Seth M. Brown

Clinical Consensus Statement Septoplasty with or without Inferior Turbinate Reduction

Objective To develop a clinical consensus statement on septoplasty with or without inferior turbinate reduction. Methods An expert panel of otolaryngologists with no relevant conflicts of interest was assembled to represent general otolaryngology and relevant subspecialty societies. A working definition of septoplasty with or without inferior turbinate reduction and the scope of pertinent otolaryngologic practice were first established. Patients 18 years and older were defined as the targeted population of interest. A modified Delphi method was then used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results The group defined nasal septoplasty as a surgical procedure designed to correct a deviated nasal septum for the purpose of improving nasal function, form, or both. After 2 iterative Delphi method surveys, 20 statements met the standardized definition of consensus, while 13 statements did not. The clinical statements were grouped into 8 categories for presentation and discussion: (1) definition and diagnosis, (2) imaging studies, (3) medical management prior to septoplasty, (4) perioperative management, (5) surgical considerations, (6) adjuvant procedures, (7) postoperative care, and (8) outcomes. Conclusion This clinical consensus statement was developed by and for otolaryngologists and is intended to promote appropriate and, when possible, evidence-based care for patients undergoing septoplasty with or without inferior turbinate reduction. A complete definition of septoplasty with or without inferior turbinate reduction was first developed, and additional statements were subsequently produced and evaluated addressing diagnosis, medical management prior to septoplasty, and surgical considerations, as well as the appropriate role of perioperative, postoperative, and adjuvant procedures, in addition to outcomes. Additionally, a series of clinical statements were developed, such as “Computed tomography scan may not accurately demonstrate the degree of septal deviation,” “Septoplasty can assist delivery of intranasal medications to the nasal cavity,” “Endoscopy can be used to improve visualization of posterior-based septal deviation during septoplasty,” and “Quilting sutures can obviate the need for nasal packing after septoplasty.” It is anticipated that the application of these principles will result in decreased variations in the care of septoplasty patients and an increase in the quality of care.

Practice patterns in endoscopic skull base surgery: survey of the American Rhinologic Society

The introduction of advanced endoscopic techniques has facilitated significant growth in the field of endoscopic skull base surgery (SBS). The purpose of this study is to evaluate the impact of endoscopic SBS on the clinical practice patterns of the American Rhinologic Society (ARS) membership.

The Role of Alternative Medicine in Rhinology

Complementary and alternative medicine (CAM) includes treatments from traditional Chinese medicine, homeopathy, naturopathy, herbal medicine, Ayurvedic medicine, mind-body medicine, chiropractic or osteopathic manipulations, and massage. More than 40% of patients in the United States use CAM, with 17% of CAM use related to otolaryngology diagnoses, but nearly half of CAM users do not communicate their use of these medications to their physicians. Perioperative risk of bleeding is a particular concern in surgical specialties, and knowledge of these therapies and their potential adverse effects is critical.

Endoscopic resection of maxillary sinus inverted papillomas with inferior turbinate preservation

The surgical management of inverted papillomas of the maxillary sinus has evolved from large en block excisions requiring external incisions to the minimally invasive endoscopic and endoscopic-assisted techniques used today. The traditional endoscopic approach involves resection of the inferior turbinate to perform an endoscopic medial maxillectomy, which can cause atrophic rhinitis and shrinking of the maxillary sinus, resulting in difficulty following these patients for recurrence in the office. In this article, we present a series of patients who underwent a modified endoscopic surgical approach for the excision of maxillary sinus inverted papillomas. In our approach, we preserve the inferior turbinate to preserve nasal mucosa physiology. Patient characteristics, recurrence rates, and complications associated with this approach are reviewed.

The subspecialty of rhinology: a survey of otolaryngology chairmen.

The past decade has witnessed the emergence of rhinology as a distinct subspecialty within otolaryngology. A critical evaluation of this process is necessary to define the field and to determine the impact of subspecialization on residency education.

Complementary and Integrative Treatments: Allergy

Allergic rhinitis (AR) is a global disease affecting hundreds of millions internationally. Substantial pharmacologic gains have been made in the treatment of allergy, including antihistamines, steroids, and leukotriene inhibitors. Pharmacology and immunotherapy are the 2 primary choices in an otolaryngologists armamentarium of allergy treatment. Outside of these options lie complementary and integrative medicine, including various herbs and supplementation along with acupuncture. Some of these methods have shown great efficacy in treating AR and others have failed to show any improvement. This article reviews AR and some of the more common therapies used to care for the disease.

Complementary and Integrative Treatments

Allergic rhinitis (AR) is a global disease affecting hundreds of millions internationally. Substantial pharmacologic gains have been made in the treatment of allergy, including antihistamines, steroids, and leukotriene inhibitors. Pharmacology and immunotherapy are the 2 primary choices in an otolaryngologists armamentarium of allergy treatment. Outside of these options lie complementary and integrative medicine, including various herbs and supplementation along with acupuncture. Some of these methods have shown great efficacy in treating AR and others have failed to show any improvement. This article reviews AR and some of the more common therapies used to care for the disease.

Nasal Endoscopy Billing Patterns: A Survey of the American Rhinologic Society

Introduction Nasal endoscopy (NE) is an essential element of office-based clinical rhinology, including the evaluation of chronic rhinosinusitis. Despite the presence of guidelines, variability exists regarding coding and billing for NE especially with regard to inclusion of evaluation and management (E&M) codes and use of the 25 modifier. The goal of this survey was to assess the billing patterns for NE among American Rhinologic Society (ARS) members. Methods An invitation to participate in a web-based survey was electronically sent to all ARS members. Survey participants were queried regarding demographics and billing patterns for NE in several different clinical scenarios using a 5-point Likert-type scale, with a score of 5 representing “always” and a score of 1 representing “never” for billing E&M. Results A total of 93 respondents successfully completed the survey with a range of the number of years since completing training, practice type (50.5% private, 44.1% academic) and completion of a rhinology fellowship (40.9%). Variable responses for billing patterns for distinct clinical scenarios were noted. Higher scores for billing both E&M and NE for the queried clinical scenarios were noted for new patients (mean 4.50) compared to established patients (mean 3.81) and postoperative patients (mean 3.04). Inclusion of a septoplasty as part of the surgery impacted billing an E&M code 28% of the time. Practice type and history of performing a fellowship did not significantly influence billing patterns for NE. Conclusions Significant variability exists among ARS respondents with regard to billing patterns for NE, despite the presence of coding guidelines. Additional teaching of standard coding practices for NE may limit variability among otolaryngologists.

Medical Management of Frontal Sinusitis

Rhinosinusitis is a term that has long been used to describe a diverse disease entity that encompasses several related but distinct conditions involving the paranasal sinuses. Frontal sinusitis represents one such entity with its own unique treatment considerations. Like rhinosinusitis as a whole, the role of medical management in the treatment of frontal sinusitis cannot be overlooked. Contemporary medical management of frontal sinusitis requires recognition of the unique disease process with implementation of targeted therapies aimed at addressing the specific pathophysiology.

Academic rhinology: a survey of residency programs and rhinology faculty in the United States

Rhinology has rapidly evolved as a subspecialty over the past decade. The professional activities of rhinology faculty in otolaryngology residency programs is an important defining feature of this process but remains incompletely understood.