15 / 236
ii.
Topical (saline, steroids, and antibiotics)
Smith KA, French G, Mechor B, Rudmik L. Safety of long-term high-volume
sinonasal budesonide irrigations for chronic rhinosinusitis.
Int Forum Allergy
Rhinol
. 2016; 6(3):228-232. EBM level 3..................................................152-156
Summary
: Smith et al evaluated the impact of high-dose topical budesonide on the
hypothalamic-pituitary-adrenal (HPA) axis in chronic rhinosinusitis patients. These
patients used 2 mg of budesonide in saline irrigations daily for over 2 years. The authors
evaluated serum AM cortisol levels. Over half of the patients had lower-than-normal
serum cortisol levels prompting a cosyntropin stimulation test. None of the 19 patients
tested were found to have abnormal cosyntropin tests. The authors concluded no HPA
axis suppression occurs with the use of budesonide, even at high doses.
Soudry E, Wang J, Vaezeafshar R, et al. Safety analysis of long-term budesonide
nasal irrigations in patients with chronic rhinosinusitis post endoscopic sinus
surgery.
Int Forum Allergy Rhinol
. 2016; 6(6):568-572. EBM
level 3............................................................................................................157-161
Summary
: Soudry et al evaluated budesonide irrigations in 48 patients with chronic
rhinosinusitis. The mean duration of use was 22 months, using 0.5 mg of budesonide in
240 mL saline, once or twice daily. The authors used the cosyntropin stimulation test on
all patients and found that 23% showed evidence of adrenal suppression. Interestingly,
none of these patients exhibited any other signs or symptoms of adrenal suppression.
Logistic regression suggested the highest risk for adrenal suppression occurs when the
budesonide irrigations were used with other exogenous corticosteroids such as nasal
steroid sprays or inhaled steroids.
D.
Advanced Techniques
1.
Orbital applications
Bleier BS, Castelnuovo P, Battaglia P, et al. Endoscopic endonasal orbital cavernous
hemangioma resection: global experience in techniques and outcomes.
Int Forum Allergy
Rhinol
. 2016; 6(2):156-161. EBM level 4.....................................................................162-167
Summary
: The purpose of this study was to combine the experience of multiple international centers to
create a composite of the global experience on the endoscopic management of a single type of tumor,
the orbital cavernous hemangioma. Extraconal lesions were managed similarly; however, greater
variability was evident for intraconal lesions. These included the laterality and number of hands in the
approach, methods of medial rectus retraction, and the need for reconstruction.
2.
Endoscopic skull base surgery
Dixon BJ, Daly MJ, Chan H, et al. Augmented real-time navigation with critical structure
proximity alerts for endoscopic skull base surgery.
Laryngoscope
. 2014; 124(4):853-859.
EBM level NA................................................................................................................168-174
Summary
: Dixon et al present a cadaver study of a novel image guidance technology with proximity
alerts.
Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large
dural defects: a systematic review of published evidence.
Laryngoscope
. 2012; 122(2):452-
459. EBM level 3...........................................................................................................175-182
Summary
: Harvey et al present a systematic review of retrospective studies supporting overall success
of skull base repair and the role of vascularized tissue.