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Sultan Qaboos University Medical Journal May 2023
Topics: Humans; Sphenoid Sinus; Aspergillosis; Tomography, X-Ray Computed; Pain
PubMed: 37377830
DOI: 10.18295/squmj.12.2022.063 -
International Forum of Allergy &... Sep 2023A long-duration pain block did not decrease postoperative pain or opioid consumption. Extended sinus procedures do not lead to additional postoperative pain or opioid...
A long-duration pain block did not decrease postoperative pain or opioid consumption. Extended sinus procedures do not lead to additional postoperative pain or opioid consumption.
Topics: Humans; Analgesics, Opioid; Endoscopy; Paranasal Sinuses; Anesthesia; Pain, Postoperative
PubMed: 36811323
DOI: 10.1002/alr.23143 -
British Journal of Hospital Medicine... Oct 2014So-called 'sinus pain' is a common complaint in GP and ear, nose and throat clinics, and patients often receive treatment with antibiotics and decongestants. Recent...
So-called 'sinus pain' is a common complaint in GP and ear, nose and throat clinics, and patients often receive treatment with antibiotics and decongestants. Recent evidence suggests that facial pain may not be related to the sinuses at all and that doctors may have to rethink their prescribing strategy.
Topics: Adrenergic Uptake Inhibitors; Amitriptyline; Diagnosis, Differential; Disease Management; Facial Pain; Humans; Migraine Disorders; Nasal Mucosa; Natural Orifice Endoscopic Surgery; Pain Measurement; Paranasal Sinuses; Prognosis; Sinusitis; Tomography, X-Ray Computed
PubMed: 25291607
DOI: 10.12968/hmed.2014.75.10.558 -
European Annals of Otorhinolaryngology,... Feb 2019The absence of opacities on CT scan usually eliminates paranasal sinus disease as a cause of facial pain. The authors report a case, which constitutes an exception to...
INTRODUCTION
The absence of opacities on CT scan usually eliminates paranasal sinus disease as a cause of facial pain. The authors report a case, which constitutes an exception to this general rule, corresponding to a new aetiology of sinus pain.
CASE REPORT
A 16-year-old boy presented with very painful "recurrent acute sinusitis" triggered by pressure changes (altitude, diving, surfing), with no sinus opacity on CT scan. Surgical exploration demonstrated absence of a primary or accessory maxillary ostium. Middle meatus antrostomy relieved the patient's pain.
DISCUSSION
The pathophysiology of this case of recurrent acute pseudo-sinusitis and the efficacy of antrostomy can be explained by the evo-devo theory of the origin and function of the paranasal sinuses. This case illustrates the absence of communication in the ethmoid of the membranous sac lining the maxillary sinus, formed by degeneration of the maxillary erythropoietic bone marrow. Under stable environmental conditions, the continuous production of nitric oxide by the sinus epithelium is eliminated by simple transmembrane diffusion, but is insufficiently eliminated in the case of rapid pressure changes, inducing sometimes very severe sinus pain, mimicking sinusitis. This case report paves the way for more detailed studies on the role of the paranasal sinuses in facial disease and respiratory physiology.
Topics: Adolescent; Facial Pain; Humans; Male; Maxillary Sinus; Sinusitis; Tomography, X-Ray Computed
PubMed: 30344083
DOI: 10.1016/j.anorl.2018.10.001 -
Otolaryngologic Clinics of North America Oct 2020Perioperative analgesic management is multifaceted, and an individualized approach should be taken with each patient. Preoperative discussion of the plan for pain... (Review)
Review
Perioperative analgesic management is multifaceted, and an individualized approach should be taken with each patient. Preoperative discussion of the plan for pain control and the patient's postoperative expectations is a necessary facet for optimal outcomes of analgesia. There is the potential for significant abuse and development of dependence on opioids. Nonopioids, such as nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentinoids, provide reliable alternatives for analgesic management following sinus and skull-base surgery. There is a paucity of literature regarding perioperative pain regimens for sinus and skull-base surgery, and the authors hope that this review serves as a valuable tool for otolaryngologists.
Topics: Acetaminophen; Analgesia; Analgesics; Analgesics, Opioid; Anti-Inflammatory Agents, Non-Steroidal; Endoscopy; Evidence-Based Medicine; Humans; Pain Measurement; Pain, Postoperative; Paranasal Sinuses; Perioperative Care; Skull
PubMed: 32771245
DOI: 10.1016/j.otc.2020.05.008 -
Otolaryngology--head and Neck Surgery :... Jun 2020To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS).
