Arif Janjua

A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial

Aspirin‐exacerbated respiratory disease (AERD) is a clinical triad consisting of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Although respiratory reactions following ingestion of ASA and other nonsteroidal anti‐inflammatory drugs (NSAIDs) are considered a hallmark of the condition, respiratory inflammation persists despite patients’ avoidance of NSAIDs. Treatment of this condition remains challenging and includes both medical and surgical options.

Endoscopic Resection of Solitary Fibrous Tumors of the Nose and Paranasal Sinuses

Solitary fibrous tumors (SFTs) are uncommon neoplasms of mesenchymal origin that were first described as primary spindle-cell tumors of the pleura in 1931. Since then, infrequent case reports of extrapleural SFTs have been described including various subsites within the head and neck. Based on a review of the literature and a description of the endoscopic treatment of three patients with SFTs of the nasal cavity and ethmoid sinuses, the challenges associated with the management of sinonasal SFTs are discussed. Successful endoscopic resection was performed at a tertiary referral rhinology practice within a university center in three cases of sinonasal SFTs with no evidence of recurrence at 26, 35, and 49 months following resection. Summarized are the common presenting symptoms, appropriate diagnostic workup, and indicative computed tomography and magnetic resonance imaging appearance of SFTs. Further discussed are the challenge associated with accurate histological and immunohistochemical diagnosis, the difficulty in assessing the aggressiveness and malignant potential of these lesions, and the appropriate treatment and follow-up duration that these neoplasms require.

Analyzing the 22-item Sino-Nasal Outcome Test using item response theory

The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is a widely applied patient‐reported outcome instrument used to assess the severity of symptoms associated with chronic rhinosinusitis. The purpose of this study was to evaluate the measurement performance of the SNOT‐22 instrument on an item‐level basis, in a sample of patients awaiting elective surgery for chronic rhinosinusitis.

The impact of surgical wait time on patient reported outcomes in sinus surgery for chronic rhinosinusitis: Surgical wait time and post-ESS CRS outcomes

In many developed countries, wait times for elective surgery are increasing. Among these elective surgeries is endoscopic sinus surgery (ESS) performed for treatment of chronic rhinosinusitis (CRS). Little is known about the impact of wait times on patients’ surgical outcomes. The purpose of this study was to evaluate the association between patients’ wait times and postoperative patient‐reported outcomes.

Establishing utility values for the 22-item Sino-Nasal Outcome Test (SNOT-22) using a crosswalk to the EuroQol-five-dimensional questionnaire-three-level version (EQ-5D-3L): SNOT-22 crosswalk to EQ-5D-3L utility values

Chronic rhinosinusitis (CRS) is a common condition for which there are numerous medical and surgical treatments. The 22‐item Sino‐Nasal Outcome Test (SNOT‐22) is a patient‐reported outcome measure often used with patients diagnosed with CRS. However, there are no utility values associated with the SNOT‐22, limiting its use in comparative effectiveness research. The purpose of this study was to establish utilities for the SNOT‐22 by mapping responses to utility values associated with the EuroQol–5‐dimensional questionnaire–3‐level version (EQ‐5D‐3L).

Assessment of the current Canadian rhinology workforce.

BackgroundThe Canadian Rhinologic workforce and future needs are not well defined. The objective of this study was to define the current demographics and practice patterns of the Canadian Rhinologic workforce. Outcomes from this study can be used to perform rhinologic workforce needs assessments.MethodsA national survey was administered to all Canadian otolaryngologists who were identified to have a clinical practice composed of >50% rhinology.Results42 surgeons participated in the survey (65% response rate). The mean age was 46 (SD 10.1) years and the average age of planned retirement was 66 (SD 4.0). Eighty three percent of respondents had completed a rhinology fellowship and 17% practiced exclusively rhinology. Thirty three percent hold advanced degrees. Forty two percent of surgeons felt their access to operative time was insufficient. Six percent of surgeons reported not having access to image guided surgery. Fourteen percent felt that there were too many practicing rhinologists in Canada while 17% believed there were too few practicing rhinologists. Seventeen percent have advised their residents to pursue other fields due to a perceived lack of future jobs. Overall, 66% of respondents were satisfied with their income, and 83% were satisfied with their careers.ConclusionsThis study has demonstrated that there is a perceived mismatch between the current supply of Rhinology labor and the capacity to treat patients in a timely manner. Outcomes from this study will begin to improve Rhinologic workforce planning in Canada and reduce the gap between patient demand and access to high quality care.

