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

"THE HEARING RESULTS IN OTOSCLEROSIS AFTER STAPEDOTOMY"

Otosclerosis is the most frequent cause of conductive hearing loss in patients with intact tympanic membrane. It can be treated by surgery with various techniques. Because of limited manipulation and comparably similar results, stapedotomy at present is preferred over other surgical techniques by most surgeons. Here we present the operative results of 114 otosclerotic patients who underwent stapedotomy between 1997-2002 in Rahnemoom hospital, Yazd and Amiralam hospital, Tehran. The aim of this study is to evaluate the efficacy and safety of stapedotomy in otosclerosis surgery. The average air-bone gaps of patients improved significantly from 41.82 db to 14.23 db after operation. Other hearing parameters of patients (including air conduction, bone conduction and speech discrimination score) also improved significantly. Permanent vertigo did not occur after operation and preoperative tinnitus resolved in 56 of 78 patients. Stapedotomy is a safe and effective modality for improving conductive hearing loss in otosclerotic patients

The effect of intravenous dexamethasone in reducing periorbital edema, ecchymosis and intraoperative bleeding in rhinoplasty patients

Background: In rhinoplasty, periorbital edema and ecchymosis is due to soft tissue trauma and small vessel injury with subsequent exudation and bleeding. The main purpose of this study is to determine the effect of dexamethasone in reducing periorbital edema and ecchymosis and intraoperative bleeding in rhinoplasty patients.Methods: This double-blind study included 90 patients who underwent rhinoplasty from October 2004 to March 2005. In group A, 8 mg of intravenous dexamethasone was administered only preoperatively. In group B, 8 mg of dexamethasone was administered preoperatively and continued every 8 hours postoperatively. Group C, the control group, received no dexamethasone. Results: The degree of upper lid edema in groups A and B was significantly less than that of group C. During the first and second day the severity of upper lid edema in group B was less than that of group A, but the difference was not significant. The degree of lower lid edema during the first and second days in groups A and B was significantly less than that of group C, although it was identical in all groups during the fifth and seventh days. The degree of upper lid ecchymosis during the first and fifth days in group C was significantly more than that of groups A and B, but it was similar on the seventh day in all groups. The degree of lower lid ecchymosis on the first day in groups A and B was significantly less than that of group C; however, it was similar in all groups during the second, fifth and seventh days. The volume of intraoperative bleeding in the three groups was similar. The mean period of recovery (12 days) was comparable in all groups.Conclusions: Dexamethasone administration leads to the reduction of upper lid edema, ecchymosis and lower lid edema during the first and second postoperative days, and reduction of lower lid ecchymosis on the first postoperative day

The effect of intravenous Dexamethasone and local Bupivacaine in post -tonsillectomy vomiting and pain

 Background: Tonsillectomy is the second most common pediatric surgery. Despite improvements in anesthetic and surgical technique, post-tonsillectomy pain continues to be a significant clinical concern for the patient, family, and physician. Young patients undergoing tonsillectomy experience postoperative pain and vomiting resulting in delays in oral feeding and in discharge from the hospital. Reduction of these side effects will lead to the improved quality of postoperative care. This study was performed to compare the efficacies of local Bupivacaine and intravenous Dexamethasone with that of a placebo on post-tonsillectomy pain and vomiting.Methods: This clinical trial included 120 ASA I children, aged 3-15 years, undergoing tonsillectomy. The patients were randomly categorized into three groups: 1- local infiltration of 2 ml normal saline into the tonsillar pillar as a placebo; 2- IV Dexamethasone (0.5 mg/kg, with a maximum of 16 mg); 3- local infiltration of 2 ml 0.5% Bupivacaine into the tonsillar pillar. After the operation, patients were observed regarding vomiting and pain at 0.5, 4, 24, 120 hours postextubation.Results: Of 120 patients, 70 were male and 50 were female. The mean age of patients was 8.4 years. Three patients were missed in follow up. The questionnaire was completed for 117 patients. The mean duration of operation was longest in the placebo group (55 minutes) and shortest in Dexamethasone group (50 minutes). We noticed significant reduction in postoperative pain only in the Bupivacaine group and at the fourth postoperative hour. In the Dexamethasone group, during the first 24 hours, we could not statistically analyze the effect on vomiting. Since Bupivacaine and Dexamethasone reduce postoperative pain and vomiting, respectively, and are safe, cost-effective and available, we recommend using these drugs for tonsillectomy patients.Conclusion: Considering the greater efficacy of Dexamethasone in the reduction of vomiting and that of Bupivacaine in pain reduction in other studies, we recommend further study to assess the use of these two drugs together

