About

Daniel M. Beswick, MD, is an Associate Professor-in-Residence in the department of Head and Neck Surgery at UCLA. He is a board-certified otolaryngologist with fellowship training in the surgical and medical management of diseases of the sinuses, nose, and skull base. His clinical practice focuses on sinus surgery, nasal surgery, and endoscopic skull base surgery, including the management of chronic rhinosinusitis, deviated septum, CSF leaks, nasal polyps, and sinonasal tumors. Dr. Beswick completed his residency in Otolaryngology – Head and Neck Surgery at Stanford University, earned his medical degree at the University of Pittsburgh, and his undergraduate degree from Brown University. He also completed a fellowship in Rhinology and Endoscopic Skull Base Surgery at Oregon Health and Science University. Prior to joining UCLA in 2020, he served as an Assistant Professor at the University of Colorado. He is actively involved in research, having received multiple extramural grants, and has published extensively on topics related to sinusitis, sinus surgery, cystic fibrosis, and sinonasal tumors. Dr. Beswick is a Fellow of the American Rhinologic Society, serves as the chair of its Membership Committee, and is an active speaker at scientific meetings both nationally and internationally. He also serves on the Task Force for New Materials for the American Board of Otolaryngology Head and Neck Surgery and is an Associate Editor for the journal International Forum of Allergy and Rhinology.

Research topics

• Medicine
• Surgery
• Internal medicine
• Computer Science
• Operations management
• Dermatology
• Management
• Biotechnology
• Business
• Medical emergency
• Law
• Economics
• Pathology
• Engineering
• Family medicine
• Anesthesia
• Marketing
• Nursing
• Immunology

Selected publications

• A Systematic Classification of Surgical Approaches for the Sphenoid Sinus: Establishing a Standardized Nomenclature for Endoscopic Sphenoid Sinus Surgery

  Clinical and Experimental Otorhinolaryngology · 2025-04-09 · 5 citations

  reviewOpen access

  The sphenoid sinus presents significant challenges during endoscopic sinus surgery. It is essential that surgeons employ strategies that effectively address sphenoid pathology while minimizing surgical risks and optimizing outcomes. Although nomenclature for maxillary and frontal sinus surgery is well established, there is currently no standardized nomenclature for sphenoid sinus surgery. We present a comprehensive review of techniques for accessing the sphenoid sinus and propose a common surgical classification system to better define and categorize these approaches. Each technique is classified based on surgical extent, anticipated operation time, complexity, potential complications, and expected wound healing, aligning with established standards in the literature. The proposed sphenoidotomy types are as follows: type I, sphenoid ostial dilation; type IIa, transnasal sphenoidotomy (sphenoidotomy without ethmoidectomy); type IIb, transethmoidal sphenoidotomy (sphenoidotomy with ethmoidectomy); type III, bilateral, common cavity sphenoidotomy, or "sphenoid drill-out;" type IV, transpterygoid approach, to expose the lateral sphenoid sinus recess; and type V, sphenoid nasalization, completely removing the sphenoid sinus floor. By standardizing the nomenclature for these techniques, we aim to enhance consistency in terminology for teaching, surgical planning, clinical research, and interdisciplinary communication in sphenoid sinus surgery.

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• Outcomes of Acute Invasive Fungal Rhinosinusitis Patients Treated with Retrobulbar Amphotericin B Injections versus Orbital Exenteration

