Rakesh K Chandra

Vanderbilt University, Nashville, Michigan, United States

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Publications (163)719.23 Total impact

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    ABSTRACT: To examine the existing evidence on gender differences in the prevalence, treatment, and quality of life of patients with chronic rhinosinusitis (CRS). Review of the literature and expert opinion. From a sociologic standpoint, women have historically been considered more likely to report symptoms, seek medical care, and give poorer self-evaluation of health, which may bias data toward increased prevalence and a greater effect of CRS on quality of life in women. However, the influence of gender seems to be restricted primarily to the evaluation of general quality of life, whereas the disease-specific health-related quality of life is not different between genders. Furthermore, migraine headaches, which are more common among women, may be misdiagnosed as CRS, which contributes to gender differences in the prevalence of CRS. The degree to which reported differences in prevalence and health utilization represent biologic or physiologic differences between genders is not known; however, differences in anatomic size, tobacco susceptibility, and hormonal factors have been speculated to increase the overall susceptibility to CRS in women compared with men. Focused research that examines the effect of gender on the development, treatment, and outcomes of CRS is warranted.
    08/2015; 6(2):82-8. DOI:10.2500/ar.2015.6.0120
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    ABSTRACT: To provide the final results from the REMODEL (randomized evaluation of maxillary antrostomy versus ostial dilation efficacy through long-term follow-up) full-study cohorts and perform meta-analyses of standalone balloon sinus dilation studies to explore long-term outcomes in a large patient sample. Randomized controlled trial and meta-analysis. Final outcomes from the REMODEL randomized trial, including a larger cohort of 135 patients treated with functional endoscopic sinus surgery (FESS) or in-office balloon dilation, were evaluated. One hundred thirty patients had 12-month data, 66 had 18-month data, and 25 had 24-month data. In addition, a meta-analysis evaluated outcomes from six studies including 358 standalone balloon dilation patients with up to 24 months follow-up. Outcomes out to 2 years from the REMODEL full-study cohort are consistent with 6-month and 12-month outcomes. In the meta-analysis of standalone balloon dilation studies, technical success is 97.5%, and mean 20-item Sino-Nasal Outcomes Test scores are significantly and clinically improved at all time points (P < .0001). There are significant reductions (P < .0001) in work/school days missed, homebound days, physician/nurse visits, acute infections, and antibiotic prescriptions. Mean recovery time is 1.4 days. Comparison of 12-month symptom improvements and revision rates between the REMODEL FESS arm (n = 59), REMODEL balloon dilation arm (n = 71), and pooled single-arm standalone balloon dilation studies (n = 243) demonstrated no statistical difference. All outcomes are comparable between FESS and balloon dilation at all time points from 6 months to 24 months. Balloon dilation produces faster recovery, less postoperative pain, and fewer debridements than FESS. There is significant, durable benefit in a large series of 358 patients undergoing standalone balloon dilation. 1b/2a. Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
    The Laryngoscope 07/2015; DOI:10.1002/lary.25507 · 2.14 Impact Factor
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    ABSTRACT: Chronic rhinosinusitis (CRS) is a common condition encountered in primary care medicine and is estimated to affect 12.5% of the United States population. This study aims to compare methods of assessing health utility in CRS. A cross-sectional sample of CRS patients (n = 137) were interviewed using direct health utility assessment measures: the visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). General quality of life (QOL) scores were obtained via the 36-item Short Form Health Survey (SF-36) and converted to SF-6D health utility values using a Bayesian algorithm. Disease-specific QOL was measured with the 22-item Sino-Nasal Outcome Test (SNOT-22). A selected subgroup of patients (n = 51) not initiating surgery or new treatment for CRS were re-interviewed within 3 weeks. The mean ± SD health utilities were VAS 0.69 ± 0.19; TTO 0.80 ± 0.27; SG 0.93 ± 0.11; and SF-6D 0.72 ± 0.12; they differed significantly (p < 0.001). Only VAS scores differed based on disease state classification or the presence of nasal polyposis. Correlations between methods of determining health utility were weak, but significant. VAS, TTO, and SF-6D scores were significantly associated with SNOT-22 (p < 0.001 for all); however, SG and SNOT-22 were poorly correlated (Spearman correlation = -0.33). The test-retest reliability of TTO (Spearman correlation = 0.71) and SG (0.73) was strong. CRS patients show significant impairment in QOL, with health utility values similar to those of patients with acquired immune deficiency syndrome (AIDS) or intermittent claudication using similar methods. The method of ascertainment significantly affects measured health utility, but the degree of impairment warrants improved recognition and appropriate treatment of the condition. © 2015 ARS-AAOA, LLC.
