Rhinologic Society Research Articles

The Italian Society Indication for Rhinologists during Covid-19: Italy Phase 2.

SARS-CoV-2 is highly contagious, with a huge impact on the healthcare systems worldwide; medical staff, and rhinologists in particular, are at high risk of viral contamination. Indeed, due to the exposure of airway and mucosal surfaces and the possibility of generating aerosols, many head and neck, as well as otolaryngologic oral diagnostic, and surgical procedures are high-risk. Therefore, the Italian Rhinologic Society proposed some brief and clear indications to go through the so called “fase 2” (“phase 2”) in our country.

The SARS-CoV-2 pandemic impact on rhinology research: A survey of the American Rhinologic Society.

BackgroundThe COVID-19 pandemic has radically shifted healthcare operations within hospitals and universities across the globe. However, the effect of the COVID-19 pandemic on research endeavors and clinical trials is unclear.ObjectiveThis study investigates the impact of the COVID-19 pandemic on basic science and clinical research within the rhinology community.MethodsA cross-sectional study was designed utilizing an 8-question survey to identify changes to rhinology research. Questions evaluated the impact of the COVID-19 pandemic on administrative research support and staffing, basic science research, clinical trials and resident research involvement.ResultsSeventy-one participants responded to the survey (8.5% response rate). Most respondents noted changes in IACUC/IRB approval (faster, 33%; slower, 31%). Of those who employed laboratory personnel, 64% were able to continue staff employment with full salary. The majority of animal research and in vitro studies were halted (64% and 56%, respectively), but animal care and cell line maintenance were allowed to continue. Clinical trial enrollment was most commonly limited to COVID derived studies (51%). Forty-seven percent of respondents noted increased resident research participation.ConclusionThe rapid spread of the SARS-CoV-2 virus has markedly impacted rhinology-related research. Maintaining safe workplace practices as restrictions are lifted will hopefully mitigate the spread of the virus and allow research productivity to resume.

Nasal Packs for Epistaxis: Predictors of Success

To investigate factors affecting the haemostatic success of non-dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED). Prospective cohort study. A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30-day period. Patients 16years or older, presenting to the ED with acute epistaxis managed with non-dissolvable intranasal packs. The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology. A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21hours) were more successful than shorter-duration packs (89.9% vs. 84.3%, χ2 P=.028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR)=2.3; 95% Confidence Interval (CI)=1.4-3.8), alongside ischaemic heart disease (OR=1.9; 95% CI=1.1-3.3), normal admission haemoglobin (OR=2.0; 95% CI=1.2-3.4) and no attempt at cautery following pack removal (OR=2.5; 95% CI=1.4-4.2). The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24hours. Further work is needed to explore alternatives to non-dissolvable intranasal packs to improve patient experience in epistaxis.

Incorporation of telemedicine by rhinologists: The COVID-19 pandemic and beyond.

ObjectivesThe current analysis queries rhinologists' attitudes about the use of telemedicine, including the degree to which it has impacted practice patterns during the COVID-19 pandemic. Our objective was to survey rhinologists and understand the extent to which telemedicine serves as a rejoinder to in-person consultation: appreciation of relevant factors may be important in planning for present and future considerations.MethodsA 14-question anonymous survey sent out to the American Rhinologic Society (ARS) membership in April 2020. It included demographic factors and detailed questions examining the extent of telemedicine use. Numerous topics including the degree of use, satisfaction with services, and utility of services were evaluated.ResultsThere were 134 respondents. Most reported seeing ≤30% of typical in-person volume, with 14.8% not seeing any patients at all. 88.1% used telemedicine; 82.0% reported some level of satisfaction with telemedicine. The vast majority utilized platforms employing audio and video (83.3%), and a plurality reported spending 5–15 min on calls. Numerous reasons were cited for the use of telemedicine, including significant public health benefits amid the crisis (89.7%). Only 12.0% of respondents reported using telemedicine for hospital consultation.ConclusionRhinologists have embraced telemedicine during the COVID-19 pandemic in an attempt to improve accessibility, patient satisfaction, and revenue stream. When utilized appropriately, this technology obviates the need for seeing at-risk patients and performing procedures such as nasal endoscopy. Only a minority of rhinologists was dissatisfied, viewing this as a temporary fix during the pandemic.

