Laryngoscope investigative otolaryngology, Nov 7, 2022
ObjectiveIt is hypothesized that patients who are actively provided with more treatment‐related e... more ObjectiveIt is hypothesized that patients who are actively provided with more treatment‐related education may report increased satisfaction and have improved overall outcomes. The aim of this study was to demonstrate the feasibility of an audiovisual education platform in patients undergoing head and neck surgery and to investigate whether patients using this module reported increased satisfaction.MethodsThis was a prospective pilot study of patients undergoing major head and neck reconstructive surgery who were randomized to either (1) control group or (2) intervention (i.e., in‐patient audiovisual educational module). Both study groups then completed a discharge survey.ResultsTotal 35 patients were recruited into the study (N = 16 Intervention; N = 19 Control). Patients in the intervention group reported an increased satisfaction with their overall outcome. Exactly 87.5% (14 of 16) found the intervention to be “Extremely useful,” “Quite useful,” or “Sometimes useful.” Exactly 68.8% (11 of 16) would recommend similar patients to receive the same educational intervention. However, there was no significant difference in patients' perceived level of involvement amongst the two groups. For future improvements to the intervention, patients requested further information such as how to look after themselves, postoperative radiation, course in hospital, and nutrition.ConclusionThis pilot study demonstrated the feasibility of an audiovisual education platform in the postoperative setting for patients undergoing major head and neck reconstructive surgery. Although most patients found the module useful, future steps will incorporate patient feedback to further improve the educational platform and confirm the current preliminary impressions in prospective studies.Level of Evidence1b
Objective To provide a comprehensive overview on the applications of artificial intelligence (AI)... more Objective To provide a comprehensive overview on the applications of artificial intelligence (AI) in rhinology, highlight its limitations, and propose strategies for its integration into surgical practice. Data Sources Medline, Embase, CENTRAL, Ei Compendex, IEEE, and Web of Science. Review Methods English studies from inception until January 2022 and those focusing on any application of AI in rhinology were included. Study selection was independently performed by 2 authors; discrepancies were resolved by the senior author. Studies were categorized by rhinology theme, and data collection comprised type of AI utilized, sample size, and outcomes, including accuracy and precision among others. Conclusions An overall 5435 articles were identified. Following abstract and title screening, 130 articles underwent full-text review, and 59 articles were selected for analysis. Eleven studies were from the gray literature. Articles were stratified into image processing, segmentation, and diagno...
Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity... more Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity. The US Food and Drug Administration defines side effects as unwanted or unexpected events or reactions. Our objective was to examine the unintended otolaryngology-related side effects associated with E-cigs. Data Sources Medline, EMBASE, CINAHL, Web of Science, and CENTRAL databases. Review Methods Study selection was independently performed by 2 authors in accordance with the PRISMA-ScR statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews); discrepancies were resolved by the senior author. English studies from database inception to May 1, 2020, with a sample size >5 were included. In vitro, animal, and lower respiratory tract studies were excluded. The main outcome was defined as otolaryngology-related side effects following E-cig use. Levels of evidence per the Oxford Centre for Evidence-Based Medicine were used to determine s...
Rhinology is a subspecialty within Otolaryngology that studies medical and surgical diseases of t... more Rhinology is a subspecialty within Otolaryngology that studies medical and surgical diseases of the nasal passages and paranasal sinuses. Rhinology conditions can be categorized into rhinosinusitis, rhinitis, inflammatory nasal masses, benign tumours, systemic diseases, nasal anatomic abnormalities, olfactory dysfunction and epistaxis [1]. Chronic rhinosinusitis alone affects 5.2% of the population in Canada and in 2007 consumed $8.6 billion healthcare resources in the United States of America [2,3]. The management of these conditions could be improved from the technological innovations that are currently being introduced into medical practice. These innovations include artificial intelligence, robotic surgery and telesurgery. Artificial intelligence systems refers to the use of computer algorithms and advanced modeling to process big data and overall automate cognitive processes [4]. Artificial intelligence is an umbrella term that includes machine learning, neural networks, comput...
