Rhinology Practice Research Articles

Switching biologics in chronic rhinosinusitis with nasal polyps: A multicenter Canadian experience.

Type 2 biologics have been used increasingly for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). However, patterns of biologic switching are understudied, and established guidelines for sequential or simultaneous use do not yet exist. This is a Canadian multicenter retrospective study of real-world patient data. Patients were included if they had recurrent CRSwNP despite maximal medical and surgical management, and received at least one dose of a type 2 biologic. Patients who remained on their initial biologic comprised the continuous group. Patients with sequential or simultaneous use of more than one biologic comprised the switched group. We compared the characteristics of patients who continued and switched biologics. Note that 225 consecutive patients were included. Thirty-six (16%) switched biologics at least once, and six (3%) switched twice. The most common switch was from mepolizumab to dupilumab, with poor control of CRSwNP symptoms being the leading cause for this switch. Lack of efficacy was the main reason for switching off mepolizumab and omalizumab, while adverse events were the leading cause for switching off dupilumab. Additionally, mepolizumab patients were more likely to switch biologics late in their treatment, while dupilumab patients rarely switched after 12 months of therapy (p-value<0.001). Switching biologics for CRSwNP is frequent in Canadian rhinology practices, with 16% of patients switching at least once. The most common switch is from mepolizumab to dupilumab with inadequate CRSwNP control driving this switch. This study may help guide sequential or simultaneous use of biologics in CRSwNP patients.

Rhinomanometry: A Comprehensive Review of Its Applications and Advancements in Rhinology Practice.

Rhinomanometry is a pivotal diagnostic technique in rhinology, providing a quantitative assessment of nasal airflow and resistance. This review comprehensively examines the historical development, principlesand clinical applications of rhinomanometry, emphasising its role in diagnosing nasal obstructions, preoperative evaluationsand monitoring therapeutic outcomes. Recent advancements, including the integration with imaging technologies and the application of artificial intelligence (AI), have significantly enhanced the accuracy and utility of rhinomanometry. Despite facing challenges such as technical limitations and the need for standardisation, rhinomanometry remains an invaluable tool in both clinical and research settings. The review also explores future directions, highlighting the potential for device miniaturisation, telemedicine integration, personalised protocolsand collaborative research efforts. These advancements will likely expand the accessibility, accuracyand clinical relevance of rhinomanometry, solidifying its importance in the ongoing evolution of rhinology practice.

Multi-Institutional Analysis of Insurance Denial Patterns Within Rhinology.

Obtaining insurance approval is a necessary component of healthcare in the United States and denials of these claims have been estimated to result in a loss of 3% to 5% of revenue. Examine the trends in insurance denials for rhinological procedures. A retrospective review of deidentified financial data of patients who were treated by participating physicians across 3 institutions from January 1, 2021, to June 30, 2023. The data was queried for rhinological and non-rhinological procedures via CPT codes. Cumulative insurance denials were calculated and stratified by procedure and insurance type. Write-offs were dollar amounts associated with final denials. A sample of 102,984 procedures and visits revealed a final denial rate between 2.2% and 2.9% across institutions (p = .72). The top three rhinological procedures for final write-offs were: nasal endoscopy (16.24%, $111,836.87), nasal debridement or polypectomy (6.48%, $79,457.51), and destruction of intranasal lesion (2.11%, $56,932.20). The write-off percentage for each procedure was highest among commercial insurance payers as opposed to Medicare or Medicaid. Final denial rates of rhinology procedures ranged between 2% and 3%. Common procedures such as nasal endoscopy and nasal debridement are among the highest written-off procedures. Insurance denials can lead to notable revenue loss. Rhinology practices must continue to remain knowledgeable of the changes and effects of insurance reimbursement on their practice.

Multidisciplinary Decision-Making-ITAlian Consensus After Two Years of Real Practice on the Management of Severe Uncontrolled CRSwNP by Biologics (ITACA Study).

