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Concept: Rhinology


Balloon dilation technology (BDT), also known as balloon sinuplasty, has been in clinical use since September, 2005. Prior to BDT, surgeons performed a procedure called FESS, or functional endoscopic sinus surgery, for patients with chronic sinusitis. As is true with any new technology or procedure in medicine, a debate often ensues between early adopters and mainstream practitioners. Over the past 7 years, much has been discussed, debated, and learned about BDT. What follows is a review of the origins of the BDT: the theory, technology, indications and applications; and a review of the pertinent outcomes literature. Independent of how one feels about BDT, the evidence strongly supports its safety, efficacy, and growing popularity among patients and physicians alike.

Concepts: Medicine, Hospital, Surgery, Sinusitis, Physician, Otolaryngology, Functional Endoscopic Sinus Surgery, Rhinology


The use of nasal irrigation in the management of postoperative endoscopic sinus surgery (ESS) patients is commonplace; however, the potential contamination of these bottles is concerning. The Sinugator® cordless pulsating nasal wash (NeilMed Pharmaceuticals, Inc., Santa Rosa, CA) is a battery-operated, positive pressure, pulsatile pump with a unidirectional flow. The principal aim of this study was to determine the incidence of cross-contamination using the pulsating nasal irrigation device and compare it with the traditional squeeze bottle.

Concepts: Medicine, Mucus, Bottle, Bottles, Hygiene, Nasal cavity, Nasal irrigation, Rhinology


A concha bullosa forms when the middle turbinate becomes pneumatized, which is a common anatomic variation; however, fungus ball in concha bullosa is rather rare. An otherwise healthy 52-year-old man presented to our ear, nose and throat clinic with the complaints of midfacial pressure headache and malodorous postnasal drip. Computed tomography of the paranasal sinuses demonstrated a polypoid hyperdense lesion with slight microcalcifications in the right nasal cavity, accompanied with a complicated fluid collection in the right frontoethmoideal recess seen as hypodensity in contrast to this hyperdensity. The histopathological examination reported a fungal infection. We present an extremely rare case of isolated fungal mass in the right middle concha detected in an early stage without any evidence of fungal infection of the other paranasal sinuses and discuss the importance of reevaluation of the computed tomography scans in suspicion of a fungal sinusitis.

Concepts: Medicine, Sinusitis, Respiratory system, Nose, Nasal cavity, French Revolution, Concha bullosa, Rhinology


Objective: To evaluate the postoperative clinical effects of balloon sinuplasty on chronic rhinosinusitis. Methods: PubMed, OVID, Embase, Cochrane Library, Proquest, Web of Science, Sinomed, Wan Fang and CNKI database (from established time to March of 2017) were searched for trials about the chronic rhinosinusitis treated by balloon sinuplasty. The relavent literatures were screened, and the prospective control studies were chosen. Lund-Mackay and SNOT-20 scores were used as the outcome idicators, and the methodological quality of the literatures were evaluated strictly. The extracted data were analyzed by Revman 5.3 software. Results: A total of 7 prospective before-after self-controlled studies were included, and the overall quality of which was relatively high. Meta-analysis showed that the Lund-Mackay scores at 6 months post-operation, the SNOT-20 scores at 6 months and more than 1 year post-operation were significant lower than baseline when balloon sinuplasty used in the surgery; the SNOT-20 scores at more than 1 year post-operation was lower than baseline when a standalone ballon sinuplasty was performed. All the results was statistically significant (P<0.05), and all the SMD were more than 0.8. Conclusions: The postoperative effect of balloon sinuplasty on chronic rhinosinusitis is obvious, and the subjective symptoms in patients is relieved effectively.

Concepts: Statistics, Evidence-based medicine, Statistical significance, Effectiveness, MEDLINE, Effect size, Otolaryngology, Rhinology


Previous studies have shown controversial results of topical amphotericin B (AMB) nasal irrigation for chronic rhinosinusitis (CRS). The purpose of this study was to evaluate the efficacy of 200 μg/mL AMB nasal irrigation as an adjuvant therapy after functional endoscopic sinus surgery (FESS).

Concepts: Medicine, Sinusitis, Amphotericin B, Adjuvant, Otolaryngology, Functional Endoscopic Sinus Surgery, Rhinology


Steroid nasal irrigation for chronic rhinosinusitis patients following endoscopic sinus surgery reduces symptom recurrence. There are minimal safety data to recommend this treatment. This study evaluated the safety of betamethasone nasal irrigation by measuring its impact on endogenous cortisol levels.

Concepts: Sinusitis, Glucocorticoid, Cortisol, Mucus, Nasal cavity, Functional Endoscopic Sinus Surgery, Nasal irrigation, Rhinology


Balloon Sinuplasty for the management of paranasal sinus inflammatory diseases was introduced in otolaryngology in 2005. Over the past decade, evidence strongly supports its safety and efficacy for the treatment of chronic rhinosinusitis (CRS) in adults. Because it requires no bone or tissue removal, this procedure could be suitable in children. We present our initial experience of its use for the treatment of CRS in children.

Concepts: Medicine, Extracellular matrix, Sinusitis, Effectiveness, Meningitis, Otolaryngology, Rhinology, Balloon Sinuplasty


Objectives Polypoid change of the middle turbinate (PCMT) is a finding on intranasal examination whose significance is not well understood. We present a comparison of the clinical characteristics of PCMT with paranasal sinus polyposis (PSP), a common condition with potentially similar appearance. Study Design Parallel case series. Setting Tertiary rhinology clinic. Subjects and Methods Data were prospectively compiled from consecutive patients during a 12-month period with either PSP arising from the middle meatus or PCMT limited to the middle turbinate as identified on nasal endoscopy. Recorded data included comorbidities, the 22-item Sinonasal Outcome Test (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE), Lund-Mackay score from computed tomography (CT) imaging, and total eosinophil levels. Results Of 593 patients, 23 (3.9%) had PCMT and 44 (7.4%) had PSP. The PSP group was predominantly male (75% vs 52%, P < .001) with an older mean age (53.4 vs 35.4 years, P < .0001). PCMT was more often associated with allergic rhinitis (83% vs 34%, P < .001), whereas PCMT was rarely associated with chronic rhinosinusitis (10% vs 100%, P < .0001). Mean eosinophil count (7.1 vs 3.1, P = .096) was not significantly different between groups, whereas mean Lund-Mackay score was higher in PSP (14.9 vs 2.8, P < .0008). Mean NOSE score was greater in PSP (65.3 vs 46.8, P = .025), whereas SNOT-22 score was comparable between groups (40.6 vs 34.6, P = .29). Conclusion PCMT is a unique physical finding with clinical associations that distinguish it from PSP. PCMT has greater association with allergic rhinitis than chronic rhinosinusitis, and both PCMT and PSP are associated with impaired quality of life.

Concepts: Asthma, Sinusitis, Allergy, Nose, Rhinitis, Rhinorrhea, Nasal congestion, Rhinology


Over the past decade, the use of balloon sinuplasty has increased widely in the United States. Since its introduction, no nationally representative, population-based study has examined its use among chronic rhinosinusitis (CRS) patients.

Concepts: United States, Poverty in the United States, U.S. state, Otolaryngology, Nationalism, United States House of Representatives, Rhinology, Balloon Sinuplasty


To describe sinus procedure trends from 2000 to 2014, particularly following the introduction of balloon sinuplasty Common Procedural Technology (CPT) codes in 2011.

Concepts: Otolaryngology, Rhinology