  International Forum of Allergy & Rhinology · 2025-03-21

  articleOpen access

  Acute invasive fungal rhinosinusitis (AIFRS) is a rare, aggressive disease process with an estimated mortality rate of 50.3% [1]. The rates of orbital invasion in AIFRS range from 40% to 60% [1, 2], and management of rhino-orbital disease remains controversial, with options ranging from orbital exenteration to tissue debridement to, more recently, transcutaneous retrobulbar amphotericin (TRAM-B) [3, 4]. In 2019, our institution began to treat rhino-orbital AIFRS primarily via TRAM-B. The objective of this study is to detail our experience with TRAM-B in the management of AIFRS and analyze patient outcomes. IRB-approved retrospective review of patients with tissue-confirmed sinonasal AIFRS at a tertiary center from 2010 to 2024. Demographic, medical, and surgical history, imaging, and laboratory information were obtained. Patient MRIs were reviewed, and orbital involvement was defined as the presence of abnormal contrast enhancement or loss of contrast enhancement attributed to invasive fungal disease within the orbital tissues [3]. Descriptive statistics, as appropriate, were reported. Bivariate and multivariate analyses were evaluated using independent two-tailed t-testing or ANOVA for parametric data. A binary logistic regression using alive and deceased as outcomes was performed to determine the impact of various treatment-related factors on patient mortality. All tests used a significance level of ≤0.05. Patients with orbital AIFRS underwent retrobulbar injection of 1 mL of 3.5 mg/mL liposomal amphotericin B compounded by the inpatient pharmacy. TRAM-B is an off-label application that is not approved by the Food and Drug Administration. The procedure was performed in conjunction with sinonasal debridement in the operating room or the inpatient wards. The globe is manually displaced laterally with direct instillation of amphotericin B into the retrobulbar space. Postinjection, manual pressure was applied to the globe, and the patient was monitored for orbital compartment syndrome. Initially, injections were performed daily for a total of three injections, but injections were transitioned to every other day intervals, due to orbital chemosis seen with daily injections. Ninety-five patients were included: 50 (52.6%) patients with nonorbital AIFRS, 32 orbital AIFRS patients (33.7%) received TRAM-B, 10 (10.5%) patients underwent orbital exenteration, and three (3.2%) patients received at least one dose of TRAM-B followed by exenteration. Among patients receiving TRAM-B followed by exenteration, one patient received a single injection of TRAM-B for postseptal orbital changes on MRI but developed same-day eyelid and facial soft tissue necrosis, necessitating exenteration and local debridement. Two patients received three TRAM-B injections followed by exenteration. One patient progressed to complete ophthalmoplegia and proptosis concerning clinical disease progression, and another developed complete ophthalmoplegia and proptosis with continued progression on MRI with loss of enhancement involving the optic nerve, remaining extraocular muscles, and extending toward the inferior orbital fissure. Demographic and disease-related characteristics are in Table 1. Patients with orbital AIFRS had higher hemoglobin A1C than nonorbital AIFRS (p = 0.003), were more likely to be transferred from an outside hospital (p = 0.027), and had Rhizopus/mucor as the underlying fungal pathogen (p = 0.003). There were no differences between the TRAM-B groups or orbital exenteration groups in any demographic, comorbidity, or presenting symptoms/extent of disease. The mortality rate for the total cohort was 50.1% (n = 48) with six (6.3%) patients lost to follow-up after discharge: 46% in the nonorbital AIFRS group, 53.1% in the TRAM-B, 70% in the orbital exenteration group, and 33.3% in patients receiving TRAM-B and exenteration. These rates were not significantly different. Binary logistic regression found no difference in odds of survival between nonorbital AIFRS, TRAM-B, or orbital exenteration patients when accounting for the severity of DM2, causative fungal organism, or transfer status (Table 2). There was no difference in mortality between patients undergoing orbital exenteration, TRAM-B, or nonorbital AIFRS. Other studies have examined patients with rhino-orbital AIFRS and noted a decrease in exenteration rate from 36–54% to 9–12% in patients managed with TRAM-B without differences in mortality [3, 4], which is comparable to our population where 8.6% (3 of 35 patients) receiving at least one injection of TRAM-B required exenteration. A recent meta-analysis examining the role of TRAM-B in AIFRS noted that no studies were sufficiently powered to substantiate differences in mortality, and there may be a role for TRAM-B in decreasing exenteration rates, but direct comparative studies remain limited [5]. There is a paucity of literature examining the role of orbital exenteration in survival outcomes in AIFRS patients. Turner et al. [1], in a systematic review of 807 patients, found that 20% of patients underwent exenteration without any impact on survival outcomes. Hargrove et al. [6] examined 224 cases of orbital AIFRS and found that exenteration only improved survival in patients with fevers but could identify no other prognostic factors associated with exenteration, emphasizing that alternatives to exenteration should be considered in the management of orbital AIFRS. Our data adds to the literature supporting TRAM-B as an alternative management approach to patients with AIFRS and demonstrates that these patients have no worse mortality than those undergoing exenteration. There were three patients in our cohort that had progressive orbital AIFRS despite TRAM-B, requiring exenteration. Orbital symptoms in each patient progressed rapidly and developed progression during the course of their TRAM-B or within 24 h of completion of their treatment course. Monitoring for disease progression via clinical and/or imaging examination is necessary to ensure that treatment failures are captured early enough to determine if additional surgical intervention is required. There are multiple limitations to this study, including the small sample size for the cohort undergoing orbital exenteration, which limits the ability to perform robust multivariate analyses. TRAM-B is a more recent treatment, and the study design may not fully account for advances in medical and anti-fungal therapy that may impact mortality. Multi-institutional studies with larger population sizes would be beneficial to evaluate these associations. The opinions or assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense, the Department of the Air Force, the Uniformed Services University of the Health Sciences, or any other agency of the U.S. Government. The authors declare no conflicts of interest.