We aimed to reach an Italian multidisciplinary consensus on some crucial aspects of treatment decision making in CRSwNP, following 2years of clinical experience in order to support specialists in the management of CRSwNP in clinical practice. We addressed issues relating to therapeutic decision-making and shared criteria for the treatment choice, as well as appropriate timing and criteria for evaluating treatment response, and highlighted the need for repeated multidisciplinary assessments. A national survey has been conducted recently to understand how rhinology practice has changed in Italy with the advent of biologics and how this affects patients with uncontrolled, severe CRSwNP. Despite the many published consensus documents, practical recommendations, and protocols on the use of biologics in CRSwNP, heterogenous behaviors in practice are still observed mainly conditioned by the novelty of the topic. The consensus procedure followed a modified Delphi approach. The scientific board included 18 otorhinolaryngologists and 8 allergists, who selected the 4 main topics to be addressed and developed overall 20 statements. Consensus on these statements was sought by a larger group of 48 additional experts, through two rounds of voting, the first web-based, the second in presence with discussion and possible refinement of the statements. The statements reaching an average score ≥ 7 at the second voting round were approved. Five statements were proposed for each of the following topics: baseline evaluation of patients eligible for biologic therapy; choice between different therapeutic options; assessment of the response to biologic treatment; multidisciplinary management. At the first voting round, 19 out of the 20 statements reached a mean score ≥ 7. Following the discussion and a few consequent amendments, at the second round of voting all the 20 statements were approved.

Unique clinical and prognostic behavior of patients diagnosed with combined exophytic and inverted papilloma histologic subtype.

To evaluate the clinical and prognostic behaviors of sinonasal papillomas. Patients diagnosed with sinonasal papilloma were reviewed between 2001 and 2016 at a tertiary rhinology practice. Using pathology-specific electronic medical record software, patients diagnosed with sinonasal papilloma were identified. Four subcategories of this lesion were identified: inverting (IP), exophytic (EP) oncocytic (OP) and inverting + exophytic (IP + EP) papillomas. A total of 107 patients were identified with unique sinonasal papilloma diagnoses. Of these, the majority were diagnosed with IP (87, 81.3%). The subpopulation of patients co-diagnosed with IP and EP (IP + EP) was unique with respect to clinical presentation and prognosis relative to both the IP and EP alone populations. IP + EP patients (5, 4.7%) were older with an average age of 75.25 years compared to 45 (EP) and 55.26 (IP), p < .0001. IP + EP patients more often presented with epistaxis (60%) compared to 33.3% (EP) and 4.6% (IP). Finally, all IP + EP patients had at least one recurrence of their disease, compared to 33.3% (EP) and 28.5% (IP). Each histopathologic subtype of sinonasal papilloma has unique clinical characteristics and recurrence rates after surgical resection. The subpopulation of patients diagnosed with IP + EP tends to be older, more likely to present with epistaxis, and more likely to recur. Additional investigation and analysis of this subpopulation is warranted. 4.

Validation and cross-cultural adaptation of the Arabic version of the self-reported mini olfactory questionnaire (Self-MOQ).

A simple self-assessment screening questionnaire for olfactory dysfunction is direly needed in Rhinology practice, and this questionnaire should be accessible to affected individuals. The self-reported mini olfactory questionnaire (Self-MOQ), constructed to fill this gap, could be an important tool, especially in the era of telemedicine. The aim of this study was to assess the validity and reliability of the Arabic version of the self-reported mini olfactory questionnaire (Self-MOQ) in patients with olfactory dysfunction. This cross-sectional study included all adult patients who visited a rhinology clinic between January and June 2023 with a complaint of olfactory dysfunction and a control group. The participants completed a questionnaire that included items on demographics, risk factors of olfactory dysfunction, the olfaction VAS, SNOT-22, and Arabic Self-MOQ. The Self-MOQ was forward- and back-translated by qualified professional translators familiar with American English and Arabic.The reliability of the Arabic Self-MOQ was evaluated using Cronbach's α. The test-retest reliability was assessed by estimating the intraclass correlation coefficient (ICC) for the total Arabic Self-MOQ score and the individual items. The discriminative ability was examined by comparing the scores of the case and control groups. The construct validity was assessed by comparing the Arabic Self-MOQ to the olfaction VAS. The study sample included 307 respondents (196 cases and 111 controls; 34 undertook the retest). The Cronbach's α coefficients were 0.92 (total Self-MOQ) and considered excellent. The ICC for the total Self-MOQ score was 0.87 (95% CI: 0.757, 0.933; p < .001), which indicated good test-retest reliability. Strong correlations were observed between the Self-MOQ items and VAS scores (r = 0.732, p < .001), (r = 0.689, p < .001). The current investigation showed the Arabic version of the Self-MOQ to be a reliable tool for olfactory dysfunction screening.

