F A Kuhn

Texas Institute for Robotic Surgery, Austin, Texas, United States

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Publications (53)78.77 Total impact

  • Karen A Bednarski, Frederick A Kuhn
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    ABSTRACT: Synechiae and ostial stenosis are common and troublesome complications following endoscopic sinus surgery. Many investigators have advocated the use of stents to minimize the risk of postoperative stenosis while others have found their use to be of no benefit. This article reviews the advantages and disadvantages of various stents used in sinus surgery, and discusses such innovations as drug-releasing stents.
    Otolaryngologic Clinics of North America 10/2009; 42(5):857-66, x. · 1.46 Impact Factor
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    Christopher T Melroy, Frederick A Kuhn
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    ABSTRACT: We sought to evaluate an instrument that allows a drug-eluting catheter to be inserted into the ethmoid sinuses and to demonstrate its safety and reproducibility in a cadaver model. A drug-eluting catheter was placed into 12 cadaveric anterior and posterior ethmoid sinuses by use of a trocar-based insertion device. The device's position was analyzed with computed tomographic scans, and postprocedural dissection was performed. The drug-eluting catheter system was successfully inserted in all ethmoid sinuses without injury to the medial orbital wall, skull base, or sphenoid face. The final position of the distal tip of the catheter averaged 8.1 mm (root mean square [RMS], 3.3 mm) from the skull base, 5.6 mm (RMS, 3.5 mm) from the sphenoid face, and 5.0 mm (RMS, 3.5 mm) from the lamina papyracea; the proximal tip was at the face of the ethmoid bulla and 17.1 mm (RMS, 3.5 mm) below the skull base. A trocar-based instrument can relatively safely and reproducibly introduce a drug-eluting catheter into the ethmoid sinuses without injuring the skull base, lamina papyracea, or sphenoid face. This device may allow safe topical drug delivery into the ethmoid sinuses and serve as a vehicle to treat chronic ethmoid sinusitis with direct and sustained topical therapy.
    The Annals of otology, rhinology, and laryngology 10/2009; 118(10):708-13. · 1.21 Impact Factor
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    ABSTRACT: Less invasive instruments such as balloon catheters are available for sino-ostial dilation during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization. Radiation exposure has been an area of concern. This study was initiated to determine surgeon radiation exposure when fluoroscopy is used during ESS with balloon catheters. A multi-center, prospective evaluation of surgeon radiation exposure was conducted. For three months, 14 sinus surgeons wore dosimeters to record radiation exposure while using C-arm fluoroscopy during balloon catheter-aided sinus surgery. One dosimeter was placed at collar level (chest), outside the lead apron and another dosimeter was placed on a finger (extremity). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated. Thirteen chest badges recorded annualized averages of 191.08, 193.54, and 187.69 mrems for deep, eye, and shallow exposure respectively. Eleven ring badges recorded 584.00 mrems. A recent publication reported low levels of surgeon radiation exposure during ESS with balloon catheters. This study validates radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit of 50,000 mrem. With vigilant technique and education, fluoroscopy reliance can be minimized.
    Otolaryngology Head and Neck Surgery 07/2009; 140(6):834-40. · 1.73 Impact Factor
  • Yvonne Chan, Frederick A Kuhn
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    ABSTRACT: This review is timely and relevant because rhinosinusitis is a disease process that is heterogeneous in its clinical and pathologic manifestations. Therefore, no one causative factor has been identified that fully accounts for all rhinosinusitis. The purpose of this review is to provide a succinct update of rhinosinusitis classification, pathophysiology, and management given the new movement toward evidence-based guidelines. The term rhinosinusitis reflects the concurrent inflammatory and infectious processes that affect the nasal passages and the contiguous paranasal sinuses. The most recent classification scheme is intended primarily to guide clinical research and divides rhinosinusitis into four categories: acute bacterial rhinosinusitis, chronic sinusitis with nasal polyposis, chronic rhinosinusitis with nasal polyposis, and allergic fungal rhinosinusitis. The goals of treatment include reduction of mucosal edema, reestablishment of sinus ventilation, and eradication of infecting pathogens. Multiple therapies are available for the management of chronic rhinosinusitis, including antibiotics, hypertonic and isotonic saline irrigations or sprays, topical and systemic glucocorticords, antileukotriene agents, and endoscopic sinus surgery. Rhinosinusitis is a common medical problem that interferes with patient quality of life and loss of work productivity. Because of the heterogeneity that underlies its pathology, no one treatment regimen exists for the management of rhinosinusitis.
