2016 Section 5 Green Book

ii. Topical (saline, steroids, and antibiotics) Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume sinonasal budesonide irrigations for chronic rhinosinusitis. Int Forum Allergy Rhinol . 2016; 6(3):228-232. EBM level 3..................................................152-156 Summary : Smith et al evaluated the impact of high-dose topical budesonide on the hypothalamic-pituitary-adrenal (HPA) axis in chronic rhinosinusitis patients. These patients used 2 mg of budesonide in saline irrigations daily for over 2 years. The authors evaluated serum AM cortisol levels. Over half of the patients had lower-than-normal serum cortisol levels prompting a cosyntropin stimulation test. None of the 19 patients tested were found to have abnormal cosyntropin tests. The authors concluded no HPA axis suppression occurs with the use of budesonide, even at high doses. Soudry E, Wang J, Vaezeafshar R, et al. Safety analysis of long-term budesonide nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus surgery. Int Forum Allergy Rhinol . 2016; 6(6):568-572. EBM level 3............................................................................................................157-161 Summary : Soudry et al evaluated budesonide irrigations in 48 patients with chronic rhinosinusitis. The mean duration of use was 22 months, using 0.5 mg of budesonide in 240 mL saline, once or twice daily. The authors used the cosyntropin stimulation test on all patients and found that 23% showed evidence of adrenal suppression. Interestingly, none of these patients exhibited any other signs or symptoms of adrenal suppression. Logistic regression suggested the highest risk for adrenal suppression occurs when the budesonide irrigations were used with other exogenous corticosteroids such as nasal steroid sprays or inhaled steroids. Bleier BS, Castelnuovo P, Battaglia P, et al. Endoscopic endonasal orbital cavernous hemangioma resection: global experience in techniques and outcomes. Int Forum Allergy Rhinol . 2016; 6(2):156-161. EBM level 4.....................................................................162-167 Summary : The purpose of this study was to combine the experience of multiple international centers to create a composite of the global experience on the endoscopic management of a single type of tumor, the orbital cavernous hemangioma. Extraconal lesions were managed similarly; however, greater variability was evident for intraconal lesions. These included the laterality and number of hands in the approach, methods of medial rectus retraction, and the need for reconstruction. 2. Endoscopic skull base surgery Dixon BJ, Daly MJ, Chan H, et al. Augmented real-time navigation with critical structure proximity alerts for endoscopic skull base surgery. Laryngoscope . 2014; 124(4):853-859. EBM level NA................................................................................................................168-174

D. Advanced Techniques 1. Orbital applications

Summary : Dixon et al present a cadaver study of a novel image guidance technology with proximity alerts.

Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope . 2012; 122(2):452- 459. EBM level 3...........................................................................................................175-182

Summary : Harvey et al present a systematic review of retrospective studies supporting overall success of skull base repair and the role of vascularized tissue.