    International Forum of Allergy and Rhinology 06/2015; DOI:10.1002/alr.21556 · 2.37 Impact Factor
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    ABSTRACT: The mechanisms that underlie the pathogenesis of chronic rhinosinusitis without nasal polyps (CRSsNP), with nasal polyps (CRSwNP) and aspirin exacerbated respiratory disease (AERD) are not clear. To first evaluate the inflammatory profiles of CRSsNP and CRSwNP tissues and to then investigate whether clinical differences observed between CRSwNP and AERD are in part secondary to differences in inflammatory mediator expression within NP tissues. Expression levels of numerous inflammatory mediators were determined by qRT-PCR, ELISA, and multiplex immunoassay. CRSwNP NP had increased levels of type-2 mediators including IL-5 (p<0.001), IL-13 (p<0.001), Eotaxin-2 (p<0.001), and MCP-4 (p<0.01) compared to sinonasal tissue from CRSsNP and controls. Expression of IFNγ mRNA or protein was low and not different among CRS subtypes examined. Compared to CRSwNP, AERD NP had elevated protein levels of ECP (p<0.001), GM-CSF (p<0.01), and MCP-1 (p=0.01) as well as decreased gene expression of tissue plasminogen activator (t-PA) (p=0.02). Despite the higher eosinophilia in AERD, there was no associated increase in type-2 mediator protein levels observed. CRSwNP was characterized by a predominant type-2 inflammatory environment while CRSsNP did not reflect a classic type-1 milieu, as has been previously suggested. AERD can be distinguished from CRSwNP by elevated ECP levels, but this enhanced eosinophilia is not associated with elevations in traditional type-2 inflammatory mediators associated with eosinophil proliferation and recruitment. However, other factors including GM-CSF, MCP-1, and t-PA may be important contributors to AERD pathogenesis.
    American Journal of Respiratory and Critical Care Medicine 06/2015; 192(6). DOI:10.1164/rccm.201412-2278OC · 13.00 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo assess relevant variations in the anatomical course of the infraorbital nerve (ION). This understanding may reduce the risk of surgical injury.MethodsA total of 100 consecutive computed-tomography sinus studies obtained in a tertiary referral center were reviewed, and measurements were made of the 200 IONs. Anatomic variants were classified into three types based on the degree to which (if any) the nerve's course descended from the maxillary roof into the sinus lumen.ResultsA total of 60.5% of IONs were entirely contained within the sinus roof. In 27.0%, the nerve canal descended below the roof but remained juxtaposed to it. In 12.5%, the ION descended into the sinus lumen. The proportion of IONs descending into the sinus significantly increased to 27.7% when an infraorbital ethmoid cell was present (chi-square P < 0.001) and to 50% when the nerve was contained within a lamella of such a cell (chi-square P < 0.001). Descended nerves terminated in a foramen located an average of 11.9 ± 2.5 mm below the infraorbital rim, significantly further below the orbit than nondescended nerves (t test P < 0.001). Descended nerves were located a mean distance of 8.6 ± 2.9 mm below the sinus roof and traversed the sinus lumen diagonally for a mean length of 15.4 ± 3.1 mm.Conclusions Descent of the ION into the maxillary sinus is a common anatomic variant that is more prevalent in the setting of an ipsilateral infraorbital ethmoid cell. Descended nerves are associated with the foramen significantly further below the inferior orbital rim than those of nondescended nerves. These observations may help surgeons avoid iatrogenic ION injury.Level of EvidenceN/A. Laryngoscope, 2015
    The Laryngoscope 06/2015; 125(6). DOI:10.1002/lary.25089 · 2.14 Impact Factor
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    ABSTRACT: Epithelial barrier dysfunction is thought to play a role in many mucosal diseases, including asthma, chronic rhinosinusitis (CRS), and eosinophilic esophagitis. The objective of this study was to investigate the role of oncostatin M (OSM) in epithelial barrier dysfunction in human mucosal disease. OSM expression was measured in tissue extracts, nasal secretions, and bronchoalveolar lavage fluid. The effects of OSM stimulation on barrier function of normal human bronchial epithelial cells and nasal epithelial cells cultured at the air-liquid interface were assessed by using transepithelial electrical resistance and fluorescein isothiocyanate-dextran flux. Dual-color immunofluorescence was used to evaluate the integrity of tight junction structures in cultured epithelial cells. Analysis of samples from patients with CRS showed that OSM mRNA and protein levels were highly increased in nasal polyps compared with those seen in control uncinate tissue (P < .05). OSM levels were also increased in bronchoalveolar lavage fluid of allergic