to the endoscopic assisted technique. [ABSTRACT FROM AUTHOR]

Purpose: Laryngopharyngeal reflux (LPR)--gastroesophageal reflux above the upper esophageal sphincter--is a common problem encountered by otolaryngologists. Despite consensus guidelines, the presentation, diagnosis, and treatment remain controversial. We surveyed Canadian otolaryngologists to assess current perspectives. Methods: Web-based questionnaires were e-mailed to 135 otolaryngologists. Respondents were categorized by subspecialty as head and neck (H&N) or non-H&N (rhinology, otology, laryngology, facial plastics, general and pediatric otolaryngology). Data were analyzed to determine differences in proportions between groups. Results: The response rate was 48 of 135 otolaryngologists. Symptoms considered to be strongly or moderately associated with LPR included globus sensation, excessive throat clearing, sore or burning throat, hoarseness, chronic cough, and dysphonia. The laryngoscopic signs considered strongly associated with LPR were edema, intra-arytenoid changes, and granulomata. The majority of otolaryngologists in both the H&N (12 of 15) and non-H&N groups (27 of 32) use flexible laryngoscopy for investigation and diagnosis of LPR. Proton pump inhibitors in addition to lifestyle modifications are recommended by both groups as first- and second- line therapy for an initial course of 6 to 12 weeks, with long-term therapy extended for 4 to 12 months. Conclusion: Canadian otolaryngologists do correlate specific signs and symptoms with LPR patients. This is consistent across subspecialties within the field. Flexible fibre-optic laryngoscopy is the preferred diagnostic tool. Although evidence based on randomized controlled trials has yet to demonstrate a reproducible, statistically significant improvement in LPR from medical therapy, first-line pharmacologic treatment (in addition to lifestyle changes) is generally provided as a proton pump inhibitor, with the duration of therapy being somewhat variable and less than that recommended by the current literature. [ABSTRACT FROM AUTHOR]

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The article focuses on the capability of prednisolone and valacyclovir to improve recovery of facial nerve function in patients with Bell palsy in Canada. A trial has revealed on the capability of prednisolone to reduce the time of recovery of facial nerve function in patients with Bell palsy. Other study has supported the efficiency of corticosteroid therapy and the inefficiency of the antiviral therapy.

The authors comment on a report by Langille and colleagues on the use of patient-initiated Internet searches in the setting of the obstructive sleep apnea. They offer a discussion of the Google search engine and how search engine optimization (SEO) influences the search ranking of a website. The authors also share their experience when they searched the phrase 'obstructive sleep apnea' in Google and mention the result of a search using other used terms, including 'sleep apnea,' and 'snoring.'

The article presents information on a randomized, placebo-controlled trial (RCT) which evaluated the effectiveness of prednisolone or valacyclovir in improving the recovery of facial-nerve function in patients with Bell's palsy. The trial conducted revealed that prednisolone, but not valacyclovir, reduced time to complete recovery of facial-nerve function in patients with Bell palsy. Possible causes of Bell's palsy include autoimmune processes, demyelination, and herpes simplex virus infection.

Importance: Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve., Objective: To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs)., Data Sources: EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021., Study Selection: English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review., Data Extraction and Synthesis: We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis., Main Outcomes and Measures: SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy., Results: Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting., Conclusions and Relevance: The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.

Background: Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA., Methods: A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures., Results: Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients' CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon's choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001)., Conclusion: Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.

Pediatric post-tonsillectomy analgesia continues to be highly debated and an area of active research. Tonsillectomy pain can lead to significant patient morbidity, and incur potentially avoidable healthcare costs. Moreover, the various analgesic classes, each present their own risk profiles and unique side effects when used in children post-tonsillectomy. This review delineates the clinical and pathophysiological basis for post-tonsillectomy pain, types of analgesics and their risk profiles, as well as special considerations in this clinical population and a review of alternative analgesic treatment options. This article presents a summary of recent literature and discusses evidence-based management options to aid medical and allied health professionals who may encounter these patients.

Importance: Bilateral anterior nasal packing is used after septoplasty with the goals of decreasing the risk of postoperative bleeding and adhesions. However, multiple studies caution against the use of nasal packing because of the risk of cardiopulmonary complications., Objective: To evaluate the cardiopulmonary risks associated with bilateral anterior nasal packing after septoplasty., Evidence Review: A literature review was conducted by 2 independent reviewers using EMBASE, Ovid, Medline, PubMed, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and reference list review from January 1966 to September 2012 to identify studies assessing nasal packing after septoplasty. The studies were reviewed and assigned an Oxford level of evidence grade, Detsky score, and Methodological Index for Nonrandomized Studies (MINORS) score. Data were extracted for arterial blood gases, oxygen desaturations, oxygen saturations, and adverse outcomes. Pooled estimates for randomized studies were performed when possible., Findings: Fourteen studies conducted between 1973 and 2011 were included: 2 randomized clinical trials (RCTs) with a total of 119 patients and 12 prospective observational studies with a total of 356 patients. Nine studies showed a significant change within 1 of the cardiopulmonary parameters investigated. However, there was no consistency in changes across both observational and randomized studies. Furthermore, pooled estimates for cardiopulmonary parameters were all nonsignificant: standard mean differences of the pooled results of the RCTs were 0.05 (95% CI, -0.31 to 0.41) for arterial pH, 0.08 (95% CI, -0.30 to 0.46) for Paco2, and -0.32 (95% CI, -1.28 to 0.63) for Pao2. There were no major cardiopulmonary complications after nasal packing., Conclusions and Relevance: Bilateral anterior nasal packing does not seem to cause adverse cardiopulmonary changes after septoplasty.