Abstract
Allergy: It’s Not Just The Nose!
Christopher D. Brook, MD (moderator); J. Pieter Noordzij, MD; Maria C. Veling, MD; Peter C. Weber, MD, MBA
Session Description:
This miniseminar will provide up-to-date, evidence-based information regarding the effect of allergy on the ear, oral cavity, paranasal sinuses, pharynx, and larynx. The role of allergy in diseases such as eustachian tube dysfunction, chronic otitis media, Ménière’s disease, obstructive sleep apnea, chronic cough, laryngitis, sinusitis, and oral allergy syndrome will be discussed by experts in each individual field. The pathophysiology, clinical features, and treatment options will be reviewed. The learner will leave the course with a more comprehensive understanding of the impact and manifestations of allergic disease throughout the head and neck.
Outcome Objectives:
(1) Describe the role of allergic disease in the pathophysiology of the sinuses, ears, oral cavity, obstructive sleep apnea, pharynx, and larynx. (2) Describe the role of allergy testing in head and neck diseases other than allergic rhinitis. (3) Describe the role of allergy treatment in the management of diseases of the head and neck other than allergic rhinitis.
Aspirin-Exacerbated Respiratory Disease: State-of-the-Art Multidisciplinary Management in 2021
Waleed M. Abuzeid, MD (moderator); Zara M. Patel, MD; Joshua M. Levy, MD, MPH; Elina Jerschow
Session Description:
Aspirin-exacerbated respiratory disease (AERD) is a syndrome consisting of chronic rhinosinusitis with nasal polyposis, respiratory reactions to nonsteroidal anti-inflammatory drugs, and eosinophilic asthma. AERD affects approximately 0.9% of the general population in the United States. The prevalence of AERD is much higher among certain groups including asthmatics (10%–20%), patients with nasal polyposis (10%), and in asthmatics with polyposis (40%). Despite an increased recognition of this disease entity, there continues to be an average delay of 10 years between onset of symptoms and the formal diagnosis of AERD. Once diagnosed, the adequate management of symptoms in AERD patients continues to be a challenge. Despite the introduction of several new medical treatment options such as immunomodulating biologics and surgical options including extended endoscopic sinus surgery, the respective roles of medical and surgical treatment options in the management of AERD has yet to be fully established. This miniseminar will engage attendees in an evidence-based discussion incorporating real cases. Attendees will learn about the efficient diagnosis of AERD, including the importance of timing of the diagnostic aspirin challenge and the need for coordination of the management plan with allergy providers. Attendees will achieve insight into the role of endoscopic sinus surgery, including extended sinusotomies, nasalization, and resection of involved structures, all of which will be debated. The role of aspirin therapy in the era of biologics and the nuances of these treatment approaches will be discussed. Attendees will also learn about adjunctive treatments such as dietary modification. Attendees will gain an understanding of the optimal timing of medical and surgical interventions. The multidisciplinary panel consists of academic specialists in allergy/immunology and rhinology with considerable expertise in AERD.
Outcome Objectives:
(1) Understand how to efficiently identify potential cases of AERD and confirm the diagnosis through history, physical examination, and objective testing. (2) Review the evidence underlying the role of aspirin therapy, immunomodulating biologics, and adjunctive treatments in the management of AERD. (3) Discuss the role of primary and revision endoscopic sinus surgery in controlling AERD and appreciate where surgery fits in the context of advanced medical therapies.
Avoiding Complications in Endoscopic Sinus Surgery
David A. Gudis, MD (moderator); Kibwei A. McKinney, MD; Benjamin S. Bleier, MD; Zach Soler, MD, MSc
Session Description:
Primary and revision endoscopic sinus surgery is performed frequently by otolaryngologists with a high rate of success, but complications can be devastating. This panel discusses preoperative and intraoperative considerations and recommendations to minimize the risk of surgical complications. The format is a unique combination of the panelists’ own tips and tricks in addition to a review of the current evidence and knowledge base, equipping the practitioner with several essential tools with which to stay safe and avoid complications in endoscopic sinus surgery. The panel offers a critical understanding of preoperative computed tomography (CT) review, essential intraoperative fixed anatomic landmarks, image-guided navigation, perioperative pain management, antibiotics and steroids, surgical hemostasis, and the best practice immediate management of dreaded surgical complications when they do occur.
