Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale最新文献

{"title":"A national study of choanal atresia in tertiary care centers in Canada - part I: clinical presentation.","authors":"Josee Paradis,&nbsp;Agnieszka Dzioba,&nbsp;Hamdy El-Hakim,&nbsp;Paul Hong,&nbsp;Frederick K Kozak,&nbsp;Lily H P Nguyen,&nbsp;Demitri Perera,&nbsp;Evan Jon Propst,&nbsp;Jennifer M Siu,&nbsp;Monika Wojtera,&nbsp;Murad Husein","doi":"10.1186/s40463-021-00517-x","DOIUrl":"https://doi.org/10.1186/s40463-021-00517-x","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada.</p><p><strong>Methods: </strong>Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center.</p><p><strong>Results: </strong>The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome.</p><p><strong>Conclusions: </strong>The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"45"},"PeriodicalIF":3.4,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40463-021-00517-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39177288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human-derived acellular dermal matrix may be an alternative to autologous grafts in tympanic membrane reconstruction: systematic review and meta-analysis.","authors":"Shan Xu, Xia Sun, Ning Yang, Aihui Yan","doi":"10.1186/s40463-021-00518-w","DOIUrl":"10.1186/s40463-021-00518-w","url":null,"abstract":"<p><strong>Background: </strong>Human-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty. However, evidence of ADM as an alternative to autologous grafts in the repair of tympanic membrane (TM) perforation still lacks adequate empirical evidence.</p><p><strong>Objectives: </strong>To determine the clinical safety and efficacy of human-derived ADM as TM graft material for tympanoplasty.</p><p><strong>Data sources: </strong>The PubMed, EMBASE, Cochrane Library, EBSCO, Ovid, Scopus, and Web of Science databases and reference lists of the retrieved articles were searched, with no language restriction.</p><p><strong>Selection criteria: </strong>All randomized controlled trials and retrospective cohort studies that compared the use of human-derived ADM and autologous grafts in tympanoplasty for TM perforation were included.</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed risk of bias in the included studies and extracted data. The pooled results for continuous data were reported as a mean difference (MD) and 95% confidence intervals (CI). For dichotomous data, odds risk (OR) with 95% CI was used. ChI² statistic and Galbraith plots were used to assess the heterogeneity. Publication bias was assessed with a funnel plot and Egger's test.</p><p><strong>Main results: </strong>Five retrospective cohort studies and four randomized controlled studies with a total of 610 participants were included in the meta-analysis. No significant differences in graft success (OR: 0.71 [0.39, 1.29], p = 0.26), air-bone gap (ABG) reduction (MD: - 0.59 [- 3.81, 1.19], p = 0.51), or complications (OR: 1.23 [0.07, 20.64], p = 0.89) were found between the ADM group and autologous graft group. The use of ADM significantly shortened tympanoplasty surgery time (MD: - 16.14 [- 21.22, - 11.07], p < 0.00001) and reduced postoperative pain (MD: - 2.57 [- 3.57, - 1.58], p < 0.00001) compared with the autologous graft group.</p><p><strong>Conclusion: </strong>Human-derived ADM might be an effective alternative to autologous grafts for tympanoplasty. However, some of the studies that were included in the present meta-analysis had rather low methodological quality, and more adequately designed clinical trials should be performed in the future.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"43"},"PeriodicalIF":2.2,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39158889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic and other reviews: criteria and complexities.","authors":"Robert T Sataloff,&nbsp;Matthew L Bush,&nbsp;Rakesh Chandra,&nbsp;Douglas Chepeha,&nbsp;Brian Rotenberg,&nbsp;Edward W Fisher,&nbsp;David Goldenberg,&nbsp;Ehab Y Hanna,&nbsp;Joseph E Kerschner,&nbsp;Dennis H Kraus,&nbsp;John H Krouse,&nbsp;Daqing Li,&nbsp;Michael Link,&nbsp;Lawrence R Lustig,&nbsp;Samuel H Selesnick,&nbsp;Raj Sindwani,&nbsp;Richard J Smith,&nbsp;James Tysome,&nbsp;Peter C Weber,&nbsp;D Bradley Welling","doi":"10.1186/s40463-021-00527-9","DOIUrl":"https://doi.org/10.1186/s40463-021-00527-9","url":null,"abstract":"","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"41"},"PeriodicalIF":3.4,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40463-021-00527-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-acid reflux and sleep apnea: the importance of drug induced sleep endoscopy.","authors":"Carlos O'Connor-Reina,&nbsp;Jose Maria Ignacio Garcia,&nbsp;Peter Baptista,&nbsp;Maria Teresa Garcia-Iriarte,&nbsp;Carlos Casado Alba,&nbsp;Monica Perona,&nbsp;Paz Francisca Borrmann,&nbsp;Laura Rodriguez Alcala,&nbsp;Guillermo Plaza","doi":"10.1186/s40463-021-00526-w","DOIUrl":"https://doi.org/10.1186/s40463-021-00526-w","url":null,"abstract":"<p><strong>Background: </strong>We present the first case of a patient with obstructive sleep apnea syndrome (OSA), where drug induced sleep endoscopy was helpful to suspect a non-acid reflux disease and showed an improvement in a swollen epiglottis after treatment. Patient ameliorated significantly his disease only with medical therapy.