Topical anaesthesia and decongestion in rhinology.

Topical anaesthesia and decongestion of the sinonasal mucosa are used commonly in rhinology practice to facilitate nasal endoscopy, as well as debridement and biopsies. Topical agents used for sinonasal anaesthesia include lignocaine, tetracaine and cocaine. Unlike lignocaine and tetracaine, cocaine also has a decongestant effect. Phenylephrine, oxymetazoline, xylometazoline or adrenaline are usually added to lignocaine and tetracaine to provide decongestion. Several studies have been performed seeking to identify the optimal nasal preparation for nasal endoscopy in the clinic setting. However, there remains no clear consensus in the literature resulting in ongoing wide variation between anaesthetic-decongestant preparations used in clinical practice. Indeed, some authors have argued that no anaesthetic is required at all for flexible nasendoscopy despite the apparent consensus that nasal instrumentation is generally uncomfortable, inferred by the persistence of ongoing research in this area. This review provides a practical summary of local anaesthetic and decongestant pharmacology as it relates to rhinologic practice and summarises the literature to date, with the goal of identifying current gaps in the literature and guiding future research efforts.

Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics.

We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.

Direct impact of the COVID-19 pandemic on rhinology practice.

The pandemic caused an increase in computed tomography imaging in patients with sinusitis, which persisted post-COVID. Nasal endoscopies significantly decreased during COVID but returned to pre-COVID levels in 2022. The management of cerebrospinal fluid leaks, tumors, and orbital pathology was not impacted by the pandemic.

Clinical outcomes of dupilumab therapy in chronic rhinosinusitis with nasal polyps in a Canadian tertiary care rhinology practice

BackgroundIn 2020, dupilumab became the first monoclonal antibody therapy to be approved by Health Canada for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP). The primary aim of this study was to characterize the outcomes in an initial cohort of patients with CRSwNP who have undergone dupilumab therapy.MethodsA retrospective study was conducted of patients with CRSwNP who were treated with dupilumab. Demographic information, comorbidities, number of previous surgeries, and insurance information were collected. The primary outcome were changes in the sinonasal outcome test (SNOT-22) scores from baseline to timepoints after receiving dupilumab.ResultsForty-eight patients were considered for dupilumab therapy, and 27 (56%) received coverage or were able to fund the medication independently. Patients waited an average of 3.6 months to obtain access to the medication. The mean age of the patients was 43. Forty-one percent (11/27) of patients had aspirin exacerbated respiratory disease, and 96% (26/27) had a diagnosis of asthma. The mean length of time on dupilumab was 12.1 months. The baseline SNOT-22 score was 60.6. The mean decrease at 1 month, 3 months, 6 months, and 12 months after starting dupilumab was 8.8, 26.5, 42.8, and 33.8, respectively. There were no serious adverse events.ConclusionPatients treated with dupilumab in a Canadian tertiary care rhinology clinic demonstrated substantial clinical improvement as measured by disease-specific sinonasal outcomes. Further studies are needed to determine the longer-term effectiveness and adverse event profile of this novel therapy.

Sinonasal Complications Following the Sinus Lift Procedure.

