BackgroundThe incidence of adverse sequelae related to trauma of cranial nerve V2 (V2) and the Vidian nerve (VN) during endoscopic pterygoid recess repair (PRR) of lateral sphenoid encephalocele is insufficiently reported in the medical literature. As part of our quality assessment and improvement program we sought to analyze the incidence and severity of V2 and VN injury during a 9‐year experience (2010‐2018) with PRR.MethodsHypoesthesia, paresthesia, and dry eye and their impact on patient quality of life were sought through chart review and a self‐reported 0 to 5 Likert scale for each symptom.ResultsThirty‐five patients underwent repair of spontaneous cerebrospinal‐fluid (CSF) rhinorrhea, with 11 consecutive patients undergoing endoscopic PRR. Mean follow‐up for PRR was 32.5 months (range, 2.4 to 103.3 months). Although definitive management resulted in 100% success, 1 required secondary treatment. Eight patients were available for long‐term follow‐up (72.7%) and completed a symptom severity questionnaire using a Likert‐scale. All patients observed either hypoesthesia, paresthesia, or dry eye of varying gradation (scale, 0 to 5). None described disabling symptoms, and some reported gradual improvement. Numbness, paresthesia, and dry eye were reported by 6 of 8 (75%), 5 of 8 (62.5%), and 4 of 8 (50%) patients, respectively. The mean Likert score among the 8 patients who completed this questionnaire noticing hypoesthesia, paresthesia, and dry eye was 2.6, 1.3, and 1.8, respectively.ConclusionMeticulous surgical technique is paramount for successful PRR and minimizing nerve injury, yet the anatomic variation of the lateral pterygoid recess can be challenging, and neural injury is a real risk. Preoperatively, patients should be counseled that although V2 or VN injury is common, most patients describe resulting symptoms to be rarely bothersome.

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Objectives: To identify the prevalence of Barrett's esophagus (BE) in patients with nasopharyngeal reflux (NPR) presenting to a tertiary rhinology practice in 2017, and to assess for any correlation with the presence of symptomatic gastroesophageal reflux disease (GERD). Methods: Demographic data, self-reported symptoms and relevant past medical history were compiled from a standardized intake questionnaire. Symptoms were grouped into 3 categories: NPR, laryngopharyngeal reflux (LPR) and GERD. Descriptive and nonparametric statistical analyses were performed. Results: Out of 807 new patients seen in 2017, 86 (10.7%) were referred to gastroenterology (GI) with NPR-associated symptoms, based on pre-existing referral indications. Forty-three patients were evaluated by a gastroenterologist, and 25 underwent EGD with pathology report available for review. BE was identified in 6/25 (24%) patients. Five of these six patients (83.3%) reported either mild or no GERD symptoms. No patient factors or presenting symptoms were significantly associated with the diagnosis of BE. Conclusions: This data in consecutive new patients suggests that compliance with referral recommendations is poor among NPR patients and that the incidence of BE in this population may be higher than that generally reported among GERD patients. This experience strengthens indications for referral for EGD to rule out BE, and it highlights the importance of patient education to improve compliance.