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  • 1
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    Determinants of physician assessment of chronic rhinosinusitis disease control using EPOS 2020 criteria and the importance of incorporating patient perspectives of disease control
    Wiley ; 2023
    In:  International Forum of Allergy & Rhinology
    Details
    In: International Forum of Allergy & Rhinology, Wiley
    Abstract: We identify chronic rhinosinusitis (CRS) manifestations associated with how rhinologists assess CRS control, with a focus on patient perspectives (patient‐reported CRS control). Methods Fifteen rhinologists were provided with real‐world data from 200 CRS patients. Participating rhinologists first classified patients’ CRS control as “controlled,” “partly controlled,” and “uncontrolled” using seven CRS manifestations reflecting European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) CRS control criteria (nasal obstruction, drainage, impaired smell, facial pain/pressure, sleep disturbance, use of systemic antibiotics/corticosteroids in past 6 months, and nasal endoscopy findings) and patient‐reported CRS control. They then classified patients’ CRS control without knowledge of patient‐reported CRS control. Interrater reliability and agreement of rhinologist‐assessed CRS control with patient‐reported CRS control and EPOS guidelines were determined. Results CRS control classification with and without knowledge of patient‐reported CRS control was highly consistent across rhinologists ( κ w  = 0.758). Rhinologist‐assessed CRS control agreed with patient‐reported CRS control significantly better when rhinologists had knowledge of patient‐reported CRS control ( κ w  = 0.736 vs. κ w  = 0.554, p   〈  0.001). Patient‐reported CRS control, nasal obstruction, drainage, and endoscopy findings were most strongly associated with rhinologists’ assessment of CRS control. Rhinologists’ CRS control assessments weakly agreed with EPOS CRS control guidelines with ( κ w  = 0.529) and without ( κ w  = 0.538) patient‐reported CRS control. Rhinologists classified CRS as more controlled than EPOS guidelines in almost 50% of cases. Conclusions This study directly demonstrates the importance of patient‐reported CRS control as a dominant influence on rhinologists’ CRS control assessment. Knowledge of patient‐reported CRS control may better align rhinologists’ CRS control assessments and treatment decisions with patients’ perspectives.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Article
    DOI: 10.1002/alr.23168
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 2
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    Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists
    Wiley ; 2023
    In:  International Forum of Allergy & Rhinology Vol. 13, No. 6 ( 2023-06), p. 973-978
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 13, No. 6 ( 2023-06), p. 973-978
    Abstract: A patient‐reported history of penicillin allergy is a common label with a prevalence of about 10%. However, as many as 95% of patients reporting a penicillin allergy do not have a true immunoglobin‐E (IgE)‐mediated allergic reaction. Unfortunately, penicillin allergy mislabeling is problematic, leading to inappropriate antibiotic use and negative consequences, such as adverse drug events, suboptimal outcomes, and increased costs. As physicians who treat patients of all ages for common sinonasal pathology in the clinic and operating room in addition to frequently providing testing and management of allergic diseases, rhinologists are well positioned to aid in delabeling patients with inaccurate penicillin allergies. This viewpoint highlights the consequences of inaccurate penicillin allergy designation in the clinic and perioperative period and explores misconceptions regarding cross‐reactivity between penicillins and cephalosporins. Opportunities are explored for shared decision‐making with colleagues in other specialties, such as anesthesiology, and practical recommendations are provided to aid rhinologists when faced with a patient who holds a questionable history of penicillin allergy. Rhinologists can play an active role in delabeling patients with inaccurate penicillin allergies with the goal of ensuring appropriate antibiotic use for future medical encounters.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.v13.6
    DOI: 10.1002/alr.23173
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 3
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    Clinical Consensus Statement: Balloon Dilation of the Sinuses
    Wiley ; 2018
    In:  Otolaryngology–Head and Neck Surgery Vol. 158, No. 2 ( 2018-02), p. 203-214
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    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 158, No. 2 ( 2018-02), p. 203-214
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599817750086
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 4
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    Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score
    Wiley ; 2021
    In:  International Forum of Allergy & Rhinology Vol. 11, No. 8 ( 2021-08), p. 1177-1186
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 11, No. 8 ( 2021-08), p. 1177-1186