</p><p><strong>Case presentation: </strong>A 54-year-old man without significant anatomical findings with obstructive sleep apnea syndrome and non-acid gastroesophageal reflux disease (GERD) disease whose Apnea- hypopnea index (AHI) was significantly reduced with the intake of 500 mg of sodium alginate twice a day for 6 months. Conventional digestive tests such as esophagoscopy and simple- and double-channel 24-h pH-metry suggested mild GERD. Conventional proton-pump inhibitor treatment with pantoprazole (40 mg daily) was started without any improvement in his sleep. Multichannel intraluminal 24-h impedanciometry indicated the presence of severe pathological GER of gaseous origin. The patient's AHI decreased from 25.3 at baseline to 8 after treatment with sodium alginate. A drug-induced sleep endoscopy study showed the changes before and after this treatment and was helpful for the diagnosis.</p><p><strong>Conclusions: </strong>Thus, medical treatment can be a therapeutic option in some patients with OSA. Multichannel 24-h impedanciometry should be performed when nonacid GERD is suspected.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"42"},"PeriodicalIF":3.4,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39122939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the Canadian Thyroid Cancer Active Surveillance Study Group 2019 national investigator meeting.","authors":"David P Goldstein,&nbsp;Sangeet Ghai,&nbsp;Martin Corsten,&nbsp;Eric Bissada,&nbsp;Nathalie Audet,&nbsp;Han Zhang,&nbsp;Anthony Nichols,&nbsp;Deric Morrison,&nbsp;Stephanie Johnson-Obeski,&nbsp;Donald W Anderson,&nbsp;Eitan Prisman,&nbsp;Nancy N Baxter,&nbsp;Jennifer Jones,&nbsp;Amiram Gafni,&nbsp;Ian Witterick,&nbsp;Anna M Sawka","doi":"10.1186/s40463-021-00514-0","DOIUrl":"https://doi.org/10.1186/s40463-021-00514-0","url":null,"abstract":"<p><p>Active surveillance (AS) in the management of small, low risk papillary thyroid cancer (PTC) as an alternative option to thyroidectomy, is an area of active research. A national Canadian study is proposed to evaluate the long-term outcomes of patients with small, low risk PTC who choose AS or surgery. This letter describes the proceedings of a national investigator meeting to plan the study.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"40"},"PeriodicalIF":3.4,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40463-021-00514-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39108156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microwave ablation eustachian tuboplasty: a preliminary investigation with long-term follow-up.","authors":"Zhengcai Lou, Zihan Lou, Junzhi Sun, Zhengnong Chen, Shankai Yin","doi":"10.1186/s40463-021-00520-2","DOIUrl":"10.1186/s40463-021-00520-2","url":null,"abstract":"<p><strong>Objectives: </strong>This study was performed to evaluate the efficacy of microwave ablation (MWA) eustachian tuboplasty for the treatment of patients with retracted tympanic membrane (TM) due to eustachian tube dysfunction (ETD).</p><p><strong>Methods: </strong>This was a prospective study of 20 patients with ETD (middle ear atelectasis) who underwent MWA eustachian tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, audiometry results, tympanometry results, ETD Questionnaire (ETDQ-7) score, and TM status.</p><p><strong>Results: </strong>Eighteen patients (18 ears) were included in this study. There were statistically and clinically significant improvements in the mean ETDQ-7 score at 6 months postoperatively (change in mean score of 16.7 ± 3.6, P < 0.001) and at 30 months postoperatively (change in mean score of 18.9 ± 2.9, P < 0.001). Type A tympanogram was obtained in 27.8% of patients (5/18) at 6 months postoperatively, and in 77.7% at 30 months postoperatively. A Valsalva maneuver was possible in 72.2% of patients at 6 months postoperatively and in 88.9% of patients at 30 months postoperatively. In addition, the ears of 13 patients (72.2%) showed both normal tympanograms and TM at 30 months postoperatively. Interestingly, 38.5% of patients (5/13) exhibited complete sclerosis of the pars tensa. None of the patients experienced severe MWA-related complications during follow-up.</p><p><strong>Conclusions: </strong>MWA eustachian tuboplasty is a feasible alternative to conventional tuboplasty, and can improve subjective and objective outcomes in patients with ETD for up to 30 months following treatment. In addition, this study showed that the extent of sclerotic plaque increased over time, whereas the extents of atrophy and tensa retraction decreased following tuboplasty in most patients.