BACKGROUND CSF leaks have been historically difficult to diagnose and treat as their etiology can... more BACKGROUND CSF leaks have been historically difficult to diagnose and treat as their etiology can widely vary. There are currently insufficient diagnostic predictors and no clinically accepted standards for their treatment. This large institutional study reports on the diagnosis, management, and outcomes of patients presenting with CSF leak over 10 years and aims to identify potential comorbidities and risk factors for primary and recurrent leaks. METHODS Patients diagnosed with CSF leak from 2007-2017 were analyzed retrospectively. The data included medical history, BMI, surgical treatment, and postoperative outcomes. RESULTS 116 cases were identified. The location of leaks was 91 CSF rhinorrhea and 28 CSF otorrhea (3 both). The average BMI for females was greater than males (p = 0.01). Leak etiologies were 64 non-iatrogenic, 47 iatrogenic, and 9 traumatic. 108 cases had surgical treatment. 69 involved endoscopic approaches, 42 involved open approaches, and 83 involved the placement of a lumbar drain. 18 cases had a VP shunt and 6 had a LP shunt. 78 (72.22%) cases had an associated encephalocele with the CSF leak. The average length of stay was 7.73(0.76) days. The average length of follow-up was 1.58(0.22) years. The primary repair rate was 80.17% (n = 93) and the overall repair outcome was 99.14% (n = 115). CONCLUSION The overall CSF repair outcome was 99.14% over 10 years at a single institution. Despite this high percentage, CSF leaks continue to be a complex problem and require vigorous multidisciplinary work with close follow-up and use of multiple imaging strategies.
Special Virtual Symposium of the North American Skull Base Society, Feb 1, 2021
Objective: Due to COVID-19, patients who had sinus or skull base surgery in February and early Ma... more Objective: Due to COVID-19, patients who had sinus or skull base surgery in February and early March 2020 were unable toreceive standard postoperative care. Currently, there is a lack of data on the short- and long-term impacts of this. Wesought to examine the effects of the interruption of care due to COVID-19 on sinus and skull base surgery patientoutcomes. Study Design: Retrospective chart review. Methods: A retrospective review was conducted examining outcomes and healthcare utilization of patients at our institutionwho underwent sinus or skull base surgery in February and March of 2020, and who experienced an interruption inpostoperative care due to the pandemic. We then compared these measures with those of patients from the same timeperiod in 2019, who did not experience an interruption in care. Patient characteristics including age, indication for surgery,extent of surgery, polyps, preoperative Lund-Mackay and sinonasal outcome (SNOT22) scores and history of prior sinus orskull base surgery were recorded. Study outcomes included 3 and 6 month postoperative SNOT22 and Modified Lund-Kennedy endoscopy scores, antibiotic usage, sinonasal debridements performed, and number of telephone calls andtelehealth visits in the postoperative period. Results: A total of 107 patients were included. Of the SNOT22 scores available, the average change between preoperativeand 3 month postoperative SNOT22 scores for 2020 ( n = 15) compared to 2019 patients ( n = 30) was not significantlydifferent (a decrease of 17.27 and 19.93, respectively;p = 0.68). The average change between preoperative and 6-monthpostoperative SNOT22 scores for 2020 ( n = 13) compared to 2019 patients ( n = 26) was also not significantly different (adecrease of 18.69 and 20.77, respectively;p = 0.75). The average number of oral postoperative antibiotics received did notsignificantly differ between 2020 ( n = 52) and 2019 ( n = 55) cohorts (0.18 vs. 0.09, respectively;p = 0.53). The averagenumber of postoperative telephone calls did not significantly differ between 2020 and 2019 patients (1.51 vs. 1.19;p = 0.95). Patients in 2019 received an average of 2.35 postoperative sinonasal debridements compared to 1.90 in 2020 ( p =0.03). The average number of postoperative telehealth visits for 2020 patients was 0.72. Of the 2020 patients, 50% werelost to follow-up at 3 months postoperatively compared to 18% in 2019 ( p = 0.0005) and 71% were lost to follow-up at 6months postoperatively in 2020 compared to 36% in 2019 ( p = 0.0003). Conclusion: Although there was an interruption in postoperative care due to COVID-19, patients in 2020 who returned forfollow-up 3 and 6 months after surgery did not report significantly different subjective sinonasal outcomes compared topatients in 2019. A significantly greater number of patients have been lost to follow-up in 2020 compared to 2019 and havenot received routine postoperative care. Further study is required to determine the impact of the interruption of care due toCOVID-19 on sinus and skull base surgery outcomes.
