Sarah K Wise

Emory University, Atlanta, Georgia, United States

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Publications (59)98.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Rhinologists are seeing an increasing number of immunosuppressed patients. Currently, no treatment paradigm exists for treating acute and chronic noninvasive rhinosinusitis (ARS, CRS) in this growing population. This study aims to identify patient and treatment factors that affect rhinosinusitis outcomes in this vulnerable population. Prognostic retrospective cohort study. Immunocompromised patients treated by rhinologists for ARS or CRS 10/2007 to 10/2012 were identified by rhinosinusitis diagnostic codes, codes for transplant, cancer, HIV, diabetes, and codes indicating immunosuppression in the intensive care setting. Associations between patient factors and outcome were analyzed by logistic regression. Associations between treatment and outcome were analyzed by Firth logistic regression. A total of 132 subjects were identified. Of those, 90.9% had CRS and 9.1% had ARS; 12.9% were transplant patients; 47% were diabetic; 37.9% were cancer patients; and 16.7% were in the intensive care unit. Patients with higher American Society of Anesthesiologists (ASA) scores had decreased disease resolution (odds ratio [OR] = 0.5, P = 0.021). Transplant patients (OR = 22.5, P = 0.001), diabetics patients (OR = 6.4, P = 0.017), cancer patients (OR = 5.4, P = 0.046), and patients with prior medical therapy for rhinosinusitis (OR = 5.84, P < 0.001) had increased disease resolution compared to immunosuppressed critical care patients. Patients treated with antibiotics alone had no statistically significant difference in disease resolution compared to those receiving no treatment. In contrast, treatment plans including surgery were associated with greater disease resolution. This data indicates that surgical treatment provides improved outcomes for patients presenting with acute exacerbations of rhinosinusitis related to their immunocompromised state. Given the limited study population, these findings may not apply to HIV-positive or ARS patients, and further study should be undertaken in these groups. 4. Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
    The Laryngoscope 05/2015; DOI:10.1002/lary.25305 · 2.03 Impact Factor
  • Patricia A. Loftus, Sarah K. Wise
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    ABSTRACT: Background The “asthma epidemic” is on the rise, with the Center for Disease Control (CDC) epidemiological studies reporting a 3.0% asthma prevalence in the United States in 1970, 5.5% in 1996, and 7.8% in 2006 to 2008. This results in an immense economic burden, with asthma costing an estimated $56 billion in the United States in 2007, which is a 6% increase from the $53 billion that was spent in 2002.MethodsA review of the current literature and CDC reports were used to thoroughly examine and summarize the epidemiology and economic burden of asthma domestically and globally.ResultsAsthma shows a male predominance before puberty, and a female predominance in adulthood. Studies show Puerto Ricans to be the most commonly affected ethnicity, and a higher prevalence of asthma is found in lower income populations. Asthma is related to some of the more common otolaryngologic diseases such as allergy and obstructive sleep apnea. The condition results in significant morbidity, such as an increase in emergency department visits and a decrease in productivity due to missed school and works days.Conclusion Epidemiological statistics report an undisputable increase of asthma both domestically and worldwide, which means the economic burden of this disease is also on the rise. Better access to healthcare, improved asthma education, and bridging the gap between ethnic and racial disparities in the treatment and management of asthma may help to control this epidemic, promote better outcomes, and prevent continued rising costs related to the management of this widespread disease.
    International Forum of Allergy and Rhinology 05/2015; DOI:10.1002/alr.21547 · 2.37 Impact Factor
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    ABSTRACT: Seasonal influenza causes significant morbidity and mortality, with cardiovascular and respiratory complications the most common among susceptible individuals. Upper respiratory tract infections (URIs) are known to precede olfactory dysfunction in some patients. To our knowledge, there has been no study assessing the possible relationship between influenza vaccination status and olfactory dysfunction. To compare vaccination status of a group of patients with subjective olfactory dysfunction with that of a group of controls. Retrospective medical record review and telephone survey in a matched case-control study. Forty-two patients were identified via diagnosis codes who presented to a tertiary care academic rhinologic center with subjective smell dysfunction over the course of 1 year. Only post-URI and idiopathic etiologies were included. Forty-two age-, sex-, and race/ethnicity-matched control patients were also selected. Demographic data, influenza vaccination status, and smoking status were reviewed. χ2 Testing was used. We were able to obtain vaccination data for 36 of 42 patients in the olfactory dysfunction group and 38 of 42 in the control group. Seven of the 36 (19%) in the olfactory dysfunction group had received the vaccine in the year prior to presentation compared with 16 of 38 (42%) in the control group (P = .04). Influenza vaccination seems to be associated with a decreased rate of subjective olfactory dysfunction. This is a preliminary finding, and further studies would be needed to elucidate the exact role of influenza and influenza vaccination in patients with olfactory loss.
