BackgroundA comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon‐performed US (SUS) can be more accurate than radiology‐performed US for the... more
BackgroundA comprehensive neck ultrasound (US) is essential in the operative planning of patients with thyroid disease. Recent literature has shown surgeon‐performed US (SUS) can be more accurate than radiology‐performed US for the purpose of surgical planning. Missed findings on radiology‐performed ultrasound may lead to inadequate surgical management.MethodsA retrospective cohort study of patients undergoing total thyroidectomy with lateral neck dissection for thyroid cancer, with both radiology‐performed US and SUS performed by a Head and Neck surgeon. Ultrasound findings and adherence to American Thyroid Association (ATA) guidelines were compared, and changes in management based on SUS findings were identified.ResultsA total of 26 patients who underwent total thyroidectomy with lateral neck dissection met the inclusion criteria. Preconsultation US investigations fulfilled criteria as recommended by the American Thyroid Association (ATA) guidelines in 57.7%% of cases. The central and lateral neck compartments were assessed in 57.7% and 84.6% of preconsultation US investigations respectively. Central and lateral metastatic neck metastases were incorrectly reported or not reported in 78.6% and 42.3% of cases. The SUS findings prompted a change in surgical management in 65.4% of cases.ConclusionSUS changed surgical management in two thirds (65.4%) of patients. Reliance on radiology‐performed ultrasound alone may result in incorrect staging. Awareness of the additional benefits of SUS is important for surgeons treating patients with thyroid disease to prevent inadequate surgery being performed.
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The one-bone forearm (OBF) is a salvage technique that may be used to correct global forearm instability secondary to osseous defects. This study aims to provide an overview of the contemporary literature regarding the OBF. A literature... more
The one-bone forearm (OBF) is a salvage technique that may be used to correct global forearm instability secondary to osseous defects. This study aims to provide an overview of the contemporary literature regarding the OBF. A literature review was conducted electronically across MEDLINE, Embase, and PubMed databases in May 2020. Studies were eligible for inclusion if published in the English language; detailed the use of the OBF procedure to correct forearm instability; and were original data studies reporting qualitative or quantitative outcomes. Thirty-four studies, describing a cohort of 210 patients undergoing 211 OBFs, were documented in the literature. The primary etiology necessitating the OBF was trauma, followed by genetic/congenital disorders and infections. Technically, the OBF was most frequently achieved via an end-to-end osteosynthesis with plate fixation. In total, 85.0% (154/182) of OBF were fused in neutral rotation or varying degrees of pronation. Union was achieved in more than 80.0% (174/211) of OBFs. The OBF is a feasible salvage technique that has been used for a wide spectrum of pathology, providing satisfactory outcomes in most cases.
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Objective: The development of evidence-based medicine has contributed to improved patient outcomes. This study aims to identify the trends in levels of evidence in otolaryngology journals over time, as represented by the 4 most widely... more
Objective: The development of evidence-based medicine has contributed to improved patient outcomes. This study aims to identify the trends in levels of evidence in otolaryngology journals over time, as represented by the 4 most widely circulated peer-reviewed otolaryngology journals. Methods: A review of all articles from 2007, 2010, 2013, 2016, and 2019, in 4 major otolaryngology journals. Data points included journal source, year of publication, country of origin, first author sex, and subspecialty category within otolaryngology. Level of evidence was determined based on the study’s primary research question and was graded on a scale of 1 (strongest) to 4 (weakest) based on the Oxford Centre of Evidence-based Medicine - Levels of Evidence guideline. Comparison of levels of evidence was performed using Kruskal-Wallis analysis of variance for ordinal data. Results: About 4297 articles were identified over 12 years. The number of research articles remained consistent over the 12 years of this study. Clinical research increased from 78.6% to 85.1%. Female first authorship increased from 20.3% in 2007 to 31.0% in 2019. Of 3558 articles that constituted clinical research from 2007 to 2019, level 1 studies increased from 0.9% to 3.6%, with level 4 studies remaining stable at an overall rate of 60.3%. Randomized controlled trials remained stable at 4.6% of all studies. Systematic reviews increased from 3.2% to 8.4%. Conclusion: This article provides an update on the levels of evidence to allow for an honest self-assessment of otolaryngology as a scientific field.
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Objective: The development of evidence-based medicine has contributed to improved patient outcomes. This study aims to identify the trends in levels of evidence in otolaryngology journals over time, as represented by the 4 most widely... more
Objective: The development of evidence-based medicine has contributed to improved patient outcomes. This study aims to identify the trends in levels of evidence in otolaryngology journals over time, as represented by the 4 most widely circulated peer-reviewed otolaryngology journals. Methods: A review of all articles from 2007, 2010, 2013, 2016, and 2019, in 4 major otolaryngology journals. Data points included journal source, year of publication, country of origin, first author sex, and subspecialty category within otolaryngology. Level of evidence was determined based on the study’s primary research question and was graded on a scale of 1 (strongest) to 4 (weakest) based on the Oxford Centre of Evidence-based Medicine - Levels of Evidence guideline. Comparison of levels of evidence was performed using Kruskal-Wallis analysis of variance for ordinal data. Results: About 4297 articles were identified over 12 years. The number of research articles remained consistent over the 12 year...
