Literature Review: A Roundup of Important Recent Studies

• MRI Cost Justified in Dysosmia
• ESS Superior to Medical Therapy for QOL in CRS
• First-Line Steroid Therapy Can Improve Outcomes for ISSHL
• TORS Total Laryngectomy Effective for Salvage Surgery
• Cidofovir Effective for Recurrent Respiratory Papillomatosis
• High-Volume Academic Medical Centers Have Lower Complication Rates for Head and Neck Oncologic Surgery

MRI Cost Justified in Dysosmia

Is magnetic resonance imaging (MRI) warranted for the workup of idiopathic anosmia in today’s climate of cost containment in health care?

Background: Anosmia can result from many causes, both intranasal and intracranial. Failure to diagnose an intracranial cause of anosmia can lead to a poor medical outcome for the patient and a negative medicolegal outcome for the physician.

Study design: Retrospective chart review.

Setting: Tertiary care academic center: Feinberg School of Medicine, Northwestern University, Chicago.

Synopsis: Of the 122 patients included in the study, 44.3 percent of MRIs were normal, and 55.7 percent were abnormal, of which 25.4 percent were dysosmia-related findings and 40.2 percent were incidental findings. The most common dysosmia-related disagnosis was frontoethmoid sinusitis (18.8 percent) and the most common incidental finding was small vessel disease. Nine patients had intracranial causes of dysosmia and six had intracranial neoplasms. MRI cost per dysosmia etiology diagnosis was $9,445. From 1997 to 2003, median medical malpractice settlements and jury awards ranged from $625,616 and $975,000 for misdiagnosis to between $682,500 and $1,550,000 for delay in treatment. In patients with idiopathic anosmia, MRI identified a possible etiology in one-quarter of the cases.

Bottom line: The consequences of missing an intracranial process or neoplasm in a patient with anosmia justify the expense of an MRI.

Citation: Decker JR, Meen EK, Kern RC, Chandra RK. Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient. Int Forum Allergy Rhinol. 2013;3:56-61.

—Reviewed by John M. DelGaudio, MD

ESS Superior to Medical Therapy for QOL in CRS

For patients with chronic rhinosinusitis (CRS), does surgery provide better results for symptom control and quality of life (QOL) than medical treatment alone?

Background: Anecdotal evidence supports the effectiveness of endoscopic sinus surgery (ESS) in improving symptoms of chronic sinusitis, but there has been a lack of prospective control studies. This study prospectively compares the results of ESS with medical therapy for CRS patients who are candidates for ESS based on failed maximal medical therapy.

Study design: Prospective nonrandomized cohort.