Citations

BackgroundA recent analysis suggested potential narrowing of the gender gap in research productivity in the field of rhinology. This analysis did not, however, provide insight into how the genders are represented in the rhinologic literature. This study aimed to evaluate 11 years of literature to evaluate for gender differences in authorship position, collaborations, category and content of research, citations, and funding to gain perspective on how gender and authorship has changed over time.MethodsAuthorship data for all articles on rhinologic subject matter published between January 1, 2008 and December 31, 2018 in four otolaryngology journals was collected. The gender of authors was determined by protocol. Category and content of research and funding status/source were additionally obtained.ResultsData were collected from 2666 articles. Gender of 14,510 authors was determined. Female authors accounted for 23% of the overall authors and male authors accounted for 77%. Female first authorship increased significantly over time, but there was no change in female senior authorship. The percentage of female authors steadily increased over time, whereas male authorship decreased slightly. Mixed gender teams were shown to be increasing in frequency. Women published more than expected in basic science and allergy and less than expected in skull base. On funded studies, women were significantly underrepresented as senior authors.ConclusionThis study represents the first assessment of gender differences in the rhinology literature. Areas where female representation can improve include senior authorship, increased involvement in skull base publications, and increased funding.

BackgroundAsthma and some chronic rhinosinusitis (CRS) subtypes are mediated by similar pathophysiologic mechanisms. The purpose of this study was to evaluate the effects of biologic therapy for asthma on co‐existent CRS in the “real‐world” setting.MethodsA review of electronic health records (2016‐2019) at Mayo Clinic was conducted to identify asthma patients treated with biologics who had co‐existent CRS. Matched‐pair analyses compared pretherapy and posttherapy Lund‐Mackay computed tomography (CT) scores and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) scores. Performance of endoscopic sinus surgery (ESS) after initiating biologics was studied.ResultsWe identified 247 patients who received anti‐asthma biologic therapy and had co‐existent CRS. Of these, 181 patients (73.3%) had CRS with nasal polyposis (CRSwNP) and 66 (26.7%) had CRS without nasal polyposis (CRSsNP). The biologics utilized were omalizumab (51.0%), mepolizumab (46.6%), benralizumab (10.5%), reslizumab (1.6%), and dupilumab (2.4%). Anti‐interleukin‐5 (anti‐IL‐5) intervention was associated with significant improvement in CT scores (CRS overall, CRSwNP subgroup, CRSsNP subgroup) and SNOT‐22 scores (CRS overall, CRSwNP subgroup). Patients on omalizumab had a decrease in CT scores, but not SNOT‐22 scores. ESS was performed in 206 patients (84.1%); 55 (22.3%) underwent surgery post–biologic intervention (anti‐IL‐5: 16.5%; omalizumab 27.8% of patients).ConclusionAnti‐IL‐5 agents were associated with improved CT and SNOT‐22 scores in the overall CRS group and in CRSwNP subgroup; CRSsNP patients showed improved CT scores only. Omalizumab improved CT but not SNOT‐22 scores. ESS was performed in 22% of patients after initiating biologics. These real‐world results may influence future trial designs and clinical applications of biologics for CRS. ©2021 ARSAAOA, LLC.

ObjectiveThis study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported.Study DesignCase series.SettingTertiary care center.MethodsIn this institutional review board–approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow‐up.ResultsFifty‐six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3‐41) mm in length by 9.3 (range, 2‐23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow‐up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs.ConclusionPatients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

Background The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. Objective This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). Methods 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery. Results SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery. Conclusion These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.

I. Executive Summary Background The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS.

ObjectiveAdvanced practice providers (APPs) may see patients independently or assist in “collaborative” clinics in otolaryngology practices. Our goal was to redesign the collaborative physician‐APP clinic model to increase patient access, maintain financial sustainability, and optimize patient and staff experience.MethodsThe study was performed in a tertiary care academic rhinology clinic seeing adult patients. The DMAIC framework (define, measure, analyze, improve, control) was used to develop the new model. The process shift between old and new models was analyzed by utilizing a statistical process control chart. Patient and staff surveys were tracked.ResultsThe collaborative physician‐APP model was redesigned into 2 parallel and independently run (“concurrent”) physician and APP clinics. Patient access increased by 38.9% from a mean of 17.9 patients per collaborative clinic (n = 15 days, 269 patients) to 29.3 patients per concurrent clinic (n = 12 days, 352 patients). Medicare reimbursement rate modeling showed the collaborative clinic to operate at a loss of $1341.51 per day, while the concurrent clinic model operated at a $1309.88 gain (200% positive change). Patient and staff experience tracked positively.DiscussionOtolaryngology clinics can become overwhelmed by the volume of empaneled established patients. Traditional collaborative physician‐APP clinics see the same panel of patients together. However, these can be successfully redesigned to a concurrent model. Concurrent clinics improve patient access and provider satisfaction while maintaining patient satisfaction and fiscal performance.Implications for PracticeLeveraging an experienced APP to run a parallel and independent clinic alongside the physician (concurrent clinic model) may improve patient access, financial metrics, and patient/staff experience.