    Abstract: Standardized diagnostic criteria for Eustachian tube (ET) dysfunction (ETD) have not been established. The purpose of this study was to characterize the relationship between ET inflammation and ETD symptoms and to determine the diagnostic performance of a quantitative score. Methods Patients were enrolled in a rhinology clinic between October 2018 and June 2019. Patients underwent nasal endoscopy and completed the 7‐item Eustachian Tube Dysfunction Questionnaire (ETDQ‐7). Nasopharyngeal inflammation identified on endoscopy was quantified using the Endoscopic Evaluation of the Eustachian Tube (3ET) score. Tympanometry was performed as indicated. Comorbid conditions were assigned during the patient encounter. Results A total of 414 patients were included in the study. Patients with clinically significant ETD symptoms (ETDQ‐7 ≥2.1) had higher 3ET scores than those without symptoms. A 1‐point increase in 3ET score was associated with a 1.7‐fold increase in odds of clinically significant ETD symptoms (adjusted OR [aOR], 1.72; 95% CI, 1.46 to 2.05). The 3ET scores were correlated with ETDQ‐7 scores ( ρ  = 0.54) and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) scores ( ρ  = 0.52). 3ET scores were not associated with tympanometric peak pressures. Patients with ETD symptoms were more likely to have laryngopharyngeal reflux (aOR, 2.71; 95% CI, 1.24 to 6.18). A 3ET score of 4 predicted symptomatic state in 80% of cases with a specificity of 97.8% and positive predictive value of 96.6%. Conclusion Inflammatory findings at the nasopharyngeal ET orifice are associated with clinically significant ETD symptoms. The 3ET score is specific for a symptomatic state and has potential clinical utility in the evaluation of suspected ETD. ©2021 ARSAAOA, LLC.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.v11.8
    DOI: 10.1002/alr.22771
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 5
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    Enhanced Recovery After Surgery Protocols for Head and Neck Cancer: Systematic Review and Meta‐analysis
    Wiley ; 2023
    In:  Otolaryngology–Head and Neck Surgery Vol. 168, No. 4 ( 2023-04), p. 593-601
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 168, No. 4 ( 2023-04), p. 593-601
    Abstract: Enhanced recovery after surgery (ERAS) protocols aim to optimize the pre‐, intra‐, and postoperative care of patients to improve surgery outcomes, reduce complications, decrease length of stay, and more. We aim to perform a systematic review and meta‐analysis of ERAS protocols for head and neck cancer surgery with or without microvascular reconstruction. Data Sources PubMed, Embase, and Web of Science databases were queried, and abstracts were screened independently by 2 investigators. Review Methods This review was conducted in accordance with the PRISMA guidelines. We included comparative observational studies but excluded animal studies, case reports, and case series. Results Of 557 articles initially reviewed by title and/or abstract, we identified 30 for full‐text screening, and 9 met the criteria for qualitative synthesis. Meta‐analysis of length of stay revealed a mean decrease of 1.37 days (95% CI, 0.77‐1.96; I 2 = 0%; P 〈 .00001) with the ERAS group as compared with non‐ERAS controls. The standardized mean difference of the morphine milligram equivalent was 0.72 lower (95% CI, 0.26‐1.18; I 2 = 82%; P = .002) in the ERAS group vs controls. The quality of studies was moderate with a median MINORS score of 18.5 (range, 13.5‐21.5). Conclusion Implementation of ERAS protocols can lead to decreases in length of stay and opioid drug utilization. However, further high‐quality prospective studies of ERAS protocols are needed, especially with stratified analysis of outcomes based on the type of head and neck cancer surgery.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/01945998221082541
    Language: English
    Publisher: Wiley
    Publication Date: 2023
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  • 6
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    Olfactory Training for Postviral Olfactory Dysfunction: Systematic Review and Meta‐analysis
    Wiley ; 2021
    In:  Otolaryngology–Head and Neck Surgery Vol. 164, No. 2 ( 2021-02), p. 244-254
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    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 164, No. 2 ( 2021-02), p. 244-254
    Abstract: Olfactory dysfunction is a common problem that is most frequently attributed to upper respiratory infection. Postviral olfactory dysfunction (PVOD) can be prolonged and clinically challenging to treat. Olfactory training (OT) has demonstrated potential benefit for patients with nonspecific olfactory dysfunction. We sought to evaluate the efficacy of OT specifically for PVOD by pooled analysis of the existing evidence. Data Sources PubMed, Embase, and Web of Science. Review Methods Following PRISMA guidelines, PubMed, Embase, and Web of Science databases were queried and abstracts screened independently by 2 investigators. We included studies evaluating the efficacy of OT for PVOD and excluded studies evaluating pharmacologic interventions or olfactory loss from other causes. Results Of the initial 1981 abstracts reviewed, 16 full‐text articles were included. Sniffin’ Sticks olfactory testing results were reported in 15 (93%) studies as threshold (T), discrimination (D), and identification (I) subscores and TDI total scores. All studies reported clinically significant results after OT, defined as a score improvement of TDI 〉 5.5. Four studies were included in the meta‐analysis, in which pooled estimates revealed that patients with PVOD who received OT had a 2.77 (95% confidence interval, 1.67‐4.58) higher odds of achieving a clinically important difference in TDI scores compared to controls. Conclusion Meta‐analysis of existing data demonstrates clinically significant improvements in PVOD associated with OT. Variability exists among OT protocols and may benefit from further optimization. Existing data supports the use of OT for the treatment of existing and newly emerging cases of PVOD.
