Devyani Lal

Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience.

The aim of this study was to review complications occurring as a result of endoscopic sinus surgery by one surgeon in an academic practice during a 25‐year period.

Oral corticosteroids in the management of adult chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations.

Oral steroids are commonly used in the management of chronic rhinosinusitis (CRS) with and without nasal polyps (CRSwNP and CRSsNP, respectively). Past reports have included evaluation of the evidence for the use of oral steroids in CRS subtypes. However, a review with evidence‐based recommendations for all CRS subtypes has never been performed. The purpose of this article is to provide a comprehensive, evidence‐based approach for the utilization of oral steroids in the management of CRS.

Electrical stimulation facilitates rat facial nerve recovery from a crush injury

Objective To study the effect of electrical stimulation on accelerating facial nerve functional recovery from a crush injury in the rat model. Study Design Experimental. Method The main trunk of the right facial nerve was crushed just distal to the stylomastoid foramen, causing right-sided facial paralysis in 17 Sprague-Dawley rats. An electrode apparatus was implanted in all rats. Nine rats underwent electrical stimulation and eight were sham stimulated until complete facial nerve recovery. Facial nerve function was assessed daily by grading eyeblink reflex, vibrissae orientation, and vibrissae movement. Results An electrical stimulation model of the rat facial nerve following axotomy was established. The semi-eyeblink returned significantly earlier (3.71 + 0.97 vs 9.57 + 1.86 days post axotomy) in stimulated rats (P = 0.008). Stimulated rats also recovered all functions earlier, and showed less variability in recovery time. Conclusion Electrical stimulation initiates and accelerates facial nerve recovery in the rat model as it significantly reduces recovery time for the semi-eyeblink reflex, a marker of early recovery. It also hastens recovery of other functions.

Efficacy of targeted medical therapy in chronic rhinosinusitis, and predictors of failure

Background No standardized medical therapy for chronic rhinosinusitis (CRS) is universally accepted. Success of medical therapy is reportedly 50% to 88%, but studies differ in inclusion criteria, medications, duration of therapy, and defining “success.” The objectives of this study were to determine efficacy of a standardized targeted medical therapy (TMT) regimen in CRS and to analyze factors associated with failure of therapy. Methods Retrospective analysis of prospectively collected data was performed. CRS was diagnosed based on CRS Taskforce guidelines. TMT was defined as a minimum 4-week treatment with oral antibiotics, oral steroids, topical nasal steroids, topical nasal decongestant rotation, and saline nasal douching. “Failure” was defined as relapse/persistence of signs/symptoms or need for surgery. One hundred forty-five patients that received TMT, with a minimum 2-month follow-up, were identified. The results of therapy were reviewed to determine efficacy and analyze factors associated with failure. Results Seventy-four patients (51.03%) were successfully treated. Failures included 26 patients (17.8%) with only partial improvement and 45 (31.03%) who underwent surgery. Only history of facial pressure/pain (p = 0.049), presence of mucosal inflammation (p = 0.013), and higher endoscopic severity grade (p = 0.011) were associated with failure of TMT. Conclusions TMT was unequivocally successful in 51% of patients. Failures included 31% who underwent surgery and 18% with partial benefit. Surgery was avoided in 69%. Facial pressure/pain, mucosal inflammation, and higher endoscopic severity grade were associated with failure of medical therapy.

Oral corticosteroid therapy in chronic rhinosinusitis without polyposis: a systematic review.

Recognition of inflammation in the pathophysiology of chronic rhinosinusitis (CRS) has caused corticosteroid therapy in CRS to gain favor. A systematic evaluation of oral steroid use in CRS without nasal polyps (CRSsNP) has not been previously conducted. The objective of the study was to assess evidence on oral steroid therapy in CRSsNP, via a systematic literature review.

Update on the management of chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms persisting for greater than 12 weeks. The etiology of CRS is incompletely understood. Current understanding supports inflammation, rather than infection, as the dominant etiologic factor. CRS significantly impacts patients’ quality of life and health care expenditure. There is no standard management of CRS. Treatment strategies differ based on divergent etiologies of the various CRS subclasses. Both systemic and topical agents are used. These interventions differ in CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP) and specific situations such as allergic fungal rhinosinusitis or aspirin-exacerbated respiratory disease. Antibiotics are the most commonly prescribed medication for CRS, but their role in management is not strongly supported by high-level studies. This paper provides a succinct review of the evidence supporting or refuting common therapeutic agents in the management of CRS. Novel and emerging strategies will also be discussed.

Radiation Dose Reduction in Paranasal Sinus CT Using Model-Based Iterative Reconstruction

BACKGROUND AND PURPOSE: CT performed with Veo model-based iterative reconstruction has shown the potential for radiation-dose reduction. This study sought to determine whether Veo could reduce noise and improve the image quality of low-dose sinus CT. MATERIALS AND METHODS: Twenty patients consented to participate and underwent low- and standard-dose sinus CT on the same day. Standard-dose CT was created with filtered back-projection (120 kV[peak], 210 mA, 0.4-second rotation, and 0.531 pitch). For low-dose CT, mA was decreased to 20 (the remaining parameters were unchanged), and images were generated with filtered back-projection and Veo. Standard- and low-dose datasets were reconstructed by using bone and soft-tissue algorithms, while the low-dose Veo reconstruction only had a standard kernel. Two blinded neuroradiologists independently evaluated the image quality of multiple osseous and soft-tissue craniofacial structures. Image noise was measured by using multiple regions of interest. RESULTS: Eight women and 12 men (mean age, 63.3 years) participated. Volume CT dose indices were 2.9 mGy (low dose) and 31.6 mGy (standard dose), and mean dose-length products were 37.4 mGy-cm (low dose) and 406.1 mGy-cm (standard dose). Of all the imaging series, low-dose Veo demonstrated the least noise (P < .001). Compared with filtered back-projection low-dose CT using soft-tissue and bone algorithms, Veo had the best soft-tissue image quality but the poorest bone image quality (P < .001). CONCLUSIONS: Veo significantly reduces noise in low-dose sinus CT. Although this reduction improves soft-tissue evaluation, thin bone becomes less distinct.

Contemporary management of frontal sinus mucoceles: A meta-analysis

To analyze trends in the surgical management of frontal and fronto‐ethmoid mucoceles through meta‐analysis.

Comprehensive management of patients presenting to the otolaryngologist for Sinus pressure, pain, or headache

To study differential diagnosis and efficacy of management strategies in patients presenting to an otolaryngologist for sinus pressure, pain, or headache.

Oral steroid therapy in chronic rhinosinusitis with and without nasal polyposis.

Chronic rhinosinusitis (CRS) is a heterogeneous group of disorders characterized by inflammation of the sinonasal mucosa. CRS can be divided into two subtypes: CRS without polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). Corticosteroids are frequently employed to treat CRS due to their potent anti-inflammatory effects. Treatment of CRS with oral steroids must be carefully balanced against potential adverse effects. This article reviews the current literature on management of CRS with systemic corticosteroids. We discuss the available evidence in CRSsNP, CRSwNP, and allergic fungal sinusitis (AFS). Studies are evaluated for level of evidence and graded to provide evidence-based recommendations. Our review finds a lack of high-quality evidence supporting oral corticosteroid therapy in CRSsNP. In comparison, randomized controlled trails support the use of oral corticosteroids for CRSwNP. Similarly, systemic steroids for AFS treatment are supported by quality studies demonstrating efficacy. Utilization of steroids is also recommended in the perioperative setting for CRSwNP.