The novel corona virus and rhinology: Impact on practice patterns and future directions.

ObjectivesTo evaluate the impact of the novel coronavirus pandemic on practice patterns, clinical behavior, personal health, and emotional/psychological concerns of rhinologists.MethodsA 15-question survey was sent out to the American Rhinologic Society's (ARS) membership to determine the impact of COVID-19 during the crisis. Demographic factors and practice patterns were collected and evaluated.ResultsThere were 224 total respondents out of 835 ARS members queried (26.8% response rate). Study queries were sent in April 2020. Notably, 17.8% reported illness in themselves or their staff and 74.4% noted a psychological/emotional impact. A plurality of rhinologists noted their practice volume and in-office procedure volume has become 20.0% and 0.0% of their prior volumes, respectively. In addition, 96.2% were noted to be using telemedicine in our subspecialty.ConclusionIn addition to severely impacting volume and the perception of future decreases in patients and revenue, the COVID-19 pandemic has had a physical and emotional impact on rhinologists in ways that need to be further studied. These data include significantly novel and objective information. The COVID-19 crisis also reveals the important role of telemedicine in rhinology. Guidelines regarding personal protective equipment for in-office visits, nasal endoscopy, and other in-office and operating room procedures would be particularly helpful as future waves are expected.

Sniffing out the evidence; It's now time for public health bodies recognize the link between COVID-19 and smell and taste disturbance.

Since the outbreak of the pandemic, anecdotal observations have been accumulating rapidly that sudden anosmia and dysgeusia are peculiar symptoms associated with the COVID-19 infection. Prof C. Hopkins, as President of British Rhinological Society, published a letter describing "the loss of sense of smell as a marker of COVID-19 infection" and proposed that adults presenting with anosmia but no other symptoms should self-isolate for seven days. The Hopkins team published the first case report and case series as well as other evidence that isolated sudden onset anosmia (ISOA), should be considered highly suspicious for SARS-CoV-2(1). Subsequently, a larger series of 2428 patients presenting with new onset anosmia during the COVID-19 pandemic has been reported, of whom 16% report loss of sense of smell as an isolated symptom. Only 51% reported the recognized symptoms of cough or fever. A major limitation of this series however, was a lack of access to testing to confirm the COVID-19 status of the patients(2); in the 80 who had been tested 74% were positive. In the same way, the American Academy of Otolaryngology-head and neck surgery (AA0-HNS) proposed "that anosmia could be added to the list of screening tools for possible COVID-19 infection. More, they warrant serious consideration for self-isolation and testing those patients".

Diagnosis and Management of Depression in CRS: A Knowledge, Attitudes and Practices Survey.

Introduction Comorbid major depressive disorder (MDD) is present in up to 25% of chronic rhinosinusitis (CRS) cases and provides prognostic information for patients undergoing endoscopic sinus surgery (ESS). Clinical visits offer an opportunity to identify at-risk patients. Objective The purpose of the present study is to evaluate practice patterns among members of the American Rhinologic Society (ARS) in screening for/diagnosing MDD. Methods A 21-question survey was distributed to 1,206 members of the ARS from May 26, 2018 to June 12, 2018. The impact of demographic factors, including hospital setting, fellowship status, and experience were assessed through chi-squared analysis. Results A total of 80 members of the ARS completed the survey, yielding a response rate of 7%. Half of the respondents worked in academic settings and 43% had completed a rhinology fellowship. Twenty percent of the participants felt comfortable diagnosing or managing MDD, while only 10% of participants screened for MDD in patients with CRS. Respondents cited a lack of training (76%) and unfamiliarity with diagnostic criteria (76%) as barriers to the routine assessment of MDD. Most respondents (95%) considered comorbid psychiatric illness to negatively impact outcomes following ESS. Fellowship-trained respondents were significantly more likely to implement screening tools in their practice ( p = 0.05), and believe in the negative impact of MDD on postoperative outcomes ( p = 0.007), cost of care ( p = 0.04) and quality of life ( p = 0.047). Conclusion Amongst ARS members, 95% of the respondents consider comorbid MDD to negatively impact patient outcomes following ESS. Regardless, a large proportion of surgeons neither screen nor feel comfortable diagnosing MDD.