Outcome Objectives:
(1) Understand how to review a sinus CT scan for high-risk anatomy and recognize critical intraoperative landmarks. (2) Implement intraoperative techniques to maximize surgical hemostasis. (3) Develop familiarity with the best practice immediate management of intraoperative complications.
Balloon Sinus Dilation: Indications, Technique, and Evidence
Waleed M. Abuzeid, MD (moderator); Spencer C. Payne, MD; Satish Govindaraj, MD; Michael Setzen, MD
Session Description:
Balloon sinus dilation involves the use of catheter-based devices to dilate sinus ostia with the goal of improving the ventilation and drainage of diseased sinuses in the treatment of a variety of inflammatory sinus disease pathologies. Although increasingly popular, this technique is debated with regard to its efficacy in an expanding body of literature. Furthermore, there is increasing concern regarding the potential overuse of this technology. Consequently, the American Academy of Otolaryngology–Head and Neck Surgery Foundation published Clinical Consensus Statement: Balloon Dilation of the Sinuses in 2018 to ensure patient safety and proper utilization. This miniseminar will engage attendees in an evidence-based discussion regarding the indications, contraindications, and outcomes for balloon sinus dilation in the operating room and office setting. Attendees will enhance their understanding of the primary findings, conclusions, and limitations of the scientific literature as it relates to balloon sinus dilation and as viewed from the perspectives of the panel members. Attendees will gain insight into the controversy surrounding potential overuse and abuse of balloon sinus dilation. They will also gain practical knowledge pertaining to the successful use of balloon sinus dilation, as well as possible complications directly related to the use of this technology. The panelists are experts in advanced rhinology from both academic and private practice environments and all have significant experience, and varied views, on balloon sinus dilation.
Outcome Objectives:
(1) Understand the indications, contraindications, techniques, and outcomes for balloon sinus dilation. (2) Discuss the primary findings, conclusions, and limitations of the scientific literature related to balloon sinus dilation. (3) Review the evidence underlying claims of overuse of this technology and the factors that may influence physician utilization.
Biologics for Nasal Polyps: Why, Who, and When
Devyani Lal, MD (moderator); Matthew A. Rank, MD; Stella E. Lee, MD; Joseph K. Han, MD
Session Description:
The recent approval of dupilumab for severe cases of chronic rhinosinusitis with nasal polyposis (CRSwNP) provides clinicians with a novel therapeutic tool. Current experience with dupilumab shows that the agent can be very effective in some but not all patients. It is also unclear how long patients may require maintenance on dupilumab and what long-term adverse effects and total costs might be. Many patients with recurrent nasal polyposis have severe biologically recalcitrant disease, whereas in others, inadequate surgery may contribute to early recurrence of nasal polyps. Given these considerations, diligence must be exercised in selecting patients for biologic therapy vs standard of care (surgery and conventional maintenance medical therapy). While patients with severe biological recalcitrance may be optimally served by the use of a biologic, other patients may be well or better served by standard of care utilizing meticulous revision surgery and postoperative maintenance medical therapy. Thoughtful interpretation of postoperative sinus computed tomography and lower airway and immunologic testing is crucial to determine the most appropriate therapeutic intervention. Biologically recalcitrant CRSwNP patients often have coexistent asthma, aspirin-exacerbated respiratory disease, eosinophilic granulomatosis with polyangiitis, and other immunological abnormalities. Multidisciplinary management of these patients with an allergist-immunologist is optimal. This panel of seasoned experts in otolaryngology and allergy immunology will discuss optimal use of biological therapy for CRSwNP. Using illustrative case presentations, we will outline how to identify which patients are best suited for potential biological therapy. In addition, we will also discuss practical steps and considerations in administering dupilumab. While dupilumab is currently the only approved biologic for CRS, trial results for other biologics in CRSwNP have been published. Each biologic targets a distinct mechanism in CRS pathogenesis, and we will highlight salient trial results as well.
