Allen M. Seiden

The Diagnosis of a Conductive Olfactory Loss

Objectives/Hypothesis Two of the most common causes of olfactory loss include upper respiratory infection (URI) and nasal or sinus disease. The etiology of most URI‐related losses is thought to be viral and, as yet, there is no available treatment. In contrast, nasal or sinus disease produces an obstructive or conductive loss that often responds dramatically to appropriate therapy. Therefore, the distinction is important but in many cases may be difficult because such patients often present with no other nasal symptoms, and routine physical findings may be nonspecific. The purpose of this report is to characterize those aspects of the history and physical examination that will help to substantiate the diagnosis of a conductive olfactory loss.

The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery.

OBJECTIVES We sought to determine the efficacy of MeroGel, an absorbable hyaluronic acid nasal dressing (HA) in reducing synechia after functional endoscopic sinus surgery (FESS) compared with Merocel, a nonabsorbable packing (NAP) requiring removal. METHODS We conducted a blinded, randomized, controlled trial of 37 patients requiring bilateral FESS for chronic sinusitis. Patients were randomized to placement of HA within the right or left middle meatus and NAP on the other side. Patients were evaluated at 2, 4, 6, and 8 weeks postoperatively. RESULTS Blinded evaluation revealed 5 patients (14%) with synechia at last follow-up: 3 sides (8%) with HA and 3 (8%) with NAP. Thirteen patients (35%) had synechia at any visit, 10 sides (27%) with HA and 9 (24%) with NAP. Seven patients (19%) required lysis of synechia, 5 sides (14%) with HA and 3 (8%) with NAP. CONCLUSION We found no statistically significant difference between HA and NAP dressings.

Evidence supporting endoscopic sinus surgery in the management of adult chronic rhinosinusitis : A systematic review

Background Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence on the use of endoscopic sinus surgery (ESS) in the management of adult chronic rhinosinusitis (CRS) examining the clinical question: “In adults with CRS who have failed medical management, does ESS improve symptoms and/or quality of life (QOL)?” Methods The American Rhinologic Society and the American Academy of Otolaryngology–Head and Neck Surgery convened a steering committee composed of the authors. Primary research articles evaluated for this report were identified using appropriate search terms and a Medline search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines (level 1 = randomized trials; level 2 = prospective cohort studies with comparison group; level 3 = case-control studies; level 4 = retrospective case series; level 5 = expert opinion). Results We identified 886 abstracts to review, retrieved 75 articles for full review, and included 45 articles in our report. The vast majority of articles represented level 4 evidence (n = 42) and two articles represented level 5 evidence. One article was identified that qualified for level 2 evidence. All of these articles generally supported the finding that ESS improves symptoms and/or QOL in adult patients with CRS. Conclusion There is substantial level 4 evidence with supporting level 2 evidence that ESS is effective in improving symptoms and/or QOL in adult patients with CRS. Future research efforts should focus on prospective studies that include appropriate comparison groups in their design.

Surgical management of adult inferior turbinate hypertrophy: a systematic review of the evidence.

The evidence‐based medicine (EBM) schema advocates critical appraisal of the scientific literature for treatment of diseases. The objective of this review was to analyze the role of surgery for symptomatic adult inferior turbinate hypertrophy (ITH) by focusing on the following question: In adults with nasal airway obstruction (NAO) from documented ITH having failed medical therapy, does inferior turbinate surgery improve disease‐specific quality of life, symptoms, and/or objective parameters with minimum 6‐month follow‐up?.

Histoplasmosis: The otolaryngologist's perspective

Within the upper aerodigestive tract, histoplasmosis often mimics carcinoma, making prompt and accurate diagnosis imperative. More severe and potentially lethal infections with Histoplasma capsulaturn are now being seen as the numbers of patients at the extremes of age, as well as those with compromised immune systems, increase. We reviewed the cases of 115 hospitalized patients with disseminated histoplasmosis. Of these, 9 patients were identified with tolaryngologic manifestations: 4 were infected with human immunodeficiency virus (HIV), 1 was diabetic, and 3 were renal transplant patients. Sites of involvement included the larynx (in 2 cases) and the oral cavity and oral pharynx (in 7 cases). Eight of the 9 patients had a positive biopsy result; the other, a positive culture. Treatment with amphotericin B was generally effective, while the use of newer azole antifungal agents were less effective. As the number of immunocompromised patients continues to increase in modern clinical practice, histoplasmosis will undoubtedly be encountered more frequently in the head and neck area.

Frontal sinus surgery: The state of the art

Perhaps no other area of sinus surgery has generated more controversy than that dealing with chronic frontal sinusitis. The history of frontal sinus surgery is replete with descriptions of widely varying surgical approaches by well-known surgeons, yet no one approach has been universally embraced as the standard of care. The controversy centers largely around whether to attempt restoration of ventilation to the sinus or to simply obliterate the cavity. Varying success rates, excessive morbidity, and the potential for catastrophic infectious complications continue to detract from many of these procedures and fuel the controversy surrounding the treatment of chronic frontal sinus disease. The first external procedures performed on

Papillary-cystic variant of acinic cell carcinoma of the salivary gland diagnosed by fine needle aspiration biopsy. A case report.

BACKGROUND Fine needle aspiration (FNA) biopsy is reliably used to classify most conditions involving the salivary glands. It is useful for establishing, or at least suggesting, the diagnosis in unusual cases or narrowing the differential diagnosis. CASE A 25-year-old male presented with a slowly enlarging mass of the left parotid. FNA biopsy of the parotid gland was performed, and a diagnosis of papillary-cystic variant of acinic cell carcinoma was suggested. The patient underwent incomplete resection of the lesion, which was interpreted as acinic cell carcinoma. CONCLUSION Papillary-cystic variant of acinic cell carcinoma is rarely seen, especially in young people. FNA biopsy is a useful diagnostic procedure that can help diagnose this relatively uncommon type of salivary gland neoplasm and guide its management.

Clinical Consensus Statement Septoplasty with or without Inferior Turbinate Reduction

Objective To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction. Methods An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes. Conclusion This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as “Computed tomography scan may not accurately demonstrate the degree of septal deviation,” “Septoplasty can assist delivery of intranasal medications to the nasal cavity,” “Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty,” and “Quilting sutures can obviate the need for nasal packing after septoplasty.” It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care.

Headache and the frontal sinus

Frontal headache is a common complaint associated with frontal sinus disease and is often the only complaint. It is also a common location for headache pain in association with other primary and secondary headache disorders. Therefore, the clinician needs to have a thorough understanding of the differential diagnosis of frontal headache pain. This article reviews the causes of frontal pain in association with nasal and sinus pathology and also discusses other headache disorders that can present with similar symptoms.

The utility of magnetic resonance imaging in the diagnostic evaluation of idiopathic olfactory loss

To report the utilization and cost effectiveness of magnetic resonance imaging (MRI) in the evaluation of patients with idiopathic olfactory loss.