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BackgroundEndotypic and prognosticating features of chronic rhinosinusitis without nasal polyposis (CRSsNP) are poorly understood. Our objectives were to use an unbiased symptom‐based approach to: (1) study symptoms, clinical and endotypic features; and (2) identify features predicating outcomes from endoscopic sinus surgery (ESS).MethodsClinical, computed tomography (CT), histopathology, and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) data was collected on 146 adult CRSsNP patients who underwent ESS. Unsupervised network modeling of presurgical SNOT‐22 scores was performed to classify symptom‐based clusters. Subject characteristics and post‐ESS SNOT‐22 scores were compared between clusters.ResultsBaseline characteristics of the subject population were as follows: females, 56.2%; revision ESS status in 35%; asthma prevalence, 32.6%; median Lund‐Mackay CT score, 8; and median SNOT‐22 total score, 43. Network mapping and unsupervised clustering of preoperative SNOT‐22 scores revealed 4 clusters: (A) severely burdened with high scores in all 4 subdomains; (B) moderately burdened with high scores in the rhinologic subdomain; (C) moderately burdened with high scores in psychological‐sleep subdomains; and (D) mildly burdened. The number of previous ESS and asthma prevalence differed significantly between clusters; CT scores were similar. Asthma burden and tissue eosinophilia were greatest in cluster A (p = 0.03). All groups showed significant improvement at 3 months post‐ESS (p < 0.0001). At 6 months, patients in cluster C tended to worsen.ConclusionSNOT‐22–based network modeling of CRSsNP patients yielded 4 clusters with distinct features. Asthma prevalence and tissue eosinophilia were highest in the cluster with highest SNOT‐22 scores. All patients showed significant improvement from ESS at 3 months; those with high sleep‐psychosocial symptoms tended to show worsening at 6 months.

Background Recurrence of inverted papilloma (IP) is a problem in 12–17% of tumors. Controversy exists regarding benefits of intraoperative frozen section histopathology (IFSH) for IP resection; however, to our knowledge, no study has specifically investigated this. IFSH for IP resection is the standard of care in our practice. We, therefore, reviewed our outcomes of using IFSH for IP resection. A secondary goal was to assess the reliability of IFSH. Methods Patients with IP who underwent surgical resection (2010–2016) with minimum 9–month follow-up were included. Results Twenty-two adults with IP met inclusion criteria. All underwent surgery via endoscopic techniques, supplemented by external ports in five patients. At the time of presentation, 36% IPs were recurrent tumors; 68% were graded as Krouse stage 3. Resection was conducted until “clear” (negative) mucosal margins were achieved on IFSH. In 6 (27%), a “positive” IFSH result dictated additional resection to clear margins. Final negative margins were achieved in all the patients. Both positive and negative predictive values for IFSH were 100% (concordance with final pathology results). Surveillance was performed every 1–6 months with nasal endoscopy by using imaging when necessary. No recurrences were noted (0%) at mean follow-up of 40 months (range, 10 -73 months). Conclusions Positive IFSH results led to increased resection in 27% of the patients, with a 0% recurrence rate in this cohort. The reliability of IFSH for IP is very high. No recurrence of IP was noted in any patient at a mean follow-up of 3.3 years. IFSH may help reduce recurrence rates of IP, but additional studies with longer follow-up are warranted.

Background Very few studies have examined vestibular schwannoma (VS) management trends across centers and between providers. The objective of this study is to examine current practice trends, variance in treatment philosophies, and nuanced or controversial aspects of VS care across North America. Methods This is a cross-sectional survey of North American Skull Base Society (NASBS) members who report regular involvement in VS care. Results A total of 57 completed surveys were returned. Most respondents claimed to have over 20 years of experience and the majority reported working in an academic practice with an affiliated otolaryngology and/or neurosurgery residency program. Sixty-three percent of respondents claimed to evaluate VS patients in clinic with both an otolaryngologist and neurosurgeon involved. Eighty-six percent of respondents claimed to operate on VS with both an otolaryngologist and neurosurgeon involved, while only 18% of neurosurgeons and 9% of otolaryngologists performed surgery alone. There was a wide range in the number of cases evaluated at each center annually. Similarly, there was wide variation in the number of patients treated with microsurgery and radiation at each center. Additional details regarding management preferences for microsurgery, stereotactic radiosurgery, stereotactic radiotherapy, and conservative observation are presented. Conclusion VS management practices vary between providers and centers. Overall, most centers employ a multidisciplinary approach to management with collaboration between otolaryngology and neurosurgery. Overall, survey responses concur with previous studies suggesting a shift toward conservatism in management.

Introduction Perioperative care of vestibular schwannoma (VS) patients is extremely variable across surgeons and institutions making practice patterns difficult to standardize. No data currently exist detailing this practice variability. Methods The North American Skull Base Society membership was electronically surveyed regarding perioperative care of surgically operated VS patients. Results There were 87 respondents to the survey. Surgical positioning, surgical approach utilized, and perioperative medical adjuncts are quite variable. However, of those performing retrosigmoid approaches, 49% perform this in the supine position, while 33% use a park-bench position with only 2% using the sitting position. In those performing translabyrinthine approaches, 86% perform this in supine position. Although the use of neuromonitoring appears to be standard of care (98%), other than the seventh nerve, there is substantial variability between respondents regarding monitoring of additional cranial nerves. Postoperative antibiotics are used by 65%, postoperative steroids 81%, and postoperative chemical deep vein thrombosis prophylaxis in 68% of survey respondents. Conclusion Although the perioperative adjuncts to VS surgery are variable, there does appear to be a trend in common practice. Therefore, making surgeons aware of these trends may lead to standardized practice or alternatively trials of these variances to instruct which truly improve patient outcomes.

Background Endoscopic endonasal resection (EER) of sinonasal mucosal melanoma (SMM) is a newer surgical alternative to traditional external and/or open resection (OR). Studies on long-term outcomes are necessary to validate EER for this aggressive sinonasal malignancy. Objective To compare outcomes of EER versus OR in SMM. Methods A case series of patients who underwent surgical resection of SMM at a tertiary-care institution (2000–2015) was studied retrospectively. Demographics, tumor site and stage, surgical approach, surgical margin status, local control, and survival were compared between those who underwent EER and OR. Results Twenty-two patients met inclusion criteria. Nine underwent EER and 13 underwent OR. The mean age in the EER and OR groups was similar, 78.7 and 72.3 years, respectively. Two-thirds of patients were women (EER, 66.7%; OR, 61.5%). The nasal cavity was the most common primary tumor site (EER, 77.8%; OR, 84.6%). The local tumor stage in both groups was similar, with the majority of cases being T4 (EER, 55.6%; OR, 61.5%; p = 0.99). Negative margins were achieved in all EERs and in 69.2% of ORs. Median follow-up was 25.0 months for the overall group (range, 1.7–172.9 months), 32.6 months (range, 3.4–58.7 months) for EER and 14.1 months (range, 1.7–172.9 months) for OR cohorts. The 5-year overall survival was statistically similar in both groups (EER, 53.3%; OR, 22.7%; p = 0.214) as was disease-free survival (EER, 55.6%; OR, 22.8%; p = 0.178). Local control, however, was significantly higher in the EER cohort (EER, 85.7%; OR, 37.6%; p = 0.026). Conclusion In carefully selected patients with sinonasal melanoma, endoscopic surgery with an experienced team may offer comparable survival and improved local control over open surgery. Prospective, multicentered studies with larger cohorts are needed to validate these results.