Outcome Objectives:
(1) Evaluate candidature of CRSwNP patients for biologic therapy vs standard of care. (2) Explain potential adverse effects of dupilumab, omalizumab, and other biologics in the pipeline for potential approval for CRSwNP. (3) Implement plans for administration of biologic therapy in office-based practices.
Chronic Cough: Addressing Multifactorial Sources
Angela M. Donaldson, MD (moderator); Joseph K. Han, MD; Elina Toskala, MD, MBA, PhD; Johnathan Bock, MD
Session Description:
Chronic cough can be a debilitating condition with a significant impact on quality of life. It is temporally defined as symptoms present for greater than 8 weeks in adults and 4 weeks in children. Its prevalence is approximately 11% in the United States, and one-fifth of these patients also have a diagnosis of chronic rhinosinusitis. For otolaryngologist, it can be one of the most daunting diagnoses to treat. There are no standardized guidelines for the workup of chronic cough, and decision making on a treatment regimen is complicated by the fact that many of these patients have multiple causes of cough, including asthma, gastroesophageal reflux, obesity, chronic bronchitis, chronic obstructive pulmonary disease, heart failure, and medication side effects. Determining which of these disease processes are contributing to the cough is a challenge to most otolaryngologists. In this multidisciplinary panel, we will use interactive case presentations to discuss the workup, treatment algorithms, and various medical therapies to address these difficult patients. This presentation will discuss practical tips to use when deciding to proceed with surgery vs medical therapy in the setting of chronic rhinosinusitis or abnormal imaging studies. This panel will focus on more complex patient presentations with 1 or more causes of cough. Our panelists will describe how they implemented a cough clinic into their practice and tips for patient selection. Lastly, the experts will discuss new medication interventions, such as gefapixant, that may change the way we treat chronic cough.
Outcome Objectives:
(1) List workup exams, imaging, and labs for different phenotypes of cough. (2) Identify ways new therapies may be implemented in the treatment of chronic cough. (3) Apply treatment algorithms used by specialty experts to help manage complex multifactorial chronic cough.
Controversies in the Contemporary Management of Nasal and Sinus Disease
Joseph K. Han, MD (moderator); Rakesh K. Chandra, MD; Eric H. Holbrook, MD; Pete S. Batra, MD
Session Description:
The past decade has hallmarked considerable evolution in the management of nasal and sinus disease. This has emerged from a proliferation in technology, mounting clinical experience, clinical and translational evidence, and a better understanding of the physiological basis of many nasal and sinus disorders. Simultaneously, socioeconomic pressures have affected practice patterns. The cumulative effect of these forces has led to many novel and alternative therapeutic pathways in the management of various sinonasal conditions. Consequently, this has also led to many controversies regarding what constitutes best practice with regard to patient satisfaction, objective outcomes, and economic value. The panel is composed of an experienced and diverse group of fellowship-trained rhinologists who will examine these controversies, largely utilizing a case-based format in which each given case will highlight 1 or more particular points of controversy. Potential topics to be explored include (1) in-office surgery vs an alternate care site vs a hospital operating room, (2) balloon sinuplasty vs conventional functional endoscopic sinus surgery, (3) what constitutes maximum medical therapy, (4) the role of surgery for headaches, (5) the value of nasal or sinus surgery in sleep apnea, (6) pain management in sinonasal surgery, and (7) use of biologics in chronic rhinosinusitis. The discussion will include a mixture of evidence-based recommendations, expert opinion, and current practice guidelines. We will also address how these cases may have been handled in the past and how the current environment has shaped practice.
Outcome Objectives:
(1) Identify areas of variation in practice patterns in the management of nasal and sinus disease. (2) Explore how the proliferation of treatment options has led to controversies in medical decision making. (3) Apply evidence, expert opinion, and current treatment guidelines to promote best subjective and objective outcomes.
Evidence-Based Rhinology for the General Otolaryngologist
Michael G. Stewart, MD, MPH (moderator); Abtin Tabaee, MD; Stacey Gray, MD
Session Description:
Advances in pathophysiology and treatment have allowed for greater refinement in the medical and surgical management of chronic rhinosinusitis (CRS). Given the rapidly evolving and dynamic nature of the literature, the otolaryngologist needs to be up to date on the latest evidence and clinical guidelines. This course will provide a framework for interpreting and applying evidence-based medicine (EBM) and evidence-based guidelines. The panelists will summarize current EBM recommendations and the underlying research for fundamental aspects of medical and surgical treatment of CRS. This evidence-based approach will help the clinician understand the current guidelines and recommendations and also allow them to interpret new evidence as it is released. We will use a case-based approach to pose management questions from actual cases and then address the literature supporting management decisions.