International Journal of Pediatric Otorhinolaryngology, 2021
OBJECTIVES Mastoid pressure dressing (MPD) has routinely been used following major ear surgery, s... more OBJECTIVES Mastoid pressure dressing (MPD) has routinely been used following major ear surgery, such as cochlear implant (CI) surgery, to prevent postoperative wound complications. To date, controlled studies have suggested no difference in the incidence of wound complications following MPD use. However, there is a variation in the practice of MPD usage across pediatric CI surgeons. In this study, we aimed to identify the most common type of postoperative dressing management after pediatric cochlear implantation and the factors in the decision-making process for post-surgical care amongst Canadian pediatric CI surgeons. METHODS Canadian Otolaryngologists who perform pediatric CI surgery were identified (n = 18) and contacted via email to complete a short online questionnaire regarding current post-operative head dressing practice following CI surgery. Descriptive statistics were used to analyze the response data. RESULTS The participants provided an approximate number of CI's they performed in 2016. 100% of the recipients completed the survey. Approximately 376 CI's were completed in 2016 with an average of 21 CI's per surgeon. 61% of participants routinely used MPDs following surgery justified by reasons such as wound protection, institutional standard of care, and physician's original training practice. CONCLUSION There is no clear consensus on the use of MPDs amongst Canadian pediatric CI surgeons. Since the current evidence in the literature suggests no difference in wound complication incidence post-surgery with MPD use, a change in postoperative dressing management to non-use in those that employ this practice may be justified. Eliminating the usage of a MPD may also have potential economic benefits. Further prospective controlled studies may be warranted.
Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free ... more Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. This report presents a novel technique for intraoral hirudotherapy that is safe and simple for treatment of free flap venous congestion. The base of a clear cup or a plastic lid is utilized, and the leech is attached onto the inside of the lid with 2 sutures near each end. Several cups with leeches attached are made at a time to reduce delay and difficulty of application by less experienced clinical staff. The leech is then applied onto the compromised flap and then simply removed once it has unlatched from the flap. This method a...
International Forum of Allergy & Rhinology, 2021
Empty Nose Syndrome (ENS), an iatrogenic disorder, is a diagnosis of exclusion associated with pa... more Empty Nose Syndrome (ENS), an iatrogenic disorder, is a diagnosis of exclusion associated with paradoxical nasal obstruction despite patent nasal passages.1,2 Presenting signs and symptoms are typically characterized by a sensation of stuffiness, pain, dryness, and excessive crusting.1,3 The incidence of ENS is largely unknown, although some have reported an incidence of up to 20% ENS following inferior turbinate (IT) surgery.1,3 In primary care and otolaryngology clinics, patients frequently present with symptoms of nasal obstruction.4 Anatomic causes, which is the focus of this work, include deviated nasal septum (DNS) and inferior turbinate hypertrophy (ITH). We grouped these patients as primary nasal obstruction (PNO). Overall, nasal obstruction is a rather nonspecific symptom for which both ENS and PNO patients may present with as their subjective complaint.1,4 However, it is felt that certain subjective symptoms are more representative of ENS. The Empty Nose Syndrome 6item Questionnaire (ENS6Q) was developed and validated as a quantifiable disease-specific quality of life questionnaire, serving as an adjunct to the 22-item Sino-Nasal Out-
This case series assesses the incidence of human papillomavirus (HPV)-associated sinonasal squamo... more This case series assesses the incidence of human papillomavirus (HPV)-associated sinonasal squamous cell carcinoma (SNSCC) and the prevalence of HPV-positive SNSCC among US adults.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 15, 2018
Synechiae formation in the middle meatus is the most common complication of functional endoscopic... more Synechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively. A retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables. Two hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6-24.4%) patients developed synechiae. Individuals receiving primary FESS and nasa...
International forum of allergy & rhinology, May 2, 2017
Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe ... more Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. Treatment adherence was subjectively assessed using a medication adherence scale (MMAS-8) to evaluate the validity of s...
International forum of allergy & rhinology, May 2, 2017
Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe ... more Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. Treatment adherence was subjectively assessed using a medication adherence scale (MMAS-8) to evaluate the validity of s...
Background: Although short-term use (2 months) of at-omized topical nasal steroids has been shown... more Background: Although short-term use (2 months) of at-omized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).
