Phillip S. LoSavio

Radiofrequency Tonsil Reduction: Safety, Morbidity, and Efficacy

Objectives To evaluate the safety, morbidity, and efficacy of radiofrequency tissue volume reduction of tonsils using two different surgical techniques and to compare these two techniques with each other and with classic tonsillectomy.

Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis

BACKGROUND It is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. OBJECTIVE To identify the risk factors for OSA in CRS to determine who should be screened for OSA among patients with CRS. METHODS We evaluated a large cohort of patients with confirmed diagnostic criteria for CRS. Patient medical records were reviewed to identify those with OSA confirmed by overnight polysomnography. Records were further reviewed for demographic information (age, sex, race, and ethnicity), body mass index, and medical history, including the presence of nasal polyps, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, and eczema. The number of endoscopic sinus operations, duration of CRS, presence of subjective smell loss, and computed tomography Lund-Mackay score were also ascertained. RESULTS A total of 916 patients with CRS were included in the study. Implementation of a multivariable regression model for identifying adjusted risk factors revealed that African American patients had a significantly higher risk for OSA than white patients, with an adjusted odds ratio of 1.98 (95% confidence interval, 1.19-3.29). Furthermore, patients with CRS without nasal polyps were at higher risk for OSA, with an odds ratio of 1.63 (95% confidence interval, 1.02-2.61) compared with patients with CRS with nasal polyps. CONCLUSION African American patients with CRS were at higher risk for OSA compared with white patients, and this patient group needs to be screened for OSA.

Surgery of the Nasal Septum and Turbinates

Septal and turbinate surgery accounts for the majority of all sinonasal procedures performed in the United States. Nasal obstruction is a common presenting complaint in any otolaryngology practice. Surgical methods to address this problem have evolved over the last century with an increased focus on tissue preservation and structural conservation. Contemporary surgical techniques incorporate a blend of methods and strategy and now even involve the capacity to utilize endoscopic guidance. Patients are best treated with an approach based on individual nasal pathology rather than a standard surgical technique applied to all scenarios. More recently, rigorous attempts have been made to report quality of life outcome measures following these procedures in order to better assess their clinical utility.

Association of nasal microbiome and asthma control in patients with chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease involving the mucosal tissue of the upper airways, including the nose and paranasal sinuses.(1) Asthma is a related chronic inflammatory disease of the lower airways that is often comorbid with CRS. Uncontrolled upper airway inflammation in the context of CRS is associated with lower airway T-helper-2 mediated inflammation and recalcitrant asthma, however; the underlying mechanism of this link is rather complicated and currently under investigation.(2). This article is protected by copyright. All rights reserved.

Patients with chronic rhinosinusitis and obstructive sleep apnea have increased paroxysmal limb movement

Background: Patients with chronic rhinosinusitis (CRS) frequently experience sleep disruption and are at a higher than normal risk for obstructive sleep apnea (OSA). The purpose of this study was to determine how CRS affects polysomnography findings and sleep-related breathing in OSA. Methods: A cohort study was performed that included 107 adult patients with CRS and comorbid OSA (CRS+OSA group) and 137 patients with OSA and without CRS as the control group. An electronic medical records database was used to identify eligible subjects. Comorbid conditions and polysomnography data were compared between the two groups by using logistic and linear regression analyses. Results: A total of 246 patients were included: 107 patients in the CRS+OSA group and 137 patients with OSA and without CRS in the control group. After adjusting for demographic factors, the patients in the CRS+OSA group had a lower body mass index (BMI) and higher age at the time of diagnosis of OSA (p < 0.001). The patients in the CRS+OSA group had higher odds of having asthma and eczema. There was an increase in the periodic limb movement (PLM) index in the CRS+OSA group. Apnea and hypopnea indices were similar in the two groups. Conclusion: Patients with CRS developed OSA at a lower BMI; patients CRS and OSA had similar sleep-related breathing patterns but higher risks for PLMs compared with patients with OSA and without CRS.

Prevention of Tracheostomy-Related Hospital-Acquired Pressure Ulcers:

Objective To determine if standardization of perioperative tracheostomy care procedures decreased the incidence of hospital-acquired tracheostomy-related pressure ulcers. Methods All patients at least 18 years old who underwent placement of a tracheostomy tube in the operating room from July 1, 2014, through June 30, 2015, were cared for postoperatively through an institutionally adopted quality improvement protocol. This included 4 elements: (1) placement of a hydrocolloid dressing underneath the tracheostomy flange in the postoperative period, (2) removal of plate sutures within 7 days of the tracheostomy procedure, (3) placement of a polyurethane foam dressing after suture removal, and (4) neutral positioning of the head. One year after the bundle was initiated, a retrospective analysis was performed to compare the percentage of tracheostomy patients who developed pressure ulcers versus the preintervention period. Results The incidence of tracheostomy-related pressure ulcers decreased from 20 of 183 tracheostomies (10.93%) prior to use of the standardized protocol to 2 of 155 tracheostomies (1.29%). Chi-square analysis showed a significant difference between the groups, with a P value of .0003. Discussion Adoption of this care bundle at our institution resulted in a significant reduction in the incidence of hospital-acquired tracheostomy-related pressure ulcers. The impact of any single intervention within our protocol was not assessed and could be an area of further investigation. Implications for Practice Adoption of a standardized posttracheostomy care bundle at the institution level may result in the improved care of patients with tracheostomies and specifically may reduce the incidence of pressure ulcers.

Management of the Difficult Airway

A universally accepted definition for the “difficult airway” can be challenging to define based on the current literature. The American Society of Anesthesiologists describes it as “the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.” A variety of protocols, mnemonics, and guidelines have been developed to aid a physician in managing these difficult and challenging cases. As with any basic or advanced life support, the establishment of an adequate airway and ventilation are the first and foremost steps in stabilizing a patient’s vital sign parameters. Inadequate ventilation will ultimately lead to a rapid decline in oxygenation and subsequent arrest. Further efforts to resuscitate will prove fruitless without taking the time to stabilize this basic and core aspect of the patient’s physiology.