Abstract Background: Elastomeric respirators are reusable and reliable protection from infectious aerosol particles such as SARS-CoV-2. There is a lack of safety data for use in sterile fields limiting application to operating room settings where high-risk aerosol generating procedures are performed. We hypothesized an equivalent reduction in sterile field contamination would be achieved using an elastomeric respirator covered by a surgical mask as compared to a standard surgical mask or N95.Methods: Randomized controlled crossover experiment with repeat measurement comparing microbial and aerosol contamination of operating room surfaces for elastomeric respirators, elastomeric respirators covered by a surgical mask, N95, surgical mask, and no mask. 80 experiments were performed by participants with randomized order and balanced crossover to all masking groups (n=16 per masking group). Participants executed droplet and aerosol generating procedures while wearing: (Group 1) elastomeric respirator with mask, (Group 2) elastomeric respirator only, (Group 3) N95, and (Group 4) surgical mask. Positive control was established with the participant unmasked (Group 5). Contamination was measured by microbial growth on settling plates and optical particle counters (0.2+ and 2 um+ particles).Results: There was a reduction in microbial contamination at the sterile field (p<0.001) for all masks (Groups 1-4) compared to unmasked (Group 5). The mean colony forming units (CFU) at the sterile field was 0 CFUs for elastomeric respirator (+/- mask), N95, and surgical mask versus unmasked growing 1.875 CFUs. Compared to the unmasked control, the elastomeric respirator (+/- mask), N95, and surgical masks all resulted in a -0.75 difference in contamination (95% CI -0.91 to -0.48, p < 0.001). No significant difference in contamination between the elastomeric respirator (+/- mask) and a surgical mask was detected. No significant difference in particle counts (0.2 µm+ and 2.0 µm+) between the elastomeric respirator (+/- mask) and a standard surgical mask.Conclusion and Relevance: Elastomeric respirators with or without mitigation are as effective as a surgical mask and N95 for reducing contamination at the sterile field in an operating room. Consideration should be given to expanding the use of elastomeric respirators to operating rooms during high-risk aerosol generating procedures.

Objectives To address concerns related to the safety profile of both Food and Drug Administration (FDA)–approved and non‐FDA‐approved intranasal corticosteroid (INCS) use in the pediatric population. Data Source Systematic review of MEDLINE, PubMed, and EMBASE databases using comprehensive search strategy, including all INCS formulations and adverse events. The study design was developed using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Additional sources were identified from study references of relevant articles. Review Methods A structured literature search was conducted. Extracted data included age, population size, study design, drug (dosage, route, and frequency), presence of hypothalamic‐pituitary‐adrenal (HPA) axis suppression, ocular symptoms, and growth velocity adverse events. Results A total of 33 studies met inclusion criteria. The studies included use of INCS as nasal sprays and drops. There were no persistent abnormalities noted in cortisol level or intraocular pressure change. Growth velocity reduction was reported in 3 of 10 randomized trials. Meta‐analysis of epistaxis and headache showed no significant difference in the incidence of headache or epistaxis when FDA‐approved INCSs were compared to placebo, with a relative risk of 1.12 (95% CI, 0.77‐1.63; P =. 56) and 0.84 (95% CI, 0.60‐1.18; P =. 32), respectively. Meta‐analysis was not performed for growth velocity, HPA axis suppression, and ocular change. Conclusions INCSs in FDA‐approved routes of administration are generally safe to use in the pediatric population. Use of non‐FDA‐approved INCS drops may increase risk of iatrogenic Cushing’s syndrome. Growth velocity reduction, HPA axis suppression, and visual changes due to INCS are uncommon.