Outcome Objectives:
(1) Demonstrate a detailed understanding of evidence-based treatment for CRS. (2) Understand and apply evidence-based guidelines to the clinical care of a patient with CRS. (3) Interpret the clinical implications and limitations of evidence-based medicine guidelines in CRS.
Gussak Memorial: Avoiding Bad Results in Sinus Surgery
Martin J. Citardi, MD (moderator); Yvonne Chan, MD; Scott M. Graham, MD
Session Description:
This panel presentation will explore the causes of poor outcomes after endoscopic sinus surgery by addressing the theory and technique of functional endoscopic sinus surgery. The discussion will focus on the surgical management of the middle turbinate, maxillary ostium, frontal recess, and the sphenoethmoid recess. Postoperative management will be emphasized. Recognition and management of complications will be reviewed. Case presentations will serve to highlight the relevant principles. New technology, including steroid-releasing implants, as well as innovative devices, will be presented as solutions for complex surgical problems. In addition, the selection of surgical tactics will be discussed in the setting of presumed disease mechanisms of chronic rhinosinusitis. Throughout the session, the emphasis will be on practical solutions. The expert panelists will include formal didactic presentations as well discussions and will share their personal experiences in treating patients with complex rhinosinusitis. Throughout the session, lessons that can be applied immediately in the care of these patients will be highlighted. Specific cases will serve to illustrate the relevant concepts and techniques. Audience participation will be encouraged.
Outcome Objectives:
(1) Discuss potentially catastrophic complications of endoscopic sinus surgery, with an emphasis on pattern recognition that may mitigate these complications. (2) Emphasize comprehensive perioperative strategies (including intraoperative optimization and postoperative medical management) to achieve optimal surgical outcomes. (3) Review specific surgical techniques for endoscopic sinus surgery of specific sinus subsites (frontal sinus, ethmoid, maxillary sinus, and middle turbinate).
Harnessing Opportunities of Office-Based Treatment of Rhinitis and Sinusitis
Amber Luong, MD, PhD (moderator); Martin J. Citardi, MD; R. Peter Manes, MD
Session Description:
Through case presentations, the panel will discuss novel office-based treatment options for common sinonasal complaints such as nasal obstruction, eustachian tube dysfunction, and postnasal drainage. Over the past 3 years, new office devices have facilitated the introduction of new office treatments for common conditions with limited solutions. The advent of new Current Procedural Terminology codes opens up payment mechanisms that should increase patient access to these treatments. Practicing ear, nose, and throat surgeons can now offer cryotherapy or radiofrequency for postnasal drainage, radiofrequency remodeling for nasal obstruction, steroid-eluting devices for recurrent nasal polyps, balloon dilation for eustachian tube dysfunction, and nasal implants for nasal congestion. In this program, the panel will discuss new treatments and review the mechanism of action and data on their efficacy through case presentations. The presentation will also delve into reimbursement options and business practice implications with these office-based treatments. Finally, appropriate coding associated with these treatment options will also be discussed.
Outcome Objectives:
(1) Understand novel office-based treatment options for nasal valve collapse, postnasal drainage, and eustachian tube dysfunction. (2) Interpret efficacy data on these novel technologies. (3) Assess billing and reimbursement options for these novel technologies.
