International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Endoscopic sinus surgery for benign and malignant nasal and sinus neoplasm

Endoscopic sinus surgery has become widely accepted as the standard of treatment for chronic inflammatory diseases of the paranasal sinuses unresponsive to medical treatment. With increased skill with endoscopic surgical technique, advanced technologies such as intraoperative imaging systems, and a better understanding of the complex anatomy of the paranasal sinuses and surrounding vital structures, many otolaryngologists have increasingly applied their expertise in endoscopic sinus surgery to the resection of nasal and sinus neoplasms. The following represents a review of the recent literature on the latest trends regarding endoscopic resection of nasal and paranasal sinus neoplasms. There has been an increasing popularity in the removal of nasal and paranasal sinus neoplasms through an endoscopic approach. In the recent literature, emphasis has been on the endoscopic surgery of benign tumors, especially inverted papilloma and nasopharyngeal angiofibroma. Other benign neoplasms have also been reported, but only in small case reports. There have been a few recent reports supporting endoscopic removal of malignant neoplasms as well. However, the follow-up is too short and study groups too small to make definitive conclusions. In the hand of experienced and skilled surgeons, complete endoscopic removal is attainable in most cases. Especially for the more common benign neoplasms, such as inverted papilloma and early stage angiofibroma. En bloc resection is not necessary to achieve oncologic cure. However, several factors have to be considered before selection of this surgical approach. Large tumor size, intracranial or orbital extension, and extensive frontal or infratemporal fossa involvement are relative, but not absolute limitations

Lateral Cephalometric Analysis in Thai Patients without Clinical Features of Obstructive Sleep Apnea Syndrome

Objective: To obtain referent normative values of lateral cephalometric parameters of the upper airway in Thai people without clinical features of obstructive sleep apnea syndrome (OSAS). Methods: A total of 105 healthy subjects (80 males and 25 females) were recruited. Inclusion criteria were healthy people age ≥ 18 years with body mass index (BMI) of < 30 kg/m2, normal visual harmony of facial profile, no history of snoring or witnessed apnea, and no excessive daytime sleepiness (Epworth Sleepiness Scale ≤ 8). All subjects must have a regular sleep pattern with total sleep duration of 7-9 hours and must have no complaint of difficulty sleeping. Exclusion criteria were pregnant women, patients with previous orthodontic treatment, corrective jaw surgery, upper airway surgery, neoplasm, irradiation in head and neck, and patients who had underlying illnesses using medication or substance which affected the sleep-wake cycle. All subjects had lateral cephalometric radiographs taken with a standardized technique. Every data was measured twice on separate occasions. Results: The reliability of repeated measurements was excellent shown by intraclass correlation coefficients ranging from 0.95 to 0.99. The baseline data were presented in mean ± SD. SNA, SNB, PAS, MPH and PNS-P in males were 84.3 ± 4.0, 81.5 ± 4.1, 14.2 ± 3.4, 16.1 ± 5.3, and 34.8 ± 6.1, respectively. SNA, SNB, PAS, MPH and PNS-P in females were 84.4 ± 3.1, 80.7 ± 3.2, 11.1 ± 3.3, 10.8 ± 4.9, and 32.3 ± 3.1, respectively. The parameters that were different between both genders included N-ANS, GN-GO, H-PP, MPH, PAS, and TL. (p < 0.05) Conclusion: To date, this study has possibly represented the largest local database of lateral cephalometric measurements focusing on Thai people without clinical features of OSAS. It may be another useful reference for future research and clinical practice

Characteristics and Clinical Presentations of Patients at the Siriraj Snoring Clinic

Objective: To describe characteristics and clinical presentations of patients in Siriraj snoring clinic and to analyze their relationships with obstructive sleep apnea (OSA) severity. Methods: Three hundred and seventy-three patients’self-administered questionnaires regarding sleep problems recorded between January 2012 and December 2013 and 275 polysomnographic reports were reviewed. Results: Among 373 respondents, there were 247 males (66.2%) and 126 females (33.8%), with an average age of 48 years and body mass index of 28.2 kg/m2.  Their most common complaints and comorbidities were snoring ≥3 nights/week (87.9%), worrying about complications from apnea (72.4%), dyslipidemia (36.7%), hypertension (34.3%), and diabetes mellitus (12.1%), respectively. Using apnea-hypopnea index (AHI) of ≥5 and ≥30 events/hour, there were 76.7% and 38.5% of patients diagnosed as OSA and severe OSA, respectively. While using respiratory disturbance index (RDI) with similar cut-off, almost everyone (98.8%) and 60.2% of patients will be diagnosed as OSA and severe OSA, respectively.  Characteristics significantly associated with AHI ≥15 events/hour were snoring ≥3 nights/week, witnessed apneas, and nocturia (p < 0.05). The comorbidities which significantly associated with OSA group were hypertension, diabetes, and dyslipidemia.  There were only weak significant relationships between AHI (and RDI) with ESS and quality of life. Conclusion: The most common complaints in our clinic were loud snoring and worrying about OSA consequences, not excessive daytime sleepiness. Based on RDI criteria, almost everyone were diagnosed as OSA; however, it had poor relationship with patients’symptoms, comorbidities and quality of life.  Thus, for better OSA evaluation, we should use data from several aspects, not only AHI nor RDI for proper patient management

Radiofrequency Inferior Turbinate Reduction Improves Smell Ability of Patients with Chronic Rhinitis and Inferior Turbinate Hypertrophy

Radiofrequency inferior turbinate reduction (RFITR) of inferior turbinate hypertrophy (ITH) is an effective way to treat patients with intractable nasal mucosal obstruction. The objective of this study was to assess smell ability, nasal symptoms, inferior turbinate grading (ITG), peak nasal inspiratory flow (PNIF) of patients with chronic rhinitis (CR), and ITH before and after RFITR. Patients with CR and ITH, aged 18–60 years, who underwent RFITR, were prospectively recruited. Smell ability (measured by smell detection threshold [SDT]), visual analog scale (VAS) of nasal symptoms, ITG, and PNIF before and 6–10 weeks after RFITR were compared. Forty-eight subjects were included. All nasal symptoms were significantly decreased after RFITR. After surgery, SDT (tested by phenyl ethyl alcohol) was worsened in 7 patients (14.6%), improved in 8 patients (16.7%), and did not change in 33 patients (68.7%). SDT after RFITR of six patients in the worsened SDT group were still within normal range (> −6.5). There was only one patient whose SDT changed from normosmia to mild hyposmia (–7.25 to −5.38). In the improved SDT group, two of eight patients had obviously better SDT after RFITR, which changed from moderate hyposmia to normosmia (–3.65 to −10; −3.73 to −10), whereas six of eight patients had little better SDT after RFITR. RFITR also significantly reduced ITG and improved PNIF. In conclusion, the treatment of patients with CR and ITH with RFITR significantly improved PNIF, ITG, and nasal symptoms assessed by VAS, although SDT after RFITR could be the same or improved or worsened