Background: Although the incidence of postoperative acute and chronic rhinosinusitis in patients undergoing a sinus lift procedure is relatively high, a paucity of rhinology literature examines the management of and outcomes for this patient population. The objective of this study was to review the management and postoperative care of sinonasal complications and identify possible risk factors that should be considered prior to and following sinus augmentation. Methods: We identified sequential patients who had undergone a sinus lift procedure and were referred to the senior author (AK) at a tertiary rhinology practice for intractable sinonasal complications and reviewed their charts for demographic data, history of illness including prereferral treatment, examination findings, imaging results, treatment modalities, and culture results. Results: Nine patients were initially treated medically without improvement and subsequently underwent endoscopic sinus surgery. The sinus lift graft material remained intact in 7 patients. Two patients had extrusion of the graft material into the facial soft tissues, resulting in facial cellulitis requiring graft removal and debridement. Seven of the 9 patients had predisposing factors that could have prompted referral to an otolaryngologist for optimization prior to sinus lifting. The mean follow-up was 10 months, and all patients had full resolution of symptoms. Conclusion: Acute and chronic rhinosinusitis is a complication of the sinus lift procedure and is more commonly seen in patients with preexisting sinus disease, anatomic sinonasal obstruction, and Schneiderian membrane perforation. Preoperative evaluation by an otolaryngologist may improve outcomes in patients at risk of sinonasal complications from sinus lift surgery.

Impact of COVID 19 on Rhinology Practice: The Way Forward

Introduction COVID-19 has been labelled as pandemic that has spread across many countries in 2020. Otorhinolaryngologists are considered high risk for contracting disease, as the virus resides in the nasal cavity,nasopharynx, and oropharynx. There is an urgent need of safety measures regarding rhinologic practice that need to be clarified both for the current epidemic as well as for future expected “waves”. In this study significant decline was seen in patients viewed physically during pandemic. Nasal endoscopy also became rarer with maximum rhinologists preferring RTPCR before any procedure. Imaging was substituted for endoscopy frequently to adhere to safety protocols relating to OPD rhinologic procedures. We need to discuss these aspects of rhinology as well as practical concerns relating to telemedicine, as these issues take on increasing importance for Rhinologists both in the present and the future. Material and Methods A 27 question survey was designed to assess the present scenario of rhinology practise. The survey was electronically transmitted to rhinologists from 1st November 2020 and their responses were recorded. Result A total of 117 rhinologists responded to the survey. There was significant drop in the number of patients seen by each specialist in the Covid era. There was significant reduction in the number of diagnostic nasal endoscopies performed in clinic daily by the specialists. This study provides an overview of how the COVID-19 pandemic has affected Rhinologic practice. Conclusion Rhinologists need to develop standardized guidelines for their practise. These include protocols pertinent to safety, the substitution of imaging for endoscopy when appropriate, RTPCR test prior to rhinologic procedures, donning of proper PPE and liberal use of telemedicine.

Optimizing dacryocystorhinostomy success in a "low-dacryocystorhinostomy volume" rhinology practice.

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Effectiveness of Preemptive Chlorhexidine Digluconate-Flurbiprofen Spray on Postoperative Sore Throat and Hoarseness in Patients Undergoing Rhinoplasty: A Retrospective Study

BackgroundIn this retrospective study, we aimed to investigate the effect of chlorhexidine digluconate-flurbiprofen spray (Klorhex Plus® oral spray) on postoperative sore throat (POST) and hoarseness (POH) in patients undergoing rhinoplasty.MethodologyPatients who underwent rhinoplasty alone in our clinic between April 01, 2021, and February 28, 2022, were enrolled in the study. Patients’ demographics such as age, gender, height, and smoking status that could affect sore throat, difficult intubation, and operation time were recorded from the patients’ files. Patients were grouped as those who received Klorhex Plus oral spray before the surgery (Klorhex P group) and those who did not (control group). POST and POH were recorded from the patients’ postoperative surgery files. Postoperative pain evaluation was performed using the Numerical Rating Scale (NRS) at the postoperative first hour (PPL1h), 12th hour (PPL12h), and first day (PPL1d) from the postoperative nursing files.ResultsA total of 354 patients who underwent rhinoplasty alone were included in this study. No significant difference was found between the groups in terms of the demographic data. Statistically, PPL1h, PPL12h, and PPL1d were significantly lower in the Klorhex P group compared to the control group (for all, p < 0.001). POST and POH were also significantly higher in the control group (both, p < 0.001).ConclusionsThe results of this study indicate that Klorhex Plus oral spray is an efficient agent for preemptive analgesia before rhinoplasty. It significantly decreases the postoperative pain level, POST, and POH. However, further comprehensive prospective studies are needed to introduce Klorhex Plus oral spray to rhinology practice.

