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SM14: Advances in Otolaryngology Improve Surgical Techniques, Treatment of Common Disorders

by Thomas R. Collins •

Chronic rhinosinusitis (CRS) without polyps is fairly homogenous, but differentiation has to be made in CRS with polyps, he said. His center is looking at immunotherapy in patients who have asthmatic CRS with allergy. “In this group of patients, immunotherapy would be very helpful,” he said. “In fact, we’ve had several patients who have been steroid-dependent, [but] we’ve been able to get them off oral steroids with immunotherapy.”

For patients with aspirin triad, zileuton, a 5-LO enzyme inhibitor, can be helpful, because it blocks production of cysteinyl leukotriene, which drives inflammation in these patients. Before this treatment, though, a baseline liver function test (LFT) is needed. Approximately 4% of cases will develop elevated LFT, but in about half these patients, those levels eventually return to normal, Dr. Han added.

Additionally, leukotriene antagonists may be used in treating cystic fibrosis, he said.

“Understand that there are many different types of sinusitis,” he said, “and that medical treatment varies depending on what type of sinusitis you have.”

ICHD-3: Diagnostic Criteria for Vestibular Migraine

  • At least five episodes.
  • Current or past history of migraine.
  • Moderate to severe vestibular symptoms lasting from five minutes to 72 hours.
  • At least 50% of the episodes associated with at least one of three features:
    • Headache with two of four features, including unilateral location, pulsating quality, moderate or severe intensity, or aggravation by routine physical activity.
    • Photophobia and phonophobia.
    • Visual aura.
  • Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.