Concordance of self-reported practice patterns of American Rhinologic Society members with the International Consensus Statement of Allergy and Rhinology: Rhinosinusitis.

The 2016 International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS) is a collaborative distillation of available research and consensus recommendations for the management for chronic rhinosinusitis (CRS). However, implementation of the ICAR:RS recommendations in the reality of clinical practice is not clearly defined. An anonymous, web-based survey of the American Rhinologic Society membership was performed in October, 2018. Respondents were asked about the frequency that they recommended the various treatments reviewed in ICAR:RS in the context of medical management for CRS. A 7-point Likert-type scale assessed the frequency of treatment patterns. A total of 140 members completed the survey (response rate 11.9%). Seventy-two (51.4%) were in practice for 0 to 15 years, 61 (43.6%) completed a rhinology fellowship, and 73 (52.1%) worked in private practice. Disparate treatment patterns were reported for each of the therapies assessed for CRS, including those that were "recommended" or "recommended against" in ICAR:RS. Members with <15 years of experience were more likely to use nasal saline irrigation. Fellowship-trained respondents reported a greater likelihood of using nasal saline irrigation and aspirin desensitization (for patients with aspirin-exacerbated respiratory disease). Practitioners in academic medicine were more likely to utilize aspirin desensitization than those in private practice. Surgeons performing >100 sinus surgeries per year were more likely to use topical antibiotics. The range of reported treatment patterns identified in this study despite the availability of the ICAR:RS recommendations may suggest the need for improved standardization of CRS management.

Editorial message

10th Anniversary of PAJR The Pan Arab Journal of Rhinology (PAJR) has been regularly issued biannually for the past 10 years, being the official journal of the Pan Arab Rhinology Society (PARS). We are all celebrating happily the 10th anniversary of the PAJR. The PAJR is an online and open access journal, accordingly easily seen, read, and cited. It is double blind, peer reviewed, and is issued twice yearly. It is well distributed and appreciated all over the world.

Sixth Report on the Hands-on Seminar on Basic Research for Clinicians at the 58th Annual Meeting of the Japanese Rhinologic Society

Sixth Report on the Hands-on Seminar on Basic Research for Clinicians at the 58th Annual Meeting of the Japanese Rhinologic Society

Sample collection for laboratory-based study of the nasal airway and sinuses: a research compendium.

Collection of biologic samples from the nasal cavity and paranasal sinuses is of critical importance to the study of infectious or inflammatory conditions that affect both upper and lower airways. Numerous techniques for the study of ex-vivo samples exist, with specific applications, strengths, and weaknesses associated with each of them. In this compendium we summarize the available methods for collection of primary human samples and incorporate expert discussion of the pros, cons, and applications associated with each technique. An expert panel containing members of the American Rhinologic Society's Research and Grants Committee compiled this educational reference. Rationale for use and the potential advantages and disadvantages are discussed. Research protocols and key references are enumerated. Sampling of the nasal cavity and paranasal sinuses can be achieved through a number of methods. Nonspecific sinonasal secretions may be collected via forced exhalation, nasal lavage, and nasal spray aspiration. Targeted collection of sinonasal secretions may be achieved via endoscopic placement of absorbent matrices. Nasal cytology or collection of superficial epithelium may be completed via brushing or scraping of endonasal structures. Collection of mucosal biopsies may be completed via sinonasal explant or full-thickness biopsy. Multiple sampling techniques are available to collect biologic samples from the sinonasal cavity. These techniques differ in their ease of application, reproducibility, sample yield, and utility for different sinonasal pathologies or research goals. An appreciation of the benefits and drawbacks of each approach will allow investigators to select the techniques most appropriate for achieving research objectives.

Abstracts of the 5th Congress of the Romanian Rhinologic Society

Abstracts of the 5^th Congress of the Romanian Rhinologic Society

Management strategies for recurrent acute rhinosinusitis.

