Literature Review: A Roundup of Important Recent Studies

• Patients Need to Be Better Informed About Steroid Complications
• Major Complications from Endoscopic Sinus Surgery on the Decline
• First Review of Frontal Sinus Inverted Papilloma Surgical Management
• Clinical Tests of Peripheral Vestibular Function Are Reviewed
• Identification of Prognostic Factors for Head and Neck Merkel Cell Carcinoma
• Nomenclature Paradigm for Benign Midmembranous Vocal Fold Lesions

Patients Need to Be Better Informed About Steroid Complications

What are the medico-legal implications of corticosteroid use in patients with chronic rhinosinusitis and/or allergic rhinitis?

Background: Corticosteroids are a mainstay of treatment for inflammatory disease of the upper airway. Because of their beneficial anti-inflammatory effects, many physicians utilize oral corticosteroids as part of a regimen of “maximal medical therapy” for the treatment of chronic rhinosinusitis. However, in light of their potential complications, uncertainty regarding the use of these agents, as well as informed consent and medico-legal implications, exist for treating physicians.

Study design: Literature review.

Setting: Division of Otolaryngology, Department of Surgery, Zablocki VA Medical Center, Milwaukee, Wisconsin; Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.

Synopsis: Complications from steroid use can be extensive, ranging from psychiatric reactions to skin changes, loss of bone density and avascular necrosis (AVN) of the bone. AVN is the complication that most often leads to litigation. While this condition typically occurs with longer courses of higher doses of steroids, studies of short-term use with lower doses also exist. One notable study found 15 patients with AVN who had received a single course of steroids over a three-year period. The mean cumulative dose was 850 mg of prednisone (range, 290–3300 mg), and the mean duration was 20.5 days (range, 6–39 days). Litigation related to steroid use, according to the WESTLAW database, identifies 65 percent of cases related to “negligent use of steroids,” while 36 percent allege “lack of informed consent or incomplete/unclear consent.”

Bottom line: Clear explanations regarding the use of steroids and their expected benefits and potential risks, as well as possible alternatives, should be presented to patients. These discussions should be documented.

Reference: Poetker DM, Smith TL. What rhinologists and allergists should know about the medico-legal implications of corticosteroid use: a review of the literature. Int Forum Allergy Rhinol. 2012;2(2):95-103.

—Reviewed by Brent Senior, MD

Major Complications from Endoscopic Sinus Surgery on the Decline

What is the nationwide incidence of major complications from endoscopic sinus surgery?

Background: Although endoscopic sinus surgery is one of the most common surgeries performed in otolaryngology, knowledge of major complications is limited. Early studies with small patient cohorts at academic institutions estimated the occurrence of complications to be 1 to 3 percent of cases. This study is an attempt to determine a more accurate rate by utilizing a large nationwide patient database.