Abstract Background Hypoxia due to closure at the ostiomeatal complex is widely considered one of the major pathogenic mechanisms leading to chronic inflammation in chronic rhinosinusitis (CRS). The objective of this study was to develop and characterize an oxygen‐generating biomaterial (OGB) as an innovative treatment strategy for CRS. Methods An OGB was fabricated by coating hydrophobic beeswax (BW, 15mg or 30mg) on the surface of calcium peroxide ‐ catalase complex (CPO‐CA, 30mg) and characterized using scanning electron microscopy (SEM). In vitro releases of both oxygen and hydrogen peroxide (H 2 O 2 ) were spectrophotometrically quantified, and cytotoxicity in human sinonasal epithelial cells (HSNECs) was evaluated. The influence of OGB on transepithelial Cl – secretion was also determined by pharmacologically manipulating HSNECs, cultured under hypoxic conditions, in Ussing chambers. Results Three groups of OGBs: (1) CPO only; (2) CPO coated with CA and BW (1:1 ratio, CPO‐CA(1)‐BW(1)); and (3) CPO coated with CA and BW (1:0.5 ratio, CPO‐CA(1)‐BW(0.5) were analyzed for accumulated oxygen release over 7 days: highest release (mmol/mg) was observed in CPO‐CA(1)‐BW(1) = 0.11 ± 0.003, followed by CPO‐CA(1)‐BW(0.5) = 0.08 ± 0.010, and CPO = 0.05 ± 0.004 ( p < 0.0001). H 2 O 2 production (mM) was significantly higher in CPO (1.87 ± 0.50) compared to CPO‐CA (1)‐BW(1) (0.00 ± 0.00) ( p < 0.001) after 24 h. CPO‐CA(1)‐BW(1) showed significantly reduced cytotoxicity and increased Cl – transport compared to the CPO group. Conclusion A novel OGB (CPO‐CA‐BW complex) exhibited sustained oxygen release over 7 days without significant cytotoxicity after 24 h in vitro. Preclinical studies evaluating the efficacy of OGB in CRS are warranted, especially for potential therapy in an obstruction‐based CRS model.
The severe acute respiratory syndrome (SARS)-CoV-2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS-CoV-2 outbreaks, aerosol-generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS-CoV-2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS-CoV-2 pandemic and the SARS epidemic of 2002/2003.
Abstract Objectives Chronic rhinosinusitis (CRS) is a multifactorial disease affecting up to 16% of the United States population and disproportionately affecting the cystic fibrosis (CF) patient population. Despite treating the underlying infection, the use of systemic antibiotics has shown little efficacy in alleviation of symptom burden. This review seeks to discuss recent research on novel antibiotic eluting stent therapy in vitro and within animal models as well as the factors that contribute to its efficacy. Data Sources PubMed literature review. Review Methods A review of all published literature related to antibiotic eluting sinus stents was conducted to integrate and summarize this innovative approach to chronic sinus infections. Results Placement of the ciprofloxacin sinus stent (CSS) and ciprofloxacin‐ivacaftor sinus stent (CISS) exhibited improvement in endoscopic and radiographic findings in rabbit CRS models. While the CSS showed an overall trend toward improvement in microscopic findings and a reduction in biofilm mass, there remained a significant quantity of planktonic bacteria due to antibiotic depletion from an initial burst release in the first 48 hours of stent placement. The CISS and ciprofloxacin‐azithromycin sinus stents (CASSs) exhibited controlled antibiotic release over the study period leading to greatly reduced planktonic bacterial load and biofilm mass. In vitro studies indicate that CASS may be just as efficacious at reducing biofilm mass. Conclusion Antibiotic eluting sinus stents show significant promise as a novel therapeutic strategy for CRS. The CISS may have particular promise for the CF patient population by addressing both the infectious and genetic components of disease. Animal studies demonstrate significant promise for translation into human studies. Human clinical trials are warranted to determine the efficacy of antibiotic sinus stents in human patients. Level of Evidence NA
Background Surgical approaches to the pituitary have undergone significant changes from transcranial, sublabial, direct transnasal microscopic, and now endoscopic. This study compares sinonasal outcomes from patients from these techniques. Methods A cross-sectional study of patients who underwent pituitary surgery in a tertiary setting was conducted. Patients were recruited via phone, mail, e-mail, and in person. Surveys with questions on nasal function, subsequent nasal treatment, the Nasal Symptom Score (NSS), Sinonasal Outcome Test-22 (SNOT-22), Chronic Sinusitis Survey (CSS), and Short Form 36 version 2 (SF-36v2) were obtained. Results A total of 252 surveys were sent, of which 165 were returned (65.48% response rate) and 16 were excluded (3 records destroyed, 13 transcranial approach). A total of 149 patients (age 60.10 ± 13.99 years, 47.83% female) were assessed with the following breakdown: sublabial (n = 69), transnasal microscopic (n = 28), and endoscopic (n = 52) approaches. Sublabial and transnasal microscopic, compared to endoscopic, had more sinus treatment (30.43%, 39.29%, and 15.38%; P = .05), medication use (28.99%, 32.14%, and 11.54%; P = .04), and new allergy symptoms (21.74%, 7.14%, and 1.92%; P < .01). Compared to sublabial and transnasal microscopic, endoscopic patients had superior NSSs (0.40 [1.00], 0.60 [1.75], and 0.20 [0.60]; P = .05), SNOT-22 total scores (1.02 ± 0.58, 1.40 ± 0.78, and 1.00 ± 0.59; P < .01), and CSS medication subscores (100.00 [8.33], 100.00 [8.33], and 100.00 [0.00]; P = .03). Endoscopic patients also reported superior SF-36v2 physical subscores (44.02 ± 11.14, 41.13 ± 9.86, and 47.60 ± 10.12; P = .03). Conclusion Nasal function was superior, and further sinus therapy and medication use was lower in patients with endoscopic approaches. Disease-specific quality of life was superior and the endoscopic approach resulted in reduced long-term sinonasal morbidity.
