2018 Section 5 - Rhinology and Allergic Disorders

Levy et al

Additional study of patients with advanced CRS is neces- sary to further support the use of BCD among all patients with CRS. Exclusion of patients undergoing hybrid procedures (BCD as part of ESS) from systematic review may limit the generalizability of the study findings. Our study design intentionally separated the BCD and ESS groups to mini- mize confounding variables in analysis; however, this artifi- cial separation may not be clinically necessary. BCD uniquely represents a surgical instrument as well as an operative procedure, and its application may not be limited to single modality interventions. The high prevalence of industry support introduces a potential conflict of interest in the majority of studies included in this analysis. Quantitative evaluation of studies without industry sponsorship or conflicts of interests was not possible, as only a single study met criteria for meta- analysis when those with possible financial conflicts of interest or industry support were excluded. 19 While the find- ings of this study are consistent with the above quantitative analysis, future research without industry support is needed to further evaluate this potential bias. The current literature does not support the suggestion that indications for BCD and ESS are identical. Additional research is needed to determine the role for BCD in specific patient populations, including revision surgery and CRS with nasal polyposis. Further study is also needed to com- pare the incidence of postoperative complications and debri- dements among patients with CRS undergoing BCD versus ESS. Finally, additional study is needed to directly evaluate patient outcomes following BCD in the operating room versus office setting. Conclusion Current evidence supporting the role of BCD in CRS remains incomplete. Long-term within-group improvements in quality-of-life and sinus opacification scores are demon- strated among a restricted adult population with CRS. Extensive exclusion criteria in the current literature confine evaluation to a subgroup of CRS patients with limited dis- ease. Additionally, the majority of studies are affected by potential conflicts of interest and inherent bias. Additional study is needed to further evaluate outcomes following BCD in the office setting, as well as the role for BCD in specific patient populations, such as those with moderate to advanced sinus disease, prior ESS, and nasal polyposis. Author Contributions Joshua M. Levy , study design, data collection, drafting, final approval, accountability for all aspects of the work; Michael J. Marino , data collection, statistical analysis, drafting, final approval, accountability for all aspects of the work; Edward D. McCoul , study design, revision, final approval, accountability for all aspects of the work.

Sponsorships: None. Funding source: None.

References

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Disclosures Competing interests: None.

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