Otolaryngology-Head and Neck Surgery, Jul 20, 2021
ObjectiveSocioeconomic status (SES) is often used to quantify social determinants of health. This... more ObjectiveSocioeconomic status (SES) is often used to quantify social determinants of health. This study uses the National Cancer Institute SES index to examine the effect of SES on disease‐specific survival and 5‐year conditional disease‐specific survival (CDSS; the change in life expectancy with increasing survivorship) in paranasal sinus cancerStudy DesignCross‐sectional analysis.SettingNational Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program.MethodsA study of adults with sinus cancer between 1973 and 2015 was performed. The Yost index, a census tract–level composite score of SES, was used to categorize patients. Kaplan‐Meier analysis and Cox regression for disease‐specific survival were stratified by SES. CDSS was calculated with simplified models. Logistic regression was conducted to identify risk factors for advanced stage at diagnosis, multimodal therapy, and diagnosis of squamous cell carcinoma.ResultsThere were 3437 patients analyzed. In Cox models adjusting for patient‐specific factors, the lowest SES tertile exhibited worse mortality (hazard ratio, 1.22; 95% CI, 1.07‐1.39; P <. 01). After addition of treatment and pathology, SES was not significant (P =. 07). The lowest SES tertile was more often diagnosed at later stages (odds ratio [OR], 1.52; 95% CI, 1.12‐2.06; P <. 01). For those with regional/distant disease, the middle tertile (OR, 0.75; 95% CI, 0.63‐0.90; P <. 01) and lowest tertile (OR, 0.75; 95% CI, 0.62‐0.91; P <. 01) were less likely to receive multimodal therapy. SES tertiles primarily affected 5‐year CDSS for regional/distant disease. CDSS for all stages converged over time.ConclusionLower SES is associated with worse outcomes in paranasal sinus cancer. Research should be devoted toward understanding factors that contribute to such disparities, including tumor pathology and treatment course.
Objective In this nationwide retrospective study, the authors aimed to identify demographic, clin... more Objective In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs). Methods The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of ICD-10 codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery. Results Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; P < .001). Black patients (OR: 1.49; P < .001) and Hispanic patients (OR:...
BackgroundCritical review of computed tomography (CT) imaging is essential in preoperative planni... more BackgroundCritical review of computed tomography (CT) imaging is essential in preoperative planning for endoscopic sinus surgery. In this study, we used a systematic review and a modified Delphi method to develop a comprehensive checklist that facilitates preoperative review of sinus CT imaging.MethodsWe performed a systematic review of PubMed, Embase, CINAHL, Cochrane, and Web of Science databases to identify existing checklists developed to evaluate sinus CT imaging. An inclusive list of items from these checklists was compiled and a modified Delphi methodology was used to assign ranked priority. The Delphi process involved 14 rhinologists and had three phases: an initial survey with Likert priority (scale of 1–9) and two rounds of live discussions followed by survey to confirm consensus.ResultsNinety‐seven possible checklist items were identified from a systematic review and panelist input. On initial survey, 63 items reached a consensus score of 7+, and 13 items had near consens...
To characterize the clinical features associated with sinonasal complaints after maxillectomy wit... more To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm.
ObjectiveTo characterize the clinical features, risk factors, symptom time‐course, and quality of... more ObjectiveTo characterize the clinical features, risk factors, symptom time‐course, and quality of life implications for parosmia among coronavirus disease (COVID)‐related olfactory dysfunction patients.MethodsIndividuals with olfactory dysfunction associated with laboratory‐confirmed or clinically suspected COVID‐19 infection were recruited from otolaryngology and primary care practices over a period from August 2020 to March 2021. Participants completed olfactory dysfunction and quality of life surveys.ResultsA total of 148 (64.1%) of 231 respondents reported parosmia at some point. Parosmia developed within 1 week of any COVID‐19 symptom onset in 25.4% of respondents, but more than 1 month after symptom onset in 43.4% of respondents. Parosmia was associated with significantly better quantitative olfactory scores on Brief Smell Identification Test (8.7 vs. 7.5, P = .006), but demonstrated worse quality of life scores, including modified brief Questionnaire of Olfactory Dysfunction—...