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• Outcomes of Immunotherapy Treatment in Sinonasal Mucosal Melanoma

  American Journal of Rhinology and Allergy · 2025-01-09 · 5 citations

  article

  Background Sinonasal mucosal melanoma has poor survival despite multimodality treatment. While the impact of immunotherapy (IT) on metastatic cutaneous melanoma is well-defined, there are relatively little data on sinonasal mucosal melanoma. Objective We sought to define immunotherapy outcomes in patients with sinonasal mucosal melanoma. Methods A retrospective cohort study evaluated patients treated with IT during their overall treatment strategy for SNMM. Patient demographics, treatment, and survival outcomes were recorded. Results 52 patients had IT treatment for SNMM from 2000 to 2022, with an average age of 69.1 ± 11.9 years. The most common treatment was surgery with radiation and IT ( n = 26, 50%). Most regimens consisted of a combination of Nivolumab and Ipilimumab ( n = 17, 32.7%) or pembrolizumab ( n = 14, 26.9%). 44.2% of patients experienced reported complications. Overall survival at 1-, 2-, and 5 years was 86.9%, 74.1%, and 39.1%, respectively. Conclusion Approximately half of patients will have a local response following immunotherapy, but it is rare to have improvement at metastatic locations. Further research within our group will assess optimal timing and markers that are predictive of response.

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• Unilateral Versus Bilateral Endoscopic Resection of Olfactory Neuroblastoma: Pooled Analysis From Prospective and Retrospective Multicenter Data

  International Forum of Allergy & Rhinology · 2025-01-15 · 1 citations

  articleOpen access

  BACKGROUND: Olfactory neuroblastoma (ONB) is a rare sinonasal malignancy primarily treated with surgery. For tumors arising from the olfactory area, traditional treatment involves transcribriform resection of the anterior cranial fossa. Surgery can be performed with unilateral or bilateral resection depending on extent of involvement; however, there are currently no studies comparing outcomes between the two. METHODS: Prospective and retrospective data on primary ONB patients were collected from a multicenter registry involving eight academic sites. Propensity score matching (PSM) was used to create patient cohorts with similar baseline characteristics. Cox proportional hazards and Kaplan Meier analyses assessed overall survival (OS). Logistic regression assessed associations between extent of resection (unilateral versus bilateral) and tumor recurrence or postoperative cerebrospinal fluid (CSF) leak. RESULTS: A total of 187 ONB patients (47.6% female) with an average age of 53.6 ± 15.1 years were analyzed. Most tumors were unilateral (81.3%) and predominantly Kadish C (58.3%) or Hyams II (55.8%). Overall, 56.7% of patients underwent bilateral resection. Fifty-four patients experienced tumor recurrence and nine had postoperative CSF leaks. Following PSM (n = 45/group), extent of resection was not associated with mortality (hazard ratio [HR] 1.73; p = 0.407) or OS (p = 0.400). There was no association between extent of resection and recurrence (odds ratio [OR] 0.90; p = 0.814) or postoperative CSF leak (OR 1.54; p = 0.647). CONCLUSIONS: For ONB tumors where unilateral resection may be feasible and oncologically sound, the decision for unilateral versus bilateral resection showed no significant effect on survival, recurrence, or postoperative CSF leak. Oncologic outcomes may be comparable when resection is tailored to individual patient and tumor characteristics.

