Zachary M. Soler

Health state utility values in patients undergoing endoscopic sinus surgery.

The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments.

Relationship between clinical measures and histopathologic findings in chronic rhinosinusitis.

OBJECTIVE: Describe detailed histopathologic findings from a cohort of patients with chronic rhinosinusitis and evaluate whether histologic measures correlate with baseline clinical factors. STUDY DESIGN: Cross-sectional study with planned data collection. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Disease severity was measured by computed tomography (CT), endoscopy, Smell Identification Test (SIT), the Chronic Sinusitis Survey, Rhinosinusitis Disability Index, and SF-36 General Health Survey. Mucosal specimens were assessed for the presence of mucosal inflammation, including cellular (eosinophils, neutrophils, lymphocytes, mast cells, plasma cells, macrophages), epithelial (squamous metaplasia, basement membrane thickening, goblet cells), and stromal markers (subepithelial edema, fibrosis). Histopathologic findings were correlated to baseline clinical factors. RESULTS: A total of 147 subjects were enrolled with histologic samples available for review. Presence of inflammatory markers was diverse, with lymphocytes present in 100 percent of subjects, eosinophils in 49.7 percent, and neutrophils found in 0.7 percent. Total eosinophil counts correlated with the presence of nasal polyposis (r = −0.367; P < 0.001), asthma (r = 0.264; P = 0.001), and aspirin intolerance (r = 0.279; P = 0.001). Mucosal eosinophilia correlated with worse disease severity on CT (r = 0.414; P < 0.001), endoscopy (r = 0.376; P < 0.001), and SIT (r = −0.253; P = 0.002), with the highest correlations seen in subgroups without nasal polyps. Histopathologic findings did not significantly correlate with any quality-of-life measure. CONCLUSION: Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with quality-of-life scores.

Impact of mucosal eosinophilia and nasal polyposis on quality-of-life outcomes after sinus surgery.

OBJECTIVE: Assess whether the presence of mucosal eosinophilia correlates with surgical outcomes in patients with chronic rhinosinusitis. STUDY DESIGN: Prospective cohort. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Adult patients with chronic rhinosinusitis were prospectively enrolled, and demographic data and medical comorbidities were recorded. Preoperative quality of life (QOL) was measured by the Chronic Sinusitis Survey (CSS), Rhinosinusitis Disability Index (RSDI), and Short Form-36 General Health Survey (SF-36). Sinus mucosal specimens were collected at the time of surgery and the degree of eosinophilia quantified. Postoperative QOL was measured, and differences in QOL improvement were compared between those with and without eosinophilia. RESULTS: A total of 102 patients had both histopathological and QOL outcome data available for review. Follow-up averaged 16.5 months. Patients with eosinophilia showed significantly less improvement in the RSDI total (17.9 vs 25.0; P = 0.044), RSDI functional (5.7 vs 8.8; general health subscale; P = 0.018), CSS medication (3.6 vs 17.3; P = 0.013), SF-36 general health (0.6 vs 9.6; P = 0.008), SF-36 physical role (16.1 vs 34.7; P = 0.036), and SF-36 vitality (11.9 vs 21.2; P = 0.034) scales than those without eosinophilia. The greatest improvement in QOL was seen in patients without eosinophilia or polyps, with the least improvement seen in those with eosinophilia but without polyps. CONCLUSION: The presence of mucosal eosinophilia at the time of surgery consistently predicted less improvement in both disease-specific and general QOL compared with patients without eosinophilia. The impact of eosinophilia on outcomes was greatest for patients without nasal polyposis, a group that demonstrated the least improvement in QOL measures.

Symptom-based presentation of chronic rhinosinusitis and symptom-specific outcomes after endoscopic sinus surgery.