Objective Demonstrate feasibility, safety and outcome metrics of geriatric sinus surgery (GESS). ... more Objective Demonstrate feasibility, safety and outcome metrics of geriatric sinus surgery (GESS). Study Design Retrospective review of patients undergoing sinus surgery for indication of chronic rhinosinusitis with and without nasal polyposis. Setting Tertiary referral center. Participants Patients who underwent FESS from 2008–2017; excluding skull base, craniofacial, or oncologic surgery. Primary study group were patients aged 65 years and older. Patients aged 40–64 years of age were included for comparison. Main Outcomes and Measures: Multivariate analysis was performed to identify independently associated patient characteristics and perioperative variables. Preoperative medical and treatment history, revision and primary surgery, preoperative and post-operative SNOT-22 and NOSE scores, Lund-McKay scores were recorded when available. Post-operative data was assessed at a minimum of two months after the index procedure. Post-operative complications were included. Results Ninety-one ...
Objectives/HypothesisNo studies have evaluated the impact of the types of frontal sinus surgery (... more Objectives/HypothesisNo studies have evaluated the impact of the types of frontal sinus surgery (FSS) on objective olfaction scores. This study evaluated olfactory function and quality of life (QOL) in chronic rhinosinusitis (CRS) patients before and after total ethmoidectomy with frontal sinusotomy (FS).Study DesignProspective cohort study.MethodsA prospective study of adult CRS patients undergoing FSS (Draf 2 or Draf 3 procedures) was conducted at a tertiary care center. Primary outcomes included brief smell identification test (BSIT) and sinonasal outcome test‐22 (SNOT‐22), which were assessed during preoperative evaluation, 6 to 9 weeks postoperatively, and 12 to 24 weeks postoperatively. Normosmia was defined as BSIT ≥9. Statistical significance was determined using the Wilcoxon signed‐rank test with α = .05.ResultsThirty‐eight patients followed up 12 to 24 weeks after FSS. The differences between baseline and long‐term outcomes for BSIT (6.11 vs. 8.24, P = .00034) and SNOT‐22 ...
PURPOSE To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of ... more PURPOSE To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery. MATERIALS AND METHODS Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described. RESULTS The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ. CONCLUSIONS VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.
Objectives/HypothesisSuboptimal ergonomics during endoscopic sinus surgery can lead to considerab... more Objectives/HypothesisSuboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS).Study DesignPilot prospective trial.MethodsSix surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0–15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronauti...
Objective The purpose of this study was to explore the use of immersive and interactive virtual r... more Objective The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements. Study Design Randomized crossover-controlled trial. Setting Academic outpatient clinic. Subjects and Methods Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM). Results Eighty-two participants were recruited. At PO1, 39 received standard analgesi...
BACKGROUND CSF leaks have been historically difficult to diagnose and treat as their etiology can... more BACKGROUND CSF leaks have been historically difficult to diagnose and treat as their etiology can widely vary. There are currently insufficient diagnostic predictors and no clinically accepted standards for their treatment. This large institutional study reports on the diagnosis, management, and outcomes of patients presenting with CSF leak over 10 years and aims to identify potential comorbidities and risk factors for primary and recurrent leaks. METHODS Patients diagnosed with CSF leak from 2007-2017 were analyzed retrospectively. The data included medical history, BMI, surgical treatment, and postoperative outcomes. RESULTS 116 cases were identified. The location of leaks was 91 CSF rhinorrhea and 28 CSF otorrhea (3 both). The average BMI for females was greater than males (p = 0.01). Leak etiologies were 64 non-iatrogenic, 47 iatrogenic, and 9 traumatic. 108 cases had surgical treatment. 69 involved endoscopic approaches, 42 involved open approaches, and 83 involved the placement of a lumbar drain. 18 cases had a VP shunt and 6 had a LP shunt. 78 (72.22%) cases had an associated encephalocele with the CSF leak. The average length of stay was 7.73(0.76) days. The average length of follow-up was 1.58(0.22) years. The primary repair rate was 80.17% (n = 93) and the overall repair outcome was 99.14% (n = 115). CONCLUSION The overall CSF repair outcome was 99.14% over 10 years at a single institution. Despite this high percentage, CSF leaks continue to be a complex problem and require vigorous multidisciplinary work with close follow-up and use of multiple imaging strategies.
