Background A randomized controlled trial was held to compare nonabsorbable packs to steroid‐eluting absorbable stents as middle meatal spacers after endoscopic sinus surgery in patients with chronic rhinosinusitis (CRS). Methods CRS patients were randomly assigned to receive either nonabsorbable Merocel packs wrapped in non‐latex glove material (packing type A) or Propel steroid eluting stents (packing type B). Twenty‐two–item Sino‐Nasal Outcome Test (SNOT‐22) scores were collected preoperatively and postoperatively during the initial 4 debridements up to 3 months. Recording of the nasal endoscopy was also collected during all postoperative visits. In addition, Lund‐Kennedy scores and middle turbinate lateralization scores, using a new visual analogue scale, were compared between the 2 types of packing. Results Forty CRS patients were prospectively enrolled in this institutional review board (IRB)‐approved study. Patients with packing type A had significantly lower middle turbinate lateralization scores at their first (∼10 days) postoperative visit (p = 0.02 and p = 0.04, for left and right sides, respectively). This difference disappeared by later postoperative visits (from 20 days to 3 months). Overall, patients receiving packing type A had significant lower SNOT‐22 scores at 20 days postsurgery (p = 0.05). This difference also disappeared at 1 and 3 months postoperation. There were no statistically significant differences in Lund‐Kennedy scores. Conclusion In this study, nonabsorbable packing materials showed significant superior middle meatal spacing capacities as evidenced by greater middle turbinate medialization capability at the first postoperative visit. Additionally, patients with this type of packing saw improvements in their SNOT‐22 scores at the 20‐day postoperative visit. This study showed that there was no significant improvement in postoperative outcomes with drug‐eluting stents when compared to nonabsorbable packing.

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

Objectives Our objective in this study is to examine the association between chronic sphenoid rhinosinusitis and community acquired pneumonia (CAP). Study Design Retrospective chart review. Methods A list of chronic rhinosinusitis (CRS) patients who presented to a tertiary rhinology clinic from 2013 to 2015 was conducted. Patients were excluded if they were not seen for at least 2 years. Patients were categorized into CRS with sphenoid sinusitis (group A) and CRS without sphenoid sinusitis (group B). The former group was divided into 2 categories according to their computed tomography scan/endoscopy findings: mucosal thickening and opacification (partial, complete, purulent sphenoid drainage on endoscopy). Posterior ethmoid disease was analyzed in the same fashion. Charts were then reviewed on whether the patients developed CAP within 2 years of their visit to the rhinologist. Results Six hundred forty-five of 1061 patients were included in the analysis. There were 178 (27.60%) patients in group A and 467 (72.40%) patients in group B. There were 40 total cases of pneumonia with 27 (67.50%) cases having chronic sphenoid sinusitis. Patients with sphenoid sinusitis were 6.77 (95% confidence interval [CI], 3.36–13.66) times more likely to have pneumonia. Patients with partial/complete opacification of the sphenoid sinus were 19.76 (95% CI, 8.78–44.47) times more likely to have pneumonia. Patients with only mucosal thickening of the sphenoid sinus did not have significantly increased odds of having pneumonia. Posterior ethmoid disease did not have an association with CAP nor did it increase the risk of CAP in sphenoid sinusitis patients. Conclusions There is an association between chronic sphenoid rhinosinusitis and CAP. Partial/complete opacification of the sphenoid sinus had the highest association with pneumonia.

The control group had a higher incidence of hypoventilation and apnea compared to the RVM intervention group. Respiratory monitoring using the RVM can potentially be a useful tool for identifying early signs of respiratory depression and for titrating anesthetics to maintain adequate ventilation while minimizing patient risk.