    Current opinion in otolaryngology & head and neck surgery 05/2009; 17(3):204-8.
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    ABSTRACT: The frontal recess is the drainage pathway that connects the frontal sinus to the anterior ethmoid sinus. Mechanical obstruction is the primary cause of chronic frontal sinusitis with or without a secondary inflammatory process. Eosinophilic inflammation is one of the underlying causes for chronic rhinosinusitis. OBJECTIVES/HYPHOTHESIS: To evaluate long-term frontal sinus patency after endoscopic frontal sinusotomy in chronic rhinosinusitis patients and to assess the effect of eosinophilic inflammation on frontal sinus patency. Retrospective chart review. Symptom assessment and archived endoscopic photographs were prospectively collected on patients who underwent frontal sinusotomy between 7-1-1999 and 12-31-2000. Subjective symptom improvements were evaluated using the SNOT-20 = 20-item Sino-Nasal Outcome Test. Objective findings of endoscopic frontal sinus patency were documented by archived digital photography. A total of 161 patients with 294 frontal sinuses who underwent endoscopic frontal sinus surgery in the 18 months had an average follow-up of 45.9 months. The patient population was divided into two groups: 58 patients had eosinophilic CRS (ECRS), and 103 patients had CRS without eosinophils (non-ECRS). The mean follow-up for patients with ECRS is 61.6 months and 37.0 months for non-ECRS patients. The non-ECRS patients had a documented endoscopic frontal sinus patency of 90%, and the ECRS patients had an endoscopic frontal sinus patency of 85%. The overall frontal ostium patency rate for all patients was 88.0%. Long-term endoscopic confirmation of frontal ostium patency demonstrates that endoscopic frontal sinusotomy can yield high quality, durable results. There was no significant difference in patency results between ECRS and non-ECRS patients. Laryngoscope, 2009.
    The Laryngoscope 05/2009; 119(6):1229-32. · 1.98 Impact Factor
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    ABSTRACT: Assess two-year postoperative clinical outcomes for patients receiving balloon catheter sinusotomy. Patients who had sinus ostia dilated with balloon catheters were prospectively evaluated two years after surgery by Sinonasal Outcome Test (SNOT-20) and computed tomographic (CT) scan. Sixty-five patients (195 ballooned sinuses) were followed for two years after surgery, including 34 "balloon-only" patients and 31 "hybrid" patients. SNOT-20 symptom scores were significantly improved from baseline (0.87 vs 2.17 baseline, P < 0.001) and stable compared to six months and one year; this was the case for both balloon-only (1.09 vs 2.09, P < 0.001) and hybrid (0.64 vs 2.26, P < 0.001) patients. Lund-MacKay CT scores were significantly improved from baseline (2.69 vs 9.66, P < 0.001) and stable compared to one year, confirmed for both balloon-only (1.75 vs 5.67, P < 0.015) and hybrid (3.25 vs 12.05, P < 0.001) subsets of patients. A total of 85% of patients reported improvement of their sinus symptoms, with 15% same and 0% worsened. Revision treatment was required in seven of 195 sinuses (3.6%) in six of 65 patients (9.2%). Patients who receive balloon catheter sinusotomy in endoscopic sinus surgery have significant improvement in symptoms two years after surgery. Radiographic evidence also confirms resolution of disease after two years. This demonstrates durability of clinical results previously reported at 24 weeks and one year after surgery.