Special Virtual Symposium of the North American Skull Base Society, Feb 1, 2021
Objective: Due to COVID-19, patients who had sinus or skull base surgery in February and early Ma... more Objective: Due to COVID-19, patients who had sinus or skull base surgery in February and early March 2020 were unable toreceive standard postoperative care. Currently, there is a lack of data on the short- and long-term impacts of this. Wesought to examine the effects of the interruption of care due to COVID-19 on sinus and skull base surgery patientoutcomes. Study Design: Retrospective chart review. Methods: A retrospective review was conducted examining outcomes and healthcare utilization of patients at our institutionwho underwent sinus or skull base surgery in February and March of 2020, and who experienced an interruption inpostoperative care due to the pandemic. We then compared these measures with those of patients from the same timeperiod in 2019, who did not experience an interruption in care. Patient characteristics including age, indication for surgery,extent of surgery, polyps, preoperative Lund-Mackay and sinonasal outcome (SNOT22) scores and history of prior sinus orskull base surgery were recorded. Study outcomes included 3 and 6 month postoperative SNOT22 and Modified Lund-Kennedy endoscopy scores, antibiotic usage, sinonasal debridements performed, and number of telephone calls andtelehealth visits in the postoperative period. Results: A total of 107 patients were included. Of the SNOT22 scores available, the average change between preoperativeand 3 month postoperative SNOT22 scores for 2020 ( n = 15) compared to 2019 patients ( n = 30) was not significantlydifferent (a decrease of 17.27 and 19.93, respectively;p = 0.68). The average change between preoperative and 6-monthpostoperative SNOT22 scores for 2020 ( n = 13) compared to 2019 patients ( n = 26) was also not significantly different (adecrease of 18.69 and 20.77, respectively;p = 0.75). The average number of oral postoperative antibiotics received did notsignificantly differ between 2020 ( n = 52) and 2019 ( n = 55) cohorts (0.18 vs. 0.09, respectively;p = 0.53). The averagenumber of postoperative telephone calls did not significantly differ between 2020 and 2019 patients (1.51 vs. 1.19;p = 0.95). Patients in 2019 received an average of 2.35 postoperative sinonasal debridements compared to 1.90 in 2020 ( p =0.03). The average number of postoperative telehealth visits for 2020 patients was 0.72. Of the 2020 patients, 50% werelost to follow-up at 3 months postoperatively compared to 18% in 2019 ( p = 0.0005) and 71% were lost to follow-up at 6months postoperatively in 2020 compared to 36% in 2019 ( p = 0.0003). Conclusion: Although there was an interruption in postoperative care due to COVID-19, patients in 2020 who returned forfollow-up 3 and 6 months after surgery did not report significantly different subjective sinonasal outcomes compared topatients in 2019. A significantly greater number of patients have been lost to follow-up in 2020 compared to 2019 and havenot received routine postoperative care. Further study is required to determine the impact of the interruption of care due toCOVID-19 on sinus and skull base surgery outcomes.
Otolaryngology-Head and Neck Surgery, Jul 20, 2021
ObjectiveSocioeconomic status (SES) is often used to quantify social determinants of health. This... more ObjectiveSocioeconomic status (SES) is often used to quantify social determinants of health. This study uses the National Cancer Institute SES index to examine the effect of SES on disease‐specific survival and 5‐year conditional disease‐specific survival (CDSS; the change in life expectancy with increasing survivorship) in paranasal sinus cancerStudy DesignCross‐sectional analysis.SettingNational Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program.MethodsA study of adults with sinus cancer between 1973 and 2015 was performed. The Yost index, a census tract–level composite score of SES, was used to categorize patients. Kaplan‐Meier analysis and Cox regression for disease‐specific survival were stratified by SES. CDSS was calculated with simplified models. Logistic regression was conducted to identify risk factors for advanced stage at diagnosis, multimodal therapy, and diagnosis of squamous cell carcinoma.ResultsThere were 3437 patients analyzed. In Cox models adjusting for patient‐specific factors, the lowest SES tertile exhibited worse mortality (hazard ratio, 1.22; 95% CI, 1.07‐1.39; P &lt;. 01). After addition of treatment and pathology, SES was not significant (P =. 07). The lowest SES tertile was more often diagnosed at later stages (odds ratio [OR], 1.52; 95% CI, 1.12‐2.06; P &lt;. 01). For those with regional/distant disease, the middle tertile (OR, 0.75; 95% CI, 0.63‐0.90; P &lt;. 01) and lowest tertile (OR, 0.75; 95% CI, 0.62‐0.91; P &lt;. 01) were less likely to receive multimodal therapy. SES tertiles primarily affected 5‐year CDSS for regional/distant disease. CDSS for all stages converged over time.ConclusionLower SES is associated with worse outcomes in paranasal sinus cancer. Research should be devoted toward understanding factors that contribute to such disparities, including tumor pathology and treatment course.
Objective In this nationwide retrospective study, the authors aimed to identify demographic, clin... more Objective In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs). Methods The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of ICD-10 codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery. Results Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; P < .001). Black patients (OR: 1.49; P < .001) and Hispanic patients (OR:...
