Brian W. Rotenberg

Microscopic versus endoscopic pituitary surgery: a systematic review.

To critically review current literature comparing microscopic versus endoscopic surgery in the treatment of pituitary adenomas.

Postoperative care for Samter's triad patients undergoing endoscopic sinus surgery: A double‐blinded, randomized controlled trial

Evidence is lacking to guide the postoperative management of Samters triad patients with chronic rhinosinusitis with polyposis (CRSwP) undergoing endoscopic sinus surgery (ESS). The purpose of this study was to compare three different standardized medication regimens prescribed to these patients after ESS.

The effect of nasal surgery on nasal continuous positive airway pressure compliance.

Nasal continuous positive airway pressure (CPAP) is the standard therapy for sleep apnea; however, compliance rates are historically poor. Among the most commonly cited reasons for nonadherence is nasal obstruction. Our study sought to examine if nasal surgery actually increases CPAP compliance.

Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: a randomized controlled trial

Postoperative hyposmia and anosmia is an often overlooked complication of endoscopic pituitary surgery. Septal flaps have been utilized as a strategy for repairing and preventing postoperative cerebrospinal fluid (CSF) leaks. The olfactory impact of raising this flap for sellar reconstruction and CSF repair needs qualitative assessment. This study aims to ascertain the effect of the Hadad‐Bassagasteguy (HB) flap on olfaction in endoscopic pituitary surgery.

Wait Times for Sleep Apnea Care in Ontario: A Multidisciplinary Assessment

BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden. In general, wait times for health care in Ontario are believed to be lengthy; however, many diseases lack specific corroborative wait time data. OBJECTIVE To characterize wait times for OSA care in Ontario. METHODS Cross-sectional survey. A survey tool was designed and validated to question physicians involved in OSA care about the length of the wait times their patients experience while traversing a simplified model of OSA care. The survey was sent to all otolaryngologists and respirologists in the province, as well as to a random sample of provincial family physicians. RESULTS Patients waited a mean of 11.6 months to initiate medical therapy (continuous positive airway pressure), and 16.2 months to initiate surgical therapy. Sleep laboratory availability appeared to be the major restriction in the patient management continuum, with each additional sleep laboratory in a community associated with a 20% decrease in overall wait times. Smaller community sizes were paradoxically associated with shorter wait times for sleep studies (P<0.01) but longer wait times for OSA surgery (P<0.05). Regression analysis yielded an r2 of 0.046; less than 5% of the wait time variance could be explained by the simplified model. CONCLUSION Patients experienced considerable wait times when undergoing management for OSA. This has implications for both individual patient care and public health in general.

Outcome measurements in obstructive sleep apnea: Beyond the apnea‐hypopnea index

The apnea‐hypopnea index (AHI) is overwhelmingly used as the main therapeutic metric in the assessment of obstructive sleep apnea (OSA) in surgical studies. However, using AHI as the sole measure is problematic. This study investigates the utility of other outcome measures for patients with OSA undergoing surgery.

Endoscopic ligation of the patulous eustachian tube as treatment for autophony

Patulous eustachian tube remains a challenging management problem in otolaryngology. The autophony experienced by this patient population can be severe, and as yet no reliable surgical method exists to reduce or eliminate this annoying symptom. Our objective was to develop a novel endoscopic technique to assist these patients.

Aspirin desensitization for aspirin-exacerbated respiratory disease (Samter's Triad): a systematic review of the literature

To critically review the current literature regarding aspirin desensitization treatment for nasal polyposis in patients with Aspirin‐Exacerbated Respiratory Disease (AERD).

Computer-assisted teaching of epistaxis management: a Randomized Controlled Trial.

To determine whether computer‐assisted learning (CAL) is an effective tool for the instruction of technical skills.

Reconsidering first-line treatment for obstructive sleep apnea: a systematic review of the literature

BackgroundContinuous positive airway pressure (CPAP) is typically recommended as first line therapy for obstructive sleep apnea, but the adherence rate of CPAP is problematic. This study’s objective was to systematically review the literature relating to CPAP as first line therapy for OSA and compare it to surgical literature on the same topic.MethodsA systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. The primary search objective was to identify all papers reporting the results of (1) randomized clinical trials (RCT) of CPAP for the treatment of adults with OSA; and (2) both randomized and non-randomized clinical trials and case series on the surgical treatment of OSA in adults. A PhD-level biostatistician first screened papers, and then those that met study criteria were retrieved and analyzed using standardized forms for each author. The primary outcomes were adherence rates of CPAP.ResultsA total of 82 controlled clinical trials for CPAP and 69 controlled and non-controlled surgery trials were identified for analysis. Variation in CPAP use within reported RCT trials were identified, and the majority of patients in the studies would eventually be considered non-adherent to CPAP.ConclusionsWhen considering the numerous patient-related factors that come into play when CPAP is prescribed, the concept of CPAP as gold-standard therapy for OSA should be reconsidered. In many cases surgery can provide a better overall outcome. This study’s results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence.