Jose Gurrola

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.

Analysis of the petrous portion of the internal carotid artery: landmarks for an endoscopic endonasal approach.

While there are many benefits to the endoscopic endonasal approach to the infratemporal fossa, involvement of the petrous portion of the internal carotid artery (ICA) poses a unique challenge. The endoscopic endonasal approach requires establishing the relationship of the petrous ICA to anatomical landmarks to guide the surgeon. This study evaluates the relationship of petrous ICA to specific anatomic landmarks, both radiographically and through cadaveric dissections.

Immunoglobulin replacement therapy reduces chronic rhinosinusitis in patients with antibody deficiency.

Patients with primary antibody deficiencies have an increased frequency of sinonasal and pulmonary infections. Immunoglobulin (Ig) replacement is a standard therapy for common variable immunodeficiency (CVID) and other antibody deficiency diseases. Although there is convincing evidence that Ig replacement reduces pulmonary infections, there is little evidence that it reduces sinus infections or abates chronic rhinosinusitis (CRS). This study aims to identify the impact of Ig replacement on CRS in antibody deficiencies.

Variation in Delivery of Sinus Surgery in the Medicaid Population across Ethnicities

Objective To evaluate differences in sinus surgery rates in the US Medicaid population by ethnicities. Study Design Retrospective administrative database analysis. Setting US-based outpatient settings. Methods All patients from the MarketScan Medicaid database with endoscopic sinus surgery from 2009 to 2013 were stratified by ethnicity, age (5-year increments, as per US Census), and sex. Crude rates of endoscopic sinus surgery per age group and sex were compiled for all patients and each ethnic group (African American, Caucasian, Hispanics, and others). Age and sex standardization was done with the MarketScan Medicaid overall population as standard. The coefficient of variation, extremal ratio, and chi-square statistics were calculated to determine variation across ethnicities. Results Overall sinus surgery rates per 1000 people in the Medicaid population ranged from 0.36 to 0.40 from 2009 to 2013 (African Americans: 0.24-0.26; Hispanics: 0.21-0.37; Caucasians: 0.47-0.56; rate of surgery statistically lower for African American vs Hispanics for 4 of 5 years). The coefficient of variation and extremal ratio ranged from 29.3% to 45.6% and 1.98 to 2.6, respectively. Differences among groups were significant for all years (P < .0001). Comparison of sex-adjusted ratios by age group demonstrated greater rates of surgery in the Caucasian group versus other groups for all age categories. Conclusion The Medicaid database was selected for this analysis to eliminate payer and wealth as potential confounders in access to health care. Despite this approach, significant differences in surgery rates among ethnic groups were observed. Further research is critical to understand those differences and provide actionable and effective recommendations for change.

The Effect of Smoking on Quality of Life following Sinus Surgery: 10-Year Follow-Up

Objectives: The purpose of this study is to investigate the 10-year postoperative quality of life outcomes in smokers and nonsmokers with chronic rhinosinusitis. Study Design: This is a single-institution prospective cohort study. Methods: 235 patients who have previously been enrolled in a 4-year follow-up study were identified and contacted for a telephone interview. Rates of revision surgery, smoking status and 20-item sinonasal outcomes test (SNOT-20) scores were obtained. Preoperative SNOT-20 scores were compared with those obtained at the 10-year follow-up. Results: Of the patients enrolled in the initial 4-year study, 22.5% were available for a telephone interview, including 43 out of 185 nonsmokers (23.2%) and 9 out of 50 smokers (18%). Demographic data including age, sex and race were analyzed and found to be similar between the two groups. Preoperative SNOT-20 scores were similar between nonsmokers and smokers (28.9 vs. 25.8, p = 0.89). There was no significant difference in long-term SNOT-20 scores (10 years postoperatively) between nonsmokers and smokers (31.5 vs. 28.2, p = 0.629). Conclusions: While cigarette smoke may have long-term adverse effects on the sinonasal mucosa, we found no difference in quality of life outcomes between smokers and nonsmokers 10 years after functional endoscopic sinus surgery.

Rhinologic Evaluation of Patients Undergoing Transsphenoidal Surgery

Transsphenoidal surgery, while considered minimally invasive compared to transcranial approaches, may still lead to significant issues if the delicate anatomy of the nasal cavity and paranasal sinuses is not evaluated and any comorbid disease not recognized. Preexisting anatomical variations such as septal deviation or concha bullosa of the turbinates may significantly limit access. Underlying sinonasal inflammation may predispose to increased difficulty of the surgery or protracted symptomatology during the postoperative course. Other patient issues such as the tumor pathology and/or hormone production must also be considered. A thorough history of the patient’s sinonasal history must be obtained and, when necessary, specialty consultation obtained in order to optimize the surgery and recovery periods. At times, this may require delay of the surgery in order to avoid the unexpected complications such as nasal scarring, chronic or recurrent sinusitis, or sinus mucoceles. This chapter will help direct the surgeon with preoperative assessment in order to optimize outcome.

Why sinonasal disease spares the inferior turbinate: An immunohistochemical analysis

Clinically, inflammatory polyps are found in the middle turbinate (MT) in patients with chronic rhinosinusitis (CRS) but not in the inferior turbinate (IT). The purpose of this study was to investigate differences in protein expression between IT and MT tissue in patients with CRS.

Comorbidities in patients with all‐positive symptoms on sinonasal outcomes test quality‐of‐life instrument

The Sinonasal Outcomes Test‐20 (SNOT‐20) is a validated tool to assess treatment outcomes in patients with chronic rhinosinusitis (CRS). In the clinic, we observed that patients who responded with a positive score on all 20 items of the SNOT‐20 questionnaire (pan‐positive patients) often did not have evidence of CRS upon workup. Many of these patients had other underlying diseases contributing to their complaints.