Kevin C. McMains

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

Purpose: Most anterior skull base defects causing cerebrospinal fluid (CSF) rhinorrhea can be readily approached using endoscopic techniques when surgical repair is necessary. We present our data from endoscopic repair of CSF rhinorrhea with long‐term follow‐up.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Isam Alobid, MD, PhD1, Nithin D. Adappa, MD2, Henry P. Barham, MD3, Thiago Bezerra, MD4, Nadieska Caballero, MD5, Eugene G. Chang, MD6, Gaurav Chawdhary, MD7, Philip Chen, MD8, John P. Dahl, MD, PhD9, Anthony Del Signore, MD10, Carrie Flanagan, MD11, Daniel N. Frank, PhD12, Kai Fruth, MD, PhD13, Anne Getz, MD14, Samuel Greig, MD15, Elisa A. Illing, MD16, David W. Jang, MD17, Yong Gi Jung, MD18, Sammy Khalili, MD, MSc19, Cristobal Langdon, MD20, Kent Lam, MD21, Stella Lee, MD22, Seth Lieberman, MD23, Patricia Loftus, MD24, Luis Macias‐Valle, MD25, R. Peter Manes, MD26, Jill Mazza, MD27, Leandra Mfuna, MD28, David Morrissey, MD29, Sue Jean Mun, MD30, Jonathan B. Overdevest, MD, PhD31, Jayant M. Pinto, MD32, Jain Ravi, MD33, Douglas Reh, MD34, Peta L. Sacks, MD35, Michael H. Saste, MD36, John Schneider, MD, MA37, Ahmad R. Sedaghat, MD, PhD38, Zachary M. Soler, MD39, Neville Teo, MD40, Kota Wada, MD41, Kevin Welch, MD42, Troy D. Woodard, MD43, Alan Workman44, Yi Chen Zhao, MD45, David Zopf, MD46

UNILATERAL NASAL POLYPOSIS: CLINICAL PRESENTATION AND PATHOLOGY

OBJECTIVES The aim of this study is to determine the clinical presentation and pathology of unilateral nasal polyposis (UNP). STUDY DESIGN Retrospective chart review. METHODS A retrospective analysis was completed on 301 consecutive patients with nasal polyposis that underwent functional endoscopic sinus surgery from 1995 to 2004. Of the charts reviewed, 46 patients were identified with UNP. In this group, there were 28 males and 18 females with a mean age at presentation of 34.85 years. Pathologic diagnosis was not available for 2 patients, so there were 44 UNP patient records for analysis. Presenting symptoms, surgical findings, and pathology were analyzed. RESULTS All 44 patients underwent surgical management for their symptoms, and specimens were sent for pathologic evaluation. There were 17 cases of chronic rhinosinusitis, 15 of allergic fungal sinusitis, 7 of inverting papilloma, 2 of squamous cell carcinoma, 1 of esthesioneuroblastoma, 1 of mucocele, and 1 of human papilloma virus polyp-type papilloma. The only presenting symptom that correlated with the presence of inverted papilloma or neoplastic process in our patients with UNP was epistaxis. CONCLUSIONS Chronic rhinosinusitis, allergic fungal sinusitis, inverting papilloma, and other neoplasms account for most UNP cases and must be considered when a patient presents with symptoms of unilateral polyps. A careful history and endoscopic examination play a key role in identifying possible disease processes and proper management.

Effect of head position and surgical dissection on sinus irrigant penetration in cadavers

Effective treatment for recalcitrant rhinosinusitis requires unobstructed surgical marsupialization of sinus cavities and use of delivery systems that will topically penetrate the sinuses.

Irrigation penetration of nasal delivery systems: A cadaver study

To determine the sinus penetration potential of several commercially available irrigation systems in maximally operated sinus cavities; cadaveric study in a tertiary care center.

Unexpected consequences of transnasal balloon dilation of the maxillary ostium

Nasal irrigations and topical sprays have been demonstrated to have benefit in chronic sinusitis. Increasingly, it is evident that delivery system, patient anatomy, and inflammatory process have significant impacts on irrigant distribution.

