Recovery rates of persistent post-COVID-19 olfactory dysfunction using psychophysical assessment:A longitudinal cohort study

Objectives:Persistent olfactory dysfunction(OD)following loss of smell associated with SARS-CoV-2 infection is a major feature of long COVID.Perspectives on the prevalence of persistent OD predominantly rely on self-reported olfactory function.Few studies have tracked longitudinal rates of recovery using psychophysical assessment among patients presenting for evaluation of persistent OD beyond a window of acute recovery.Data anchored in standardized testing methods are needed to counsel patients who fail to acutely regain their sense of smell.This study aims to quantify the degree of persistent OD in post-COVID-19 patients who experience subjective and psychophysical OD.Methods:We grouped participants presenting for OD evaluation into cohorts based on both subjective and psychophysical olfactory status at a baseline assessment and assessed their olfactory abilities with a visual analogue scale and the Sniffin'Sticks extended test at baseline and 1-year time points.Participants had confirmed a history of COVID-19 by lab evaluation or clinical diagnosis if lab evaluation was not available.Results:Baseline olfactory evaluation was completed by 122 participants,53 of whom completed the 1-year follow-up assessment.Among participants presenting with perceived OD,74.5%had confirmed psychophysical OD at baseline,with 55.1%at 1-year follow-up.Participants had reliable trends in self-rated versus psychophysically tested olfactory function at both time points.The total threshold,discrimination,and identification(TDI)score improved by+3.25 points in the cohort with psychophysical OD(p=0.0005),with this improvement largely attributable to an increase in median threshold scores(+2.75 points;p=0.0004).Conclusions:OD persists in a significant number of patients who fail to acutely recovery their sense of smell after COVID-19,with many demonstrating lingering deficits at 1-year.Improvements in threshold,but not discrimination or identification,most significantly mediate improvement of total TDI score at follow-up.

Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management

Objective:Endoscopic approaches for sinus and skull base surgery are increasing in popularity.The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery(EES),highlight preventative measures,and illustrate key management principles.Data Sources:Comprehensive literature review.Methods:Relevant literature was reviewed using PubMed/MEDLINE.Results:Carotid artery injury in EES is rare,with most studies reporting an incidence below 0.1%.Anatomic aberrancies,wide dissection margins,as well as specific provider and hospital factors,may increase the risk of injury.Multidisciplinary teams,comprehensive preoperative imaging,patient risk assessment,and formal training in vascular emergencies may reduce the risk.Management protocols should emphasize proper visualization of the injury site,fluid replacement,rapid packing,angiography,and endovascular techniques to achieve hemostasis.Conclusions:While EES is a relatively safe procedure,carotid artery injury is a devastating complication that warrants full consideration in surgical planning.Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging.Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

Olfactory outcomes in the management of aspirin exacerbated respiratory disease related chronic rhinosinusitis

Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.

Exclusively endoscopic surgical resection of esthesioneuroblastoma: A systematic review

Background:Historically sinonasal malignancies were always addressed via open craniofacial surgery for an oncologic resection.Increasingly esthesioneuroblastomas are excised using an exclusively endoscopic approach,however,the rarity of this disease limits the availability of long-term and large scale outcomes data.Objective:The primary objective is to evaluate the treatment modalities used and the overall survival of patients with esthesioneuroblastoma managed with exclusively endoscopic surgery.Methods:In accordance with PRISMA guidelines,PubMed was queried to identify studies describing outcomes associated with endoscopic management of esthesioneuroblastomas.Results:Forty-four out of 2462 articles met inclusion criteria,totaling 399 patients with esthesioneuroblastoma treated with an exclusively endoscopic approach.Seventy-two patients(18.0%)received adjuvant chemotherapy and 331 patients(83.0%)received postoperative radiation therapy.The average age was 50.6 years old(range 6-83).Of the 399 patients,57(16.6%)were Kadish stage A,121(35.2%)were Kadish stage B,145(42.2%)were Kadish stage C,and 21(6.1%)were Kadish stage D.Pooled analysis demonstrated that 66.0%of patients had Hyams histologic GradeⅠorⅡ,while 34.0%of patients had GradeⅢorⅣdisease.Negative surgical margins were achieved in 86.9%of patients,and recurrence was identified in 10.3%of patients.Of those with 5-year follow-up,reported overall survival was 91.1%.Conclusion:Exclusively endoscopic surgery for esthesioneuroblastoma is performed for a wide range of disease stages and grades,and the majority of these patients are also treated with adjuvant chemotherapy or radiation therapy.Reported overall recurrence rate is 10.3%and 5-year survival is 91.1%.

Simulation training in endoscopic skull base surgery: A scoping review

Objective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning.Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes.The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines,we systematically searched PubMed,Embase,CINAHL,and Cochrane databases.Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references,with 55 studies ultimately meeting inclusion criteria.Of these,19 studies described cadaveric dissection models,17 discussed three-dimensional(3D)printed models,14 examined virtual surgical planning and augmented reality-based models,and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery,including high-fidelity cadaveric,virtual reality,and 3D-printed models.These models are an asset for trainee development and preoperative surgical preparation.

The Draf Ⅲ procedure: A review of indications and techniques

The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.

Pediatric sinonasal and skull base lesions

Pediatric skull base lesions are complex and challenging disorders.Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team.Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements,multidisciplinary team approaches,and continued innovation.Similar principles continue to advance the care delivered to the pediatric population.The approach and management of these lesions varies considerably based on tumor anatomy,pathology,and surgical goals.An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.