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• Reassessment of Age‐Group Subanalyses in Sinus Surgery Complications in a TriNetX Database

  International Forum of Allergy & Rhinology · 2025-10-21

  letter

  To the Editor, We would like to sincerely thank Dr. Lan and Dr. Wang for their thoughtful comments on our recent study “Complications in Endoscopic Sinus Surgery: A TriNetX Network analysis [1].” We are grateful to be provided the opportunity to re-examine our age-group subanalysis of the complications associated with endoscopic sinus surgery (ESS) and will present the results of that analysis below. The authors of the letter specifically examined the data regarding the age-group subanalysis regarding complications in ESS and noted that our patient population had been filtered based on current age rather than age at the time of their surgical intervention. This had the potential to inadvertently alter the result such that a portion of the pediatric population would have been included in an age group that was not representative of their age at the time of surgery. They also posed a method with which to filter patients specifically by their age at the time of surgery. Given this feedback, we took the opportunity to re-examine our data and performed additional analysis to compare the results of the two modalities. First, we examined the overall complication rates and found that they were largely consistent to the initial study across all age groups. The largest difference between analysis methods was noted when examining the complication rates among patients < 12 years of age and those 12–18 years of age, which would coincide with this group being the most likely to be impacted by the difference in analytical methods. We noted a decrease in orbital injury rates and 30-day hospital admissions in both patients < 12 years of age and patients 12–18 years of age while the other metrics were largely consistent with the initial analysis (Table 1). We then re-examined the relative incidence of the complications of ESS based on age after propensity score matching (PSM). When directly comparing the initial analysis to the current reanalysis (Table 2) we found that the relative risk (RR) of complications was overall relatively consistent with the initial study cohort, which we would expect in a propensity score-matched analysis. We found the reanalysis beneficial in terms of increasing the patient population for each propensity score-matched group, particularly in the comparison of children less than 12 years of age to children 12–18, and in comparing children less than 12 to adult patients as the compared populations quadrupled in size. As a result, there were largely minor differences on reanalysis that primarily centered on those differences that were borderline statistically significant on initial analysis. Examples of this would include hemorrhage requiring intervention when comparing younger children (aged < 12 years) to adult patients, and meningitis rates in younger adults (aged 18–59 years) and older adults (aged > 60 years). Perhaps the most noticeable changes in this reanalysis were among orbital injury rates and readmission rates when comparing patients younger and older children (aged 12–18 years). Orbital injury rates, had a notable decrease in younger and older children, decreasing from 4.58% and 3.56% to 2.91% and 2.16%, with younger children having an increased RR of orbital complications (RR: 1.35; 95% confidence interval (CI), 1.00–1.81, p = 0.047). These results are now more in line with previous publications examining orbital complication rates which have previously noted increased orbital complications in younger children [2]. The reanalysis also revealed that 30-day readmission rates decreased when compared to the initial analysis in younger and older children, decreasing from 7.77% and 4.10% to 4.02% and 3.15% with no significant difference in 30-day readmissions between groups (RR: 1.27; 95% CI, 0.99–1.65, p = 0.056). This is a change from the previous reported RR of 1.89% (95% CI, 1.21%–2.95%, p = −0.004) and may indicate a type 1 error in the initial data set, although the reanalysis value is borderline significant and serves to highlight the difficulties in determining risk factors for rare outcomes, even with larger patient databases. In conclusion, we greatly appreciate the insights provided by Dr. Lan and Dr. Wang, which highlight an alternative technique for obtaining data using the TriNetX database. Reanalyzing our data allowed us to increase our pediatric patient population, specifically, fourfold for analysis and minimized the likelihood of patients being miscategorized in terms of age by accounting for age at time of surgery. Daniel M. Beswick: In the last 36 months, Daniel M. Beswick has received grant support from NIH/NHLBI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity). The authors declare no conflicts of interest.