Fabrication and validation of a low-cost, medium-fidelity silicone injection molded endoscopic sinus surgery simulation model.

Develop a low‐cost, medium‐fidelity model for education in endoscopic sinus surgery techniques. Establish face and content validity of the model based on the feedback of otolaryngology faculty including fellowship‐trained rhinologists.

Correlating regional aeroallergen effects on internet search activity.

Objective To investigate the correlation between the change in regional aeroallergen levels and Internet search activity related to allergies. Study Design A retrospective time series analysis using a graphical analytical approach and statistical modeling was used. Setting Tertiary academic hospital setting. Subjects and Methods There were no specific enrolled subjects. Data from Google Trends were obtained (google.com/trends) for the following search terms: “allergy,” “allergies,” “pollen,” “runny nose,” “congestion,” and “post nasal drainage.” Daily pollen and mold spore count data were obtained for the same period from throughout Texas. Graphical analysis, correlation, and autoregressive integrated moving average (ARIMA) were employed to assess the relationship between aeroallergens on Google search activity. Results A strong positive correlation was observed between observed pollen counts and search activity for the terms “allergies” (r pollen = 0.798), “allergy” (r pollen = 0.781), and “pollen” (r pollen = 0.849). Symptom term searches were weakly correlated with pollen and mold counts. Also, ARIMA modeling supported the relationships indicated by the correlations. Conclusion Search activities for surrogate terms such as “allergy,” “allergies,” and “pollen” correlate strongly with observed pollen counts but not mold counts. These data demonstrate the usefulness of Google Trends search data in assessing regional disease burdens and offer insight into how the public seeks information about their own illness.

Validating the use of report-derived Lund-Mackay scores

Background The Lund-MacKay score (LMS) is the standard for communicating radiological extent of chronic rhinosinusitis in research. However, retrospective analyses are often hindered by a substantial lack of radiological data. Calculating LMS from radiologists’ reports may overcome this but has not been formally validated. Methods Twenty South Australian and 20 Texan patients with varying degrees of sinus disease were randomly chosen to undergo analysis. CT-derived LMSs were calculated directly by two expert rhinologists at each institution and compared with scores derived solely from accompanying radiology reports by two blinded reviewers. Results The total LMS obtained via the expert rhinologists correlated very highly with that obtained from radiology reports (Spearman rank correlation, 0.75-0.88; p < 0.001). However, when individual sinuses were specifically analyzed, the correlation was highly variable. Conclusion The results show that in both South Australian and Texan tertiary rhinology centers, radiologists’ reports can be reliably used to calculate the total LMS.

Surfactant improves irrigant penetration into unoperated sinuses.

Background Saline irrigations are proving to be a valuable intervention in the treatment of chronic sinusitis. The use of surfactants is a well established additive to topical treatments known to reduce surface tension and may prove to be a simple, nonoperative intervention to improve intrasinus douching penetration. Methods Six 30-mL, flat-bottomed medicine cups with circular holes cut through the bottom center and varying in diameter from 1 to 6 mm were created with punch biopsies. Water, saline, saline/dye, and saline/dye/surfactant were compared for maximum holding pressure via these modeled ostia. Holding pressures also were determined for cups with septal mucosa fused to the bottom with holes ranging from 1 to 6 mm. In addition, analysis was carried out with blood and blood/surfactant. Finally, five thawed, fresh-frozen cadaver heads were evaluated before any sinus surgery with water/dye and water/dye/surfactant for intrasinus penetration. Results Surfactant significantly improved the ability of all solutions to penetrate ostia in both the plastic cup and fused septal mucosa model. All nonsurfactant-containing solutions were not statistically different from one another, nor did surfactant change the ostial penetration of blood. Surfactant significantly improved the ability of sinus irrigant to penetrate unoperated sinus cavities (3.12 vs 3.5, p = .021). Conclusions The addition of surfactant to saline irrigation improves ostial penetration in undissected and undiseased cadavers. This has practical implications for unoperated patients seeking care for sinus-related symptoms in that we have now described a method for improving topical treatment of target sinus mucosa prior to surgical intervention.