Objectives: To validate each of the sino-nasal outcome test and the sinus and nasal quality of life (SN5) surveys for the adolescent population defined as 12 to 18 years old, and to determine if they correlate in regard to reports of sinonasal symptoms and quality of life.Study Design: Cross-sectional study.Methods: Adolescent patients, age 12 to 18 years old, presenting to our otolaryngology clinic between August 2020 and June 2021 were asked to fill both the SNOT-22 and the SN5 forms. Demographics and comorbidities were reviewed. Patients recruited were then divided into a sinonasal cohort (those with chronic sinonasal symptoms) and a control cohort (those who did not have any sinonasal disorders at time of visit).Results: One hundred fifteen patients completed both surveys, 80 patients in the sinonasal cohort and 35 patients in the control cohort. Average age was 14.9 years, and 49.6% were female. Mean SNOT-22 and SN5 scores were significantly higher in the sinonasal cohort as compared with the control cohort which confirmed validity of both surveys for the adolescents. Good test-retest reliability for both surveys was obtained (r = 0.76 for SNOT-22, and r = 0.64 for SN5). SNOT-22 and SN5 scores correlated well in both the sinonasal cohort (r = 0.63, p < 0.0001) and the control cohort (r = 0.61, p = 0.0003). Both surveys strongly predicted chronic sinonasal disorders with an odds ratio of 2.5 for SNOT-22 and 2.2 for SN5.Conclusion: Both instruments can be used to study the outcome of treatment for sinonasal disorders in adolescent patients.
Introduction: The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The purpose of this study is to study the outcome of this technique. Methods: A retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap among 2 institutions from August 2020 to July of 2022 was conducted. Demographics and comorbidities were collected preoperatively and postoperatively. The main outcome of this study was to identify the risk factors for surgical failure. Results: Forty-one patients were included. Mean perforation size was 2.2 cm (range 0.5-4.5 cm). Mean age was 42.5 years (range 14-65 years), 53.6% were female, 39% were active smokers, mean body-mass-index (BMI) was 31.9 (range 19.1-45.5), 20% with history of CRS and 31.7% had diabetes mellitus (DM). Etiologies of the perforation included idiopathic (n = 12), iatrogenic (n = 13), intranasal drug use (n = 7), trauma (n = 6), and secondary to tumor resection (n = 3). Overall success rate for complete closure was 73.2%. Active smoking, history of intranasal drug use, and DM were significantly associated with surgical failure (72.7%vs 26.7%, P = .007; 36.4%vs 10%, P = .047; and 63.6%vs 20%, P = .008 respectively). Conclusion: The endoscopic AEA flap is a reliable technique for closure of nasal septal perforation. It may not work when the etiology is intranasal drug use. Close attention to diabetes and smoking status is also needed.
Introduction: Morbidly obese patients with obstructive sleep apnea (OSA) are often intolerant of continuous positive airway pressure (CPAP). The effects of sleep surgery in this population is not well documented, and sleep surgery is generally avoided due to the expectation of poor outcomes, leaving these patients untreated. Methods: This retrospective study included 42 patients with a body mass index (BMI) ≥40.0 and OSA with a preoperative apnea hypopnea index (AHI) ≥5. Preoperative BMI ranged from 40.0 to 69.0 kg/m2. Preoperative AHI ranged from 7.2 to 130.0. Of 42 patients, 12 (28.6%) underwent concurrent pharyngeal and retrolingual surgery. Subgroup analysis of change in AHI was measured with respect to preoperative OSA severity, change in preoperative BMI, and BMI severity. Univariate linear and logistic regression was performed assessing change in AHI and surgical success with respect to age, sex, preoperative AHI, preoperative BMI, change in BMI, total procedures, palatal procedure, retrolingual procedure, nasal procedure, and multilevel procedures. Results: The mean AHI improved from 45.9 ± 31.8 to 31.9 ± 31.6 ( P = .007). Epworth sleepiness score (ESS) improved from 13.2 ± 5.5 to 9.6 ± 5.4 ( P = .00006). Lowest oxygen saturation (LSAT) improved from 74.4 ± 10.7 to 79.9 ± 10.4 ( P = .002). About 33.3% of patients had surgical success (AHI < 20 with at least 50% reduction in AHI). Preoperative AHI was the most significant factor for change in AHI in univariate and multivariate models ( P = .015). Conclusion: Sleep surgery is effective in reducing OSA burden in most morbidly obese patients and can result in surgical cure for a third of patients.
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