Contralateral sinus involvement of surgically treated unilateral allergic fungal rhinosinusitis.

Recurrence of allergic fungal rhinosinusitis (AFRS) is well recognized. However, there is scarcity in the literature describing involvement of the non-diseased sinuses. We aimed to evaluate the recurrence forms of unilateral AFRS as well as to study the possible predictor factors of developing the disease in the contralateral side. Patients with exclusive unilateral AFRS from (2010 to 2015) were enrolled in multi-institutional case-control study. All patients were evaluated after endoscopic sinus surgery for recurrence. Patient's records were reviewed for demographics, medical treatment, and clinical, radiological, and surgical data. A total of 68 patients were identified. Delayed contralateral involvement after the initial surgery was found in 30.8% with mean duration of recurrence 16.9 months. A significant association was found with the presence of pre-operative contralateral symptoms and signs of inflammation (OR 3.49, 95% CI 1.19-10.22, p value 0.02). Post-operative use of budesonide irrigation was associated with less contralateral involvement (OR 0.11, 95% CI 0.01-0.87, p value 0.01). Association of other variables like: comorbidities, perioperative use of systemic steroid, radiological signs, extent of surgery, additional surgery to the contralateral side, and post-operative use of systemic steroids did not show statistical significance. Involvement of the contralateral sinuses in 30% of unilateral AFRS cases is considered significant. The non-diseased sinuses should be involved in the routine endoscopic examination and post-operative treatment. Further studies are necessary to investigate the possibility of prophylactic surgical intervention of the non-diseased sinuses.

Development of a tool for Global Rating of Endoscopic Surgical Skills (GRESS) for assessment of otolaryngology residents.

OBJECTIVE: To develop a valid and reliable assessment tool for endoscopic sinus surgery (ESS). MATERIAL AND METHODS: Data were collected prospectively in an observational study through evaluations at two tertiary academic institutions, i.e. St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada, and King Fahd Medical City, Riyadh, Saudi Arabia, from December 2006 to December 2009. A 2-page evaluation form was developed in conjunction with the Objective Assessment of Technical Skills Surgery (OSATS) evaluation form developed by Reznick et al in Toronto to assess residents' surgical skills. A Likert scale (1-5 where 5 = excellent) was used for evaluations. The Global Rating of Endoscopic Surgical Skills (GRESS) evaluation instrument was designed with input from academic otolaryngologists, fellowship-trained rhinologists, and experts in medical education. The experts' comments were incorporated, establishing face and content validity. Residents from various levels of training were assessed objectively using this instrument. Internal consistency was evaluated using Cronbach's alpha. Test-retest and inter-rater reliability was measured using intra-class correlation. RESULTS: A total of 31 assessments were completed by 15 residents. GRESS showed high reliability in the context of internal consistency (alpha = 0.99), test-retest (0.95, CI = 0.83-0.98), and inter-rater reliability (0.86, CI = 0.31-0.98). CONCLUSIONS: This pilot study demonstrated that GRESS is a valid and reliable assessment tool for operating room performance.