OBJECTIVE
To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS).
STUDY DESIGN
Case series with planned data collection.
SETTING
Tertiary referral medical center.
SUBJECTS AND METHODS
We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7.
RESULTS
A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3.
CONCLUSION
Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.
Topics: Analgesics, Opioid; Endoscopy; Ethmoid Sinus; Female; Follow-Up Studies; Frontal Sinus; Humans; Male; Middle Aged; Pain Management; Pain, Postoperative; Prescription Drugs; Prospective Studies
PubMed: 32284006
DOI: 10.1177/0194599820915472 -
The Laryngoscope Jun 2019Recent increases in opioid-related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting...
OBJECTIVES
Recent increases in opioid-related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS).
METHODS
Sixty-four consecutive patients undergoing ESS were enrolled. Baseline 22-item SinoNasal Outcomes Test (SNOT-22) and Short-Form 8 (SF-8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT-22/SF-8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables.
RESULTS
Day-of-surgery pain scores were significantly correlated with the SF-8 role-physical domain (Rs = 0.32, P = 0.04). Whereas SF-8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF-8 pain score became correlated with self-reported pain (Rs = 0.39, P = 0.02). SNOT-22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF-8 role-physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R = 0.359, P < 0.0001).
CONCLUSION
Baseline patient-reported global quality-of-life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS.
LEVEL OF EVIDENCE
2c Laryngoscope, 129:1274-1279, 2019.
Topics: Adolescent; Adult; Aged; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures; Pain, Postoperative; Paranasal Sinuses; Preoperative Period; Prognosis; Quality of Life; Rhinitis; Severity of Illness Index; Sinusitis; Young Adult
PubMed: 30613981
DOI: 10.1002/lary.27763 -
JAMA Otolaryngology-- Head & Neck... Aug 2017
Topics: Acetaminophen; Analgesics; Endoscopy; Humans; Pain Management; Pain, Postoperative; Paranasal Sinuses
PubMed: 28542678
DOI: 10.1001/jamaoto.2017.0344 -
Current Opinion in Otolaryngology &... Feb 2019Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily... (Review)
Review
PURPOSE OF REVIEW
Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain.
RECENT FINDINGS
Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology.
SUMMARY
Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority.
Topics: Endoscopy; Ergonomics; Humans; Otolaryngology; Paranasal Sinuses
PubMed: 30516549
DOI: 10.1097/MOO.0000000000000504 -
American Journal of Rhinology & Allergy Jan 2018"Sinus headache" is a common chief complaint that often leads patients to an otolaryngologist's office. Because facial pain may or may not be sinogenic in origin, the... (Review)
Review
"Sinus headache" is a common chief complaint that often leads patients to an otolaryngologist's office. Because facial pain may or may not be sinogenic in origin, the otolaryngologist should be equipped to evaluate and treat or to appropriately refer these patients. Analysis of current data indicates that the majority of patients who present with sinus headaches actually have migraines. Furthermore, the downstream effect of the cytokine cascade initiated in migraine physiology can cause rhinologic symptoms, including rhinorrhea, congestion, and lacrimation, which may also confound diagnosis. Other causes of sinus headache include the following: cluster headaches, Sluder neuralgia, trigeminal neuralgia, myofascial trigger point pain (tension headaches, temporomandibular joint dysfunction), and contact point headaches. The diagnostic dilemma for an otolaryngologist occurs when a patient has facial pain and symptoms that may indicate chronic rhinosinusitis but with nondiagnostic endoscopy. Traditionally, these patients have been primarily managed with empiric antibiotics. An alternative strategy is to first screen these patients with an upfront computed tomography. This algorithm may ultimately decrease cost; avert unnecessary antibiotics prescriptions; and prompt more timely referrals to other, more appropriate, disciplines, such as neurology, dentistry, and/or pain management specialists.
Topics: Diagnosis, Differential; Facial Pain; Headache; Humans; Paranasal Sinuses; Rhinitis; Sinusitis; Tomography, X-Ray Computed
PubMed: 29336283
DOI: 10.2500/ajra.2018.32.4501