    01/2015; 141(3). DOI:10.1001/jamaoto.2014.3399
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    ABSTRACT: Background Workup of cerebrospinal fluid (CSF) leaks can be challenging. Patients with intermittent or infrequent clear rhinorrhea that cannot be collected, those with questionable or multiple skull-base (SB) defects on imaging, and those with previous SB surgery can present diagnostic dilemmas. In this patient population, radiologic studies that allow repeat imaging over hours to days can increase the diagnostic yield. We report our experience with magnetic resonance cisternogram with intrathecal gadolinium (MRCgGd) in this patient population.Methods This study was a retrospective review of patients who underwent MRCgGd for workup of suspected CSF leaks at a tertiary care academic center.ResultsOver the past 3 years, 11 patients (10 females; mean age 50 years) underwent MRCgGd. Seven patients had suspected spontaneous CSF leaks from idiopathic intracranial hypertension and 2 had postsurgical defects. All patients had previous imaging that was indeterminate in localizing the site of the leak. Only 3 patients had positive beta-2 transferrin studies, all with multiple potential leak sites. MRCgGd confirmed the absence of leaks at 4 previously repaired SB defects, identified spinal canal leaks but no SB leaks in 2 patients (1 of whom had a nonleaking SB defect), and identified 5 patients with one or more SB leaks. Repeat imaging, from 30 minutes to 20 hours, was beneficial in identifying 4 leaks not confirmed in the immediate imaging, and ruling out leaks in 5 cases, therefore guiding further treatment. No complications occurred.ConclusionMRCgGd is a useful diagnostic test in the workup of patients with difficult CSF leaks, with delayed imaging providing valuable diagnostic information.
    International Forum of Allergy and Rhinology 01/2015; 5(4). DOI:10.1002/alr.21475 · 2.37 Impact Factor
  • Neurosurgery 12/2014; 10 Suppl 4:654. DOI:10.1227/NEU.0000000000000469 · 3.03 Impact Factor
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    ABSTRACT: Background: There may be substantial variation in paranasal sinus pneumatization across patients and between right and left sides. Patients with extensive sinus aeration, especially of the sphenoid sinus and along the skull base, often have protrusion of critical structures into the pneumatized sinus cavities, which potentially places these structures at risk during sinus surgery. Objective: To evaluate associations between anatomic markers of increased paranasal sinus aeration along the skull base and to determine whether the presence of certain markers predicts other critical anatomic variants. Methods: Submillimeter axial computed tomography (CT) scans and associated triplanar reconstructions from 100 subjects were reviewed for the presence of 22 anatomic variants by two separate evaluators. Twelve of these variants were selected as markers of increased pneumatization. Average numbers of markers were compared with t-tests; associations between markers were evaluated by logistic regression analyses. The Holm-Bonferroni method was used to correct for multiple tests. Results: Five anatomic variants were associated with increased paranasal sinus pneumatization, as defined by total number of markers of pneumatization: anterior ethmoid artery below the skull base, dehiscent/protruding internal carotid artery (ICA), dehiscent/protruding optic nerve (ON), pneumatized pterygoid recess, and middle turbinate (MT) concha bullosa (all p Conclusion: The markers of increased pneumatization and anatomic associations identified in this study have important implications for surgeons planning and undertaking operative approaches in and around the sinuses.
