BACKGROUND:Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS. METHODOLOGY:Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty. RESULTS:Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty. CONCLUSIONS:Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.

OBJECTIVES:To examine the national rates of complications, readmission, reoperation, death and length of hospital stay after laryngectomy. To explore the risks of neck dissection with laryngectomy using outcomes.METHODS:The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. The database was analyzed for patients undergoing laryngectomy with and without neck dissection. Demographic, perioperative complication, reoperation, readmission, and death variables were analyzed.RESULTS:754 patients who underwent total laryngectomy during this time were found. Demographic analysis showed average age was 63 years old, 566 (75.1%) were white, and 598 (79.3%) were male. Of these patients, 520 (69.0%) included a neck dissection while 234 (31.0%) did not. When comparing patients who received a neck dissection to those who did not, there were no significant differences in median length of hospital stay (12.5 days w/vs. 13.3 days w/o, P = 0.99), rates of complication (40% w/vs. 35% w/o, P = 0.23), reoperation (13.5% w/vs. 14% w/o, P = 0.81), readmission (14% w/vs. 18% w/o, P = 0.27), and death (1.3% w/vs. 1.3% w/o, P > 0.99). Furthermore, neck dissection did not increase the risk of complication (P = 0.23), readmission (P = 0.27), reoperation (P = 0.81), death (P = 0.94), or lengthened hospital stay (P = 0.38).CONCLUSIONS:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies. These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.

Objective To identify whether irrigation devices become contaminated when used by patients with allergic rhinitis (AR). Methods Ten AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus rinse system and instructed on its proper use, cleaning, and storage. Two squeeze bottles (bottle A and bottle B) were given to each patient for twice‐a‐day rinsing. Bottle A was used in the morning and analyzed after four weeks. Bottle B was used in the evening and analyzed after 8 weeks of use. Microbial contaminants were cultured from the nose pieces and the inner surface of the bottles obtained from patients. Results Seventeen sinus rinse devices (17/20) from all individuals in this study grew bacteria commonly in the nozzles. Twenty‐four bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus. In addition, no correlation was apparent between the length of bottle use and the degree of contamination ( r = 0.13, p = 0.76). During the study period, no patient developed acute sinus infections. Conclusion Microbial contamination of the sinus rinse system occurs commonly, even in uninfected AR patients; however no evidence exists linking this to clinically relevant sinus infections. Trial Registration clinicaltrials.gov Identifier: NCT01030146.

Objectives/Hypothesis Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea. Study Design Prospective, unblinded, single‐center pilot study. Methods From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index < 15, minimum oxygen saturation > 85%, and body mass index (BMI) < 32 were included. Outcomes were assessed comparing the results of quality‐of‐life questionnaires, bed partner‐assessed snoring, pain visual analog scales, WatchPAT (Itamar Medical Ltd, Caesarea Ind. Park, Israel) home sleep studies, and flexible endoscopy at baseline and 90‐day follow‐up. Results Thirteen males and seven females were enrolled. Average age was 49.1 (range 31–67) and BMI of 25.8 ± 2.66. TranQuill Sling Snoreplasty significantly reduced snoring symptom scores from 8.70 ± 4.27 to 6.42 ± 4.14, P = 0.012. Snoring visual analog scores demonstrated reduction of 17.8 mm (59.4 mm ± 22.1 to 41.6 mm ± 29.2), P = 0.0184. Thirty‐five percent (7/20) of subjects reported complications related to the trial, with no serious adverse events. Conclusion TranQuill Sling Snoreplasty is a safe therapy that improves snoring symptoms in most adult subjects with benign snoring or mild sleep apnea. Further study is required to better identify patients likely to respond to the therapy. Level of Evidence 4. Laryngoscope , 126:243–248, 2016

Objectives:Recognize the correlation between WatchPAT and Polysomnography (PSG) results including the apnea‐hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI).Methods:A systematic literature review was performed by searching Pubmed, OVID Medline, and the Cochrane database for articles from June 2000 comparing WatchPAT to PSG. Meta‐analysis of continuous measures using the fixed effect model was performed.Results:Twelve studies that directly compared the results of AHI, RDI, and ODI between WatchPAT and PSG were identified. Five of the 12 studies, involving a total of 476 patients, measured AHI. WatchPAT AHI was not found to be significantly different from PSG AHI (standardized mean difference [SMD], 0.10; 95% confidence interval [CI], –0.08 to 0.28). RDI values, obtained from 5 studies with a total of 612 patients, did not significantly differ between WatchPAT and PSG (SMD, 0.08; 95% CI, –0.07 to 0.24). No significant difference was found between WatchPAT ODI and PSG ODI values from 2 studies with a total of 298 patients (SMD, 0.11; 95% CI, –0.12 to 0.34).Conclusions:The respiratory indices provided by WatchPAT are comparable to those obtained by PSG. This meta‐analysis reinforces the validation of WatchPAT as an alternative to PSG in the diagnosis of obstructive sleep apnea (OSA). With WatchPAT, patients can be evaluated in their own habitual environment rather than in a sleep lab. Therefore, the use of WatchPAT provides a less stress‐inducing option for patients and a more financially efficient method for the evaluation of OSA.

Objective To systematically review the available evidence regarding steroid treatment for sudden sensorineural hearing loss (SSHL) and to update prior analyses when possible. Data Sources OVID Medline. Review Methods An electronic database search (OVID Medline) was performed with the objective of identifying all randomized controlled trials examining the use of steroids for the treatment of SSHL. The search was limited to English‐language publications between January 1980 and June 2013. Reference lists were examined for additional articles. Results A total of 15 articles including 1,166 subjects were included in three separate analyses. Three articles (181 subjects) were included in the steroid versus placebo analysis, which resulted in an odds ratio of 1.52 (95% confidence interval [CI]: 0.83‐2.77). Six articles (702 subjects) were included in the systemic versus intratympanic steroids analysis, which resulted in an odds ratio of 1.14 (95% CI: 0.82‐1.59). Six articles (283 subjects) were included in the salvage treatment analysis, which resulted in an odds ratio of 6.04 (95% CI: 3.26‐11.2). Conclusions A meta‐analysis of randomized controlled trials does not support the use of steroids over placebo in this condition, a finding consistent with previous analyses. Although systemic or intratympanic steroid administration does not have a significant treatment effect, steroids for salvage treatment of patients failing traditional therapy appear to have an effect. However, this result should be interpreted with caution given the poor quality of component trials. Implications for clinical practice and future trial design are discussed. Level of Evidence NA Laryngoscope , 125:209–217, 2015