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"39"},"PeriodicalIF":2.2,"publicationDate":"2021-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39024074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is otologic surgery contributing to the opioid epidemic?","authors":"Valerie Dahm,&nbsp;Justin T Lui,&nbsp;Rudolfs Liepins,&nbsp;Joseph M Chen,&nbsp;Trung N Le,&nbsp;Christoph Arnoldner,&nbsp;Vincent Y W Lin","doi":"10.1186/s40463-021-00521-1","DOIUrl":"https://doi.org/10.1186/s40463-021-00521-1","url":null,"abstract":"<p><strong>Background: </strong>The opioid epidemic is a significant public health crisis challenging the lives of North Americans. Interestingly, this problem does not exist to the same extent in Europe. Surgeons play a significant role in prescribing opioids, especially in the context of post-operative pain management. The aim of this study was to compare the post-surgical prescribing patterns of otologists comparing Canada and Austria.</p><p><strong>Methods: </strong>An online questionnaire was sent to 33 Canadian and 32 Austrian surgeons, who perform otologic surgery on a regular basis. Surgeons were asked to answer some questions about their background as well as typical prescribing patterns for postoperative pain medication for different ear surgeries (cochlear implant, stapedotomy, tympanoplasty). In addition, surgeons were asked about the typical use of local anesthetics for pain control at the end of a procedure. Otologists gave an estimate how confident they were that their therapy and prescriptions provide sufficient pain control to their patients.</p><p><strong>Results: </strong>Analysis of the returned questionnaires showed that opioids are more commonly prescribed in Canada than in Austria. Nonsteroidal anti-inflammatory drugs are used for postoperative pain more regularly after ear surgery in Austria, as opposed to Canada. Some of the prescribed drugs by European otologists are not available in North America. The use of local anesthetics at the end of surgery is not common in Austria. Surgeons´ confidence that the prescribed pain medication was sufficient to control postoperative symptoms was higher in the group not prescribing opioids than in the group that did routinely prescribe opioids.</p><p><strong>Conclusion: </strong>Prescribing patterns differ substantially between the two evaluated countries. This data suggests an opportunity to reduce opioid prescriptions after otologic surgeries. Studies to evaluate pain after these operations as well as efficacy of analgesics following ear surgery are an important next step.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"38"},"PeriodicalIF":3.4,"publicationDate":"2021-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40463-021-00521-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39096807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specimen oriented intraoperative margin assessment in oral cavity and oropharyngeal squamous cell carcinoma.","authors":"P Horwich, C MacKay, M Bullock, S M Taylor, R Hart, J Trites, L Geldenhuys, B Williams, M H Rigby","doi":"10.1186/s40463-021-00501-5","DOIUrl":"10.1186/s40463-021-00501-5","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the oncologic outcomes and cost analysis of transitioning to a specimen oriented intraoperative margin assessment protocol from a tumour bed sampling protocol in oral cavity (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC).</p><p><strong>Study design: </strong>Retrospective case series and subsequent prospective cohort study SETTING: Tertiary care academic teaching hospital SUBJECTS AND METHODS: Retrospective case series of all institutional T1-T2 OCSCC or OPSCC treated with primary surgery between January 1st 2009 - December 31st 2014. Kaplan-Meier survival estimates with log rank tests were used to compare patients based on final margin status. Cost analysis was performed for escalation of therapy due to positive final margins. Following introduction of a specimen derived margin protocol, successive prospective cohort study of T1-T4 OCSCC or OPSCC treated with primary surgery from January 1st 2017 - December 31st 2018. Analysis and comparison of both protocols included review of intraoperative margins, final pathology and treatment cost.</p><p><strong>Results: </strong>Analysis of our intra-operative tumour bed frozen section protocol revealed 15 of 116 (12.9%) patients had positive final pathology margins, resulting in post-operative escalation of therapy for 14/15 patients in the form of re-resection (7/14), radiation therapy (6/14) and chemoradiotherapy (1/14). One other patient with positive final margins received escalated therapy for additional negative prognostic factors. Recurrence free survival at 3 years was 88.4 and 50.7% for negative and positive final margins respectively (p = 0.048). Implementation of a specimen oriented frozen section protocol resulted in 1 of 111 patients (0.9%) having positive final pathology margins, a statistically significant decrease (p < 0.001). Utilizing our specimen oriented protocol, there was an absolute risk reduction for having a final positive margin of 12.0% and relative risk reduction of 93.0%. Estimated cost avoidance applying the specimen oriented protocol to our previous cohort was $412,052.812017 CAD.