asthmatic patients after segmental allergen challenge and in esophageal biopsy specimens from patients with eosinophilic esophagitis. OSM stimulation of air-liquid interface cultures resulted in reduced barrier function, as measured by decreased transepithelial electrical resistance and increased fluorescein isothiocyanate-dextran flux (P < .05). Alterations in barrier function by OSM were reversible, and the viability of epithelial cells was unaffected. OSM levels in lysates of nasal polyps and uncinate tissue positively correlated with levels of α2-macroglobulin, a marker of epithelial leak, in localized nasal secretions (r = 0.4855, P < .05). These results suggest that OSM might play a role in epithelial barrier dysfunction in patients with CRS and other mucosal diseases. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    The Journal of allergy and clinical immunology 04/2015; 136(3). DOI:10.1016/j.jaci.2015.01.043 · 11.48 Impact Factor
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    ABSTRACT: Up to 50% of patients with chronic rhinosinusitis (CRS) have comorbid asthma, and we have reported that a subset of CRS patients who have nasal polyps (CRSwNP) have elevated autoantigen-specific antibodies within their nasal polyps (NP). While increases in the prevalence and/or severity of both asthma and autoimmunity in women are well characterized, it is not known whether CRSwNP is more severe or frequent in women than men. We sought to determine whether CRSwNP demonstrated sex-specific differences in frequency and/or severity. Using a retrospectively collected database of tertiary care patients (n = 1393), we evaluated the distribution of sex in patients with CRSwNP with or without comorbid asthma or aspirin hypersensitivity. We further compared the severity of sinus disease between men and women with CRSwNP. Although women comprised 55% of CRS patients without NP (CRSsNP), a significantly smaller proportion of CRSwNP patients were female (38%, P < 0.001). Interestingly, women with CRSwNP were significantly more likely than men to have comorbid asthma (P < 0.001), and 61% of patients with the most severe form of disease (aspirin-exacerbated respiratory disease (CRSwNP plus asthma plus aspirin sensitivity)) were women (P < 0.05). Women with CRSwNP were significantly more likely to have taken oral steroids, and were more likely to have a history of revision surgeries (P < 0.05) compared to men. These data suggest that women with CRSwNP have more severe disease than men in a tertiary care setting. Future studies are needed to elucidate the mechanisms that drive disease severity in men and women, paving the way for the development of personalized treatment strategies for CRSwNP based on sex.
    03/2015; 3(1). DOI:10.1002/iid3.46
  • Journal of Allergy and Clinical Immunology 02/2015; 135(2):AB237. DOI:10.1016/j.jaci.2014.12.1709 · 11.48 Impact Factor
  • Journal of Allergy and Clinical Immunology 02/2015; 135(2):AB170. DOI:10.1016/j.jaci.2014.12.1491 · 11.48 Impact Factor
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    ABSTRACT: To describe national trends in retropharyngeal abscess (RPA) complicating peritonsillar abscess (PTA) and to determine factors associated with RPA in patients with PTA. Cross-sectional analysis. Nationwide Inpatient Sample, 2003-2010. PTA patients ≥18 years old, with or without RPA, were extracted according to ICD-9-CM codes. The cohort was analyzed with descriptive statistics and multivariate regression modeling to identify factors associated with RPA. Of the 91,647 (95% CI: 86,433-95,449) patients identified with PTA, 885 (1.0%) also had a concurrently coded RPA. The annual rate of concomitant RPA increased from 0.5% (95% CI: 0.3%-0.8%) to 1.4% (95% CI: 1.0%-2.0%) between 2003 and 2010 (P < .001). PTA patients with RPA more frequently underwent tonsillectomy (23.5% vs 11.1%), endotracheal intubation (7.1% vs 1.5%), and mechanical ventilation (13.2% vs 2.0%) than those without RPA (all P < .001). PTA patients with RPA were significantly older (41 vs 34 years old), had a longer hospital stay (6.4 vs 2.5 days), and had more procedures (2.5 vs 0.9) when compared to patients without RPA (all P < .001). Upon multivariate regression analysis, factors associated with RPA included the age groups of 40 to 64 years (odds ratio, 2.256; P < .001) and 65 and older (odds ratio, 2.086; P = .045). Median total charges for PTA inpatients with concomitant RPA were approximately $8700 greater (P < .001) when compared to patients with PTA alone. The incidence of RPA among adult inpatients with PTA is increasing, and patients with RPA have higher in-hospital resource utilization. Further studies may help validate factors predictive of RPA to enable prevention or earlier identification. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