    Otolaryngology Head and Neck Surgery 09/2008; 139(3 Suppl 3):S38-46. · 1.73 Impact Factor
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    ABSTRACT: The primary objective was to assess the long-term effectiveness of balloon catheter sinusotomy. Patients who had sinus ostia dilated with balloon catheters were prospectively evaluated 1 year after surgery with nasal endoscopy, a CT scan, and the Sino-Nasal Outcome Test (SNOT-20). Sixty-six patients (202 sinuses) were examined. One hundred seventy-two of 202 sinus ostia (85%) were endoscopically patent, 1 percent (2/202) were nonpatent, and ostial patency could not be determined by endoscopy in 28 of 202 (14%). In these "indeterminate" sinuses, the CT scans were normal in 13, implying functional patency in 91.6 percent of sinuses (185/202). Sinus CT scan scores were 1.95 at 1 year versus 8.89 at baseline (P < 0.001), and 1-year SNOT-20 scores (0.91) were significantly improved from baseline (2.14, P < 0.0001). Balloon catheter sinusotomy results were durable over the study period, showing long-term effectiveness.
    Otolaryngology Head and Neck Surgery 09/2008; 139(3 Suppl 3):S27-37. · 1.73 Impact Factor
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    ABSTRACT: The aim of this study was to determine the extent of radiation exposure to the patient and the surgeon in balloon catheter dilation. Dosimeters were used to record radiation exposure to both patients and surgeons. The mean radiation dose per sinus treated and per patient treated was calculated for each dosimeter location. The mean patient dose (108 sinuses treated in 34 patients), was 0.32 mSv per sinus and 1.02 mSv per patient over the eye and 1.33 mSv per sinus and 4.22 mSv per patient over the temple. The average total fluoroscopy time was 3.6 minutes per patient. The average number of sinuses treated was 3.2. The mean surgeon dose at the chest (254 sinuses in 89 patients) was 0.025 mSv per sinus and 0.072 mSv per patient. The mean surgeon dose at the hand (182 sinuses in 68 patients) was 0.009 mSv per sinus and 0.023 mSv per patient. The use of fluoroscopy in balloon catheter dilation exposes both the patient and surgeon to very low doses of radiation.
    Otolaryngology Head and Neck Surgery 03/2008; 138(2):187-91. · 1.73 Impact Factor
  • Otolaryngology - Head and Neck Surgery. 01/2008; 138(1):126–127.
  • The Laryngoscope 09/2007; 117(8):1450-1. · 1.98 Impact Factor
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    ABSTRACT: The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy. Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20). At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.5% (247 of 307) sinuses and nonpatent in 1.6% (5 of 307), and could not determine ostial patency status in 17.9% (55 of 307). Of the ostia visualized on endoscopy, 98% were patent (247 of 252), while 2% (5 of 252) were considered nonpatent. SNOT 20 scores showed consistent symptomatic improvement over baseline. Revision treatment was required in 3 sinuses (3 of 307 sinuses, 0.98%) in 3 patients (3 of 109 patients, 2.75%). Balloon catheter technology appears safe and effective in relieving ostial obstruction. Patients were pleased and indicated that they experienced symptomatic improvement.
    Otolaryngology Head and Neck Surgery 08/2007; 137(1):10-20. · 1.73 Impact Factor
  • Marc G Dubin, Frederick A Kuhn, Christopher T Melroy
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    ABSTRACT: Maximal medical therapy is poorly defined in chronic sinusitis treatment. To objectively evaluate the radiographic response of chronic rhinosinusitis without polyposis after 3 and 6 weeks of oral antibiotics. Thirty-five patients with confirmed chronic sinusitis without polyposis (disease apparent on initial computed tomography [CT] with appropriate symptom duration) were prescribed 6 weeks of antibiotics. When possible, culture-directed antibiotics were used; otherwise clindamycin was used empirically. A CT was performed after 3 and 6 weeks of therapy. CTs were then graded by the Lund-Mackay system. Demographic data were reviewed. Of the 35 patients, 16 underwent all 3 CT scans and completed all 6 weeks of antibiotics. Three patients completed only 3 weeks of antibiotics, and 16 did not undergo the interval 3-week CT. Six patients (38%) had statistically significant improvement in their CT scans between weeks 3 and 6. In this subset of patients who improved, 37% of their overall radiographic improvement occurred in the 3- to 6-week treatment interval. No prognostic variables predicted which patients would radiographically improve after 3 weeks of antibiotics. Some patients achieve radiographic improvement and disease resolution after the completion of a 3-week course of antibiotics. Therefore, maximal medical therapy for chronic sinusitis may consist of longer than 3 weeks of therapy to ensure maximal benefit.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 02/2007; 98(1):32-5. · 3.45 Impact Factor
  • Frederick A Kuhn
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    ABSTRACT: This article the most useful procedures into into a comprehensive integrated approach to frontal sinus surgery. It begins with the least invasive and progresses to the most invasive procedure in a step-by-step fashion, which can be applied as needed. The selection of procedure is governed the patient's disease anatomy,and the surgeons skill. The least invasive procedure that can be used should be attempted first, and then, if more is needed, other procedures can be added, either at the same sitting or in subsequent revisions.