BackgroundCritical review of computed tomography (CT) imaging is essential in preoperative planni... more BackgroundCritical review of computed tomography (CT) imaging is essential in preoperative planning for endoscopic sinus surgery. In this study, we used a systematic review and a modified Delphi method to develop a comprehensive checklist that facilitates preoperative review of sinus CT imaging.MethodsWe performed a systematic review of PubMed, Embase, CINAHL, Cochrane, and Web of Science databases to identify existing checklists developed to evaluate sinus CT imaging. An inclusive list of items from these checklists was compiled and a modified Delphi methodology was used to assign ranked priority. The Delphi process involved 14 rhinologists and had three phases: an initial survey with Likert priority (scale of 1–9) and two rounds of live discussions followed by survey to confirm consensus.ResultsNinety‐seven possible checklist items were identified from a systematic review and panelist input. On initial survey, 63 items reached a consensus score of 7+, and 13 items had near consens...
To characterize the clinical features associated with sinonasal complaints after maxillectomy wit... more To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm.
ObjectiveTo characterize the clinical features, risk factors, symptom time‐course, and quality of... more ObjectiveTo characterize the clinical features, risk factors, symptom time‐course, and quality of life implications for parosmia among coronavirus disease (COVID)‐related olfactory dysfunction patients.MethodsIndividuals with olfactory dysfunction associated with laboratory‐confirmed or clinically suspected COVID‐19 infection were recruited from otolaryngology and primary care practices over a period from August 2020 to March 2021. Participants completed olfactory dysfunction and quality of life surveys.ResultsA total of 148 (64.1%) of 231 respondents reported parosmia at some point. Parosmia developed within 1 week of any COVID‐19 symptom onset in 25.4% of respondents, but more than 1 month after symptom onset in 43.4% of respondents. Parosmia was associated with significantly better quantitative olfactory scores on Brief Smell Identification Test (8.7 vs. 7.5, P = .006), but demonstrated worse quality of life scores, including modified brief Questionnaire of Olfactory Dysfunction—...
Objective Demonstrate feasibility, safety and outcome metrics of geriatric sinus surgery (GESS). ... more Objective Demonstrate feasibility, safety and outcome metrics of geriatric sinus surgery (GESS). Study Design Retrospective review of patients undergoing sinus surgery for indication of chronic rhinosinusitis with and without nasal polyposis. Setting Tertiary referral center. Participants Patients who underwent FESS from 2008–2017; excluding skull base, craniofacial, or oncologic surgery. Primary study group were patients aged 65 years and older. Patients aged 40–64 years of age were included for comparison. Main Outcomes and Measures: Multivariate analysis was performed to identify independently associated patient characteristics and perioperative variables. Preoperative medical and treatment history, revision and primary surgery, preoperative and post-operative SNOT-22 and NOSE scores, Lund-McKay scores were recorded when available. Post-operative data was assessed at a minimum of two months after the index procedure. Post-operative complications were included. Results Ninety-one ...
Objectives/HypothesisNo studies have evaluated the impact of the types of frontal sinus surgery (... more Objectives/HypothesisNo studies have evaluated the impact of the types of frontal sinus surgery (FSS) on objective olfaction scores. This study evaluated olfactory function and quality of life (QOL) in chronic rhinosinusitis (CRS) patients before and after total ethmoidectomy with frontal sinusotomy (FS).Study DesignProspective cohort study.MethodsA prospective study of adult CRS patients undergoing FSS (Draf 2 or Draf 3 procedures) was conducted at a tertiary care center. Primary outcomes included brief smell identification test (BSIT) and sinonasal outcome test‐22 (SNOT‐22), which were assessed during preoperative evaluation, 6 to 9 weeks postoperatively, and 12 to 24 weeks postoperatively. Normosmia was defined as BSIT ≥9. Statistical significance was determined using the Wilcoxon signed‐rank test with α = .05.ResultsThirty‐eight patients followed up 12 to 24 weeks after FSS. The differences between baseline and long‐term outcomes for BSIT (6.11 vs. 8.24, P = .00034) and SNOT‐22 ...
PURPOSE To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of ... more PURPOSE To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery. MATERIALS AND METHODS Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described. RESULTS The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ. CONCLUSIONS VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.
Objectives/HypothesisSuboptimal ergonomics during endoscopic sinus surgery can lead to considerab... more Objectives/HypothesisSuboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS).Study DesignPilot prospective trial.MethodsSix surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0–15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronauti...
Objective The purpose of this study was to explore the use of immersive and interactive virtual r... more Objective The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements. Study Design Randomized crossover-controlled trial. Setting Academic outpatient clinic. Subjects and Methods Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM). Results Eighty-two participants were recruited. At PO1, 39 received standard analgesi...
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Papers by Alfred Iloreta