    Otolaryngology Head and Neck Surgery 01/2015; 152(4). DOI:10.1177/0194599814568286 · 2.02 Impact Factor
  • Akaber M Halawi · Patrick E Simon · Alcina K Lidder · Rakesh K Chandra
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    ABSTRACT: Objectives/HypothesisVarious intranasal landmarks have been described to aid in the localization of the natural sphenoid sinus ostium. The objectives of this study are to identify the ostium location relative to the skull base and assess the relationships between the location of the ostium and sphenoid disease or pneumatization pattern. DesignDescriptive study. Methods Consecutive Xoran Mini-CAT (Ann Arbor, MI) scans of patients with no history of sinus surgery (n=202) were evaluated. The natural sphenoid ostium was identified in axial, coronal, and sagittal planes. Distances from the planum to the ostium and from the planum to the sinus floor were calculated. Lund-Mackay score and pneumatization pattern were recorded for each sphenoid sinus. ResultsThe mean distance from planum to ostium was 11.22.6 mm (range 4.4-19.2). On average, this encompassed 45.5%10% of the total sphenoid height. ANOVA with posthoc Tukey analysis revealed that the ostium was closer to the planum in sinuses with sellar (P=0.05) or presellar (P=0.02) pneumatization, compared to those with postsellar pneumatization. There was no significant relationship between the ostium location and degree of sinus disease. There was a significant difference in the pneumatization pattern between males and females (P=.04). More males had postsellar pneumatization than expected, and more females had sellar pneumatization than expected. Conclusions The natural ostium of the sphenoid sinus is located at approximately the midpoint of the sphenoid face. Nevertheless, significant variability can be observed based on the pneumatization pattern. Surgeons should recognize that the ostium may be closer to the skull base when the sinus is less pneumatized. Level of Evidence4. Laryngoscope, 125:75-79, 2015
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24393 · 2.14 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic sinus surgery (ESS) Study DesignCross-sectional analysis Methods Cases identified by Current Procedural Terminology codes as BCD (2,717) or traditional ESS (31,059) were extracted from the State Ambulatory Surgery Databases 2011 for California, Florida, Maryland, and New York. Patient demographics, surgical center and surgeon volume, mean charge, and operating room (OR) time were compared. ResultsThere were 33,776 patients who underwent sinus surgery in the included states in 2011. Of these, 4.6% of maxillary, 5.6% of sphenoid, and 13.9% of frontal procedures were performed using BCD. Adjusted analyses found increased use of BCD in patients with chronic diseases(P<.001). Patients who had limited sinus surgery were less likely to have BCD compared to patients who had all four sinuses instrumented (P<.001). Surgeons who performed a medium (odds ratio 1.38 [1.14-1.65]) or high (odds ratio 1.71 [1.42-2.07]) volume of ESSs were more likely to use BCD compared to those who performed a low volume (P<.001). However, among surgeons who utilized BCD, there was a minimal relationship between the percentage of surgeries performed with BCD and the surgeon's total number of cases (R-2=0.055). Compared to traditional ESS, the median charges for maxillary/ethmoid procedures (mini-ESS) involving BCD were approximately $4,500 (P<.001) and maxillary/ethmoid/sphenoid/frontal procedures (pan-ESS) were approximately $2,950 (P=.003) greater, whereas the median OR time involving BCD was 8 minutes less for mini-ESS procedures(P=.01) but not statistically different for pan-ESS procedures (P=.58). Conclusions In the study sample, balloon technology was used in 8.0% of ESS cases in 2011. Procedures using BCD were on average more expensive compared to traditional ESS procedures, with minimal decrease in OR time. Level of Evidence2c Laryngoscope, 125:49-56, 2015
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24901 · 2.14 Impact Factor
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    ABSTRACT: Objectives/HypothesisTo systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS). Methods Electronic databases were systematically searched for relevant studies published up to June 2012. ResultsTwenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%). Conclusions Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS. Laryngoscope, 125:57-69, 2015
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24709 · 2.14 Impact Factor
