Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P139

Oral Presentations

The Feasibility of Office Septoplasty and
Inferior Turbinate Outfracture Under Local
Anesthesia With a Novel Balloon Device
Karen Hoffmann, MD (Presenter); Marc Dean, MD
Objectives: Twenty million people suffer from chronic
nasal obstruction, and 740,000 procedures treating septal
deviation and hypertrophic inferior turbinates are performed
annually. This retrospective chart review examines whether it
is feasible to perform septoplasty and outfracture of the inferior turbinates in a clinic setting-independent private practices-under local anesthesia using a novel balloon device.
Methods: Ninety-four adult patients with septal deviation
and turbinate hypertrophy underwent septoplasty and outfracture of the inferior turbinates under local anesthesia. All
patients were treated with oxymetazoline and tetracaine 4%
spray and then 7% tetracaine/7% lidocaine compounded
cream on cottonoids for 10 to 15 minutes. Lidocaine 1% with
1:100,000 epinephrine was injected when necessary. Using an
endoscope, the Tract balloon was placed in the nose along the
floor on the more obstructed side, inflated to 12 atm of pressure, and left for 2 minutes. The procedure was then repeated
on the opposite side. Excess cartilage and bone were removed
through keyhole incisions as needed. Any persistent bleeding
was controlled with oxymetazoline or silver nitrate.
Results: Ninety-two patients were able to complete full
pressure dilation for 2 minutes on each side of the nose. Two
patients did not tolerate full dilation to 12 atm of pressure
because of pain, so the procedure was stopped. There were no
episodes of bleeding requiring packing nor any emergency
department evaluations or admissions for complications.
Conclusions: Treatment of chronic nasal obstruction with
septoplasty and outfracture of the inferior turbinates can be
performed successfully and safely in a clinic setting under
local anesthesia.
Impact of 30 Days of Budesonide Nasal
Irrigation Followed by Olfactory Training on
Post-viral Olfactory Dysfunction
Pawina Jiramongkolchai (Presenter); John S. Schneider, MD, MA;
Andrew J. Drescher, MD; Margaret A. Ogden, MD; Dorina
Kallogjeri; Jay F. Piccirillo, MD
Objectives: Olfactory training (OT) is a promising intervention for smell restoration. Topical steroid lavages that reach
the olfactory cleft may treat subclinical inflammation and also
improve smell. The objective of this study was to evaluate the
impact of a 30-day course of budesonide lavage (Neti-Cort)

followed by OT on olfaction for patients with post-viral olfactory dysfunction (PVOD).
Methods: A prospective pilot study funded by the American
Academy of Otolaryngology-Head and Neck Surgery
Foundation Resident Research Award was conducted at a tertiary academic center from September 2017 to November 2018.
Patients with PVOD of 3 months or longer duration were
recruited. Baseline olfaction was measured using the University
of Pennsylvania Smell Identification Test (UPSIT) and Sniffin'
Sticks. Participants underwent a 30-day course of Neti-Cort followed by 3 months of OT. The primary outcome measure was
the change in UPSIT and Sniffin' Sticks scores pre- and post-OT.
A clinically meaningful improvement (CMI) was defined as an
increase in 4 points or more on the UPSIT and/or 5.5 points or
more on the Sniffin' Sticks. Secondary outcome measures
included patient-reported changes in smell and quality of life.
Results: A total of 23 participants enrolled and completed the
study (17 women; median age, 62 years [range, 30-70 years]).
The median duration of smell loss was 12 months (range,
3-240 months). Of the 23 participants, 9 (39%) had a CMI in
smell following OT. Self-reported ability to smell post-OT did
not appear to be associated with objective improvements in
smell as discordances between subjective and objective
reported outcome measures of smell were observed.
Conclusions: OT may be beneficial to some patients with
PVOD. Measuring the impact of OT using objective and
patient-reported outcome measures is complex. Further research
is needed to improve our current diagnostic instruments.
Implications of Obesity on Postoperative
Complications Following Endoscopic Sinus
Surgery: An Analysis of the NSQIP Database
Robert D. Wardlow (Presenter); Isaac A. Bernstein;
Cinthia Orlov; Nicholas R. Rowan, MD
Objectives: Rates of obesity have been continually increasing worldwide. This study sought to assess the impact of obesity and associated factors on postoperative complications
following endoscopic sinus surgery (ESS).
Methods: We queried the American College of Surgeons
National Surgical Quality Improvement Program (ACS
NSQIP) database from 2006 to 2018 for all cases of ESS.
Patients were divided into cohorts based on the World Health
Organization's definition of obesity (body mass index ≥30)
with demographics, complications, readmissions, reoperations, and mortality compared between the groups.
Results: We identified 1595 cases of ESS, of which 774
(49.8%) patients were obese. Obese patients were more likely
to have higher American Society of Anesthesiologists classification, diabetes, and hypertension requiring medication, while
nonobese patients were more likely to be older than 60 years,
smoke tobacco, and have disseminated cancer. The obese
cohort was associated with a lower frequency of surgical complications (3.10% vs 5.60%; P = .009), driven by postoperative bleeding (1.81% vs 3.90%; P = .008). Obese patients less
frequently required unplanned reoperation (2.07% vs 3.78%;
P = .029). There was no significant difference in frequency of

Rhinology/Allergy

0.96 ± 0.06, and negative predictive value 0.84 ± 0.1.
Predictor variables included number of extreme eye movements, total fixation duration, mean endoscopic rotation and
depth perception, and tool motion jerk.
Conclusions: Eye tracker and tool/endoscope kinematic data
accurately predict surgical skill level in binary and continuous
skill classes. These metrics can be used to generate closedloop feedback for trainees learning ESS.

P139

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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