Brett T. Comer

Aspirin sensitivity does not compromise quality-of-life outcomes in patients with samter's triad

To demonstrate that quality‐of‐life outcomes after endoscopic sinus surgery are not compromised in patients with Samters triad (asthma, nasal polyps, aspirin sensitivity) when compared to patients with eosinophilic chronic rhinosinusitis with nasal polyposis (eCRSwP) who are not aspirin sensitive.

Frontal sinus septations predict the presence of supraorbital ethmoid cells

This study is undertaken to determine if the presence or absence of multiseptated frontal sinuses is associated with the presence or absence of supraorbital ethmoid cells (SOECs).

Impact of Endoscopic Surgical Techniques on Efficiency in Pituitary Surgery

Objective. To assess the impact of the introduction of endoscopic surgical techniques into a neurosurgical practice for pituitary surgery on operative efficiency. Study Design. Case series with chart review. Setting. Tertiary referral center. Subjects and Methods. Patients undergoing transsphenoidal pituitary surgery over a 4-year period were identified. The approach over this period evolved from classic transseptal surgery to exclusively endoscopic techniques. Patients were classified as having transseptal surgery, endoscopic approach with microsurgical resection, aborted endoscopic resection with subsequent microsurgery, and exclusive endoscopic techniques. Patient and surgeon demographics, operative times, total operating room times, and room setup time were examined. Univariate analysis and multivariate regression modeling were used to assess outcome measures. Results. One hundred seven patients were identified. The use of the endoscope for either sphenoid exposure alone (n = 41) or for the entire procedure (n = 35) resulted in a significant reduction in operative and room times compared to transseptal approaches (n = 25). Exclusively endoscopic techniques resulted in a significant reduction in operative and room times independent of all other clinical and surgical parameters (P < .001). Progressive use of endoscopic techniques resulted in statistically significant progressive reduction in setup time (P = .001), operative time (P = .04), and total room time (P = .03) over the study period. Conclusion. The transition from transseptal transsphenoidal pituitary surgery to endoscopic techniques implies a learning process for both neurosurgeon and otolaryngologist. Despite this, a noteworthy reduction in operative times, operating room times, and room setup times is observed. The impact of endoscopic techniques on efficiency in pituitary surgery is discussed.

Product comparison model in otolaryngology: Equivalency analysis of absorbable hemostatic agents after endoscopic sinus surgery

Evidence‐based medicine in otolaryngology literature continues to be lacking, especially with regard to new products brought to market. The marketing of products often includes statements of benefit that have limited objective support in research or literature. To address this, and to adequately determine product equivalency/superiority, careful evaluation must be made. In order to establish standards for this process in rhinology products, we directly compare three different absorbable hemostatic agents in patients with chronic rhinosinusitis (CRS) after undergoing endoscopic sinus surgery (ESS), using both objective and subjective outcomes.

The association between supraorbital ethmoid air cells and orbital proptosis in patients with chronic rhinosinusitis.

Orbital proptosis is a known possible complication in patients with chronic rhinosinusitis (CRS). This study was undertaken to determine the association of sinus anatomy and anatomic variants with the predisposition for such a complication.

IgG4-Related Disease Presenting as a Neck Mass.

IgG4-related disease (IgG4-RD) is now understood to be an immune-mediated condition affecting multiple anatomic sites. Disorders that were previously considered unrelated are now classified as IgG4-RD and share pathologic, serologic, and clinical features. Lacrimal and salivary gland swelling (formerly Mikulicz disease), bilateral submandibular gland enlargement (formerly Kuttner’s tumor), as well as extraocular muscle swelling and associated proptosis are common manifestations of IgG4-RD. Reidel’s thyroiditis is also considered to be one manifestation of IgG4-RD. Patients with IgG4-RD often present with swelling of lymph nodes or other organs that are enriched with IgG4-positive plasma cells; most patients have elevated serum IgG4 concentrations. Here we discuss the case of a patient with IgG4-RD presenting with a neck mass.

Factors associated with patient no-show rates in an academic otolaryngology practice

Factors affecting access to healthcare is an expanding area of research. This study seeks to identify factors associated with no‐show rates in an academic otolaryngology practice to improve clinical efficiency and patient access to care.

Endoscopically Assisted Crawford Tube Placement Results in Shorter General Anesthesia Times in Pediatric Patients

Background Crawford tube placement is commonly used to achieve patency of nasolacrimal ducts for epiphora secondary to nasolacrimal duct obstruction. The nasal passages of pediatric patients are narrower than adults, and the result is a relatively higher risk of intranasal complications (e.g., synechiae, bleeding) with Crawford tube placement. There is evidence that general anesthesia may negatively affect the neurocognitive function and behavioral development of children, which prompts efforts to decrease operation times for potential health benefits and also potentially to reduce health care costs. Analysis ofresearch reports supports the use of nasal endoscopy to reduce intranasal complications with Crawford tube placement; however, no publications currently address the effect of nasal endoscopy concurrent with Crawford tube placement on operative times on pediatric patients or the resulting effects on health care costs. Objective To determine the difference in procedure time and cost between Crawford tubes placed traditionally and those placed with endoscopic assistance in pediatric patients. Methods A chart review was performed from January 1, 2011 to December 31, 2016 for cases using CPT codes 68815 or 31231. Within this group of patients, the patient in whom nasal endoscopy was performed were placed in the “endoscopic” group and the patients without endoscopy were placed in the “traditional” group. Procedure times were noted, and the t-test was performed to examine for any statistically significant difference in operative times. Estimates of anesthesia cost savings were made. We identified 24 patients in the traditional group and 7 patients in the endoscopic group. Results The average operative time for the traditional group was 27.3 minutes compared with 14.0 minutes for the endoscopic group (p = 0.02). The cost comparison data revealed no significant difference with the traditional group averaging

The Supraorbital Ethmoid Cell

9369 per procedure and the endoscopic group averaging

Delayed Pneumocephalus Occurring Years After Pituitary Surgery

8891 (p = 0.51). Conclusion An endoscopically assisted Crawford tube placement resulted in patients who had less time under general anesthesia compared with the traditional technique at no difference in cost.