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    ABSTRACT: Although chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by Th2 inflammation, the mechanism underlying the onset and amplification of this inflammation has not been fully elucidated. Dendritic cells (DCs) are major antigen presenting cells, central inducers of adaptive immunity and critical regulators of many inflammatory diseases. However, the presence of DCs in CRS, especially in nasal polyps (NPs), has not been extensively studied. The objective of this study was to characterize DC subsets in CRS. We used real-time PCR to assess the expression of mRNA for markers of myeloid DCs (mDCs; CD1c), plasmacytoid DCs (pDCs; CD303) and Langerhans cells (LCs; CD1a, CD207) in uncinate tissue (UT) from controls and patients with CRS as well as in NP. We assayed the presence of DCs by immunohistochemistry and flow cytometry. Compared to UT from control subjects (n=15) and patients with CRS without NP (CRSsNP) (n=16) and CRSwNP (n=17), mRNAs for CD1a and CD1c were significantly elevated in NPs (n=29). In contrast, CD207 mRNA was not elevated in NPs. Immunohistochemistry showed that CD1c(+) cells but not CD303(+) cells were significantly elevated in NPs compared to control subjects or patients with CRSsNP. Flow cytometric analysis showed that CD1a(+) cells in NPs might be a subset of mDC1s, and that CD45(+) CD19(-) CD1c(+) CD11c(+) CD141(-) CD303(-) HLA-DR(+) mDC1s and CD45(+) CD19(-) CD11c(+) CD1c(-) CD141(high) mDC2s were significantly elevated in NPs compared to UT from controls and CRSsNP, but CD45(+) CD11c(-) CD303(+) HLA-DR(+) pDCs were only elevated in NPs compared to control UT. Myeloid DCs are elevated in CRSwNP, especially in NPs. Myeloid DCs thus may indirectly contribute to the inflammation observed in CRSwNP. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical & Experimental Allergy 12/2014; 45(2). DOI:10.1111/cea.12471 · 4.77 Impact Factor
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    ABSTRACT: Specific antibody deficiency (SAD) involves a deficient response to a polysaccharide vaccine in the setting of normal immunoglobulin G (IgG) levels and chronic infections. Patients with chronic rhinosinusitis (CRS) are often evaluated for SAD. There are limited data that describe patients with CRS and SAD. The objective of this study was to better characterize the role of SAD in CRS. We reviewed electronic records of adults with CRS who were evaluated for immunodeficiency with quantitative Ig levels and pre- and postantibody titers to a pneumococcal polysaccharide vaccine (PPV). Fourteen pneumococcal serotypes were determined in 239 subjects from 2002 to 2009. Of these subjects, 64 had adequate protective titers of 1.3 μg/mL or higher in 7 or more serotypes of the 14 serotypes checked; 56 (23%) had less than 7 protective titers post-PPV and were diagnosed with SAD; and 119 had an adequate response to the vaccine with 7 or more serotypes being higher than 1.3 μg/mL (>50% response) and were characterized as "responders." Subjects with SAD received more antibiotic courses relative to responders in the 2 years after immunization (3.19 ± 2.64 vs 2.19 ± 2.24, P < .05). Of 56 subjects with SAD, 10 (17.9%) received Ig replacement therapy. Subjects who received Ig had fewer numbers of protective pneumococcal titers post-PPV and had more pneumonia (40.0%) versus subjects with SAD who did not receive Ig (10.9%). Of the 239 patients with CRS with normal IgG levels evaluated for immunodeficiency, 56 (23.4%) had SAD. A majority of patients with SAD may not need Ig replacement; however, a subset of patients with SAD benefit from Ig replacement. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
    11/2014; 3(2). DOI:10.1016/j.jaip.2014.09.022
  • Matthew J Clavenna · Justin H Turner · Rakesh K Chandra
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    ABSTRACT: To discuss the current applications and indications for the use of pedicled flaps in the reconstruction of endoscopic skull base defects. Current trends in endoscopic skull base surgery include the use of vascularized pedicled flaps rather than free tissue grafts (autograft or allograft) for the repair of anterior cranial base defects. In particular, recent evidence-based algorithms for skull base reconstruction suggest that use of pedicled flaps for clival defects and high-flow cerebrospinal fluid (CSF) leaks may reduce the incidence of postoperative CSF leaks. The primary workhorse continues to be the nasoseptal flap (NSF); however, other options exist in cases wherein this flap is unavailable because of prior sacrifice or unable to reach the area of interest (e.g., defects adjacent to the frontal recess). Adoption of vascularized pedicled flaps over the last decade, particularly the recently popularized NSF, has greatly reduced complications associated with endoscopic skull base surgery. The need for vascularized flap reconstruction is governed primarily by defect size and location, and by the presence of a high-flow CSF leak. Additional vascularized flaps can be used in conjunction with the NSF, or as an alternative when the NSF is unfavorable or unavailable.