    Otolaryngologic Clinics of North America 07/2006; 39(3):437-61, viii. · 1.46 Impact Factor
  • Marc G Dubin, Frederick A Kuhn
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    ABSTRACT: Management of frontal sinus tumors has traditionally been through open approaches with obliteration of the sinus. Recently, increased comfort with endoscopic techniques has made endoscopic resection an alternative to more morbid approaches. However, many skilled endoscopists still champion obliteration of the frontal sinus after the open treatment of large osteomas. A retrospective review of the senior author's experience with frontal sinus osteomas was performed. Twelve frontal sinus osteomas were treated surgically without obliteration. All patients with greater than 2 cm vertical extension of their tumor into the frontal sinus required an open approach (n = 4), whereas the remainder (n = 8) were treated endoscopically. Frontal ostia were stented if greater that 40% of the mucosa of the frontal recess was denuded. Eleven of 12 patients had patent, functional frontal sinuses. Successful resection of frontal sinus osteomas can be performed with preservation of the natural drainage of the frontal sinus in almost all cases. EBM rating: C-4.
    Otolaryngology Head and Neck Surgery 02/2006; 134(1):18-24. · 1.73 Impact Factor
  • Marc G Dubin, Frederick A Kuhn
    American Journal of Otolaryngology 01/2006; 27(4):263-5. · 1.23 Impact Factor
  • Marc G Dubin, Frederick A Kuhn
    The Laryngoscope 10/2005; 115(9):1702-3. · 1.98 Impact Factor
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    Marc G Dubin, Frederick A Kuhn
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    ABSTRACT: There are circumstances in which image guidance is clearly useful to facilitate a more complete operation. By confirming the identity of known anatomic structures, a knowledgeable surgeon's understanding of the disease process can improve and only the necessary structures removed. CT guidance is a clear aid to understanding altered anatomy when combined with a thorough analysis of the preoperative CT scan and office nasal endoscopy. It is the combination of this preoperative planning with image guidance that allows a skilled surgeon to operate with confidence. This discussion intentionally did not refer to image guidance as the standard of care, because although this technology is clearly useful, valuable, and helpful in confirming anatomy and performing many procedures, it is not always necessary in achieving a complete operation. Therefore, it should not be considered the standard of care.
    Otolaryngologic Clinics of North America 07/2005; 38(3):535-49. · 1.46 Impact Factor
  • Walter T Lee, Frederick A Kuhn, Martin J Citardi
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    ABSTRACT: Describe frontal sinus pneumatization in patients with no history of frontal sinus disease. All 1-mm axial sinus CT scans performed from 2001 through 2003 were eligible for review on a CBYON Suite workstation (CBYON, Mountain View, CA). Exclusion criteria included frontal sinusitis, sinonasal polyposis, age < 18 years, sinus malignancy, fibroosseous lesions, maxillofacial trauma, congenital anomaly, and sinus surgery. A total of 50 patients met the inclusion criteria. The prevalence of each structure was: agger nasi cell (89%), type 1 frontal cell (37%), type 2 frontal cell (19%), type 3 frontal cell (8%), type 4 frontal cell (0%), supraorbital ethmoid cell (62%), suprabullarcell (15%), frontal bullar cell (9%), interfrontal septal cell (14%), and recessus terminalis (22%). This study describes frontal pneumatization in patients without a history of conditions that influence frontal pneumatization. The results characterize normal frontal recess/sinus pneumatization patterns.
