Greg E. Davis

Psychiatric Distress Amplifies Symptoms after Surgery for Chronic Rhinosinusitis

BACKGROUND: Psychiatric disorders are associated with increased symptom burden when combined with chronic medical conditions. However, there are no reports of how psychiatric distress influences outcomes with surgical treatment for chronic rhinosinusitis (CRS). We hypothesized that subjects with psychiatric distress (somatization, anxiety, and depression) would report more severe long-term sinus symptoms and worse quality of life (QOL) than subjects without psychiatric distress. METHODS: This is a community-based, prospective, observational cohort study of patients diagnosed with CRS presenting for surgery. Patients were interviewed before surgery; CT scans were reviewed, and questionnaires were completed about sinusitis-related symptoms (SNOT-16), general health status and QOL (SF-36), and psychiatric distress (BSI and PHQ). Outcomes were also assessed 1, 3, 6, and 12 months postoperatively. RESULTS: Ninety-five patients had complete records for analysis. Psychiatric distress was prevalent, with 31% screening positive for somatization, 17% positive for anxiety, and 25% positive for depressive disorders. Subjects with somatization had significantly worse SNOT-16 scores at each time point compared with those without somatization (P < 0.05). Subjects with depression reported more severe symptoms at 6 and 12 months after surgery than those without depression (P < 0.05). The presence of somatization preoperatively was also independently associated with worse symptom severity 12-months after surgery, even after adjusting for prior sinus surgery, CT stage, Charlson Index, and deviated septum. In addition, subjects with psychiatric distress reported significantly worse SF-36 physical and mental component summary scores 12-months after surgery than subjects without psychiatric distress. CONCLUSIONS: Psychiatric distress is associated with worse reported sinus symptoms and lower QOL throughout surgical management of chronic rhinosinusitis. Despite this, subjects with psychiatric distress report a similar degree of improvement in sinus symptoms after surgery compared with those without distress. CLINICAL SIGNIFICANCE: Psychiatric distress should be considered in patients with persistent symptoms after surgery. Psychiatric distress should also be considered in efforts to design a chronic sinusitis staging system.

Zicam-Induced Damage to Mouse and Human Nasal Tissue

Intranasal medications are used to treat various nasal disorders. However, their effects on olfaction remain unknown. Zicam (zinc gluconate; Matrixx Initiatives, Inc), a homeopathic substance marketed to alleviate cold symptoms, has been implicated in olfactory dysfunction. Here, we investigated Zicam and several common intranasal agents for their effects on olfactory function. Zicam was the only substance that showed significant cytotoxicity in both mouse and human nasal tissue. Specifically, Zicam-treated mice had disrupted sensitivity of olfactory sensory neurons to odorant stimulation and were unable to detect novel odorants in behavioral testing. These findings were long-term as no recovery of function was observed after two months. Finally, human nasal explants treated with Zicam displayed significantly elevated extracellular lactate dehydrogenase levels compared to saline-treated controls, suggesting severe necrosis that was confirmed on histology. Our results demonstrate that Zicam use could irreversibly damage mouse and human nasal tissue and may lead to significant smell dysfunction.

Treatment delay associated with alternative medicine use among veterans with head and neck cancer

Use of complementary and alternative medicine (CAM) is increasing in the United States. This study investigates whether the use of alternative medicine is associated with a delay of treatment in head and neck cancer.

Macrolide therapy for chronic rhinosinusitis: A meta-analysis

Objective The objective of this study was to systematically review patient-reported outcomes of long-term macrolide therapy, compared with any other treatment, for adults with chronic rhinosinusitis. Data Sources EMBASE and PubMed databases were searched in October 2011. Review Methods A total of 1216 citations were screened initially by a single author, 23 full-text manuscripts were evaluated by 2 authors using structured data abstraction forms to assess for inclusion criteria and study quality, and 3 studies were included in the final review. Results This review finds that 3 prospective clinical studies have evaluated the effect of macrolide therapy for chronic rhinosinusitis. Based on the limited data, there is limited scientific evidence to support the use of long-term macrolide therapy for chronic rhinosinusitis. Conclusion Further clinical research is needed to determine whether there may be a subgroup effect based on the underlying inflammatory disease process.

Children with unilateral hearing loss may have lower intelligence quotient scores: A meta-analysis.

In this meta‐analysis, we reviewed observational studies investigating differences in intelligence quotient (IQ) scores of children with unilateral hearing loss compared to children with normal hearing.