  PublisherDOI

• Abridging the 22‐Item Sino‐Nasal Outcome Test (SNOT‐22) in People With Cystic Fibrosis: Limiting Survey Burden

  International Forum of Allergy & Rhinology · 2025-05-15

  articleOpen accessSenior authorCorresponding

  Chronic rhinosinusitis (CRS) affects quality-of-life (QoL) in people with cystic fibrosis (PwCF), despite the reduction in symptoms and symptom severity associated with cystic fibrosis transmembrane conductance regulator (CFTR) modulators [1]. To precisely assess sinus symptoms and treatment needs in the post-modulator period, patient-related QOL instruments should be revisited. The 22-item SinoNasal Outcome Test (SNOT-22) measures CRS burden and QoL. Abbreviated surveys can lessen respondent fatigue. Item response theory (IRT) can help refine surveys by identifying the most informative survey items while maintaining reliability [2-4]. IRT assesses item discrimination (ɑ), the ability to differentiate trait levels, and difficulty (β), which defines thresholds for response categories [2-4]. Liu et al. refined the SNOT-22 using IRT with strong reliability and validity [5]. Given PwCF's unique CRS burden, this study used IRT to create abbreviated SNOT-22 versions by selecting the most informative items. A secondary aim explored SNOT-22 differences by modulator therapy history. This cross-sectional study, approved by local Institutional Review Boards, analyzed 185 adults (age 18 and over) with cystic fibrosis (CF) and CRS from 12 academic centers between 2018 and 2023, primarily from an ongoing trial (NCT04469439). Baseline SNOT-22 scores were analyzed, with full information maximum likelihood used to handle missingness in the graded response IRT models assessing item discrimination and difficulty. Demographic and clinical data were collected. Shortened surveys were developed by first retaining items contributing above-average information within subdomains (nasal, otologic/facial pain, sleep, emotional), whereupon we applied a stricter rule ensuring at least 30% of the test information was retained from each subdomain to produce a further shortened survey, as implemented by Feng et al. [6]. Internal consistency (Cronbach's α > 0.7) and convergent validity (Pearson's r >0.8) confirmed reliability and efficacy of shortened surveys. Statistical analyses were conducted using R with the “mirt” and “psych” packages [7, 8]. The study included 185 PwCF with CRS, predominantly male (60%), with history of modulator therapy use (77%), and with F508del variants (59%) (Table 1). The mean total SNOT-22 score was 39.3 [±19.8]. Subdomain mean scores were 13.0 [±8.3] for nasal, 4.8 [±3.8] for otologic/facial pain, 13.0 [±9.7] for sleep, and 1.5 [±2.0] for emotional. Responses ranged from 0 (“No problem”) to 5 (“Severe problem”) across most subdomains, except for the emotional subdomain, which lacked the most extreme responses. Initial IRT analysis for all PwCF retained above-average information items across subdomains, preserving 55%–63% of subdomain information and yielding an 11-item survey. A stricter 30% threshold retained six items, covering 34%–54% of information in each subdomain (Figure 1). Despite shortening, difficulty thresholds remained consistent, capturing the full range of symptom severity. Of 142 PwCF with history of modulator therapy, IRT analysis produced nine-item and seven-item surveys. Compared to the total PwCF cohort, the nine-item survey excluded “reduced concentration” and “reduced productivity,” while the seven-item survey retained “dizziness.” All other items were consistent between groups (Figure 1). Notably, PwCF with history of modulator therapy had lower average scores for “thick nasal discharge” (2.0) and “post nasal discharge” (1.7) than those not on therapy (2.4 and 2.2, respectively). Item contributions are detailed in Table S1. Correlation analysis showed strong agreement between shortened and original SNOT-22 scales, with Pearson's coefficients of r = 0.97 (11-item) and r = 0.94 (6-item) for the total PwCF cohort, and r = 0.96 (9-item) and r = 0.95 (7-item) for the modulator therapy subgroup. The original SNOT-22 had a Cronbach's α of 0.93, while shortened versions maintained strong internal consistency (0.90–0.84), ensuring reliable CRS-specific QoL assessment in PwCF. The SNOT-22 is a validated CRS assessment tool for PwCF [5]. Using IRT in a