Objectives In February 2020, the National Board of Medical Examiners (NBME) announced that the United States Medical Licensing Examination (USMLE) Step 1 licensing examination would change from a numerical score to Pass/Fail (P/F). After implementation, many believe that USMLE-Step 2-Clinical Knowledge (CK) will become an important metric for students applying to otolaryngology (ENT). The purpose of this study is to determine factors important to resident selection after these changes. Methods A survey containing 15 questions related to resident selection practices and how changing USMLE Step 1 to P/F would impact future resident selection was designed. It was distributed to all ENT residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Results Forty percent of programs responded; 66% (95% confidence interval (CI): 51.1%-78.4%) felt that changing Step 1 scoring would not lead to students being more prepared for clinical rotations; 55% believe class rank will increase in significance (95% CI: 35.7%-64.3%). There was also an increase in the importance of Step 2 CK, which had a mean ranking of 10.67 prior to changes in Step 1 scoring and increased to 7.80 after P/F. Conclusions The changes in Step 1 scoring will likely lead to increasing importance of other objective measures like class rank or Step 2 CK. This may defeat the intended purpose put forth by the NBME. Therefore, further guidance on measures correlated with student performance as a resident will be integral to the selection process.
Abstract Objective Cystic fibrosis (CF) is a clinical entity defined by aberrant chloride (Cl − ) ion transport causing downstream effects on mucociliary clearance (MCC) in sinonasal epithelia. Inducible deficiencies in transepithelial Cl − transport via CF transmembrane conductance regulator (CFTR) has been theorized to be a driving process in recalcitrant chronic rhinosinusitis (CRS) in patients without CF. We have previously identified that brief exposures to bacterial lipopolysaccharide (LPS) in mammalian cells induces an acquired dysfunction of CFTR in vitro and in vivo. The objective of the current study is to evaluate whether LPS generates a model of acquired CFTR dysfunction murine nasal airways. Study Design Basic science. Setting Laboratory. Methods CFTR +/+ murine nasal airways were irrigated with 2 µg/mL LPS or control vehicle twice daily for 1 week and transepithelial Cl − transport assessed with the nasal potential difference (NPD) assay. Histopathologic evaluation included the number of lymphoid aggregates, as well as the epithelial and subepithelial heights. Results Transepithelial Cl − secretion by NPD was markedly reduced in mice exposed to LPS (in mV, −0.14 ± 7.7 vs control, −6.98 ± 7.15, P < .05), while amiloride‐sensitive voltage was preserved (6.38 ± 5.09 vs control, 7.36 ± 2.87, P = .99). Histopathology demonstrated significantly higher lymphoid aggregates per high‐power field (2.3 ± 0.9 vs 1.1 ± 0.7, control, P < .01) and increased epithelial height (in µm, 40.88 ± 13.9 vs control, 25.32 ± 6.26, P < .05). Conclusion Twice daily irrigation with LPS in murine nasal airways over 1 week led to acquired defects in transepithelial Cl − transport. This animal model provides an excellent means to test the contributions of acquired CFTR dysfunction to CRS and test CFTR correctors and potentiators that might improve MCC.
To determine which otolaryngology residency programs have social media platforms and to review which programs are utilizing platforms to advertise virtual open houses and virtual subinternships for residency applicants.Cross-sectional study.The study was conducted online by reviewing all accredited otolaryngology residency programs in the United States participating in the Electronic Residency Application Service.Otolaryngology residency programs were reviewed for social media presence on Instagram, Twitter, and Facebook. Social media posts were evaluated for virtual open houses and virtual subinternships. Residency websites and the Visiting Student Application Service were evaluated for the presence of virtual subinternships. All data were collected between September 5, 2020, and September 9, 2020. This study did not require approval from the University of Alabama at Birmingham Institutional Review Board for Human Use.Among 118 otolaryngology residency programs, 74 (62.7%) participate on Instagram, 52 (44.1%) participate on Twitter, and 44 (37.3%) participate on Facebook. Fifty-one Instagram accounts, 20 Twitter accounts, and 4 Facebook accounts have been created during 2020. Forty-two (36%), 30 (25.4%), and 15 (13%) programs are promoting virtual open houses on Instagram, Twitter, and Facebook, respectively. Two programs on the Visiting Student Application Service offered virtual subinternships. Seven residency program websites offered virtual subinternships. Nine, 6, and 1 program offered virtual subinternships on Instagram, Twitter, and Facebook, respectively.This study demonstrates that social media presence on Instagram and Twitter among otolaryngology residency programs has substantially grown in 2020 at a higher rate compared to previous years. These data suggest that otolaryngology residency programs are finding new ways to reach out to applicants amid an unprecedented type of application cycle due to the challenges presented by COVID-19. Many programs are advertising virtual open houses via social media platforms to connect with applicants, and a few programs are offering virtual subinternships to replace traditional subinternships.
