April 2020 HSC Section 4 - Plastic and Reconstructive Problems

bump/pimple (1), and unknown reasons (10). The authors hypothesize that the unknown reasons could be due to poor placement or unknown manipulation of the nose. The inves- tigators presume the implant retrievals were not due to adverse physiologic tissue rejection because there was no evidence of tissue in fl ammation. Additionally, 16 of the retrievals were unilateral. Only one retrieval was bilateral, and this was requested by the patient because the patient did not like the cosmetic impact. Twelve of the 17 patients were treated with Latera only. All events resolved with no clinical sequelae. Patients had short- and midterm improvement in nasal obstruction symptoms as measured by NOSE scores. Overall, statistically signi fi cant reductions in mean NOSE scores were observed throughout the 12-month follow-up period after the procedure (77.4 13.4 baseline vs. 36.2 22.7 at 1 month postoper- atively, 33.0 23.4 at 3 months, 32.1 24.6 at 6 months, and 30.3 24.3 at 12 months; P < 0.001 for all). Simi- larly, patients also showed short- and midterm improve- ment in nasal obstruction symptoms as measured by VAS scores. Overall, 12-month mean VAS scores (29.7 27.9) were signi fi cantly reduced as compared with baseline (68.0 18.0, P < 0.001). Changes in the NOSE and VAS scores at all follow-up time points are shown in Table II and III, respectively. The reduction in NOSE and VAS scores throughout the 12-month follow-up period was observed for patients treated with Latera alone and those treated with Latera + ITR.

61 were concomitantly treated with ITR. A total of 27 patients (15 Latera only and 12 treated with Latera + ITR) exited from the study before completing their 12-month follow-up. Of the 15 Latera-only patients, seven were lost to follow-up; fi ve withdrew from the study for rea- sons other than NAO symptoms; and three required addi- tional NAO surgery. Of the 12 patients treated with Latera + ITR, four were lost to follow-up, three withdrew from the study for reasons other than NAO symptoms, and three required additional NAO surgery. The six patients requiring additional NAO surgery were symptomatic and needed additional intervention. The type of additional surgery was not identi fi ed in the patient data collection. Demographics and relevant clinical history for the overall study population, Latera alone, and Latera + ITR procedures are described in Table I. A majority of patients had prior surgical history for which septoplasty and ITR were the most common procedures (Table I). A total of 41 procedure- or implant-related adverse events were reported in 31 patients. The majority (82%) of the adverse device events occurred within the fi rst 3 months of the implant procedure. These events included foreign body sensation (6), sinus infection (1), mucous production (2), loss of smell/taste (1), skin irritation (1), hematoma (1), infection (4), pain (3), bumps (5), and implant retrievals (17). There were 17 implant retrievals in a total of 319 implants (5.3% retrieval rate). The reasons for implant retrievals were patient manipulation (5), patient request (1),

TABLE I. Patient Demographics and Relevant Medical History.

TABLE II. Change from Baseline in Mean NOSE Score and Responder Rate at 1, 3, 6, and 12 Months.

All Patients N = 166

Latera Alone N = 105

Latera + ITR N = 61

Characteristic

Change in NOSE Score, Mean SD

Age (years)

50.5 14.9 51.2 14.4 49.5 15.4

Responder Rate * % (95% CI)

Follow-up Period

27.0 5.0 *

BMI

26.8 4.8

27.4 5.2

N

P Value †

Sex, female

82 (49.4%)

51 (48.6%)

31 (50.8%)

All patients 1 month

Race

− 41.3 24.1 89.6% (83.9%, 93.8%) − 44.3 25.1 91.7% (86.2%, 95.5%) − 45.1 25.8 89.5% (83.5%, 93.9%) − 46.3 25.5 89.2% (82.8%, 93.8%) − 40.7 24.5 90.3% (82.9%, 95.2%) − 43.9 25.7 92.0% (84.8%, 96.5%) − 45.2 25.3 91.6% (84.1%, 96.3%) − 43.6 26.4 87.8% (79.2%, 93.7%) − 42.2 23.7 88.5% (77.8%, 95.3%) − 44.9 24.2 91.1% (80.4%, 97.0%) − 45.0 26.7 86.0% (74.2%, 93.7%) − 51.4 23.3 91.8% (80.4%, 97.7%)

164

<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

American Indian or Alaska Native

1 (0.6%)

0 (0.0%)

1 (1.6%)

3 months 156 6 months 152 12 months 139

Asian

3 (1.8%) 3 (1.8%)

2 (1.9%) 2 (1.9%)

1 (1.6%) 1 (1.6%)

Black or African American Hispanic or Latino

Latera alone 1 month

11 (6.6%)

6 (5.7%)

5 (8.2%)

103

White Other

143 (86.1%)

93 (88.6%)

50 (82.0%)

3 months 100

4 (2.4%)

2 (1.9%)

2 (3.3%)

6 months

95

Sinus disease

57 (34.3%) 76 (45.8%) 98 (59.0%)

43 (41.0%) 48 (45.7%) 75 (71.4%) 54 (51.4%) 11 (10.5%) 51 (48.6%) 27 (25.7%)

14 (23.0%) 28 (45.9%) 23 (37.7%)

12 months 90

Allergic rhinitis

Latera + ITR 1 month

Previous nasal surgery

61 56 57

3 months 6 months

Septoplasty Rhinoplasty

65 (39.2%)

11 (18.0%)

14 (8.4%)

3 (4.9%)

12 months 49

Turbinate reduction

64 (38.5%) 35 (21.1%)

13 (21.3%)

ESS

8 (13.1%)

Latera, Spirox Inc., Redwood City, CA. * Responders are de fi ned as patients who have at least 1 NOSE class improvement or a NOSE score reduction of at least 20% from baseline. † P values are based on paired t tests for change from baseline, with P < 0.05 indicating statistical signi fi cance. CI = con fi dence interval; ITR = turbinate reduction; NOSE = Nasal Obstruction Symptom Evaluation; SD = standard deviation.

Results are presented as mean SD or n (%). Latera, Spirox Inc., Redwood City, CA. * BMI was only available for 162 participants. BMI = body mass index; ESS = endoscopic sinus surgery; ITR = turbi- nate reduction; SD = standard deviation.

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