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The one-bone forearm (OBF) is a salvage technique that may be used to correct global forearm instability secondary to osseous defects. This study aims to provide an overview of the contemporary literature regarding the OBF. A literature... more
The one-bone forearm (OBF) is a salvage technique that may be used to correct global forearm instability secondary to osseous defects. This study aims to provide an overview of the contemporary literature regarding the OBF. A literature review was conducted electronically across MEDLINE, Embase, and PubMed databases in May 2020. Studies were eligible for inclusion if published in the English language; detailed the use of the OBF procedure to correct forearm instability; and were original data studies reporting qualitative or quantitative outcomes. Thirty-four studies, describing a cohort of 210 patients undergoing 211 OBFs, were documented in the literature. The primary etiology necessitating the OBF was trauma, followed by genetic/congenital disorders and infections. Technically, the OBF was most frequently achieved via an end-to-end osteosynthesis with plate fixation. In total, 85.0% (154/182) of OBF were fused in neutral rotation or varying degrees of pronation. Union was achieve...
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ObjectiveTo identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice‐daily for twelve weeks following sinus... more
ObjectiveTo identify the differences in cytokine expression between sinonasal tissue from patients treated with Leptospermum (Manuka) honey (LH) irrigation versus normal saline irrigation twice‐daily for twelve weeks following sinus surgery (FESS).MethodsForty‐six CRS patients were recruited. Sinus tissue biopsies were collected during FESS and then at 5 and 12 weeks postoperatively during the course of treatment. A multi‐plex cytokine assay quantified the abundance of 17 cytokines in biopsied tissue. Cytokine expression fold‐change was analyzed between each time point using a robust linear regression model and compared between the two treatment groups.ResultsCompared to the saline irrigation group, five cytokines were differently expressed (CI = 95%) in sinonasal tissue obtained from subjects in the LH irrigation group during the 12‐week treatment period. Cytokines IL‐6 (P = 0.0400), IL‐8 (P = 0.0398), MCP‐1 (P = 0.0284), and MIP‐1β (P = 0.016) were significantly increased in the L...
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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... 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...
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Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of... more
Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved-Merocel (GM) spacers following FESS. A double-blind, randomized controlled trial (RCT) was conducted in adults requiring bilateral FESS for chronic rhinosinusitis (CRS) ± nasal polyposis. Participants served as their own controls, with each subject receiving both a Silastic and GM spacer. Spacers were inserted into the MMS during FESS and left in situ for 6 days. Participants were reviewed at 6 days, 5 weeks, and 12 weeks postoperatively. The presence of synechiae and scarring were evaluated endoscopically. Inflammation, discharge, and pain during spacer removal were assessed using a visual a...
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Patients undergoing revision functional endoscopic sinus surgery (rFESS) for refractory chronic rhinosinusitis (CRS) are more likely to be older, have worse pre-operative Lund-Mackay CT scores, and poorer quality-of-life scores than... more
Patients undergoing revision functional endoscopic sinus surgery (rFESS) for refractory chronic rhinosinusitis (CRS) are more likely to be older, have worse pre-operative Lund-Mackay CT scores, and poorer quality-of-life scores than primary FESS patients. Patients with more aggressive forms of CRS such as CRS with nasal polyposis (CRSwNP) or allergic fungal rhinosinusitis (AFRS) may fare worse in the long term with residual disease and be more likely to seek out tertiary institutions for treatment including rFESS. Computed tomography (CT) findings most frequently associated with failure of primary FESS were frontal sinus/recess residual bony partitions (91.8%), remnant ethmoid sinus shelves (88.2%) and unopened pneumatized ethmoid cells (77.7%). Patients with a diagnosis of allergic fungal rhinosinusitis (AFRS) who required rFESS presented with significantly fewer frontal sinus residual bony partitions, residual uncinate process, and ethmoid sinus residual unopened pneumatized cells...
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Research Interests: Chemistry, Analytical Chemistry, Chromatography, Mass Spectrometry, Medicine, and 12 moreHumans, Tandem Mass Spectrometry, High Performance Liquid Chromatography, High Pressure Liquid Chromatography, Liquid Chromatography / Electrospray Ionization Mass Spectrometry, Reproducibility of Results, Budesonide, Glucocorticoids, SELECTED REACTION MONITORING, hydrocortisone, Pharmacology and pharmaceutical sciences, and limit of detection
Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which... more
Liposarcoma is a common soft tissue malignancy that occurs infrequently in the head and neck. Liposarcoma of the retropharynx is exceptionally rare, only four cases being described in the literature. We present a case in which retropharyngeal liposarcoma occurred in a patient who had had multiple previous subcutaneous lipomas excised. This paper explores this very unusual presentation and discusses the difficulties in the diagnosis and management of this rare tumour.