Endoscopic Endonasal Approach for Olfactory Groove Meningiomas

Background: Endoscopic endonasal approaches (EEAs) have been applied for pathologies across the entire anterior skull base. Olfactory groove meningiomas are tumors of the anterior b

Fungal Rhinosinusitis: A Radiological Review With Intraoperative Correlation

The interaction between fungi and the sinonasal tract results in a range of clinical presentations with a broad spectrum of clinical severity. The most commonly accepted classification system divides fungal rhinosinusitis into invasive and noninvasive subtypes based on histopathological evidence of tissue invasion by fungi. Invasive fungal rhinosinusitis is subdivided into acute invasive and chronic invasive categories. The chronic invasive category includes a subcategory of chronic granulomatous disease. Noninvasive fungal disease includes localized fungal colonization, fungal ball, and allergic fungal rhinosinusitis. Noninvasive disease is simply fungal material (or the products of the inflammatory reaction of the sinus mucosa) that fills the sinuses but does not invade tissue. Bone loss is related to expansion of the sinus(es). Invasive disease causes tissue destruction, such that it expands past the bony confines of the sinuses. It can rapidly spread, causing acute necrosis. Alternatively, there may be slow tissue invasion characterized by symptoms confused with normal sinusitis, but destruction of normal nasal and paranasal structures.

Otolaryngology Head and Neck Surgery Approaches

Decisions are made on the fundamental sinus approaches for endonasal access to the skull base and the technical adjuncts that are necessary to optimize the procedure. These include discussions on pati

Patient Choice of Nonsurgical Treatment Contributes to Disparities in Head and Neck Squamous Cell Carcinoma

Objectives There are well-established outcome disparities among different demographic groups with head and neck squamous cell carcinoma (HNSCC). We aimed to investigate the potential contribution of patient choice of nonsurgical treatment to these disparities by estimating the rate of this phenomenon, identifying its predictors, and estimating the effect on cancer-specific survival. Study Design Retrospective nationwide analysis. Settings Surveillance, Epidemiology, and End Results Database (2004-2014). Subjects and Methods Patients with HNSCC, who were recommended for primary surgery, were included. Multivariable logistic regression was used to identify demographic and clinical factors associated with patient choice of nonsurgical treatment, and Kaplan Meier/Cox regression was used to analyze survival. Results Of 114,506 patients with HNSCC, 58,816 (51.4%) were recommended for primary surgery, and of those, 1550 (2.7%) chose nonsurgical treatment. Those who chose nonsurgical treatment were more likely to be older (67.1 ± 12.6 vs 63.6 ± 13.1, P < .01), were of Black (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.28-1.74) or Asian (OR = 1.79; 95% CI, 1.46-2.20) ethnicity, were unmarried (OR married, 0.50; 95% CI, 0.44-0.58), had an advanced tumor, and had a hypopharyngeal or laryngeal primary. Choice of nonsurgical treatment imparted a 2.16-fold (95% CI, 2.02-2.30) increased risk of cancer-specific death. Conclusion Of the patients, 2.7% chose nonsurgical treatment despite a provider recommendation that impairs survival. Choice of nonsurgical treatment is associated with older age, having Black or Asian ethnicity, being unmarried, having an advanced stage tumor, and having a primary site in the hypopharynx or larynx. Knowledge of these disparities may help providers counsel patients and help patients make informed decisions.