One-time intraoperative topical MMC is not effective in reducing postoperative frontal recess stenosis in both primary and revision cases.

Background Obstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy. Drug-induced sleep endoscopy (DISE) is a diagnostic tool increasingly used to assess pediatric obstructive sleep apnea, but its use has not been standardized. The overarching goal of this study was to document the current practice of Canadian otolaryngologists managing this population. Methods A nation-wide online cross-sectional survey of Canadian otolaryngologist members of the Canadian Society of Otolaryngology – Head and Neck Surgery and the Association d’otorhinolaryngologie et chirurgie cervico-faciale du Québec. The 58-question electronic survey was developed based on a validated survey redaction guide with the aim to assess management and treatment of pediatric obstructive sleep apnea, as well as indications and performance of DISE. Consensus on practice items was defined by a minimum of 75% similar answers. Results One hundred and nine Canadian otolaryngologists completed the survey on management of pediatric obstructive sleep apnea, among which 12 of them completed the questions on DISE. Overall, there was a poor rate of agreement of 55% among the respondents for the 58 questions altogether. There was a consensus to assess pediatric obstructive sleep apnea clinically ± with videos (82.6%), to assess adenotonsillar hypertrophy clinically (93.6%) and with flexible scope in the office (80.7%), as well as for the airway sites examined endoscopically during DISE. However, there was no consensus regarding anesthetic protocol and scoring system. DISE was mostly performed in cases of persistent obstructive sleep apnea after adenotonsillectomy rather than before performing any surgical procedure. There was no difference in the management of obstructive sleep apnea between otolaryngologists who perform DISE and those who do not. The only difference between otolaryngologists who practice in community centers versus in tertiary care centers was the more frequently use of the Brodsky tonsil scale by the latter ones. Conclusion This Canadian-wide survey highlighted a lack of consensus in the management of pediatric obstructive sleep apnea and DISE. Certain aspects regarding DISE remain unclear, including establishment of its ideal timing in order to eventually avoid unnecessary tonsillectomies.

Background: There is no uniform consensus on how to grow fungi from sinus aspirates in the Canadian setting. Protocols vary between institutions, and the positivity rate for fungal cultures ranges between 10 and 20% even when endoscopically obvious allergic mucin is being sent to the laboratory. The aim of this study was to compare the occurrence of positive fungal cultures obtained by our institution's fungal culture method with the occurrence obtained by the Mayo Clinic's fungal culture method. The ultimate aim was to propose a modified, feasible, standardized protocol for culturing fungi from sinus aspirates in the Canadian laboratory setting.

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IntroductionObstructive sleep apnoea affects up to 6% of children worldwide. Although current guidelines recommend systematic tonsillectomy and adenoidectomy, many children do not benefit from these interventions. Drug-induced sleep endoscopy (DISE) allows the dynamic evaluation of patients’ airways to identify the specific anatomic sites of obstruction. This intervention can potentially guide subsequent invasive procedures to optimise outcomes and minimise the number of children exposed to unnecessary operations.Methods and analysisWe will identify randomised controlled trials and controlled observational studies comparing DISE-directed interventions to systematic tonsillectomy and adenoidectomy in paediatric populations. We will search MEDLINE, EMBASE, CINAHL, CENTRAL as well as clinical trial registries and conference proceedings (initial electronic search date 9 October 2018). Screening, data extraction and risk of bias assessments will be performed in duplicate by independent reviewers. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence and present our results.Ethics and disseminationEthics approval is not required for this systematic review of published data. This review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will present our findings at otorhinolaryngology conferences and publish a report in a peer-reviewed journal.PROSPERO registration numberCRD42018085370.