multi-institutional cohort, we retained high-information items and created reliable abbreviated versions of the questionnaire specifically relevant for PwCF. PwCF retained different SNOT-22 items using IRT than other populations [5], indicating distinct symptom distributions and QoL impacts. The 11-item version kept “dizziness,” “facial pain/pressure,” and “embarrassed,” while omitting “ear pain/pressure,” “nasal blockage,” and “sad.” The six-item version showed greater divergence, retaining “waking up tired” and “fatigue.” These differences underscore the need for further study on CRS symptom distribution across populations. When IRT analysis was applied only to PwCF on modulator therapy, it generated largely similar abbreviated surveys to across the entire sample. PwCF on modulators, however, omitted “reduced concentration” and “reduced productivity” from the 11-item SNOT-22 creating a nine-item version. Using the 30% threshold, they retained the six-item SNOT-22 with the addition of “dizziness.” These variations may reflect differences in symptom perception post-therapy and warrant further study. Respondent fatigue, a decline in data quality due to survey length and complexity, may be mitigated by abbreviated surveys [9]. PwCF experience significant fatigue, with severe cases affecting up to 26% [10]. While respondent fatigue in PwCF remains unstudied, abbreviated surveys could enhance participation and data quality. Our findings support shortening the SNOT-22 to reduce fatigue while retaining key information, emphasizing the need for tailored CRS patient reported outcome measures and validation for PwCF. Limitations of this study include modest sample size, limited sociodemographic data, skewed beta parameters, and SNOT-22 midpoint clustering, which may underrepresent CRS severity. Key symptoms such as nasal blockage and dysosmia were excluded in IRT-based shortening, raising concerns about capturing CRS impact. Additional psychometric validation of the shortened scales is required. Despite this, the study supports IRT-based SNOT-22 shortening for PwCF while preserving key information. This work was supported by the Cystic Fibrosis Foundation (BESWIC20A0 and BESWIC22Y5). This foundation provided support for the planning and execution of this work but did not have specific involvement in the study design, data collection, analysis, or interpretation, or decision to submit the article for publication. Research reported in this publication was supported by the National Center for Advancing Translational Science (NCATS) of the National Institutes of Health under the UCLA Clinical and Translational Science Institute grant number UL1TR001881. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE-2034835. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. Daniel M. Beswick: In the last 36 months. Daniel M. Beswick has received grant support from NIH/NHLBI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity). Jeremiah A. Alt: Consultant for OptiNose and Medtronic. Speaker panel GSK. GlycoMira board and equity holder. Kristine A. Smith: In the last 24 months, served as consultant for SanofiGenzyme. Zachary M. Soler: Consultant for OptiNose, Regeneron, and Lyra; Medical Directory for Healthy Humming. Rodney J. Schlosser: Consultant for OptiNose, Medtronic, Stryker, Cyrano; Medical Directory for Healthy Humming. Jennifer L. Taylor-Cousar: In the last 36 months, JLT-C has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants for her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; received fees from Vertex Pharmaceuticals Incorporated related to consultation on clinical research design, participation on advisory boards, and speaking engagements; and served on advisory boards and/or provided clinical trial design consultation for Insmed, 4DMT, and AbbVie. She serves on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation's Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN's Sexual Health, Reproduction and Gender Research Working Group, on the scientific advisory board for Emily's Entourage, and on the ATS Respiratory Health Awards, Scientific Grant Review and Clinical Problems Assembly Programming Committees. All other authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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• Complications in Endoscopic Sinus Surgery: A TriNetX Network Analysis