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Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is... more
Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS.
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Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this... more
Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this burden has not been quantified. We sought to determine the association of ENS with mental health and functional impairments. A cross-sectional study was performed of individuals with ENS recruited from online ENS forums. ENS status was validated based on a positive 6-item Empty Nose Syndrome Questionnaire (ENS6Q) score and sinus computed tomography imaging or supporting medical documentation. Subjects completed the ENS6Q, the 9-item Patient Health Questionnaire (PHQ-9) for depression, the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), the Epworth Sleepiness Scale for daytime somnolence (ESS), the Work Productivity and Impairment questionnaire (WPAI), and the 5-dimension EuroQol General Health State Survey (EQ-5D-5L). Pearson correlation analy...
Objectives: Despite many publications describing sheep models for functional endoscopic sinus surgery (FESS) procedures, accurate endoscopic anatomical studies are lacking. There are no publications correlating computed tomography (CT)... more
Objectives: Despite many publications describing sheep models for functional endoscopic sinus surgery (FESS) procedures, accurate endoscopic anatomical studies are lacking. There are no publications correlating computed tomography (CT) and 3D models with endoscopic anatomical descriptions. This study evaluates and describes the endoscopic anatomy of a sheep model. Methods: Ten live sheep (20-sides) were included. Two cadaveric specimens, imaged using thin slice CT for 3D reconstruction correlation were also included. Using endoscopy, anatomical structures were measured and described. Measurement of the same structures was carried out using the 3D imaging model. Results: Three sets of turbinates were identified at 2.3, 5.1 and 8.5 cm from the anterior nasal sill. Frontal recess and uncinate process were identified at 12.7 cm. The septum has a bony and cartilaginous component and measures 10.5 cm. The sphenopalatine foramen was measured at 12.1 cm. All anatomical measurements were correlated with the measurements on the CT scan 3D volume-rendering model, thereby allowing for an accurate description of the sheep sinona-sal anatomy. Conclusion: This study describes the endoscopic sinonasal anatomical measurements of the adult sheep. It is the first study to evaluate the sheep CT and endoscopic anatomy in order to determine its feasibility as an animal model for research in FESS.
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Background: Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the... more
Background: Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved-Merocel (GM) spacers following FESS.
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Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinus mucosa.1 Failing medical management, CRS patients may need to undergo functional endoscopic sinus surgery (FESS) with the goal of clearing... more
Chronic rhinosinusitis (CRS) is an inflammatory disease of the nose and paranasal sinus mucosa.1 Failing medical management, CRS patients may need to undergo functional endoscopic sinus surgery (FESS) with the goal of clearing obstructions, facilitating natural mucociliary clearance mechanisms and improving sinonasal airway
ventilation.1 The success rate of FESS has been found to be
between 76%-97.5%.2,3 Failure of FESS has been associated with the presence of residual air cells, abnormally constricted maxillary or frontal sinus ostia, a displaced uncinate process and underlying recalcitrant biological characteristics.
ventilation.1 The success rate of FESS has been found to be
between 76%-97.5%.2,3 Failure of FESS has been associated with the presence of residual air cells, abnormally constricted maxillary or frontal sinus ostia, a displaced uncinate process and underlying recalcitrant biological characteristics.
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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... 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).
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Chronic rhinosinusitis (CRS) is becoming increasingly prevalent in adults with cystic fibrosis (CF), as the median age of survival rises for these individuals. Delayed identification of CRS may contribute to worsening health-related... more
Chronic rhinosinusitis (CRS) is becoming increasingly prevalent in adults with cystic fibrosis (CF), as the median age of survival rises for these individuals. Delayed identification of CRS may contribute to worsening health-related quality of life and increased treatment burden. Our objective was to investigate the utility of the 22-item Sino-Nasal Outcome Test (SNOT-22) as a tool to identify CRS in adults with CF. In this cross-sectional study, participants were sampled from an adult-specific CF clinic in Vancouver, Canada, between September 2013 and April 2014. CRS was determined by use of standardized diagnostic guidelines. Participants completed the SNOT-22 and medical charts were reviewed for additional predictor variables. Logistic regression was used to compare the SNOT-22 as a univariable predictor variable to a multivariable prediction model, in order to best differentiate CRS and non-CRS participants. Ninety-three of 101 adults provided written informed consent. The prevalence of CRS was 56.3% (95% confidence interval [CI], 45.9% to 66.3%). Individuals with CRS reported significantly higher SNOT-22 scores than non-CRS participants (mean difference: 13.9; 95% CI, 6.1 to 21.7). The optimal SNOT-22 score to differentiate CRS was 21 out of 110 (sensitivity: 76%, specificity: 61%, positive predictive value: 71%, likelihood ratio: 1.9). Compared to the current diagnostic gold standard, SNOT-22 scores greater than 21 sufficiently identified adults with CF presenting with concomitant CRS. The SNOT-22 is a simple instrument that can easily be implemented in adult CF clinics to assist care providers identify individuals requiring more detailed assessment or referral to a sinus clinic.