Assessment of the Current Rhinology Workforce in Saudi Arabia

Introduction: Workforce planning is a relatively new approach to identify the supply and demand of labor. The goal of workforce planning is to identify talent surpluses and shortages, project future needs, and facilitate matching training decisions. Methods: An online survey was sent to otolaryngologists with a high volume of rhinology practice. Results: Twenty-nine surgeons participated in the survey. All respondents had completed a rhinology fellowship and 20% practiced exclusively rhinology. The majority of surgeons reported &lt;5 days of access to the operative room. More than 50% of surgeons reported having access to image-guided surgery. According to 65% of respondents, the number of surgeons practicing rhinology in Saudi Arabia is adequate. Overall, 62% of respondents were satisfied with their careers. Conclusion: The outcomes from this survey provided the necessary information required for rhinology physicians workforce modeling and allow us to begin strategically planning for Saudi Arabia's future rhinology needs and local fellowship requirements.

The Role of Preemptive Infiltration Anesthesia in the Management of Postoperative Pain Following Septoplasty.

Introduction Septoplasty is one of the most common surgical procedures in rhinology practice. Two major problems encountered after septoplasty are pain and bleeding. Preoperative administration of analgesics before the surgical stimulus, which is the main concept of preemptive analgesia, decreases postoperative pain. Objective The present study was designed to investigate whether preincisional lidocaine infiltration to the subperichondrial area during septoplasty surgery reduced or not postoperative pain and analgesic use. Methods The present prospective, randomized, placebo controlled, double-blind trial was conducted on 64 consecutive patients with nasal septum deviation. Patients were randomly divided into 2 groups; the study group received 2% 20 mg lidocaine/cc ( n = 31), and the control group received 6 cc 0.9% NaCl ( n = 33). A standard questionnaire was given to each patient to mark his or her pain score between 0 and 10 at the 1 st , 3 rd , 6 th , 12 th , and 24 th hours. Results The mean and the range of visual analogue scale (VAS) scores of the patients in the study group at the 1 st , 3 rd , 12 th , and 24 th hours were 4.03 ± 3.08 (0-10); 3.42 ± 2.39 (0-8); 2.97 ± 2.22 (0-8); 2.87 ± 2.61 (0-9); and 1.94 ± 2.06 (0-9) respectively. The mean and the range of VAS scores of the patients in the control group at the 1 st , 3 rd , 12 th , and 24 th hours were 4.12 ± 2.7 (0-10); 3.45 ± 2.4 (0-10); 2.94 ± 2.7 (0-10); 2.79 ± 2.34 (0-10); and 1.5 ± 1.8 (0-6), respectively. The statistical analysis revealed no significant difference among the groups. Conclusion The preemptive local anesthetic administration to the incision area and under the mucoperichondrial flap before septoplasty does not decrease the level of postoperative pain.

One year into the COVID‐19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

ObjectivesAs we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will emerge from the shadow of COVID‐19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery.DesignSystematic literature review.ResultsThe literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: (1) those which made an assessment as to the aerosolisation of droplets during sinus surgery, further sub‐divided into work which considered macroscopically visible droplets and that which considered smaller particles; (2) and those studies which examined the mitigation of this risk.ConclusionStudies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. While results both highlight a range of innovative adjunctive strategies and support suction as an important intervention to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery. Studies have demonstrated that close adherence to PPE use is effective in preventing COVID‐19 infection.

