Background Wide variations in revision endoscopic sinus surgery (ESS) rates for chronic rhinosinusitis with nasal polyposis (CRSwNP) have been reported. It is important to understand expected revision rates and factors that impact the need for revision. Methods A literature search was conducted on PubMed, Scopus, and the Cochrane Database of Systematic Reviews. Following PRISMA guidelines, a systematic review and meta‐analysis was performed on studies that reported revision surgery data for CRSwNP patients. Results Forty‐five studies with 34,220 subjects were meta‐analyzed, with an overall revision rate of 18.6% (95% confidence interval, 14.1%‐23.6%). Studies with extractable follow‐up data reported a mean revision rate of 16.2% over a weighted mean follow‐up of 89.6 months. Factors associated with increased revision rates included allergic fungal rhinosinusitis (28.7%), aspirin‐exacerbated respiratory disease (27.2%), asthma (22.6%), prior polypectomy (26.0%), and publication prior to 2008 (22.7%) (p < 0.05 for all). Conclusion Although polyps can recur after ESS, reported long‐term ESS revision rates are approximately 14% to 24%. Identifying risk factors for revision surgery can help manage patient expectations and determine optimal personalized treatments.
IMPORTANCE Multiple studies have evaluated associations between post-cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs.OBJECTIVE To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes.DATA SOURCES A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included.STUDY SELECTION Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded. DATA EXTRACTION AND SYNTHESIS Following the Preferred Reporting Items for SystemicReviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05). MAIN OUTCOMES AND MEASURESThe planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors. RESULTSOf the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = −0.31 [95% CI, −0.41 to −0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27). CONCLUSIONS AND RELEVANCEGiven that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.
Objectives Prior studies have indicated that olfactory cleft (OC) opacification correlates with olfaction in patients with chronic rhinosinusitis (CRS). However, the results have been unclear in patients without polyps. The purpose of this study was to further explore the relationship between OC opacification, sinus opacification, and olfactory function in patients with CRS. Methods One hundred and forty‐eight patients with CRS were prospectively enrolled across five institutions. Olfactory function was evaluated using the Sniffin’ Sticks tests (Burghardt, Wedel, Germany) and the 17‐item Questionnaire of Olfactory Disorders (QOD‐NS). Computed tomography (CT) scans for each patient were acquired and Lund‐Mackay scores recorded. Opacification of the OC was determined using OsiriX MD (Pixmeo, Bernex, Switzerland) and correlated with olfaction scores. Results A total of 148 CRS patients, 73 CRS without nasal polyps (CRSsNP) and 75 CRS with nasal polyps (CRSwNP), as well as 30 control subjects were enrolled. Overall OC opacification averaged 63.7% in CRS patients and 47.1% in control subjects (P < 0.001). In the overall cohort, OC opacification significantly correlated with threshold, discrimination, and identification (TDI) (r = −0.520; P < 0.001) and QOD‐NS scores (r = 0.374; P < 0.001). CRSwNP patients demonstrated a significant correlation between OC opacification and TDI scores (r = −0.464; P < 0.001) but not the CRSsNP group (r = −0.143; P = 0.229). Lund‐Mackay score correlated with TDI in both the CRSsNP (r = −0.300; P = 0.010) and CRSwNP (r = −0.271; P = 0.019) groups. Conclusion CT opacification is associated with olfactory dysfunction differentially based on nasal polyp status. Smell loss in CRSwNP correlated with both OC opacification and Lund‐Mackay score, whereas CRSsNP correlated only with Lund‐Mackay score, indicating different relationships between olfactory function and local inflammatory processes in these disorders. Level of Evidence 2 Laryngoscope, 130:2311–2318, 2020
Background Surgical treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) has evolved over the last decade as rhinologists have increasingly used topical steroid therapies and altered surgical techniques. It is important to understand the changes in success rates of surgery and frequency of revision endoscopic sinus surgery (ESS) in CRSwNP. The aim of this study was to retrospectively review the revision surgical rate of CRSwNP patients by evaluating outcomes in a cohort from the Medical University of South Carolina (MUSC). Methods Retrospective review of CRSwNP patients operated upon at the MUSC between 2002 and 2019 by a single surgeon was performed. Assessed factors included demographics, comorbidities, CRSwNP subtype, extent of surgery, and steroid rinse compliance. Logistic regression was performed to identify factors associated with revision surgery. Results Among 338 patients with at least 6 months of follow‐up, 24.9% had revision surgery, with a mean follow‐up of 52.6 months. In patients with any person‐time measure, the revision rate was 5.58 per 100 person‐years. Independent risk factors associated with increased odds ratio (OR) for revision surgery were: younger age (OR, 1.1); prior surgery (OR, 3.3); longer follow‐up (OR, 1.1); and surgery before 2009 (OR, 2.4) (p < 0.05 for all). Conclusion The revision surgery rate for CRSwNP was 24.9% among those with at least 6 months of follow‐up. Risk factors for higher revision rates included younger age, previous surgery, longer follow‐up, and surgery at the MUSC prior to 2009. As we enter an era of personalized medicine, it is important to consider patient‐ and surgeon‐specific factors, which impact revision surgery rates.
Background Endoscopic sinus surgery is an effective treatment option for patients with chronic rhinosinusitis (CRS), although approximately 20% of patients fail to improve with standard surgical procedures. Expanded procedures such as the endoscopic modified medial maxillectomy (EMMM) have been described in management of refractory maxillary sinusitis. Objective This study aims to review the current literature on the safety and efficacy of the EMMM for treatment of refractory maxillary sinusitis. Methods A literature search was performed of PubMed, Ovid, and Cochrane databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. English-language articles evaluating the EMMM procedure on patients with recalcitrant maxillary sinusitis were included. Full-text articles were obtained and evaluated by 2 reviewers independently, with a third reviewer for mediation of disagreements. Results Six studies met eligibility criteria and were included into the study, with follow-up ranging from 12 to 82.8 months. Two studies contained Level 2 evidence and 4 studies contained Level 4 evidence. EMMM was found to be effective in CRS and cystic fibrosis-related CRS (0% and 9.1% revision rate, respectively). Symptom resolution was noted 60% to 80% of patients. Four studies reported complications, with a total of 4 complications out of 211 patients. Conclusions There are no high-quality Level 1 studies evaluating the efficacy and safety of the EMMM procedure. Level 2 to Level 4 studies indicate that this procedure is relatively safe with a low complication rate and symptom resolution in up to 80% of patients with recalcitrant maxillary sinusitis.
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