Sinonasal endoscopy reporting format: emphasis on chronic rhinosinusitis.

The role of nasal endoscopy has been well characterized in terms of diagnosis and treatment, the methods of performing the endoscopy, and the findings that can be visualized within the nasal cavities. The reporting format of such findings has not been the subject of such detailed popularity. A structured format would create a common language between otolaryngologists, potentially facilitating outcomes assessment and/or research by providing an objective tool for recording findings. More so, professional associations might use a structured format for government or billing negotiations and justifications. The following sinonasal endoscopy reporting format represents a synthesis of clinical experience from three rhinologists in attempting to document endoscopic findings in the nose and sinuses. Our primary objective was limited to establishing a standardized format that will be suitable for objective outcomes assessment and communication between endoscopic sinus surgeons. It is also hoped that this reporting format can be correlated with patients' subjective quality of life outcomes.

Endoscope-assisted image-guided approach to the pituitary gland: preliminary cadaveric study.

The microscopic transsphenoidal approach to the pituitary gland is the current standard technique used by neurosurgeons to operate the pituitary gland. The endoscopic transsphenoidal approach to the pituitary gland is a current trend because more neurosurgeons are becoming familiar with the use of endoscopes. The use of associated image-guided surgery (or surgical navigation technology; these names are equivalent and are used interchangeably) allows a precise approach that increases the safety and efficacy of a surgical procedure. The InstaTrack system (GE Medical Systems Navigation and Visualization, Inc., Lawrence, MA) is a frameless electromagnetic navigational system used in this study. The objectives of this preliminary and conceptual cadaveric study (three heads) are to get familiarized with the use of image guidance and the study of the endoscopic anatomy of this region and to investigate the technical requirements and benefits of possible future shifting from microscopic towards endoscopic image guidance.

Endoscopic electrosurgical adenoidectomy: technique and outcomes.

Recent literature has embraced the use of electrosurgery and endoscopy in adenoidectomy, with several published articles on the subject. The combination of these methods and the routine use of endoscopy have not been reported. This approach provides a direct-targeted route to the nasopharynx, improved visualization, and magnification and offers a bloodless surgical field. It allows improved evaluation of the adenoids with their peritubal extensions, their lateral and central portions, and their extension to the posterior nasal choanae and even in the posterior nasal fossae and evaluation of the posterior of the middle and inferior turbinates. It permits objective documentation of the cause of nasal obstruction with possible use in outcome assessment. It is also an effective teaching method and a motivating approach for the nursing team. Our approach has proved cost and time efficient in our minimally invasive surgical (endoscopic) operating room set-up. This article reflects the experience in a series of 96 consecutive patients performed during a 9-month period and discusses the surgical technique and patients' outcomes. The endoscope and suction cautery were systematically used for all adenoid surgery. Outcomes were evaluated using a telephone survey with a global rating questionnaire.

Endoscopic electrosurgical management of posterior epistaxis: shifting paradigm.

Recent literature has embraced the use of electrosurgery, sphenopalatine vascular clipping, and endoscopy in posterior epistaxis. With the advent of endoscopy, the surgical treatment of posterior epistaxis has shifted from internal maxillary ligation to endoscopic sphenopalatine artery control. This article introduces an endoscopic electrosurgical approach for patients suffering from idiopathic posterior epistaxis that combines one or more of the following methods: endoscopic selective branch cauterization, endoscopic sphenopalatine artery cautery, and endoscopic posterior nasal cauterization. This approach is currently used in a hospital-based community otolaryngology practice and is presented from a Canadian health care perspective (Quebec). This article presents the experience in a series of 17 patients treated during a 35-month period and prospectively followed and discusses the surgical technique, patients' outcome, and the implications of such a practice.

Evidence-based endoscopic sinus surgery.

Evidence-based medicine principles applied to otolaryngology and endoscopic sinus surgery provide the surgeon, patient, and third-party payer with all of the necessary requirements to evaluate the effectiveness of the surgery. Above all, they ensure long-term improvement in quality of life and patients' satisfaction. A specific study on the outcomes of endoscopic sinus surgery is presented. A longitudinal observational study of 51 patients undergoing endoscopic sinus surgery for recurrent acute rhinosinusitis, chronic rhinosinusitis, and nasal polyposis was done in two hospitals. Patients were evaluated preoperatively and 3 months postoperatively with a disease-specific health status questionnaire (Quebec French-Rhinosinusitis Outcome Measure) and a general health status questionnaire (the Medical Outcome Study 36-Item Short-Form Health Survey). The results show statistically significant improvement in quality of life after endoscopic sinus surgery in both the disease-specific and the disease-generic health status questionnaires. The broader subject of objective and subjective outcomes assessment, along with evidence-based evaluation, is discussed.

Endoscopic septoplasty: technique and outcomes.

Recent literature has already embraced the topic of endoscopic septoplasty, with several published articles on the subject. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. It allows improved evaluation of the posterior nasal septal deformities, identification of the degree of mucosal involvement of the posterior ends of the inferior turbinates, and concomitant assessment of the middle meatus. It permits objective documentation of the cause of nasal obstruction with possible use in outcome assessment. It is also an effective teaching method and a motivating approach for the nursing team. We present our experience in a series of 47 patients performed during a 1 1/2-year period and discuss the surgical technique and patients' outcomes. We systematically used the endoscope for all septal and turbinate surgery. We evaluated outcomes using a telephone survey along with a validated disease-specific health status measure and a global rating questionnaire.