Impact of COVID-19 on rhinology practice: a global survey

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The impact of COVID-19 on healthcare services has resulted in significant changes in day to day practice in order to reduce the virus transmission and protect the public and the healthcare professionals. Rhinologists are at higher risk of contracting the virus as they are regularly exposed to the aerosols generated during out-patient and surgical procedures. The aim of the survey was to identify the impact of COVID-19 on various aspects of rhinology practice and the changes instituted to mitigate the risks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An anonymous email survey was developed and circulated among otolaryngologists from around the world. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 162 responses from 44 countries were included in the analysis. 63% of the respondents attended only emergent, urgent and time sensitive cases in the outpatient setting with introduction of various screening methods. Over 88% respondents were carrying out aerosol-generating procedures (AGPs) in their rhinology clinics. 67.39% respondents had not operated on any COVID-19 positive patient at the completion of the survey. Preoperative COVID testing and self-solation protocols differed as per the local hospital policy. 16 rhinologists reported a member of their team becoming positive after AGPs and 9 becoming positive after being involved in surgical procedures. Online teaching sessions were the most preferred (74.38%) mode of continued medical teaching/ training around the world.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Data analysis revealed that most rhinologists followed the suggested guidelines by various ear, nose and throat (ENT) national organisations like ENTUK, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) etc. in their practice and also provided insight into some of the deficiencies which need improvement as the pandemic continues to affect the global practice.&lt;/p&gt;

Intraoperative variations of the sphenopalatine artery between epistaxis and non-epistaxis cases: a comparative endoscopic analysis

BackgroundSevere epistaxis is one of the most common emergencies in rhinology practices. The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The current study was conducted to evaluate the endoscopic intra-operative variations of SPA between epistaxis and non-epistaxis cases. Forty consecutive patients who underwent exploration of SPA were included in the study. They were distributed into two groups depending upon the indication of SPA exploration; the epistaxis group (group A, n=25 patients, n=26 sides) and the non-epistaxis group (group B, n=15 patients, n=25 sides). Criteria of the main SPA in the two groups were compared regarding four parameters; arterial diameter, arterial adherence to the mucosa of the lower part of the basal lamella, sphenopalatine nerve bundle, and crista ethmoidalis erosion.ResultsA significant difference was found regarding the diameter of SPA between the two groups; a mean diameter of 4.2±0.64 mm was compared to 3.2±0.35 mm for group A and B, respectively (p=0.043). Moreover, a highly significant tendency was observed regarding the arterial adherence to the mucosa of the lower part of the basal lamella and sphenopalatine nerve bundle in the epistaxis group; (p≤0.01).ConclusionThese data clearly signify the importance of intraoperative identification of SPA criteria during surgical management of severe epistaxis. These criteria may help in altering the surgical decision between solely SPA and concomitant SPA/AEA cauterization.

Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis

Although oral corticosteroids are commonly prescribed following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) without nasal polyposis, there are little data to suggest that this is a beneficial practice. To assess the efficacy of oral corticosteroids following ESS in CRS without polyps. This prospective double-blinded, placebo-controlled, randomized noninferiority clinical trial conducted in a single academic tertiary rhinology practice included adults with CRS without polyps undergoing ESS. Of 81 patients recruited, 72 completed the study. Patients were randomized into 2 treatment groups: a 12-day postoperative taper of oral prednisone vs matched placebo tablets. All study patients also received a uniform 2-week postoperative regimen of oral antibiotics, fluticasone nasal spray, and saline rinses. The primary outcome measures were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Scores were compared between treatment groups at each time point using longitudinal difference between treatment groups and analyzed using 2-way, repeated measures analysis of variance. Secondary outcome measures included treatment-related adverse effects. Overall, 72 patients (mean [SD] age, 49.4 [14.9] years; 36 men, 36 women) completed the study, with 33 in the prednisone arm and 39 in the placebo arm. When comparing longitudinal differences between treatment groups, there was no clinically meaningful difference observed in SNOT-22 total (F[4254] = 1.71, η2 = 0.01 [95% CI, 0.00-0.05]) or Lund-Kennedy scores (F[4247] = 1.23, η2 = 0.02 [95% CI, 0.00-0.50]). In SNOT-22 subdomain analyses, there was no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains. However, the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4254] = 3.18, η2 = 0.05 [95% CI, 0.02-0.09]). Reported adverse effects were similar between the 2 treatment groups. In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery. Patients receiving prednisone, however, did demonstrate worse SNOT-22 psychologic subdomain scores. These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered. ClinicalTrials.gov Identifier: NCT02748070.