Quality of Life and Voice Changes After a Single Injection in Patients With ADSD Over Time

Introduction: Adductor spasmodic dysphonia (ADSD) is one of the most disabling voice disorders with no permanent cure. Patients with ADSD suffer from poor voice quality and repeated interruption of phonation that leads to limitations in daily communication. Botox (BT) injection, considered the gold standard treatment for ADSD, reduces the amount of voice breaks and improves voice quality for a limited period. In this study, patients with ADSD were followed after a single BT injection to track the changes in QOL and perceptual voice quality over a 6-month period. Method: This is a prospective and longitudinal study. Fifteen patients with ADSD were evaluated preinjection and 1, 3, and 6 months postinjection. They completed the Voice Activity and Participation Profile-Persian Version (VAPPP) and read a passage at each recording period. Perceptual assessment was done by three expert speech-language pathologists with knowledge of ADSD using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The data were analyzed using Friedman, Wilcoxon, and McNemar tests. The significance level was set at P < 0.05. Results: The VAPPP total score and each of the domain scores reached their peak scores at 3 months postinjection. At 6 months postinjection, the VAPPP scores increased significantly in comparison with the 3-month scores and but were lower than preinjection scores. GRBAS results also indicated that patients� voices at 1 and 3 months postinjection were significantly less severe in terms of strain and roughness (P = 0.01; P < 0.001, respectively). Conclusion: BT injection resulted in improvement of subjects� QOL. The improvement was greatest at 3 months postinjection but remained above the preinjection values at 6 months after injection. The voice quality also improved but was not judged as normal. © 2018 The Voice Foundatio

Quality of Life and Voice Changes After a Single Injection in Patients With ADSD Over Time

Introduction: Adductor spasmodic dysphonia (ADSD) is one of the most disabling voice disorders with no permanent cure. Patients with ADSD suffer from poor voice quality and repeated interruption of phonation that leads to limitations in daily communication. Botox (BT) injection, considered the gold standard treatment for ADSD, reduces the amount of voice breaks and improves voice quality for a limited period. In this study, patients with ADSD were followed after a single BT injection to track the changes in QOL and perceptual voice quality over a 6-month period. Method: This is a prospective and longitudinal study. Fifteen patients with ADSD were evaluated preinjection and 1, 3, and 6 months postinjection. They completed the Voice Activity and Participation Profile-Persian Version (VAPPP) and read a passage at each recording period. Perceptual assessment was done by three expert speech-language pathologists with knowledge of ADSD using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The data were analyzed using Friedman, Wilcoxon, and McNemar tests. The significance level was set at P < 0.05. Results: The VAPPP total score and each of the domain scores reached their peak scores at 3 months postinjection. At 6 months postinjection, the VAPPP scores increased significantly in comparison with the 3-month scores and but were lower than preinjection scores. GRBAS results also indicated that patients� voices at 1 and 3 months postinjection were significantly less severe in terms of strain and roughness (P = 0.01; P < 0.001, respectively). Conclusion: BT injection resulted in improvement of subjects� QOL. The improvement was greatest at 3 months postinjection but remained above the preinjection values at 6 months after injection. The voice quality also improved but was not judged as normal. © 2018 The Voice Foundatio