Objective To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. Methods Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. Results Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent ( p = 0.58), but greater for rural adjacent ( p < 0.001, r = 0.96). Otolaryngologists declined for rural regions ( p < 0.001 and p < 0.001, r = −0.56, and r = −0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent ( p < 0.001, r = −0.61), while increasing at a lesser rate for rural not adjacent ( p = 0.002, r = 0.96). Conclusions Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. Level of Evidence NA Laryngoscope , 134:136–142, 2024
Saline nasal irrigation has become an important aspect of post-operative care following endoscopic sinus surgery. The objective of this study was to identify the risks of contamination of both the nasal irrigation bottle and fluid following endoscopic sinus surgery.This was a prospective study of consecutive patients undergoing endoscopic sinus surgery for chronic sinusitis. All patients were given nasal irrigation bottles with detailed cleaning instructions preoperatively. Nasal irrigation bottles were collected and cultured at 1 and 2 weeks postoperatively. During the same visit, 5-ml of sterile normal saline was mixed into the irrigation bottle and then cultured separately.A total of 20 patients agreed to participate in the study. At 1 week postoperatively, 50% of the bottles had positive cultures with 40% of the irrigation samples testing positive for bacteria. At two weeks, the contamination in the irrigation bottle and fluid decreased to 26.7% and 20%, respectively. The most common bacteria cultured was Pseudomonas aeruginosa. There were no cases of postoperative infection.Despite detailed cleaning instructions, there is a relatively high risk of bacterial contamination in nasal irrigation bottles and fluid following endoscopic sinus surgery. Although these risks did not translate into higher infection rates postsurgery, it may be important for physicians to emphasize regular cleaning techniques to minimize a potential source of bacterial contaminant exposure.
Determine the prevalence of bacterial biofilms in surgical chronic rhinosinusitis (CRS) patients and characterize the inflammatory response associated with biofilm CRS.Cross-sectional.Tertiary care academic center.Sinonasal mucosa and peripheral blood were collected from 60 CRS patients. Mucosal biofilms were demonstrated by scanning electron microscopy. Leukocyte subpopulations were determined by flow cytometry. Cytokines were identified with a luminex-based assay on the lysate of homogenized tissue or plasma.Of the 60 samples, 17 were determined to be positive for the presence of biofilms. Oral steroid-naive CRS patients with biofilm demonstrated a local T(H)1 inflammatory response with significantly elevated levels of interferon-gamma (INF-gamma), granulocyte colony-stimulating factor, macrophage inflammatory protein-1 beta, and neutrophils in the sinonasal mucosa. No differences were present at the systemic level.Sinonasal bacterial biofilms correlate to a T(H)1 skewed local but not systemic inflammatory response in CRS. This difference is abrogated by the use of oral steroids.
Recently, there has been tremendous interest in the sinus microbiome and how it relates to disease. However, a lack of a standardized sample collection and DNA extraction methods makes comparison of results across studies nearly impossible. Furthermore, current techniques fail to identify which components of the microbiome are actually alive within the host at the time of sampling.To develop and optimize a method to differentiate which bacterial species in the human sinus microbiome are live versus dead.Duplicate samples from the middle meatus of patients with healthy sinus tissue and those patients with chronic rhinosinusitis were collected by using brushes (n = 12), swabs (n = 27), and tissue biopsy (n = 8) methods. One sample from each pair was either deoxyribonuclease I- or control-treated before DNA extraction. The relative bacterial versus human composition of each sample was determined. A 16S ribosomal RNA gene analysis was performed on a six-paired sample from patients with healthy sinus tissue.We found that swabs and brushes collected a higher percentage of bacterial DNA than did tissue biopsy. We also determined that as much as 50% of the bacteria collected in these samples was already dead at the time of collection. The 16S ribosomal RNA gene analysis found significant changes in the relative abundance of taxa identified in the live versus dead bacterial communities of healthy human sinuses.Our findings indicated that swabs provided the best quality microbiome samples and that a large portion of the bacteria identified in the sinus were deoxyribonuclease I sensitive. These results highlighted the need for improved techniques such as those presented here, which can differentiate between living and dead bacteria in a sample, a potentially critical distinction when examining changes in sinus innate immune function because both components play important, but distinct, functions. Further studies will determine how these living and dead bacterial populations shift in different disease states and after clinical intervention.
