Jabbour, Christopher

Background A substantial proportion of patients with chronic rhinosinusitis (CRS) remain partly controlled or uncontrolled despite endoscopic sinus surgery (ESS) and maximal medical therapy. For these difficult-to-treat cases, topical antibiotic irrigations have been proposed as an adjunctive therapy, particularly when delivered via large-volume, low-pressure systems that enhance sinus penetration post-ESS. Evidence on their efficacy and prescribing patterns in this population remains limited. Objective This study aims to evaluate the use and outcomes of topical antibiotic irrigations in patients with difficult-to-treat CRS. Methods A retrospective, multi-site cohort study was conducted across tertiary academic medical centers. Adult patients with persistent CRS symptoms despite bilateral full-house ESS and conventional postoperative medical management were included. Patients with cystic fibrosis or granulomatosis with polyangiitis were excluded. Demographic, clinical, and treatment data were collected. Primary outcomes were infection resolution at 8 weeks and changes in Sino-Nasal Outcome Test-22 (SNOT-22) scores. Results Sixty-seven patients met inclusion criteria. Mupirocin (41.8%), tobramycin (23.9%), and gentamicin (17.9%) were the most commonly prescribed agents. After 8 weeks, 62.7% of patients achieved infection clearance. Among 44 patients with SNOT-22 data, scores improved significantly from 34.8 ± 20.2 to 21.8 ± 14.7 ( P < .001). Improvement in SNOT-22 scores was more pronounced in patients who cleared the infection compared to those who did not. Conclusion Large-volume topical antibiotic irrigations were associated with high infection resolution rates and clinically meaningful SNOT-22 improvements in patients with difficult-to-treat CRS. These findings support their potential utility as an adjunctive therapy in select postsurgical patients and warrant further prospective investigation.

Background: Evaluation of otolaryngology resident technical performance has historically relied on subjective perioperative feedback. Despite various assessment tools attempting to provide consistent surgical skill evaluations, current methods remain inherently subjective. Aim: This proof-of-concept pilot study aimed to assess if a 3-dimensional surgical navigation system could capture objective surgical data during endoscopic sinus surgery (ESS). A secondary aim was to analyze if there were any differences between novice and practiced trainees. Methods: Otolaryngology residents performed supervised ESS on patients while their instrument (microdebrider, suction) motion was recorded using a TruDi ® Navigation System. Prior to the surgery, surgical landmarks were defined with sensory beacons in the navigation system using the patient’s preoperative computed tomography (CT) scan. Metrics included time to reach beacons, number of alerts at each beacon, and instrument speed. Results: Fifteen otolaryngology residents performed 87 ESS. The navigation system successfully obtained “time to reach sinus X” data for 64% of sinuses/ case, velocity data in 93% of cases, and number of beacon “alerts” per minute in 93% of cases. We found a significant difference between PGY 3 residents and PGY 4/PGY5 residents in the number of sphenoid sinus alerts per minute ( P = .01) and the percentage of cases in which the resident accessed the maxillary sinus via the natural os ( P < .001). Impact: This study demonstrates the feasibility of collecting objective, navigation-based intraoperative metrics during live surgery and is a first step toward building a comprehensive objective assessment tool in ESS. We hope this report encourages further research into this technology’s application in objective resident skill assessment and correlation with concurrent faculty assessments.