    American journal of rhinology & allergy 12/2014; 28(6). DOI:10.2500/ajra.2014.28.4086 · 2.18 Impact Factor
  • Ansley M Roche, Sarah K Wise
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    ABSTRACT: Background Allergic rhinitis, asthma, and Hymenoptera sensitivity affect approximately 20%, 9%, and 0.66% to 3.3% of adults in the United States, respectively. Various environmental control measures and pharmacologic options are available for symptomatic treatment of allergic rhinitis and allergic asthma. However, allergen-specific immunotherapy is the only form of treatment that alters the natural history of allergic disease. MethodsA literature review was performed. Information from systematic reviews, meta-analyses, and practice parameters were closely examined and summarized, and they are included in this primer. ResultsThere is evidence that supports the use of subcutaneous immunotherapy (SCIT) for the treatment of perennial and seasonal allergic rhinitis, asthma, and Hymenoptera sensitivity. Efficacy of SCIT has been established in the adult and pediatric populations. Adverse reactions occur in up to 71% of patients. However, the rate of serious or fatal side effects is very rare. ConclusionSCIT is safe and effective in the treatment of allergic rhinitis, allergic asthma, and Hymenoptera sensitivity. Adverse reactions occur but, in general, SCIT is well tolerated, and the vast majority of reactions are mild and very rarely fatal. (C) 2014 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 09/2014; 4 Suppl 2(S2):S51-4. DOI:10.1002/alr.21382 · 2.37 Impact Factor
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    ABSTRACT: Background Allergic fungal rhinosinusitis (AFRS) is a disease demonstrating substantial eosinophilic inflammation and characteristic radiographic bony erosion/expansion. Periostin is an extracellular matrix protein associated with eosinophil accumulation in eosinophilic esophagitis, allergic asthma mucus production, and chronic rhinosinusitis (CRS) polyp formation. Receptor activator of nuclear factor κ-B ligand (RANKL) is an osteoclast activator present in osteoporosis and periodontal disease. We sought to evaluate periostin and RANKL expression in AFRS and correlate these levels with radiographic scales of disease severity.Methods Thirty sinus tissue specimens were intraoperatively collected from 3 patient groups: AFRS; CRS without nasal polyps (CRSsNP); and controls (n = 10 per group). Specimens were analyzed by semiquantitative reverse-transcription polymerase chain reaction (sq-RT-PCR) and immunofluorescence (IF) labeling/confocal microscopy for the presence of both periostin and RANKL. Immunofluorescence staining intensity was quantified by pixel density analysis. Preoperative computed tomography (CT) scans from each patient were scored using both the Lund-Mackay and CT bone erosion scoring systems.ResultsPeriostin was significantly elevated in AFRS sinus tissue compared to CRSsNP and controls, as demonstrated by IF (p < 0.001) and PCR (p = 0.011). RANKL was not detected in sinus tissue by IF or PCR. Periostin levels positively correlated with radiographic indices of disease severity for both soft tissue and bone, using Lund-Mackay (r = 0.926 [PCR] and r = 0.581 [IF]) and CT bone erosion (r = 0.672 [PCR] and r = 0.616 [IF]) scoring systems, respectively.Conclusion Periostin is increased in AFRS tissue compared to CRSsNP and controls. Periostin levels positively correlate with radiologic disease severity scores. The increased levels of periostin in AFRS are possibly tied to its intense eosinophilic inflammatory etiology.
    International Forum of Allergy and Rhinology 09/2014; 4(9). DOI:10.1002/alr.21367 · 2.37 Impact Factor
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    ABSTRACT: Altered expression of epithelial intercellular junction proteins has been observed in sinonasal biopsies from nasal polyps and epithelial layers cultured from nasal polyp patients. These alterations comprise a "leaky" epithelial barrier phenotype. We hypothesize that T helper 2 (Th2) cytokines interleukin (IL)-4 and IL-13 modulate epithelial junction proteins, thereby contributing to the leaky epithelial barrier. Differentiated primary sinonasal epithelial layers cultured at the air-liquid interface were exposed to IL-4, IL-13, and controls for 24 hours at 37°C. Epithelial resistance measurements were taken every 4 hours during cytokine exposure. Western blot and immunofluorescence staining/confocal microscopy were used to assess changes in a panel of tight and adherens junction proteins. Western blot densitometry was quantified with image analysis. IL-4 and IL-13 exposure resulted in a mean decrease in transepithelial resistance at 24 hours to 51.6% (n = 6) and 68.6% (n = 8) of baseline, respectively. Tight junction protein junctional adhesion molecule-A (JAM-A) expression decreased 42.2% with IL-4 exposure (n = 9) and 37.5% with IL-13 exposure (n = 9). Adherens junction protein E-cadherin expression decreased 35.3% with IL-4 exposure (n = 9) and 32.9% with IL-13 exposure (n = 9). Tight junction protein claudin-2 showed more variability but had a trend toward higher expression with Th2 cytokine exposure. There were no appreciable changes in claudin-1, occludin, or zonula occludens-1 (ZO-1) with IL-4 or IL-13 exposure. Sinonasal epithelial exposure to Th2 cytokines IL-4 and IL-13 results in alterations in intercellular junction proteins, reflecting increased epithelial permeability. Such changes may explain some of the phenotypic manifestations of Th2-mediated sinonasal disease, such as edema, nasal discharge, and environmental reactivity.