</p><p><strong>Conclusion: </strong>Implementation of a specimen oriented intraoperative margin protocol provides a statistically significant decrease in final positive margins. This change in protocol leads to decreased patient morbidity by avoiding therapy escalation attributable only to positive margins, and avoids the economic costs of these treatments.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"37"},"PeriodicalIF":2.2,"publicationDate":"2021-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39093834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss.","authors":"Yu Hosokawa,&nbsp;Takeshi Miyawaki,&nbsp;Taisuke Akutsu,&nbsp;Kazuhiro Omura,&nbsp;Shinya Tsumiyama,&nbsp;Jiro Iimura,&nbsp;Nobuyoshi Otori,&nbsp;Hiromi Kojima","doi":"10.1186/s40463-021-00516-y","DOIUrl":"https://doi.org/10.1186/s40463-021-00516-y","url":null,"abstract":"<p><strong>Purpose: </strong>Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery.</p><p><strong>Results: </strong>The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02).</p><p><strong>Conclusions: </strong>The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"35"},"PeriodicalIF":3.4,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40463-021-00516-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39233844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives on endoscopic sinus surgery for chronic rhinosinusitis.","authors":"Nadim Saydy, Sami Pierre Moubayed, Martin Desrosiers","doi":"10.1186/s40463-021-00515-z","DOIUrl":"10.1186/s40463-021-00515-z","url":null,"abstract":"<p><strong>Background: </strong>Through shared decision-making, physicians and patients can elect endoscopic sinus surgery (ESS) when maximal medical therapy fails in patients with chronic rhinosinusitis (CRS). In this study, we aim to explore the most important themes with regards to patients' perspectives on ESS. Our objective was to define the patient experience and ensure that we have congruent physician and patient goals for obtaining success.</p><p><strong>Methods: </strong>Semi-structured face-to-face interviews were conducted with 22 patients at a tertiary-care institution in Montreal. Three themes were established a priori: living with CRS, objectives and expectations and criteria for success. This thematic approach allowed the identification, analysis and reporting of patterns found across the data set. A phenomenological methodological orientation was used. Interviews were audio-recorded and transcribed verbatim for continuous analysis. These were coded by hand by a single coder who read the transcripts multiple times and relistened to the recordings.</p><p><strong>Results: </strong>Exploration of themes on patients' perspectives on ESS for CRS yielded multiple anecdotal findings, and some recurring patterns. There is a tendency for patients to focus on one principal symptom that drives their decrease in QoL. Headaches and nasal congestion seemed to impact patients' QoL the most amongst rhinologic symptoms. Hyposmia was rarely spontaneously by patients but was often a significant source of distress when prompted during interviews. Objectives and expectations seemed to be inversely proportional to number of previous surgeries and severity of symptoms preoperatively. There was a clear association between preoperative expectations and postoperative satisfaction. There was no clear pattern in the improvement magnitude or time improved postoperatively for patients to consider the surgery a success.</p><p><strong>Conclusions: </strong>Patients' level of satisfaction postoperatively and with their care in general is multifactorial. We believe the topic of goals and expectations regarding ESS should be discussed preoperatively for every patient with CRS. This includes patients with seemingly minor disease and patients naive to surgery, as can sometimes have exceedingly high expectations. Preoperative counselling must also include an assessment of what symptom is the most cumbersome to that particular patient, as patients tend to focus a lot on one or two symptoms. Postoperatively, we encourage clinicians to be attentive to the change in each patient's principal complaints within the context of a personalized approach and to refer back to patients' preoperative goals in their assessment of operative success.</p>","PeriodicalId":520683,"journal":{"name":"Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale","volume":" ","pages":"34"},"PeriodicalIF":2.2,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39234015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}