    Current Opinion in Otolaryngology & Head and Neck Surgery 11/2014; 23(1). DOI:10.1097/MOO.0000000000000115 · 1.84 Impact Factor
  • Journal of Allergy and Clinical Immunology 10/2014; 135(2). DOI:10.1016/j.jaci.2014.08.031 · 11.48 Impact Factor
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    ABSTRACT: Objectives/HypothesisThe objective of this study was to report patients' knowledge and comfort level with computed tomography (CT) imaging for sinus disease and evaluate patient willingness to undergo empiric medical therapy (EMT) versus CT-directed therapy (CTDT).Study DesignProspective survey study.MethodsA 22-item survey was administered to patients with nasal/sinus symptoms in a tertiary care rhinology clinic. Questions elicited patient demographics, imaging history, and knowledge/comfort regarding imaging-related radiation exposure. Patients were presented with the theoretical choice of EMT versus CTDT, given the expected positive predictive value, in chronic rhinosinusitis (CRS) management.ResultsTwo hundred patients (52% female, age range 18–83 years) participated. Of these, 85% had symptoms for over 3 months. Only 91 patients (45.5%) were aware that CT imaging involved radiation exposure. Prior CT experience and past sinus surgery (P < .05), but not sex or education level, were associated with increased comfort with CT imaging. Most patients (78%) preferred CTDT over EMT. If a CT sinus was recommended, 77 patients (38.5%) had concerns, of which 26% identified radiation exposure as the leading concern. The majority (70%) were unsure about the relative radiation dose of a conventional CT.Conclusions Patients with CRS symptoms prefer CTDT over EMT if a diagnosis cannot be established definitively using exam findings. Although most patients deferred to the physician regarding the decision to utilize CT imaging, there is low awareness of CT-related radiation exposure, and a significant minority of patients have radiation-related concerns with regard to medical imaging for nasal and sinus symptoms.Level of Evidence4. Laryngoscope, 2014
    The Laryngoscope 10/2014; 125(4). DOI:10.1002/lary.24992 · 2.14 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2014; 113(4):347-85. DOI:10.1016/j.anai.2014.07.025 · 2.60 Impact Factor
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    ABSTRACT: Program Description: Failure of adequate response to endoscopic sinus surgery (ESS) is a frequent cause of frustration to chronic rhinosinusitis patients and their surgeons. Technical execution of ESS may be a factor in some common findings at revision ESS (middle meatal adhesions, lateralized middle turbinate, missed maxillary ostium, residual uncinate process, residual anterior and posterior ethmoid cells, sphenoid ostium stenosis, and frontal recess scarring). Using real-life demonstrative cases, our expert panel will share practical and key technical pearls on optimizing results from ESS. These include simple modifications in surgical techniques, selection of procedure appropriate to disease, and incorporation of state-of-the-art technology (endoscopes, instrumentation, navigation, etc).
    Otolaryngology Head and Neck Surgery 09/2014; 151(1 Suppl):P26-P26. DOI:10.1177/0194599814538403a84 · 2.02 Impact Factor

Publication Stats

2k Citations
719.23 Total Impact Points


  • 2015
    • Vanderbilt University
      Nashville, Michigan, United States
  • 2007–2015
    • Northwestern University
      • • Department of Otolaryngology - Head and Neck Surgery
      • • Division of Gastroenterology and Hepatology
      Evanston, Illinois, United States
  • 2011–2013
    • Northwestern Memorial Hospital
      Chicago, Illinois, United States
  • 2004–2009
    • The University of Tennessee Health Science Center
      • Department of Otolaryngology
      Memphis, TN, United States
    • University of Tennessee
      • Otolaryngology - Head and Neck Surgery
      Knoxville, Tennessee, United States
  • 2003
    • Hospital of the University of Pennsylvania
      • Department of Otorhinolaryngology - Head and Neck Surgery
      Philadelphia, Pennsylvania, United States
  • 2002
    • The University of Chicago Medical Center
      • Department of Pathology
      Chicago, Illinois, United States
  • 2001
    • Children's Memorial Hospital
      Chicago, Illinois, United States