    International Forum of Allergy and Rhinology 05/2014; 4(5). DOI:10.1002/alr.21298 · 2.37 Impact Factor
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    ABSTRACT: BACKGROUND: Epithelial permeability is highly dependent upon the integrity of tight junctions, which are cell-cell adhesion complexes located at the apical aspect of the lateral membrane of polarized epithelial cells. We hypothesize that sinonasal epithelial exposure to Der p 1 house dust mite antigen decreases expression of tight junction proteins (TJPs), representing a potential mechanism for increased permeability and presentation of antigens across the sinonasal epithelial layer. METHODS: Confluent cultured primary human sinonasal epithelial cells were exposed to recombinant Der p 1 antigen vs control, and transepithelial resistance measurements were performed over 24 hours. Antibody staining for a panel of TJPs was examined with immunofluorescence/confocal microscopy and Western blotting. Tissue for these experiments was obtained from 4 patients total. RESULTS: Der p 1 exposed sinonasal cells showed a marked decrease in transepithelial resistance when compared to control cells. In addition, results of Western immunoblot and immunofluorescent labeling demonstrated decreased expression of TJPs claudin-1 and junction adhesion molecule-A (JAM-A) in Der p 1-exposed cultured sinonasal cells vs controls. CONCLUSION: Der p 1 antigen exposure decreases sinonasal epithelium TJP expression, most notably seen in JAM-A and claudin-1 in these preliminary experiments. This decreased TJP expression likely contributes to increased epithelial permeability and represents a potential mechanism for transepithelial antigen exposure in allergic rhinitis.
    International Forum of Allergy and Rhinology 08/2013; 3(8). DOI:10.1002/alr.21168 · 2.37 Impact Factor
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    ABSTRACT: BACKGROUND: Prolonged healing and persistent inflammation following surgery for rhinosinusitis impacts patient satisfaction and healthcare resources. Cytokines interleukin (IL)-4, IL-5, and IL-13 are important mediators in T-helper 2 (Th2) inflammatory rhinosinusitis. Decreased wound healing has been demonstrated with Th2 cytokine exposure, but this has not been extensively studied in sinonasal epithelium. We hypothesized that in vitro exposure of primary sinonasal epithelial cell cultures to Th2 inflammatory cytokine IL-4 and IL-13 would impair wound resealing and decrease expression of annexin A2 at the wound edge. METHODS: Following 24-hour exposure to IL-4, IL-5, or IL-13 vs controls, sterile linear mechanical wounds were created in primary sinonasal epithelial cultures (n = 12 wounds per condition). Wounds were followed for 36 hours or until complete closure, and residual wound areas were calculated by image analysis. Group differences in annexin A2 were assessed by immunofluorescence labeling, confocal microscopy, and Western blots. RESULTS: Significant wound closure differences were identified across cytokine exposure groups (p < 0.001). Mean percentage wound closure at the completion of the 36-hour time course was 98.41% ± 3.43% for control wounds vs 85.02% ± 18.46% for IL-4 exposed wounds. IL-13 did not significantly impair sinonasal epithelial wound resealing in vitro. Annexin A2 protein levels were decreased in IL-4 treated wounds when compared to control wounds (p < 0.01). CONCLUSION: Th2 cytokine IL-4 decreases sinonasal epithelial wound closure in vitro. Annexin A2 is also diminished with IL-4 exposure. This supports the hypothesis that IL-4 exposure impairs sinonasal epithelial wound healing and may contribute to prolonged healing in Th2 inflammatory rhinosinusitis.
    International Forum of Allergy and Rhinology 06/2013; 3(6). DOI:10.1002/alr.21158 · 2.37 Impact Factor
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    ABSTRACT: Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery–otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation is warranted in these cases.