    Otolaryngology Head and Neck Surgery 09/2004; 131(3):164-73. · 1.73 Impact Factor
  • Frederick A Kuhn
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    ABSTRACT: Endoscopy has multiple uses in both the medical and surgical management of chronic rhinosinusitis (CRS). This article reviews applications of endoscopy in preoperative evaluation and postoperative management of CRS. Before operation, nasal endoscopy is the standard for tissue sampling, evaluation of the mucosa, identifying structural alterations, and staging of allergic fungal sinusitis. As part of the surgical procedure, endoscopy may be used to minimize the time needed for postoperative debridement. Applications of endoscopy in in-office medical management of CRS include culturing the sinuses for fungus or bacteria, inserting a cannula for the delivery of drug therapy, and various minor manipulations following a surgical procedure. Perhaps the most important role for endoscopy in patients with CRS is in medical management, particularly in cases involving eosinophilic inflammation. Angled telescopes are important for visualizing areas often overlooked in sinuses that may otherwise appear to be normal, ie, the depths of the maxillary, frontal, or sphenoid sinus. Further use and research are likely to elicit more uses for this important technology.
    The Annals of otology, rhinology & laryngology. Supplement 06/2004; 193:15-8.
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    ABSTRACT: This presentation is from the Rhinology and Sinus Committee of our academy. This presentation will bring the latest advances that have been made in endoscopic sinus surgery. The presenters are well-known members of the academy who have strived to improve the surgical technique and they will present their viewpoint on the latest advances in technology. The presentation has surgical techniques blended with the technological advances. Image-guided endoscopic sinus surgery is popular in our specialty and there is growing interest in its applications in day to day issues in surgery. The role of image-guided technology will be presented first with 2 clearly different systems. Dr Sillers will present the electromagnetic system applications and Dr Metson will speak on the infrared clinical applications in endoscopic sinus surgery. Appropriate clinical cases will be presented with clear indications for use. The improvement in tissue shaver technology will be discussed by Dr Bolger and Dr Levine will present the recent advances in turbinectomy with somnoplasty and coblation. The development and the clinical applications beyond sinus surgery will be presented by the speakers. The role of tissue shavers in submucous resection of the septum and turbinectomy will be discussed by Dr Bolger. A successful endoscopic approach to the frontal sinus has always been a difficult issue and revision frontal sinus surgery has technical challenges. The endoscopic approaches to the frontal sinus and the frontal sinus rescue procedure will be presented by Dr Kuhn. The management of cerebrospinal fluid leak and the surgical approaches to the sphenoid sinus will be discussed with the role of image guided systems. Dr Sethi will demonstrate the successful endoscopic sphenoid sinus approaches to the pituitary tumors. Dr Anand will discuss the image-guided endoscopic approaches to the closure of CSF leaks and the current advances in real time use of image guidance. At the conclusion of the presentations, there will be an interactive questionnaire session from the audience on each topic. The aim of this subcommittee presentation is to update the otolaryngologists clinical understanding of these various surgical and technical advances in endoscopic sinus surgery.
    Otolaryngology-head and Neck Surgery - OTOLARYNGOL HEAD NECK SURG. 01/2004; 131(2).

Publication Stats

1k Citations
78.77 Total Impact Points

Institutions

  • 2009
    • Texas Institute for Robotic Surgery
      Austin, Texas, United States
    • University of Toronto
      • Department of Otolaryngology - Head and Neck Surgery
      Toronto, Ontario, Canada
  • 2000–2009
    • Sinus & Nasal Institute of Florida
      St. Petersburg, Florida, United States
  • 2008
    • Loma Linda University
      Loma Linda, California, United States
  • 2007
    • University of North Carolina at Chapel Hill
      • Department of Otolaryngology/Head and Neck Surgery
      North Carolina, United States
  • 2006
    • Johns Hopkins Medicine
      • Department of Otolaryngology - Head and Neck Surgery
      Baltimore, MD, United States
  • 2005–2006
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, MD, United States
  • 2001
    • University of British Columbia - Vancouver
      Vancouver, British Columbia, Canada
  • 1998–2000
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 1992–1996
    • Georgia Health Sciences University
      • • Department of Otolaryngology
      • • Medical College of Georgia
      Augusta, GA, United States