BackgroundManagement of patients with recurrent acute rhinosinusitis (RARS) is often challenging, and robust data in the literature is scant. The aim of this study is to better characterize the current treatment strategies for RARS used by otolaryngologists.MethodsAn online survey sent to all members of the American Rhinologic Society in a 1 month period evaluated demographics, practice characteristics, and management strategies for patients with RARS, subdivided into those with (RARSwD) and without (RARSsD) septal deviation. Eighty‐eight practicing members responded, of whom 41% were fellowship‐trained rhinologists.ResultsFor most cases of RARSsD, 61% of otolaryngologists would primarily use medical management. Most would wait until patients had experienced 4–5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (79%). The sinus surgery procedure of choice was limited sinus surgery (62%). For RARSwD, 52% primarily chose medical management. Most would wait until patients had experienced 4–5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (78%). Nearly all fellowship‐trained rhinologists (97%) would perform limited sinus surgery with septoplasty for RARSwD, compared to only 70% of other otolaryngologists who would do so and 24% who would perform complete sinus surgery with septoplasty. While 89% of practitioners in private practice would wait to perform balloon sinuplasty until patients had experienced 4–5 episodes, only 68% of those in academia would wait this long and 23% would do so after only 1–3 episodes.ConclusionsTreatment of patients with RARS is complex, and the differences in strategies employed between groups of otolaryngologists may reflect their training backgrounds and different patient populations.Level of EvidenceV

Workforce analysis of practicing rhinologists in the united states.

The objective of this study is to analyze the current rhinology workforce in the United States in terms of demographics, fellowship training, and regional distribution. The American Rhinologic Society (ARS) member database was queried for workplace zip code, age, gender, and fellowship training of practicing U.S. rhinologists through 2017. The San Francisco Match data were examined for rhinology fellowships from 2006 through 2017. Each rhinologist was assigned to a specific hospital referral region (HRR) determined by the Dartmouth Healthcare Atlas to assess geographic distribution and market density. There were 296 ARS members self-identifying as rhinologists. Of those, 69.2% were fellowship-trained (FTR). The median age of FTRs and non-FTRs were 41 and 54 years, respectively (P < 0.001). Eighty percent of FTRs were male compared to 85.7% non-FTRs. Given the recent growth of rhinology fellowships, the number of FTRs is currently expanding at approximately 16% per year. HRRs with the most rhinologists were Los Angeles, Boston, and Manhattan, all with 14. Approximately 100 million people live in HRRs without a practicing rhinologist. A wide variation in rhinologist density was observed, ranging from 133,047 to 3,636,809 people per rhinologist, with a median of 747,864. There may be a need for rhinologists in select parts of the country. Whereas the ARS database is likely an underestimation of the growing workforce, under current training rates we could pass the ideal number of U.S. rhinologists within 5 years. NA Laryngoscope, 130:1116-1121, 2020.

Scientific abstracts for RhinoWorld 2019

It has been a decade since the world's rhinologic community gathered in the United States for RhinoWorld. The American Rhinologic Society (ARS), International Rhinologic Society (IRS), and International Society of Inflammation and Allergy of the Nose (ISIAN) have joined together to host this international gathering of clinicians and scientists. Herein, you will find the abstracts that will be presented orally during RhinoWorld on June 5-9, 2019, in Chicago, IL. This IFAR supplement serves as an informational centerpiece for cutting edge discovery and innovation, and commentary and debate, for clinicians and researchers worldwide with interest in the fields of rhinology, cranial base, otolaryngic allergy, and associated disorders. Many thanks to the nearly 50 members of the RhinoWorld Program Committee and its co-chairs Robert Kern, MD, Rakesh Chandra, MD, and Kevin Welch, MD. This IFAR supplement is organized such that the Top 10 Clinical Abstracts (as determined by the RhinoWorld Program Committee) and the Top 10 Basic/Translational Science Abstracts (as determined by the RhinoWorld Program Committee) are presented first followed by all abstracts in alphabetical order by title. Some abstracts required post-submission editing for length. IFAR and Wiley have published this as an open access document online so that it is available all around the globe. We sincerely hope you find this publication meaningful in your practice and research. For more cutting edge information, please visit the IFAR website at https://onlinelibrary.wiley.com/journal/20426984 and follow us on Twitter @IFAR_Journal.

Post-operative treatment patterns after functional endoscopic sinus surgery: A survey of the American Rhinologic Society.

Post-operative treatment patterns after functional endoscopic sinus surgery: A survey of the American Rhinologic Society.