    American Journal of Rhinology and Allergy 05/2013; 27(3):202-205. DOI:10.2500/ajra.2013.27.3871 · 2.18 Impact Factor
  • Adrienne M. Laury, Sarah K. Wise
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    ABSTRACT: Allergic fungal rhinosinusitis (AFRS) is a type of chronic rhinosinusitis in which patients classically exhibit nasal polyps, type I IgE-mediated hypersensitivity, characteristic findings on computed tomography scans, eosinophilic mucin, and positive fungal stain. New research has sought to further understand the pathophysiology of AFRS. However, this has also led to debate about the classification and predominance of this interesting disease process. Historically, patients with AFRS are immunocompetent. The disease is most prevalent in the southeast and south central United States and typically presents with sinus pressure, hyposmia, and congestion. Radiographically, cases of AFRS have a distinct appearance, often exhibiting unilateral heterogeneously dense material, which may erode and expand the paranasal sinus bony walls. Treatment typically consists of surgery, sinonasal irrigations, and topical and systemic steroids, all with the effort to decrease the fungal load and antigenic response. Immunotherapy is also often included in the treatment regimen for AFRS.
    American journal of rhinology & allergy 05/2013; 27(3):26-27. DOI:10.2500/ajra.2013.27.3891 · 2.18 Impact Factor
  • 03/2013; 74(S 01). DOI:10.1055/s-0033-1336273
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    ABSTRACT: PURPOSE OF REVIEW: Sublingual immunotherapy (SLIT) has been shown to be a new and promising treatment for people with various allergic syndromes. Several studies have examined its efficacy. However, significantly fewer investigations have explored its specific impact on the patient's quality of life (QOL). RECENT FINDINGS: SLIT has an excellent safety profile, superior in many ways to subcutaneous immunotherapy (SCIT). Additionally, SLIT significantly decreases the use of allergy medications, as well as decreasing the money spent on allergy symptom control. Finally, SLIT has been shown to improve the patient's QOL when compared to placebo or even second-generation antihistamines. SUMMARY: Increasing data support the use of SLIT as a well tolerated, cost-effective, and time-efficient modality for the treatment of multiple allergic syndromes. However, additional studies are needed, particularly QOL studies which compare SLIT to the FDA-approved SCIT.
    Current opinion in otolaryngology & head and neck surgery 02/2013; 21(3). DOI:10.1097/MOO.0b013e32835fcb22 · 1.39 Impact Factor
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    ABSTRACT: BACKGROUND: Chronic rhinosinusitis (CRS) is an inflammatory upper-airway disease with numerous etiologies. Patients with a characteristic subtype of CRS, allergic fungal rhinosinusitis (AFRS), display increased expression of T helper 2 (Th2) cytokines and antigen-specific immunoglobulin E (IgE). Various sinonasal inflammatory conditions are associated with alterations in epithelial barrier function. The aim of this study was to compare epithelial permeability and intercellular junctional protein expression among cultured primary sinonasal cells from AFRS patients vs noninflammatory controls. METHODS: Epithelial cells isolated from paranasal sinus mucosa of AFRS and noninflammatory control patients were grown to confluence on permeable supports and transitioned to air-liquid interface (ALI). Transepithelial resistance (TER) was measured with a horizontal Ussing chamber to characterize the functional permeability of each cell type. After TER recordings were complete, a panel of intercellular junctional proteins was assessed by Western blot and immunofluorescence labeling followed by confocal microscopy. RESULTS: After 12 samples were measured from each group, we observed a 41% mean decrease in TER in AFRS cells (296 ± 89 ohms × cm(2) ) compared to control (503 ± 134 ohms × cm(2) , p = 0.006). TER deficits observed in AFRS were associated with decreased expression of the tight junction proteins occludin and junctional adhesion molecule-A (JAM-A), and increased expression of a leaky tight junction protein claudin-2. CONCLUSION: Cultured sinonasal epithelium from AFRS patients displayed increased epithelial permeability and altered expression of intercellular junctional proteins. Given that these cells were not incubated with inflammatory cytokines in vitro, the cultured AFRS epithelial alterations may represent a retained modification in protein expression from the in vivo phenotype. © 2012 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 01/2013; 3(1). DOI:10.1002/alr.21077 · 2.37 Impact Factor
  • Kara K Prickett, Sarah K Wise
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    ABSTRACT: Successful endoscopic repair of the skull base may be performed with a variety of grafting materials. Graft materials discussed in this chapter are broadly categorized as autologous tissue, acellular human dermis, engineered collagen products, rigid support materials and tissue glues. Autologous tissues continue to be widely used due to their safety, availability, and low cost. Engineered collagen products and acellular dermis are favored in revision cases and larger repairs. The need for rigid support continues to be an area of controversy as pedicled grafts are increasingly used for larger defects. Tissue glues and sealants, however, are used by many authors. The components of, and evidence for, commonly used sealants are detailed. Relatively little high-quality, comparative evidence exists to guide decision making when selecting graft materials, but where available, this evidence is cited. If surgeon experience and patient characteristics are carefully considered, excellent results can be expected with most materials.