The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes ... more The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes even a small amount of bleeding a potentially significant hindrance. It is thought that irrigation with hot saline during surgery may improve surgical field of view by producing a hemostatic effect. Our objective was to assess the effectiveness of hot saline irrigation (HSI) compared to room temperature saline irrigation (RTSI) in the control of intraoperative bleeding during FESS. Sixty-two chronic rhinosinusitis (CRS) patients undergoing FESS were randomized to 2 treatment arms in an equal ratio. Subjects received either HSI (49°C) or RTSI (18°C), 20 mL every 10 minutes, for the duration of FESS. The Boezaart endoscopic field of view grading system was the primary outcome measure. Boezaart score, heart rate, and mean arterial blood pressure (MABP) were recorded at 10-minute intervals between irrigations. Mean endoscopic surgical field of view (Boezaart score) did not significantly differ between the HSI and RTSI groups (1.5 ± 0.6 vs 1.3 ± 0.5; p = 0.23). However, when FESS was longer than 2 hours in duration, the Boezaart scores were significantly better in the HSI group (1.6 ± 0.6 vs 1.2 ± 0.4; p = 0.04). We found that blood loss per minute was significantly reduced (p = 0.02) in all cases in which HSI was used (2.3 ± 1.0) compared to RTSI (1.7 ± 1.1). Despite this, heart rate (p = 0.32) and MABP (p = 0.14) did not significantly differ between treatment groups. HSI may be beneficial in improving surgical field of view in FESS after 2 hours of operating time. A significant reduction in rate of blood loss may be attained with HSI.
Laryngoscope investigative otolaryngology, Nov 7, 2022
ObjectiveIt is hypothesized that patients who are actively provided with more treatment‐related e... more ObjectiveIt is hypothesized that patients who are actively provided with more treatment‐related education may report increased satisfaction and have improved overall outcomes. The aim of this study was to demonstrate the feasibility of an audiovisual education platform in patients undergoing head and neck surgery and to investigate whether patients using this module reported increased satisfaction.MethodsThis was a prospective pilot study of patients undergoing major head and neck reconstructive surgery who were randomized to either (1) control group or (2) intervention (i.e., in‐patient audiovisual educational module). Both study groups then completed a discharge survey.ResultsTotal 35 patients were recruited into the study (N = 16 Intervention; N = 19 Control). Patients in the intervention group reported an increased satisfaction with their overall outcome. Exactly 87.5% (14 of 16) found the intervention to be “Extremely useful,” “Quite useful,” or “Sometimes useful.” Exactly 68.8% (11 of 16) would recommend similar patients to receive the same educational intervention. However, there was no significant difference in patients' perceived level of involvement amongst the two groups. For future improvements to the intervention, patients requested further information such as how to look after themselves, postoperative radiation, course in hospital, and nutrition.ConclusionThis pilot study demonstrated the feasibility of an audiovisual education platform in the postoperative setting for patients undergoing major head and neck reconstructive surgery. Although most patients found the module useful, future steps will incorporate patient feedback to further improve the educational platform and confirm the current preliminary impressions in prospective studies.Level of Evidence1b
Objective To provide a comprehensive overview on the applications of artificial intelligence (AI)... more Objective To provide a comprehensive overview on the applications of artificial intelligence (AI) in rhinology, highlight its limitations, and propose strategies for its integration into surgical practice. Data Sources Medline, Embase, CENTRAL, Ei Compendex, IEEE, and Web of Science. Review Methods English studies from inception until January 2022 and those focusing on any application of AI in rhinology were included. Study selection was independently performed by 2 authors; discrepancies were resolved by the senior author. Studies were categorized by rhinology theme, and data collection comprised type of AI utilized, sample size, and outcomes, including accuracy and precision among others. Conclusions An overall 5435 articles were identified. Following abstract and title screening, 130 articles underwent full-text review, and 59 articles were selected for analysis. Eleven studies were from the gray literature. Articles were stratified into image processing, segmentation, and diagno...
Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity... more Objective Electronic cigarettes (E-cigs) are nicotine delivery systems with increasing popularity. The US Food and Drug Administration defines side effects as unwanted or unexpected events or reactions. Our objective was to examine the unintended otolaryngology-related side effects associated with E-cigs. Data Sources Medline, EMBASE, CINAHL, Web of Science, and CENTRAL databases. Review Methods Study selection was independently performed by 2 authors in accordance with the PRISMA-ScR statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews); discrepancies were resolved by the senior author. English studies from database inception to May 1, 2020, with a sample size >5 were included. In vitro, animal, and lower respiratory tract studies were excluded. The main outcome was defined as otolaryngology-related side effects following E-cig use. Levels of evidence per the Oxford Centre for Evidence-Based Medicine were used to determine s...
Rhinology is a subspecialty within Otolaryngology that studies medical and surgical diseases of t... more Rhinology is a subspecialty within Otolaryngology that studies medical and surgical diseases of the nasal passages and paranasal sinuses. Rhinology conditions can be categorized into rhinosinusitis, rhinitis, inflammatory nasal masses, benign tumours, systemic diseases, nasal anatomic abnormalities, olfactory dysfunction and epistaxis [1]. Chronic rhinosinusitis alone affects 5.2% of the population in Canada and in 2007 consumed $8.6 billion healthcare resources in the United States of America [2,3]. The management of these conditions could be improved from the technological innovations that are currently being introduced into medical practice. These innovations include artificial intelligence, robotic surgery and telesurgery. Artificial intelligence systems refers to the use of computer algorithms and advanced modeling to process big data and overall automate cognitive processes [4]. Artificial intelligence is an umbrella term that includes machine learning, neural networks, comput...
International Journal of Pediatric Otorhinolaryngology, 2021
OBJECTIVES Mastoid pressure dressing (MPD) has routinely been used following major ear surgery, s... more OBJECTIVES Mastoid pressure dressing (MPD) has routinely been used following major ear surgery, such as cochlear implant (CI) surgery, to prevent postoperative wound complications. To date, controlled studies have suggested no difference in the incidence of wound complications following MPD use. However, there is a variation in the practice of MPD usage across pediatric CI surgeons. In this study, we aimed to identify the most common type of postoperative dressing management after pediatric cochlear implantation and the factors in the decision-making process for post-surgical care amongst Canadian pediatric CI surgeons. METHODS Canadian Otolaryngologists who perform pediatric CI surgery were identified (n = 18) and contacted via email to complete a short online questionnaire regarding current post-operative head dressing practice following CI surgery. Descriptive statistics were used to analyze the response data. RESULTS The participants provided an approximate number of CI's they performed in 2016. 100% of the recipients completed the survey. Approximately 376 CI's were completed in 2016 with an average of 21 CI's per surgeon. 61% of participants routinely used MPDs following surgery justified by reasons such as wound protection, institutional standard of care, and physician's original training practice. CONCLUSION There is no clear consensus on the use of MPDs amongst Canadian pediatric CI surgeons. Since the current evidence in the literature suggests no difference in wound complication incidence post-surgery with MPD use, a change in postoperative dressing management to non-use in those that employ this practice may be justified. Eliminating the usage of a MPD may also have potential economic benefits. Further prospective controlled studies may be warranted.
Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free ... more Intraoral hirudotherapy is traditionally used for venous congestion following head and neck free flap reconstruction. Many institutions and healthcare teams have been reluctant to use intraoral leech therapy due to risks such as migration into the airway, increased infection from intraoral manipulation, and patient discomfort. Several protocols recommend blocking the path to the oropharynx via gauze or leaving a tracheotomy in place to protect the airway. This report presents a novel technique for intraoral hirudotherapy that is safe and simple for treatment of free flap venous congestion. The base of a clear cup or a plastic lid is utilized, and the leech is attached onto the inside of the lid with 2 sutures near each end. Several cups with leeches attached are made at a time to reduce delay and difficulty of application by less experienced clinical staff. The leech is then applied onto the compromised flap and then simply removed once it has unlatched from the flap. This method a...