Innovations in Office-Based Therapy of the Rhinology Patient
Kibwei A. McKinney, MD (moderator); Martin J. Citardi, MD; Pete S. Batra, MD; R. Peter Manes, MD
Session Description:
Since the advent of balloon sinus dilation, there has been a proliferation of office-based techniques utilized in the treatment of diseases that affect the nose and paranasal sinuses. For these technological advances to be successful, they must be appropriately applied based on disease- and patient-specific factors. This first part of this session will focus on the selection of patients and the preauthorization process that is required to ensure reimbursement. This will include a discussion of how to counsel patients in preparation for the planned procedure. The session will then address the various anesthetic methods used in the awake patient to ensure patient comfort, including the administration of systemic and topical agents. Technical advances in nasal obstruction, including subcutaneous stenting and radiofrequency ablation of the nasal valve, will then be reviewed. This will consist of technical descriptions of these procedures and a discussion of the expected outcomes and potential complications. Nonresorbing steroid-eluting implants have recently gained favor in the long-term management of chronic rhinosinusitis with nasal polyposis. The session will conclude with a review of the data that support the use of these adjuvant therapies and address the maintenance issues that may arise while they are in place.
Outcome Objectives:
(1) Master the preauthorization process for office-based procedures, including balloon sinus dilation, nasal obstruction techniques, drug-eluting stent placement, and vidian nerve cryoablation. (2) Implement a local anesthetic protocol that may be used to facilitate the successful execution of office-based procedures in the awake patient. (3) Gain mastery of novel techniques used to treat nasal obstruction in the awake patient while minimizing patient discomfort and understand the role of drug eluting stents in the care of chronic rhinosinusitis with nasal polyps.
In-Office Rhinologic Procedures
David Brodner, MD (moderator); Christie A. Barnes, MD; Patricia A. Loftus, MD; Seth M. Brown, MD, MPH
Session Description:
The procedural management of rhinology patients is quickly evolving to incorporate minimally invasive in-office technology. Over the past few years, several medical devices have been introduced as new options for the management of vasomotor rhinitis, nasal valve collapse, and eustachian tube dysfunction. The advent of this new technology is accompanied by opportunities to determine best practices in patient selection, procedure technique, office setup, and overcoming reimbursement challenges. This panel will analyze published data and draw upon personal experience to clarify patient selection and outcomes, offer tips and pearls to refine anesthetic and surgical technique, give guidance on office equipment requirements and staff training, compare various device options, and discuss coding and reimbursement issues.
Outcome Objectives:
(1) Demonstrate understanding of patient selection and procedural technique for in-office treatment of vasomotor rhinitis, nasal valve collapse, and eustachian tube dysfunction. (2) Understand office flow, equipment requirements, and reimbursement issues. (3) Provide knowledge for attendees to implement their own in-office minimally invasive practice.
Invasive Fungal Sinusitis: Up-to-Date Treatment Strategies
Patricia A. Loftus, MD (moderator); Lauren Roland, MD; Matthew S. Russell, MD; Justin H. Turner, MD
Session Description:
Invasive fungal sinusitis is a highly morbid disease and a true otolaryngologic emergency. Guidelines for management of these complex patients are currently lacking. In this presentation, we will review the current data regarding treatment options and outcomes for both acute and chronic invasive fungal sinusitis. We will examine symptomatology, pathology, and computed tomography and magnetic resonance imaging findings, the latter which can oftentimes guide surgical planning very precisely. We will cover indications for transfer to a tertiary medical center and options for long-term follow-up of these at-risk patients. Lastly, we will discuss future research needs to improve our understanding of this disease process and help guide patient management and improve patient outcomes. Every otolaryngologist will encounter this disease process in their careers at some point. Early diagnosis and a basic understanding of treatment options are absolutely vital to ensure best possible patient outcomes.
Outcome Objectives:
(1) Demonstrate an understanding of the current literature regarding invasive fungal sinusitis and review medical and surgical treatment algorithms, with an emphasis on early diagnosis and treatment. (2) Interpret symptomatology, pathology, and imaging findings consistent with an invasive fungal sinusitis diagnosis. (3) Discuss future research needs to improve understanding and treatment of invasive fungal sinusitis.