    Advances in Oto-Rhino-Laryngology 01/2013; 74:24-32. DOI:10.1159/000342265
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    ABSTRACT: OBJECTIVE To ascertain the effect of endoscopic sinus surgery (ESS) on lung function, intravenous (IV) antibiotic use, and hospitalization in adults with cystic fibrosis (CF). DESIGN Retrospective analysis. SETTINGS Tertiary care center. PATIENTS Fifteen adults with a diagnosis of CF undergoing ESS between March 1, 2006, and June 31, 2008. MAIN OUTCOME MEASURES Twelve-month preoperative and 12-month postoperative pulmonary function testing (forced vital capacity [FVC] and forced expired volume in 1 second [FEV1]), number of IV antibiotic courses, total number of days of intravenous antibiotic use, and number of inpatient hospital days (IHDs) were assessed. RESULTS Twenty-two adults with CF underwent ESS; 15 patients had adequate data for evaluation. No significant differences were found between mean preoperative and postoperative FEV1 (61.3% vs 59.5%; P = .41) or FVC (76.4% vs 76.1%; P = .97) or between best preoperative and postoperative FEV1 (67.4% vs 67.0%; P = .95) or FVC (84.2% vs 83.0%; P = .86) (paired samples t test). The number of IV antibiotic courses and the total number of days of IV antibiotic use did not differ between the preoperative and postoperative periods (Wilcoxon signed rank test P = .61 and P = .10, respectively). However, the number of IHDs was significantly lower in the 1-year postoperative period (36.7 days) vs the 1-year preoperative period (59.1 days) (Wilcoxon signed rank test, z = -2.20, P = .03). CONCLUSIONS This preliminary study of ESS in adult CF patients indicates significant reduction in the number of IHDs in the postoperative period. However, there is no evidence that ESS improved lung function or the need for IV antibiotics.
    Archives of otolaryngology--head & neck surgery 12/2012; 138(12):1167-70. DOI:10.1001/jamaoto.2013.810 · 1.75 Impact Factor
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    ABSTRACT: The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.
    American Journal of Rhinology 11/2012; 22(6):635-41. DOI:10.2500/ajr.2008.22.3242 · 1.36 Impact Factor
  • Sarah K Wise, Rodney J Schlosser
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    ABSTRACT: In this article, the authors review the current evidence regarding the public health and economic impact of allergic rhinitis. Diagnostic methods for allergic disease are discussed as well as certain nuances of allergy skin testing protocols. In addition, the evidence supporting sublingual immunotherapy (SLIT) for allergic rhinitis is reviewed, with subsequent attention to certain subgroups, such as adults and children, seasonal versus perennial allergens, and SLIT efficacy for individual antigens. The authors consider the evidence supporting appropriate SLIT dosing as well as the existing data on SLIT safety.
    Otolaryngologic Clinics of North America 10/2012; 45(5):1045-54. DOI:10.1016/j.otc.2012.06.008 · 1.34 Impact Factor

Publication Stats

456 Citations
98.31 Total Impact Points


  • 2008–2015
    • Emory University
      • Department of Otolaryngology - Head & Neck Surgery
      Atlanta, Georgia, United States
  • 2007–2011
    • Medical University of South Carolina
      • Department of Otolaryngology-Head and Neck Surgery
      Charleston, SC, United States
    • Georgia Institute of Technology
      Atlanta, Georgia, United States
  • 2010
    • South Infirmary Victoria University Hospital
      Corcaigh, Munster, Ireland
  • 2006
    • Georgia State University
      • Department of Psychology
      Atlanta, Georgia, United States
    • Emory Hospitals
      Atlanta, Georgia, United States