International Forum of Allergy & Rhinology, 2021
Empty Nose Syndrome (ENS), an iatrogenic disorder, is a diagnosis of exclusion associated with pa... more Empty Nose Syndrome (ENS), an iatrogenic disorder, is a diagnosis of exclusion associated with paradoxical nasal obstruction despite patent nasal passages.1,2 Presenting signs and symptoms are typically characterized by a sensation of stuffiness, pain, dryness, and excessive crusting.1,3 The incidence of ENS is largely unknown, although some have reported an incidence of up to 20% ENS following inferior turbinate (IT) surgery.1,3 In primary care and otolaryngology clinics, patients frequently present with symptoms of nasal obstruction.4 Anatomic causes, which is the focus of this work, include deviated nasal septum (DNS) and inferior turbinate hypertrophy (ITH). We grouped these patients as primary nasal obstruction (PNO). Overall, nasal obstruction is a rather nonspecific symptom for which both ENS and PNO patients may present with as their subjective complaint.1,4 However, it is felt that certain subjective symptoms are more representative of ENS. The Empty Nose Syndrome 6item Questionnaire (ENS6Q) was developed and validated as a quantifiable disease-specific quality of life questionnaire, serving as an adjunct to the 22-item Sino-Nasal Out-
This case series assesses the incidence of human papillomavirus (HPV)-associated sinonasal squamo... more This case series assesses the incidence of human papillomavirus (HPV)-associated sinonasal squamous cell carcinoma (SNSCC) and the prevalence of HPV-positive SNSCC among US adults.
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, Jan 15, 2018
Synechiae formation in the middle meatus is the most common complication of functional endoscopic... more Synechiae formation in the middle meatus is the most common complication of functional endoscopic sinus surgery (FESS). Our objectives were to determine the incidence of synechiae occurring in a cohort of patients that have undergone FESS and identify characteristics associated with the development of synechiae postoperatively. A retrospective chart review was conducted of CRS patients, with or without nasal polyposis, that had undergone bilateral FESS in the past. All patients had received non-absorbable spacers intraoperatively that were left in situ for 6 days. Demographic and preoperative variables were analyzed to identify synechiae risk factors. A multivariable logistic regression model was constructed to estimate the probability of developing synechiae, given demographic and preoperative variables. Two hundred cases of bilateral FESS were retrospectively reviewed. Thirty-eight (19.0%, 95% CI 13.6-24.4%) patients developed synechiae. Individuals receiving primary FESS and nasa...
International forum of allergy & rhinology, May 2, 2017
Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe ... more Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. Treatment adherence was subjectively assessed using a medication adherence scale (MMAS-8) to evaluate the validity of s...
International forum of allergy & rhinology, May 2, 2017
Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe ... more Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. Treatment adherence was subjectively assessed using a medication adherence scale (MMAS-8) to evaluate the validity of s...
Background: Although short-term use (2 months) of at-omized topical nasal steroids has been shown... more Background: Although short-term use (2 months) of at-omized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).
The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes ... more The endoscopically magnified operative field in functional endoscopic sinus surgery (FESS) makes even a small amount of bleeding a potentially significant hindrance. It is thought that irrigation with hot saline during surgery may improve surgical field of view by producing a hemostatic effect. Our objective was to assess the effectiveness of hot saline irrigation (HSI) compared to room temperature saline irrigation (RTSI) in the control of intraoperative bleeding during FESS. Sixty-two chronic rhinosinusitis (CRS) patients undergoing FESS were randomized to 2 treatment arms in an equal ratio. Subjects received either HSI (49°C) or RTSI (18°C), 20 mL every 10 minutes, for the duration of FESS. The Boezaart endoscopic field of view grading system was the primary outcome measure. Boezaart score, heart rate, and mean arterial blood pressure (MABP) were recorded at 10-minute intervals between irrigations. Mean endoscopic surgical field of view (Boezaart score) did not significantly differ between the HSI and RTSI groups (1.5 ± 0.6 vs 1.3 ± 0.5; p = 0.23). However, when FESS was longer than 2 hours in duration, the Boezaart scores were significantly better in the HSI group (1.6 ± 0.6 vs 1.2 ± 0.4; p = 0.04). We found that blood loss per minute was significantly reduced (p = 0.02) in all cases in which HSI was used (2.3 ± 1.0) compared to RTSI (1.7 ± 1.1). Despite this, heart rate (p = 0.32) and MABP (p = 0.14) did not significantly differ between treatment groups. HSI may be beneficial in improving surgical field of view in FESS after 2 hours of operating time. A significant reduction in rate of blood loss may be attained with HSI.
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