The Multidisciplinary Approach to Hereditary Hemorrhagic Telangiectasia (HHT)
Troy D. Woodard, MD (moderator); Joseph Parambil, MD; Charles Martin, MD
Session Description:
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant vascular disorder that affects approximately 1 in 5000 individuals. It is characterized by dysplasia of both large vessels that include arteriovenous malformations and of small vessels that include telangiectasias. Debilitating epistaxis is the most common symptom of HHT, but the disease often affects multiple organs and requires a multisystem and multidisciplinary approach to successfully manage these patients. The purpose of this panel is to provide an overview of the multidisciplinary approach use to diagnose, evaluate, and treat patients with HHT. We will utilize the expertise of a nationally known otolaryngologist, pulmonologist, and interventional radiologist to discuss novel pharmacologic and surgical treatment options available for HHT-related epistaxis and multiorgan disease in a case-based format. Lastly, this panel will also demonstrate the importance of the team approach while treating patients with multiorgan disease and discuss how multidisciplinary care results in significant better outcomes.
Outcome Objectives:
(1) Discuss novel medical and surgical approaches to the management of epistaxis in HHT. (2) Highlight a multidisciplinary approach to diagnose and manage HHT and use genetic testing to identify mutations that predispose patients to have overlapping features of juvenile polyposis syndrome. (3) Emphasize the importance of surveillance for silent internal organ involvement that can be treated prophylactically prior to any clinical manifestations.
Strategic Management of Nasal Polyposis Using FESS, Biologics, and Biomarkers
Christine B. Franzese, MD (moderator); Cecelia Damask, DO; Stella E. Lee, MD; Sarah K. Wise, MD, MSCR
Session Description:
Chronic sinusitis with nasal polyposis is becoming more widely recognized as a type 2 inflammatory disease, but the best treatment strategies for personalized patient treatment and which biomarkers to use to predict treatment success are still being investigated. For some patients, a complete functional endoscopic sinus surgery (FESS) followed by medical therapy is successful at controlling disease recurrence. For others, this is not the case, and numerous additional surgeries to control the burden of disease are sometimes required. There is the potential to use available biomarkers and patient profile characteristics to direct therapy to minimize the need for further additional surgery and corticosteroid use. In addition, with more than 1 US Federal Drug Administration-approved biologic for nasal polyps available and additional phase 3 trials combining biologic use with surgery, otolaryngologists face not only the clinical dilemma of whether a biologic agent is necessary but also which one to use and when to initiate the agent—before considering additional surgery, after performing surgery, or concurrently. This panel uses updated patient cases with biomakers, images, and videos, as well as currently available evidence and guidelines, to discuss different therapeutic approaches to treatment and ways to potentially answer these questions: Who will do well with just surgery and medicated rinses? If a biologic is needed, which one is best to use, and when should it be initiated?
Outcome Objectives:
(1) Describe the utilization of biologic therapies for chronic rhinosinusitis with nasal polyposis (CRSwNP) alone, pre-FESS, and post-FESS. (2) Discuss the available biomarkers, patient profiles/characteristics, and their practical clinical application in decision making for treatment of CRSsNP and biologic agent selection. (3) Discuss a guided, personalized treatment approach to CRSwNP using FESS, medical therapy, and biologics.
Therapeutic Innovations in Rhinosinusitis: From Bench Research to Clinical Practice
Jivianne T. Lee, MD (moderator); Joseph K. Han, MD; Andrew Lane, MD; Troy Woodward, MD
Session Description:
Effective management of chronic rhinosinusitis (CRS) continues to remain a challenge. Despite appropriate therapy, a significant proportion of CRS patients develop recurrent disease with substantial impact on their quality of life. However, recent years have witnessed major advances in laboratory research that have greatly expanded our understanding of the pathophysiology of CRS. Such insights have led to the development of novel therapeutic options for recalcitrant disease. The purpose of this panel presentation is to discuss new, cutting-edge basic science research in rhinology and delineate how these findings have translated into innovative treatments for both chronic rhinitis and sinusitis. Current work aimed at defining CRS endotypes will be reviewed and their relationship to emerging systemic biologics addressed. The varied mechanisms of action, immunomodulatory capabilities, and clinical efficacy of these burgeoning agents will be elucidated in the context of CRS endotypes. The role of epithelial innate immunity and its clinical implications in CRS will also be assessed. Novel surgical approaches for recalcitrant CRS that have arisen from irrigation distribution studies will be delineated. The indications and techniques involved with such revision surgical salvage procedures will be described in conjunction with video presentations. Finally, new technologies will be presented along with the current evidence for their use in chronic rhinitis and sinusitis, including radiofrequency and cryoablation therapy. This session will be conducted by academic rhinologists using an interactive case-based format with audience polling.