Background Very few studies have comprehensively examined specific symptom outcomes of endoscopic sinus surgery (ESS). The purpose of this study was to define the individual symptoms of a cohort of patients with medically refractory chronic rhinosinusitis (CRS) using visual analog scale (VAS) scores as well as report symptom-based outcomes after ESS. Methods Patients with medically refractory CRS presenting for surgical management were asked to evaluate baseline symptoms using 10-cm VAS measures. Participants were asked to rank their most debilitating symptoms in descending order. VAS scores were assessed postoperatively at 3, 6, 12, and 18 months. The Kruskal-Wallis test was used to assess improvement in mean symptom VAS scores at each of the postoperative time points. Results Nasal congestion elicited the highest preoperative VAS score with an average of 6.5, followed by fatigue (6.0), headache (5.8), decreased sense of smell (5.5), nasal drainage (5.5), and facial pain-pressure (5.5). Headache was the most commonly reported disabling condition. Follow-up data after ESS was available for 207 patients. Average VAS scores for 6 of 7 symptoms showed significant and sustainable postoperative improvement at 3, 6, 12, and 18 months after surgery (p < 0.001). Improvement in VAS score for headache was not statistically significant (p > 0.700). Conclusion This study indicates that patients with medically refractory CRS presenting for surgery complain of associated symptoms with great frequency. ESS results in both statistically and clinically significant improvements in six of seven symptoms. Headache, which was the most highly ranked disabling symptom, did not show significant improvement from baseline.

Productivity Costs in Patients with Refractory Chronic Rhinosinusitis

Disease‐specific reductions in patient productivity can lead to substantial economic losses to society. The purpose of this study was to: 1) define the annual productivity cost for a patient with refractory chronic rhinosinusitis (CRS) and 2) evaluate the relationship between degree of productivity cost and CRS‐specific characteristics.

SNOT‐22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis

Prior study demonstrated that baseline 22‐item Sino‐Nasal Outcome Test (SNOT‐22) aggregate scores accurately predict selection of surgical intervention in patients with chronic rhinosinusitis (CRS). Factor analysis of the SNOT‐22 survey has identified five distinct domains that are differentially impacted by endoscopic sinus surgery (ESS). This study sought to quantify SNOT‐22 domains in patient cohorts electing both surgical or medical management and postinterventional change in these domains.

Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations†

Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long‐term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence‐based approach to early postoperative care following ESS.

Outcomes After Middle Turbinate Resection: Revisiting a Controversial Topic

To evaluate differences in endoscopy exam, olfactory function, and quality‐of‐life (QOL) status after endoscopic sinus surgery (ESS) for patients with and without bilateral middle turbinate (BMT) resection.

A systematic review of the endoscopic repair of cerebrospinal fluid leaks.

Objectives To provide an up-to-date review of the literature on the safety and efficacy of the endoscopic technique for cerebrospinal (CSF) leak repairs. Data Sources PubMed, Medline/Old Medline, and Cochrane Central databases. Review Methods Using the above outlined data sources, studies involving the endoscopic repair of CSF leaks were reviewed independently by 2 researchers. Studies included met the following criteria: full-text article written in the English language, at least 5 human patients undergoing purely endoscopic surgical repair of a CSF leak, and documented follow-up. Data extracted included leak etiology, presentation and location, the use of imaging, intrathecal fluorescein, and adjunctive measures as well as the success rate of the repair. Results Fifty-five studies, involving 1778 fistulae repairs, were included for analysis. Spontaneous leaks were most prevalent, with the ethmoid roof and sphenoid the most common sites involved. The overall success rate of repair was high at 90% for primary and 97% for secondary repairs. A low complication rate of less than 0.03% was reported. Conclusion The endoscopic repair of CSF fistula is both safe and effective and should be considered the standard of care for most cases. Evidence supporting adjunctive measures such as lumbar drains and antibiotics remains limited despite their common use.

Antimicrobials and chronic rhinosinusitis with or without polyposis in adults: An evidenced-based review with recommendations

Chronic rhinosinusitis (CRS) is characterized by inflammation of the mucosa of the nose and paranasal sinuses. The role of bacterial or fungal infection in CRS is unclear, yet antimicrobials are commonly prescribed for this condition. Published guidelines offer little direction regarding antibiotic strategies for CRS. The purpose of this article is to provide an evidence‐based approach to the use of antibacterial and antifungal antibiotics in the management of CRS.