The last 30 years has seen a dramatic change in the type of medical and surgical intervention for chronic rhinosinusitis. With the introduction of endoscopic sinus surgery in the 1980s there has been a marked decrease in the classical Open procedures.since the 1980s to approximately 2010 open procedures had decreased by one third while endoscopic procedures increased nearly threefold to approximately 19,262 procedures per year with the greatest increase occurring from 2007 to 2011.
Chronic rhinosinusitis is an inflammatory disorder of the paranasal sinuses. It is defined as having symptoms lasting 12 or more weeks including two major symptoms specifically nasal obstruction, nasal discharge, facial pain or pressure, and reduction of sense of smell. A study in the International Forum of Allergy and Rhinology indicates that surgery is generally more successful than ongoing medical therapy alone. In a multi-hospital study, 20% of people elected medical therapy alone while approximately 80% decided to proceed with surgery. Overall those undergoing surgery experience significantly better improvement in discharge, facial pain or pressure.
This recent study indicates that endoscopic sinus surgery results in much greater improvement in the major symptoms of chronic rhinosinusitis then ongoing medical therapy alone
Patients commonly ask what is the best product to minimize a scar after surgery. There are many conflicting reports by different manufacturers of these products. Since they are over-the-counter there is no regulation by the US FDA. Vitamin E, “surgical glue”, and onion extracts are commonly used topical products for post surgical scar healing.
A recent article in Laryngoscope in 2015 stated the most important initial standard of care to minimize scarring after surgery during epithelialization is to keep the incision moist, clean, and protected from tension and mobility. The Laryngoscope article further stated that after the incision is closed, silicon gel surgical glue products and paper taping have shown progress in reducing dermal scaring. The article also stated that topical use of vitamin E and onion extracts have not been shown to reduce scaring. Further clinical studies are indicated.
Approaches and procedures are constantly in flux as medicine involves a new technology interfaceing with clinical experience. Hearing from colleagues and attending the national meetings can also lead to a change in perspective and approach. Dr. Choi at Children’s Hospital of Pittsburgh recently reviewed numerous approaches to tonsillectomy.
The cold tonsillectomy which is the most conventional approach is still commonly used. The downside is blood loss and postoperative pain.
A new approach to tonsillectomy using “Coblation” has the advantage of utilizing relatively low heat during the procedure. Additionally suctioning throughout the procedure improves visibility. I have been utilizing this approach for the past several years and I’ve noticed that there are far less complaints by patients of postoperative pain and bleeding.
A recent report published in The journal, “Science Translational Medicine” indicates the long suspected assumption that a patient’s immune response to surgery is strongly linked to the patient’s surgical recovery. Approximately 50 to 60% of the wide range in the observed recovery time for patients undergoing hip surgery was linked to the activity of a small group of monocytes immediately followIng the surgery. The author stated that “activity in these inmate immune cells within 24 hours after surgery seems to set the stage and help patients recover days and weeks after surgery.”
If these findings are confirmed in subsequent studies this will allow identification of that group of patients who may require additional interventions to facilitate their recovery and to hopefully improve the patient’s” immune readiness” to recover from surgery.
A recent small study in the prestigious journal ,”The Laryngoscope ” suggests that older patients with hearing loss may find their balance improved when they use hearing aids.
Though the studies size was small the results were statistically significant. Dr. Timothy Hullar from St. Louis Missouri noted in the study that opening your ears give you information about balance. Older patients who could hear better had marked improvement in standard balance testing. It appears that sound itself helps maintain posture and balance stability.
Larger studies need to be performed in order to confirm these fascinating findings.
Electronic cigarettes are fairly new products. It is difficult to determine the long-term health effects on users and non-users. He recent clinical study from Cornell medical College in New York City has investigated some of the biological side effects of electronic cigarette vapor and smoking. It appears that electronic smoking we have a lower potential disease burden than conventional tobacco cigarette smoke based on specific chemical analysis of carcinogens and monitoring certain health indicating parameters.
It is still difficult to determine the long-term side effects because of the absence of any regulations for manufacturing in use.
Patients with obstructive sleep apnea and daytime sleepiness are more likely to have depression symptoms as compared with control population.patients with excessive sleepiness have the highest risk of associated depression symptoms and in addition to evaluating the nature and severity of their sleeping disorder may benefit from depression screening as well.
In office balloon sinus dilation has been proven as an effective durable and safe treatment alternative to standard care via surgical endoscopic sinus surgery in operating room. 2 1/2 times more sinusitis patients would opt for a less invasive office procedure versus traditional sinus surgery. Naturally, not every patient is a candidate for an office-based balloon sinus dilation procedure. An ear nose and throat physician can evaluate you to determine whether you are a medically and anatomically appropriate candidate for this less invasive office procedure to control chronic sinusitis.
Aspiration pneumonia is a serious medical problem in inpatients receiving chronic medical care. This problem is more frequently seen in patients who are intubated, have suffered neurological injury or are frail. A recent clinical study performed in a long term care hospital noted that patients who received an oral care program were less likely to develop aspiration ammonia and had far less side effects if they developed aspiration pneumonia. It seems that routine oral care reduces the potential for aspiration of highly dangerous oral material.