Outcome Objectives:
(1) Discuss the scientific basis underlying novel medical therapies for CRS, including systemic biologics and emerging immunomodulators. (2) Describe new surgical approaches and recent technologic innovations for management of recalcitrant CRS. (3) Understand the relevant evidence, outcomes, and indications for each therapeutic modality in patients with CRS.
Treating Patients With Cystic Fibrosis: Best Practices, Strategies, Updates 2021
Amanda L. Stapleton, MD (moderator); Brent A. Senior, MD; Stella E. Lee, MD; Adam J. Kimple, MD, PhD
Session Description:
Sixty percent of pediatric and adult patients with cystic fibrosis (CF) report chronic rhinosinusitis (CRS) symptoms when questioned and endoscopic and radiographic evidence of sinonasal inflammation is nearly universal. Frontal headaches, anosmia, obstruction, discharge, and congestion are all common to the CF population. This panel of pediatric and adult rhinology experts will discuss the evaluation, medical management, imaging indications, surgical options, and long-term care of the pediatric and adult cystic fibrosis patient. The introduction of new cystic fibrosis transmembrane receptor corrector/modulator medical therapy will also be reviewed and cases discussed.
Outcome Objectives:
(1) Evaluate and treat the CF patient and understand how CF transmembrane receptor corrector/modulators work. (2) Determine how to incorporate surgical intervention into CF care and follow best practice for imaging. (3) Learn culture-directed techniques to manage long-term sinus colonization/biofilm formation and establish a guideline for in-office debridement of CF patients.
Understanding the Rise in Frontal Sinus Surgery: Opportunity and Responsibility
Zara M. Patel, MD (moderator); Stacey Gray, MD; Pete S. Batra, MD; Marc Dubin, MD
Session Description:
The amount of frontal sinus surgery that otolaryngologists perform on a yearly average has sharply risen since the introduction of balloon sinuplasty. There are many potential reasons for this rise, and some otolaryngologists have called into question whether the increased numbers reflect increased need vs increased reimbursement. What is clear is that frank and open discussion is needed with regard to these questions, and we as a specialty have to grapple with the question of whether self-regulation or regulation by third-party payers will eventually determine our practice.
Outcome Objectives:
(1) Understand how coding and reimbursement for frontal sinusotomy has changed in recent years. (2) Consider and reflect on whether the rise in frontal sinus coding is based on increased need for frontal surgery or based on other factors. (3) Understand the evidence-based indications for frontal sinusotomy, whether performed by cold instrumentation or balloon sinuplasty.
What the Heck Is That? Challenging Nasal Endoscopy Findings
Angela M. Donaldson, MD (moderator); Eric W. Wang, MD; Roy R. Casiano, MD; Jivianne T. Lee, MD
Session Description:
Understanding the initial approach for the care of patients with a sinonasal masses is essential for every otolaryngologist. A heightened level of suspicion is necessary when patients present with unilateral epistaxis, congestion, or ear fullness, as these symptoms are highly concerning for a mass. However, sometimes your nasal endoscopy does not correlate to clinical presentation leading to the question, “What the heck is that and what do I do next?” This session features videos and stills of rare sinonasal conditions. Interactive case presentations will be presented, and a panel of rhinology experts will discuss differential diagnosis, imaging, and treatment options. The decision to perform in-office vs intraoperative biopsy can be difficult. The panelists will discuss what they would do and how they make those decisions for each vignette. The panel will also address physical exam and imaging findings that help decipher an inverting papilloma from an inflammatory polyp. Lastly, determining the presence of a nasal flare from an autoimmune vasculitis disease can be challenging; this panel of academic rhinologists will use evidence-based data and endoscopic findings to discuss indications for biopsy. Pathologies covered during the session range from inflammatory lesions to sinonasal malignancies and skull base lesions.
Outcome Objectives:
(1) Apply knowledge from cases presented to help determine need for biopsy, imaging, and treatment options. (2) Demonstrate knowledge of differential diagnoses for various nasal masses. (3) Identify strategies to decipher the etiology of common nasal polyps, such as inflammatory polyps and inverting papilloma.