2018 Section 5 - Rhinology and Allergic Disorders

Plonk DP, Luong A. Current understanding of allergic fungal rhinosinusitis and treatment implications. Curr Opin Otolaryngol Head Neck Surg . 2014; 22(3):221-226. EBM level 5.................................100-105

Summary : This article discusses the pathophysiological concept of epithelial cell-driven immune response being a major contributor to the development of AFRS. The authors also review diagnostic criteria and the surgical and medical management of the disease process.

Ryan MW, Clark CM. Allergic fungal rhinosinusitis and the unified airway: the role of antifungal therapy in AFRS. Curr Allergy Asthma Rep . 2015; 15(12):75. EBM level 3a..............................................106-111

Summary : This article summarizes the diagnostic criteria and pathophysiology for AFRS. The authors also present evidence against the use of antifungal treatment within the sinonasal cavities for most chronic sinusitis; however, the use of antifungal therapy for AFRS has yet to be fully disproven. C. Surgical Outcomes Haxel BR, Boessert P, Weyer-Elberich V, Fruth K. Course of olfaction after sinus surgery for chronic rhinosinusitis. Laryngoscope Investig Otolaryngol . 2017; 2(5):269-275. EBM level 2.........................112-118 Summary : This articles examines the return of olfaction after endoscopic sinus surgery (ESS) in patients with CRS. The authors demonstrated that improvement of olfaction starts at 2 weeks post-ESS and continues until 6 months, with CRSsNP patients achieving faster improvement.

Rudmik L, Xu Y, Alt JA, et al. Evaluating surgeon-specific performance for endoscopic sinus surgery. JAMA Otolaryngol Head Neck Surg . 2017; 143(9):891-898. EBM level 3........................................................119-126

Summary : This article evaluates the surgeon-specific performance for endoscopic sinus surgery (ESS) using revision rate as the quality metric. The authors report a revision rare of 10.6%, and list the presence of nasal polyps as one of the factors that increase the likelihood of revision ESS.

Stein NR, Jafari A, DeConde AS. Revision rates and time to revision following endoscopic sinus surgery: a large database analysis. Laryngoscope . 2018; 128(1):31-36. EBM level 4............................................127-132

Summary : This article looks into the prevalence of endoscopic sinus surgery revision surgery as well as the factors that may predict it. The authors’ findings suggest a revision rate of 6.65%. Predictive factors include presence of nasal polyps and female gender. Sukato DC, Abramowitz JM, Boruk M, et al. Endoscopic sinus surgery improves sleep quality in chronic rhinosinusitis: a systematic review and meta-analysis. Otolaryngol Head Neck Surg . 2018; 158(2):249-256. EBM level 1................................................................................................................................................133-140 Summary : This article evaluated the impact of endoscopic sinus surgery on sleep quality in patients with CRS. The authors conclude that surgery provides for substantial improvement with respect to CRS, with a smaller improvement seen in the apnea-hypopnea index.