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As the life expectancy for individuals with cystic fibrosis (CF) continues to improve, an emphasis on optimizing health-related quality of life (HRQoL) has become increasingly important. The Cystic Fibrosis Questionnaire-Revised (CFQ-R... more
As the life expectancy for individuals with cystic fibrosis (CF) continues to improve, an emphasis on optimizing health-related quality of life (HRQoL) has become increasingly important. The Cystic Fibrosis Questionnaire-Revised (CFQ-R 14+) is the most widely accepted method to quantify HRQoL in this patient population. Our objective was to systematically review the literature to identify sociodemographic and clinical factors associated with HRQoL among adolescents and adults with CF. Five major literature databases were searched (MEDLINE, EMBASE, CENTRAL, CINAHL, psychINFO) to identify studies published from January 1989 to April 2014 (n = 1,921). We included all full-text studies that: (1) focused on individuals 14 years of age or older, and (2) examined the relationship between sociodemographic (age, sex, body-mass index [BMI], socioeconomic status, and employment) and clinical (FEV1 % predicted, pulmonary exacerbation, comorbidities) factors with the CFQ-R 14+. Effect estimates and levels of statistical significance in the association between sociodemographic and clinical factors with each of the 12 CFQ-R 14+ domains were analyzed, if examined in at least two studies. Twenty-eight articles met our inclusion/exclusion criteria, but 5 studies were excluded at the data synthesis stage, leaving 23 articles for analysis. In relation to the CFQ-R 14+, 10 candidate factors were examined in at least two studies. The five most commonly studied factors were FEV1 % predicted (57.1% of 28 studies), sex (32.1%), BMI (28.6%), age (17.6%), and pulmonary exacerbations (13%). In studies incorporating multivariable methods, FEV1 % predicted was positively associated with all CFQ-R 14+ domains with the exception of Digestion, Social Functioning, and Emotional Functioning. Male subjects reported higher Physical Functioning and lower Body Image scores than female subjects, BMI was positively correlated with Body Image and Weight, and age was negatively correlated with Treatment Burden. Pulmonary exacerbations were negatively associated with multiple domains, including Respiratory Symptoms, Physical, and Role Functioning. Although several factors have been found to be associated with the CFQ-R in adolescents and adults with CF, FEV1 % predicted and pulmonary exacerbations have the broadest impact on HRQoL. Further research is required to investigate the impact of age-related comorbidities, psychosocial factors, and treatment-related factors on HRQoL in adolescents/adults with cystic fibrosis.
Research Interests: Cystic Fibrosis, Quality of life, Adolescent, Humans, Female, and 4 moreMale, Young Adult, Health Status, and Adult
ABSTRACT Objective: 1) To determine whether the 15-degree reverse Trendelenburg position (RTP) during FESS improves endoscopic field of view compared to the horizontal position (HP). 2) To determine whether the 15-degree RTP during FESS... more
ABSTRACT Objective: 1) To determine whether the 15-degree reverse Trendelenburg position (RTP) during FESS improves endoscopic field of view compared to the horizontal position (HP). 2) To determine whether the 15-degree RTP during FESS reduces intraoperative blood loss compared to the HP. Method: Fifty CRS patients undergoing FESS were randomized to either 15-degree RTP (experimental arm) or HP (control arm) from October 2011 to February 2012. Boezaart endoscopic field of view grading system was the primary outcome measure. Total blood loss, blood loss/minute, MAP, heart rate, anesthetic technique, and surgery time were recorded. Results: The 43 patients currently studied show a significant difference in mean Boezaart scoring between RTP and HP: 1.698 vs 2.124 (P = .009), with RTP producing a better endoscopic field of view. There was also less blood loss per minute with RTP (P = .05). No significant difference was found in total blood loss (P = .236), time of surgery (P = .458), or mean arterial pressure (P = .825) between the 2 surgical positions. Conclusion: The 15-degree RTP improves the endoscopic field of view during FESS and also reduces blood loss per minute during surgery. We would therefore recommend its use. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012.
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ABSTRACT Objective: Evaluate the efficacy of endoscopic sinus surgery (ESS) without orbital floor augmentation in restoring maxillary sinus volume and resolving enophthalmos in patients with silent sinus syndrome.