Search

Objective: To study the long-term outcomes of pediatric chronic rhinosinusitis (CRS) after surgical treatment. Methods: Cross-sectional survey of patients who were treated surgically for CRS as children more than 10 years ago. Survey included SNOT-22 questionnaire, additional functional endoscopic sinus surgery (FESS) since last treatment, status of allergic rhinitis and asthma, and availability of any CT scan sinus/face for review. Results: About 332 patients were contacted by phone or email. Seventy-three patients filled the survey (22.5% response rate). Current age was 26 years (±+/−4.7, 15.3-37.8 years). Age at initial treatment was 6.8 years (+/−3.1, 1.7-14.7 years). Fifty-two patients (71.2%) had FESS and adenoidectomy, and 21 patients (28.8%) had adenoidectomy only. Follow-up since surgical treatment was 19.3 years (+/−4.1). SNOT-22 score was 34.5 (+/−22.2). None of the patients had any additional FESS for the duration of the follow-up, and only 3 patients had septoplasty and inferior turbinoplasty as adults. Twenty-four patients had CT scan sinuses/face available for review. Scans were obtained at an average of 14 years after surgical intervention (+/−5.2). CT LM score was 0.9 (+/−1.9), compared to 9.3 at time of their surgery (+/−5.9) (P <.0001). Currently 45.8% and 36.9% of patients have asthma and AR, compared to 35.6% and 40.6% respectively as kids (P =.897 and P =.167). Conclusion: Children who had surgery for CRS do not seem to have CRS as adults. However, patients continue to have active allergic rhinitis that may affect their quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Endovascular embolization has emerged as an effective treatment for intractable epistaxis. This systematic review and meta-analysis aimed to calculate the rates of success, rebleeds, and complications and to identify the etiologies and complications of patients who undergo endovascular embolization. Methods: This systematic review and meta-analysis was conducted per the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were extracted from Scopus, PubMed, Web of Science, and Cochrane Central and were filtered by a systematic review process using Rayyan software. A random-effects model was used to quantify the rates success, rebleeds, and complications. Results: Forty-two studies were included, totaling 1660 patients. The pooled success rate was 89% (95% confidence interval [CI] 86%-92%) and the pooled rebleed rate was 19% (95% CI 16%-22%). The pooled minor complication rate was 18% (95% CI 11%-27%). The most common major complication was soft tissue necrosis followed by stroke. The most common minor complication was facial pain. No minor complications were reported to be permanent. Of the patients who failed initial embolization, 42% underwent repeat embolization and 34% underwent surgical arterial ligation. Conclusions: Endovascular embolization is an effective treatment for intractable epistaxis. The decision to perform embolization should be carefully weighed given the rare but significant major complications. [ABSTRACT FROM AUTHOR]

The article describes the case of anterior glottic web development in a 68-year-old femald with a past medical history of Arnold-Chiari malformation and interstitial cystitis after bioenzyme aspiration. Topics discussed include observation on the anterior glottic web during the procedure, conditions that could initiate an inflammatory response leading to the formation of a glottic web, and improvement in voice strength and quality of the patient after surgery.

Career and technical education courses, funded by a 2018 re-authorization known as the Strengthening Career and Technical Education for the 21st Century Act, provide an ideal opportunity for the advancement of science, technology, engineering, and mathematics (STEM) careers in the United States. The article takes a close look at the conditions and implications of the re-authorized "Perkins V" for the advancement and promotion of career and technical education courses among tribal communities. [ABSTRACT FROM AUTHOR]

When medical authors set out to make sense of the life around them, they are also familiar with death and how it can scupper one's dreams. This article looks at two medical doctors, one at the end of his life and the other at the start of his career and delves into their hopes and anxieties. Orlovich is an optimist while Al Achkar makes his hay for when the sun stops shining. They are both determined to make the world a better place. They reach out and share their stories and insight. The two come across as rays of sunlight against the stubborn night around them. [ABSTRACT FROM AUTHOR]

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.