Neurologic sequelae associated with delayed identification of iatrogenic skull base injury during endoscopic sinus surgery (ESS).

Neurologic sequelae associated with delayed identification of iatrogenic skull base injury during endoscopic sinus surgery (ESS).

Rhinology. 2016 Sep 25;

Authors: Kubik M, Lee S, Snyderman C, Wang E

Abstract
BACKGROUND: Skull base injury is an infrequent complication during endoscopic sinus surgery (ESS). We hypothesize that late recognition and repair of CSF leaks during ESS is associated with increased neurologic morbidity.
METHODOLOGY: A retrospective review was performed of patients with skull base injury during ESS at a tertiary center from 1999-2015. The study population was separated into early (less than 72 hrs) and late (more than 72 hrs) intervention groups. Study parameters included time to diagnosis, imaging, site of injury, type of repair, neurologic complications, and clinical outcomes.
RESULTS: Seventeen patients were studied. The primary surgical interventions included ESS and balloon sinuplasty. Mean latency from primary surgery to presentation to our facility was 11 days. The most common injury site was the cribriform plate and the mean defect size 4.5 mm. Late diagnosis was associated with increased total neurologic complications and increased rates of postoperative meningitis. No neurologic complications occurred in patients diagnosed intraoperatively. All patients underwent successful endoscopic repair.
CONCLUSION: Skull base injury is a rare but major complication following both balloon sinuplasty and traditional primary ESS. Early diagnosis and endoscopic repair may prevent neurologic morbidity in these patients.

PMID: 27665079 [PubMed - as supplied by publisher]

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A noninvasive swallowing measurement system using a combination of respiratory flow, swallowing sound, and laryngeal motion.

A noninvasive swallowing measurement system using a combination of respiratory flow, swallowing sound, and laryngeal motion.

Med Biol Eng Comput. 2016 Sep 24;

Authors: Yagi N, Nagami S, Lin MK, Yabe T, Itoda M, Imai T, Oku Y

Abstract
The assessment of swallowing function is important for the prevention of aspiration pneumonia. We developed a new swallowing monitoring system that uses respiratory flow, swallowing sound, and laryngeal motion. We applied this device to 11 healthy volunteers and 10 patients with dysphagia. Videofluoroscopy (VF) was conducted simultaneously with swallowing monitoring using our device. We measured laryngeal rising time (LRT), the time required for the larynx to elevate to the highest position, and laryngeal activation duration (LAD), the duration between the onset of rapid laryngeal elevation and the time when the larynx returned to the lowest position. In addition, we evaluated the coordination between swallowing and breathing. We found that LAD was correlated with a VF-derived parameter, pharyngeal response duration (PRD) in healthy subjects (LAD: 959 ± 259 ms vs. PRD: 1062 ± 149 ms, r = 0.60); however, this correlation was not found in the dysphagia patients. LRT was significantly prolonged in patients (healthy subjects: 320 ± 175 ms vs.
PATIENTS: 465 ± 295 ms, P < 0.001, t test). Furthermore, frequency of swallowing immediately after inspiration was significantly increased in patients. Therefore, the new device may facilitate the assessment of some aspects of swallowing dysfunction.

PMID: 27665103 [PubMed - as supplied by publisher]

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Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

Eur Arch Otorhinolaryngol. 2016 Sep 24;

Authors: Adnane C, Adouly T, Khallouk A, Rouadi S, Abada R, Roubal M, Mahtar M

Abstract
The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

PMID: 27665096 [PubMed - as supplied by publisher]

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