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820943550
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 7
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    Response to “The Association Between Reflux and Laryngeal Neoplasia Is Still Not Demonstrated”
    Wiley ; 2020
    In:  Otolaryngology–Head and Neck Surgery Vol. 163, No. 6 ( 2020-12), p. 1285-1286
    Details
    In: Otolaryngology–Head and Neck Surgery, Wiley, Vol. 163, No. 6 ( 2020-12), p. 1285-1286
    Type of Medium: Online Resource
    ISSN: 0194-5998 , 1097-6817
    URL: Article
    DOI: 10.1177/0194599820938320
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 8
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    Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial
    Wiley ; 2018
    In:  International Forum of Allergy & Rhinology Vol. 8, No. 10 ( 2018-10), p. 1114-1122
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 8, No. 10 ( 2018-10), p. 1114-1122
    Abstract: Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggesting a role for TIVA in that disease subgroup. Methods A double‐blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high‐grade CRS defined as either sinonasal polyposis or a preoperative Lund‐Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10‐point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4‐3.9] vs IA 4.1[3.0‐5.8] , p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100‐450] vs 300 mL [200‐500] , p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT‐22 scores at 3 months ( p = 0.278) and at 6 months ( p = 0.396) following ESS. Conclusion TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high‐grade inflammatory sinus disease.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2018.8.issue-10
    DOI: 10.1002/alr.22173
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2604059-1
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  • 9
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    Paranasal sinus opacification‐to‐pneumatization ratio applied as a rapid and validated clinician assessment
    Wiley ; 2017
    In:  International Forum of Allergy & Rhinology Vol. 7, No. 1 ( 2017-01), p. 24-29
    Details
    In: International Forum of Allergy & Rhinology, Wiley, Vol. 7, No. 1 ( 2017-01), p. 24-29
    Abstract: The utility of clinician‐applied instruments, particularly the Lund‐Mackay score, in the assessment of paranasal sinus computed tomography (CT) in chronic rhinosinusitis (CRS) remains incompletely defined. The purpose of this study was to determine if a new approach to the evaluation of sinus CT could accurately predict the extent of opacification while remaining simple for clinician use. Methods Twenty‐four sinus CT scans were measured for the percent of sinus opacification using three‐dimensional (3D) volumetric analyses. The same scans were also evaluated using the Lund‐Mackay score to measure opacification and the Assessment of Pneumatization of the Paranasal Sinuses (APPS) score to measure total sinus volume (TSV). Correlation analysis was performed for the Lund‐Mackay to APPS score ratio as a predictor of percent opacification. Validation analysis was also performed to determine the optimal orientation for Lund‐Mackay scoring, which has not previously been described. Results The Lund‐Mackay to APPS score ratio was very strongly correlated with the percentage of sinus opacification measured by 3D volumetric analysis ( r = 0.862, r 2 = 0.743, p 〈 0.001). Lund‐Mackay scoring was not statistically different between axial‐only, coronal‐only, or triplanar groups for interrater ( p = 0.379) and intrarater reliability ( p = 0.312). Conclusion The Lund‐Mackay score is validated for rater reliability in multiple orientations. Using the APPS score as a measure of TSV, the Lund‐Mackay‐to‐APPS ratio very strongly correlates with the percentage of sinus opacification by 3D volumetric analysis. Further study will be required to determine if this ratio is predictive of symptom severity.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.2017.7.issue-1
    DOI: 10.1002/alr.21833
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 10
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    Cost and operative time estimation itemized by component procedures of endoscopic sinus surgery
    Wiley ; 2020
    In:  International Forum of Allergy & Rhinology Vol. 10, No. 6 ( 2020-06), p. 755-761
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    In: International Forum of Allergy & Rhinology, Wiley, Vol. 10, No. 6 ( 2020-06), p. 755-761
    Abstract: Endoscopic sinus surgery (ESS) is a variable combination of individual procedures. Cost estimates for ESS as a single entity have wide variation, likely influenced by variation in procedures performed. We sought to identify operative time, supply costs, and total procedure cost specific to the component procedure combinations comprising ESS. Methods Bilateral ESS cases at 13 Intermountain Healthcare facilities (2008 to 2016) were identified from a database with corresponding cost and time data. Procedure details were obtained by chart review. Least‐squares (LS) means of cost (in 2016 US dollars) and time for specific procedures were obtained by multivariable gamma regression models. Results Among 1477 bilateral ESS cases with 19 different procedure combinations, operative time ranged from 59.5 (95% confidence interval [CI], 48.6‐73.0) minutes for total ethmoid to 147.1 (95% CI, 126.4‐171.2) minutes for full ESS with maxillary and sphenoid tissue removal. Sphenoidotomy had lowest total and supply costs (in US dollars) of $2112 (95% CI, $1672‐$2667) and $636 (95% CI, $389‐$1040), respectively. Total cost was highest for full ESS with maxillary tissue removal at $4640 (95% CI, $4115‐$5232). Supply cost was highest for full ESS with maxillary and sphenoid tissue removal at $2191 (95% CI, $1649‐$2909). Conclusion Operative time and costs for ESS vary depending on the procedures performed, demonstrating the importance of procedure specificity in assessment of ESS time, cost, and, ultimately, value. These procedure‐specific estimates of cost enable nonbinary valuation of ESS, appropriate for the multitude of procedure options intended to optimize individual outcomes.
    Type of Medium: Online Resource
    ISSN: 2042-6976 , 2042-6984
    URL: Issue
    URL: Article
    DOI: 10.1002/alr.v10.6
    DOI: 10.1002/alr.22554
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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