Randomized controlled trial: hybrid technique using balloon dilation of the frontal sinus drainage pathway

Hathorn, Iain; Pace‐Asciak, Pia; Habib, Al‐Rahim; Sunkaraneni, Vishnu; Javer, Amin R.

doi:10.1002/alr.21432

Cited by 17 publications

(25 citation statements)

References 14 publications

(15 reference statements)

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“…1133 A more recent study compared Draf 2a frontal sinusotomy to a "hybrid" frontal approach combining balloon dilation of the frontal recess and traditional endoscopic techniques; the study found comparable rates of ostial patency up to 1 year postoperatively, with the hybrid technique having a slightly shorter surgical time and less mean blood loss volume vs conventional ESS. 1134 A third RCT looked at maxillary sinus balloon dilation vs ESS in patients with chronic maxillary sinusitis with or without anterior ethmoid disease. Both techniques were found to be equally effective in improving SNOT-20 scores, maintaining ostial patency, reducing RS episodes, and improving work productivity at 1-year follow-up.…”

Section: Ixe Aecrs: Complicationsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

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548

886

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Ixe Aecrs: Complicationsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

548

886

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“…46,47 The advent of balloon dilatation of sinus ostia has further raised the question as to whether just opening the sinuses and recreating a mucus drainage pathway is sufficient therapy in patients with CRS. 48 However, this approach does little in terms of resolving the inflammation or allowing access for topical therapies, and the latter has increasingly become a goal of surgery. Balloon dilatation is not US Food and Drug Administration approved for the treatment of polypoid disease, and studies have demonstrated early involvement of the underlying bone in patients with CRS, something that might be a factor in terms of why the inflammation can be difficult to manage with medical therapy alone.…”

Section: Surgical Pitfalls Extent Of Surgerymentioning

confidence: 99%

Evolution in the surgical management of chronic rhinosinusitis: Current indications and pitfalls

Kohanski

Toskala

Kennedy

2018

Journal of Allergy and Clinical Immunology

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Chronic rhinosinusitis (CRS) consists of a range of inflammatory conditions in the sinuses that can result in clinical symptoms. The underlying pathophysiology and its relationship to lower airway disease are complex. Current definitions of CRS can serve more as an indication for potential surgical intervention rather than a marker of disease state. CRS can be asymptomatic and may require medical management to avoid disease progression and minimize the risk of lower airway disease. Endoscopic surgery has undergone a significant evolution and refinement, but the most common surgical complication remains persistent inflammation and disease recurrence. It is important to recognize that surgery alone rarely cures CRS and patients require long-term medical therapy for continued asymptomatic inflammation. Careful postoperative care and endoscopic follow-up to ensure resolution of inflammation are key to ensuring optimal surgical outcomes and reduce the risk of revision surgery. Future work on CRS endotypes will allow discovery of new therapies to treat CRS, as well as refine indications for medical or surgical intervention and postoperative care.

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“…Therefore, while the panel members met consensus on the short-term effectiveness of SOD in the management of chronic sinusitis, it became difficult to ascribe this effect to individual sinuses. Randomized trials 12,14 and observational studies 15,31,50,51 and expert opinion 52,53 suggest a benefit in certain circumstances from SOD of the frontal sinus when applied as either a stand-alone or hybrid procedure. The combination of the literature and the experience of some panel members were cited by the group as explanation for reaching consensus on the possible (''can be'' vs ''is'') use of SOD in the management of frontal sinusitis (Statement 42a).…”

Section: Discussionmentioning

confidence: 99%

Clinical Consensus Statement: Balloon Dilation of the Sinuses

Piccirillo

Payne

Rosenfeld

et al. 2018

Otolaryngol.--head neck surg.

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Objective To develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses. Methods An expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus. Results After 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices. Conclusion Expert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described.

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Randomized controlled trial: hybrid technique using balloon dilation of the frontal sinus drainage pathway

Abstract: A hybrid balloon technique successfully dilates the frontal sinus drainage pathway with reduced blood loss. Also, short-term patency appears to be comparable to traditional frontal sinusotomy.

Cited by 17 publications

References 14 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Evolution in the surgical management of chronic rhinosinusitis: Current indications and pitfalls

Clinical Consensus Statement: Balloon Dilation of the Sinuses

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