Clinical practice guidelines for the management of olfactory dysfunction — Secondary publication

ObjectiveTo provide an evidence-based recommendation for the management of olfactory dysfunction in accordance with the consensus reached by the Subcommittee of the Japanese Clinical Practice Guideline for olfactory dysfunction in the Japanese Rhinologic Society. MethodsSeven clinical questions (CQs) regarding the management of olfactory dysfunction were formulated by the subcommittee of the Japanese Clinical Practice Guideline for olfactory dysfunction. We searched the literature published between April 1990 and September 2014 using PubMed, the Cochrane Library, and Ichushi Web databases. The main search terms were “smell disorder,” “olfactory dysfunction,” “olfactory loss,” “olfactory disturbance,” “olfactory impairments,” “olfaction disorder,” “smell disorder,” “anosmia,” “cacosmia,” and “dysosmia.” Based on the results of the literature review and the expert opinion of the Subcommittee, 4 levels of recommendation, from A—strongly recommended to D—not recommended, were adopted for the management of olfactory dysfunction. ResultsBoth oral and locally administered corticosteroids have been strongly recommended for patients with olfactory dysfunction due to chronic rhinosinusitis. Nasal steroid spray and antihistamine drugs have been moderately recommended for patients with allergic rhinitis. Although no drugs have been deemed to be truly effective for post-viral olfactory dysfunction by randomized-controlled trials (RCTs) or placebo-controlled trials, olfactory training using odorants has been reported to be effective for improving olfactory function. There is considerable evidence that olfactory testing is useful for differential diagnosis, prediction of disease progression, and early detection of cognitive decline in neurodegenerative diseases. ConclusionThe Clinical Practice Guideline has developed recommendations for the management of various aspects of olfactory dysfunction.

Fifth Report of Hands-on Seminar on Basic Research for Clinicians at the 57&lt;sup&gt;th&lt;/sup&gt; Annual Meeting of the Japanese Rhinologic Society

Fifth Report of Hands-on Seminar on Basic Research for Clinicians at the 57&lt;sup&gt;th&lt;/sup&gt; Annual Meeting of the Japanese Rhinologic Society

Fourth Report on the Hands-on Seminar on Basic Research for Clinicians at the 56th Annual Meeting of the Japanese Rhinologic Society ~ Expanding the Range of Rhinologic Basic Research ~

Fourth Report on the Hands-on Seminar on Basic Research for Clinicians at the 56th Annual Meeting of the Japanese Rhinologic Society ~ Expanding the Range of Rhinologic Basic Research ~

Contemporary Trends in the Surgical Management of Nasal Septal Perforations: A Community Survey.

There currently exists an overabundance of publications advocating different septal perforation repair methods. The objective of this article was to examine the preponderance of techniques and trends in the surgical management of septal perforations in the practices of otolaryngologists, rhinologists, and facial plastic surgeons. The study was designed as a multicenter cross-sectional survey. The participants were members of the American Academy of Facial Plastic and Reconstructive Surgery and the American Rhinologic Society. Septal perforation closure rates and perforation repair approach, technique, and interposition graft material preferences were the main outcomes. A total of 320 respondents completed the survey, of whom 75% performed perforation repairs. The success rates in closing perforations < 1 cm, 1-2 cm, and > 2 cm were 84%, 64%, and 31%, respectively. The respondents had a similar preference for the endoscopic (52%) and external rhinoplasty (49%) approaches, followed by the endonasal approach (43%). Bilateral intranasal mucosal advancement flaps (79%) and unilateral intranasal mucosal rotational or advancement flaps (60%) were the favored repair techniques. Most respondents (84%) incorporated an interposition graft and intranasal splints (89%) for the repair, and the most popular interposition graft material was acellular dermis (63%). The self-reported perforation closure success rates in this survey were lower than those published in the literature, a phenomenon possibly explained by the premise that surgeons with favorable outcomes are more apt to share their results. The preferred surgical approach was evenly distributed between the external rhinoplasty and endoscopic approaches and influenced by a surgeon's training, perforation size and location, and the need for concomitant rhinoplasty. This study is the first to characterize contemporary community trends in the surgical closure of septal perforations and demonstrates that while preference for perforation repair approach among the respondents varied, surgeons favored septal perforation repair using bilateral intranasal mucosal advancement flaps with an interposition graft.