Background Intranasal corticosteroids (INCS) are used in the management of sinonasal conditions. Use of exogenous steroids can be associated with hypothalamic‐pituitary‐adrenal axis dysfunction and adrenal insufficiency (AI). We aimed to estimate the rate of AI after INCS use in a meta‐analysis, stratified by steroid type and treatment duration. Methods Ovid Medline, Embase Classic, PubMed, Web of Science, and CINAHL databases were searched following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines to identify studies investigating INCS use and AI. AI was defined as morning serum cortisol <550 nmol/L and <80 nmol/L with and without adrenocorticotropic hormone stimulation. INCS were classified as first (beclomethasone dipropionate, triamcinolone acetonide, beclomethasone, budesonide, dexamethasone) and second (ciclesonide, mometasone furoate, and fluticasone propionate) generation. Duration of treatment was classified as short (<1 month), medium (1‐12 months), and long‐term (>12 months) time periods. Results This search identified 3668 articles. A total of 39 studies (1678 patients) were included in the final analysis. The pooled percentage of AI for routinely utilized first‐ and second‐generation INCS was 0.70% (95% confidence interval [CI], 0.29‐1.12%). Stratified by type, AI was observed in 0.78% (95% CI, 0.25‐1.30%) of first‐generation and 0.58% (95% CI, −0.1% to 1.26%) of second‐generation steroids. AI was seen in 0.48% (95% CI, −0.01% to 0.96%) of short‐term, 1.13% (95% CI, 0.2‐2.1%) of medium‐term, and 1.67% (95% CI, 0.37‐2.9%) of long‐term use of INCS. Conclusion Overall, the use of INCS carries a low risk for AI. Although modest, this risk may differ depending on the length of duration and type of INCS used. Informing patients of these risks is of importance for the treatment of chronic sinonasal conditions.

Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

hysician discipline through self-regulation is important for the medical profession to ensure patient safety and improve quality of care. Estimated rates of disciplinary action against licensed physicians ranges from 0.3% to 2.8%. 1 Although disciplinary rates are low, any misconduct has the potential to compromise patient safety and quality of care. In Canada, provincial medical regulatory authorities, known as the Colleges of Physicians and Surgeons (CPS), govern standards of professional practice, and rulings of physician discipline are publicly available. We designed a national database using CPS data to compare surgeons with other physicians, and to determine areas of practice that could benefit from closer evaluation and targeted preventive strategies.Canadian physicians disciplined between Jan. 1, 2000, and Dec. 31, 2017, were identified from the CPS. Relevant demographic information was collected, including sex, type of practice licence, location of medical training (Canadian/US-trained versus international medical graduate [IMG]), and medical specialty. Information on the offenses and penalties incurred was also collected. The Canadian Institute of Health Information was used to identify the total number of practising physicians in the country during the study period. 2 Unadjusted comparisons between surgeons and other physicians were undertaken using χ 2 and Student t tests for categorical and continuous variables, respectively. For the primary analyses, we identified 11 types of offenses and 8 types of penalties, and created indicator variables for each. These were used as the outcome for logistic regression. Generalized estimating equations were selected to estimate the percent of cases with a given offense/penalty for surgeons compared with other physicians, while allowing for covariate adjustment (gender, year of study, years in the profession, and IMG status). Secondary analyses of yearly and aggregate disciplinary rates were performed using negative binomial regression. We report cases per 10 000 physician years with 95% confidence intervals (CIs). The threshold for statistical significance was α = 0.05. Statistical analyses were performed using R software, version 3.1.2.

Background ClariFix is a novel intranasal cryotherapy device developed for clinic-based cryosurgical ablation of the posterior nasal nerves region. As a relatively new technology, there is a paucity of studies within the literature assessing the efficacy and safety profile of ClariFix for chronic rhinitis. Methods A systematic review was completed in accordance with PRISMA guidelines. Databases searched included: Ovid Medline, Ovid EMBASE, Pubmed, Cochrane and Web of Science. Inclusion criteria consisted of studies investigating the use of ClariFix in chronic rhinitis (i.e., allergic and non-allergic rhinitis) in patients of all ages. Results The initial search identified 1110 studies. Final analysis consisted of 8 articles, evaluating a total of 472 patients. The data showed a significant reduction in scores post-treatment across all studies based on validated outcome measures. In all studies, at all time intervals, there was a significant improvement in outcome scores from baseline. Minor adverse effects included post-procedural pain and discomfort, headache and palate numbness. No major adverse events were identified. Conclusion ClariFix is a novel intranasal cryotherapy device that was introduced in Canada in 2021. This is the first systematic review evaluating its efficacy and safety profile. Across all studies, there was a significant reduction in validated outcome scores at multiple time intervals. Further, the treatment is safe with only minor adverse effects reported by patients. Overall, the consensus from this study highlights an apparent benefit in using this intervention for chronic rhinitis that is refractory to medical management.