Hypopharyngeal Surgery in Obstructive Sleep Apnea Practice Patterns, Perceptions, and Attitudes

Objective To characterize factors that surgeons perceive as affecting selection of procedures designed to treat hypopharyngeal obstruction in adults with obstructive sleep apnea (OSA) and to compare those factors among 2 groups of American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) member surgeons. Study Design Cross-sectional online survey. Subjects and Methods AAO-HNS members with a self-identified subspecialty interest either in sleep medicine or general otolaryngology were asked to complete an online survey, each respondent rated (5-point Likert scale) the perceived quality of their education and training and the role of specific factors in selection, both for procedure categories (eg, all hypopharyngeal) and individual procedures. Responses were examined for the entire group and for subgroups. Results Response rate was 27% (163/610). Sixty-five percent of respondents rated their surgical OSA education and training during postgraduate continuing medical education (CME) courses as of high quality, compared with 39% for residency/fellowship and 4% for medical school (P < 0.01). For individual hypopharyngeal procedures, over 40% of respondents reported limited training (except for tongue radiofrequency), and over 30% raised concerns about scientific evidence and reimbursement. Surgeon personal experience suggested treatment benefits without clearly favoring individual procedures. Respondents noted that patients were reluctant to undergo procedures, despite treatment recommendations, particularly maxillomandibular advancement. The sleep medicine subgroup reported higher ratings for education and training quality, research evidence, and personal experience with hypopharyngeal procedures. Concerns about adequate education and training, the quality of research evidence, and reimbursement issues were major factors in procedure selection. Conclusion Multiple factors affect procedure selection. Surgeons identify concerns regarding education and training and research evidence.

Children with unilateral hearing loss may have lower intelligence quotient scores

In this meta‐analysis, we reviewed observational studies investigating differences in intelligence quotient (IQ) scores of children with unilateral hearing loss compared to children with normal hearing.

The Effects of Intensive Care Unit Staffing on Patient Outcomes Following Microvascular Free Flap Reconstruction of the Head and Neck: A Pilot Study

OBJECTIVE To determine if the implementation of the closed intensive care unit (ICU) at our institution altered clinical outcomes in patients who had undergone microvascular free flap reconstruction of the head and neck by the Otolaryngology-Head and Neck Surgery Service. DESIGN Retrospective medical chart review. SETTING A single tertiary medical center. PATIENTS The open ICU cohort had 52 flaps performed on 50 patients, and the closed ICU cohort had 52 flaps performed on 52 patients. MAIN OUTCOME MEASURES Fifty-two free flap reconstructions of head and neck defects were performed on 50 patients who were admitted to an open ICU. The length of stay (LOS) in the ICU and hospital and incidence of complications were compared with those of 52 patients who underwent 52 free flap reconstructions and were admitted to a closed ICU over a separate period. RESULTS The mean length of stay in the ICU was 44 and 45 hours in the open and closed ICU cohorts, respectively (P = .90). The incidence of surgical and medical complications was similar in the open and closed ICU cohorts (P > .05). CONCLUSIONS There does not appear to be a significant difference in patient outcome between open and closed ICU care in our study.

Nasoseptal Flap Reconstruction of Pediatric Sellar Defects A Radiographic Feasibility Study and Case Series

Objectives In this study, we used computed tomography measurements to investigate the feasibility of nasoseptal flap reconstruction of sellar defects in children, and we reviewed our institutional experience with the procedure. Study Design Cross-sectional and case series. Setting Pediatric tertiary care facility. Methods We obtained 10 normal maxillofacial scans for each year of age from birth to 18. Computer-assisted nasal and skull-base measurements were performed. Patients with incomplete pneumatization were excluded from analysis. Reconstruction was presumed feasible if the ratio of nasoseptal flap length to associated sellar defect length was greater than 1. Chart review identified surgical patients. Results Of 190 scans, 125 had complete pneumatization. Of these, 120 (96%) displayed a ratio of nasoseptal flap length to sellar defect length greater than 1, suggesting that reconstruction would be feasible. Mean ratio of flap length to defect length for all subjects was 1.47 (SD 0.33; 95% CI, 1.41-1.53). Only 5 of 125 patients (4%) had a ratio less than 1; the median age for these patients was 15 years, which is older than the median age of 12 years for subjects with a ratio greater than 1 (P = .02). An inverse relationship was identified between age and ratio of flap length to defect length (r = −0.49, P < .001). Case series identified 6 children, ages 5 to 17; flap length was never described as a limitation. Conclusions Nasoseptal flap length is not a limiting factor for reconstruction of pediatric sellar defects. When compared with older patients, younger patients tend to have greater nasoseptal flap length relative to sellar defect length.

Face, content, and construct validation of a low-cost, non-biologic, sinus surgery task trainer and knowledge-based curriculum.

The purpose of this study was to evaluate face and content validity of a low‐cost, low‐technology, non‐biologic endoscopic sinus surgery (ESS) task trainer and knowledge‐based curriculum followed by construct validation of the task trainer.