Chronic rhinosinusitis that is refractory to medical or surgical intervention may involve a particularly resistant form of infection known as a bacterial biofilm that is recalcitrant to antibiotics secondary to physical barrier characteristics. Recently, a novel sinus cleansing solution, citric acid/zwitterionic surfactant (CAZS) was shown to be extremely effective in disrupting biofilms in vitro. The purpose of this study was to determine the effects of CAZS on sinonasal epithelium In vivo compared with normal saline.Indwelling catheters were placed into the right maxillary sinus of New Zealand white rabbits. CAZS solution or normal saline (10 mL) was instilled at a rate of 20 mL/minute into the sinus followed by aspiration. Rabbits were killed 1, 3, and 6 days after treatment. Mucosa from both maxillary sinuses was harvested and evaluated for physiological activity (ciliary beating) as well as morphological integrity of the epithelium by scanning electron microscopy.One day after treatment, beating cilia was evident with morphological analysis shown intact epithelium with 80-85% denudation of cilia compared with saline. Three days after treatment, ciliary activity was again noted with morphological evidence of persistent denuded cilia. By day 6 after treatment, the epithelium had regenerated cilia over the apical surface. Throughout the recovery period beating cilia was evident in CAZS-treated sinuses.This study shows that although CAZS acutely denudes respiratory cilia, the remaining cilia are active. Additionally, the epithelial barrier appears intact with active ciliogenesis, and reciliation of the mucosal surface occurring 6 days after treatment.
Adequate repair of cerebrospinal fluid leak remains a significant challenge in endoscopic skull base surgery. Laser tissue welding (LTW) is a method of creating an instant watertight wound closure using a chromophore doped biological solder, which may be used for cranial base reconstruction. The objective of this study is to assess the safety and technical feasibility of endoscopic LTW in human sinonasal mucosa.A prospective, Institutional Review Board-approved study was performed of 10 patients undergoing endoscopic LTW using an albumin and hyaluronic acid-based solder for repair of mucosal injuries. Data were collected on patient demographics, total lasing time, and volume of solder used. Wounds were prospectively followed by endoscopic exam and scored on a scale of zero to two by three blinded observers (B.S.B., J.N.P., and A.G.C.) for inflammation, thermal injury, and edema. Results were compared with control wounds using the Mann-Whitney U test.Ten patients (seven men and three women; average age 50 years; range, 33-71 years) underwent endoscopic LTW. Total lasing time was 11 +/- 11 minutes requiring 0.96 +/- 0.83 mL of solder per patient. Patients were followed for an average of 72 days (range, 12-138 days) and no complications were noted. Solder persisted for up to 26 days and there was no significant difference between the lased and control wounds with regard to inflammation (0.87 +/- 0.72 versus 1.31 +/- 0.87), thermal injury (0.06 +/- 0.25 versus 0.12 +/- 0.34), or edema scores (1.13 +/- 0.81 versus 1.44 +/- 0.73).Endoscopic LTW is a technically feasible and rapid method of wound closure in sinonasal mucosa that does not result in any significant thermal or inflammatory sequelae.
Dissemination and implementation (D&I) science analyzes interventional strategies that aid in spreading scientific knowledge, adopting evidence into practice, and identifying barriers to maximize successful integration of science into practice. This study set out to critically appraise the published D&I strategies of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Clinical Practice Guidelines (CPGs) and to introduce the theories of D&I science.The 15 AAO-HNSF CPGs underwent appraisal by 2 independent reviewers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. CPGs were rated over 23 key items in 6 domains. Each item was rated on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). CPGs were rated and quality assessments were performed. Intrarater reliability was assessed.The overall mean score of the CPGs was 85.2% (95% confidence interval, 83.4%-86.9%). Individual CPG mean scores ranged from 80.4% to 90.9%. Mean interrater reliability was strong. All domains of the AGREE II instrument, except the Applicability domain, scored a mean of 90.7% or better. D&I strategies within the CPGs, as calculated by the Applicability domain score, ranged from 22.9% to 77.1%.There is a paucity of published D&I strategies within the AAO-HNSF CPGs. Nesting a D&I framework, such as the Quality Improvement Framework, within CPGs would allow for identification of barriers to CPG adoption and evaluation of CPG-directed interventions.A D&I framework within the AAO-HNSF CPGs would allow for objective measurement of the overall impact of CPGs on otolaryngology practices.