  International Forum of Allergy & Rhinology · 2025-08-09 · 3 citations

  article

  BACKGROUND: The potential complications of endoscopic sinus surgery (ESS) remain a critical surgical consideration. This study aims to examine complication rates and identify trends in ESS-related complications. METHODS: The TriNetX network was queried for patients undergoing ESS between 2005 and 2024. Diagnosis and procedural codes identified patients with a new post-operative diagnosis relating to epistaxis, cerebrospinal fluid (CSF) leak, meningitis, and/or orbital injury. Complication rates were calculated. The relative risk for demographic differences in complication rates was assessed. Joinpoint regression analysis determined trends in complication rates. RESULTS: A total of 127,333 patients undergoing ESS were included. There was a 0.28% CSF leak rate, 0.24% meningitis rate, 2.09% rate of orbital complications, and 2.27% rate of hemorrhage requiring intervention. Among orbital complications, 0.10% of patients experienced retrobulbar hematoma, 0.40% experienced an extraocular muscle injury, and 0.30% experienced post-operative blindness or low vision. The 30-day readmission rates were 1.47% and 1.62% of patients sought emergency department (ED) care within 30 days of surgery. There were small but significant changes in rates of meningitis (annual percent change [APC] = ‒3.42; 95% confidence interval [CI] ‒5.65, 1.13), hemorrhage requiring intervention (APC = 3.0; 95% CI 1.92-4.10), and 30-day ED visits (APC = 5.43; 95% CI 2.52, 8.43) over time. There were multiple differences in complication rates based on patient sex, age, and race/ethnicity (p < 0.05) CONCLUSIONS: There are age-related and demographic differences in complication rates related to ESS. The majority of complication rates have remained stable over 20 years, with only meningitis rates decreasing while rates of hemorrhage requiring intervention and emergency room visits have increased.

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• 325 Evaluation of CFTR gene editing efficacy using patient-derived nose- on-chip model

  Journal of Cystic Fibrosis · 2025-10-01

  article
  PublisherDOI

• Correlation of the Sinonasal Outcome Test‐22 With the University of Washington Quality of Life in Assessing Quality of Life in Sinonasal Malignancy Utilizing a Multicenter Prospective Observational Cohort Registry

  International Forum of Allergy & Rhinology · 2025-01-06 · 2 citations

  article

  Key points In this multi-center sinonasal malignancies (SNM) cohort, the Sino-nasal Outcome Test has a correlation with the University of Washington Quality of Life (UWQOL) for assessing QOL. The use of both instruments remains recommended to provide complete and complementary information. Future design of an easy-to-use tool specific to SNM is needed to encompass all aspects of QOL.

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• Domain‐Specific Olfaction in Children and Adults in the Era of Modulator Therapy for Cystic Fibrosis

  Pediatric Pulmonology · 2025-10-01 · 1 citations

  article

  BACKGROUND: Little is known about when people with cystic fibrosis (PwCF) begin to experience olfactory decline, or whether sustained use of novel highly effective modulator therapies (HEMT) is predictive of better olfaction. This study evaluated psychophysical olfactory performance and HEMT-associated olfactory outcomes in children and adults with CF. METHODS: In this cross-sectional installment of a longitudinal study, individuals with a physician-confirmed diagnosis of CF completed questionnaires and psychophysical olfactory assessment (i.e., standardized assessment of olfactory domains involving a battery of olfactory stimuli). HEMT consisted of either elexacaftor-tezacaftor-ivacaftor (ETI) or vezacaftor-tezacaftor-deuivacaftor (VTD). Analysis compared performance between pediatric versus adult cohorts and assessed the impact of HEMT on psychophysical olfactory performance while controlling for age, sex, genotype, and history of sinus surgery. RESULTS: Individuals < 21 years old had better psychophysical olfactory performance than those ≥ 21 years old (61% vs. 24% normosmia). Younger age at the start of HEMT was not associated with lowered odds of threshold hyposmia [OR: 0.73; 95% CI: (0.34, 1.50)] or identification hyposmia [OR: 0.67; 95% CI: (0.35, 1.22)] within this cohort. CONCLUSION: Younger people with CF appear to have relatively preserved psychophysical olfactory function that appears to prematurely decline through early adulthood compared to the general population. Although younger age at the start of HEMT therapy was not associated with better olfactory outcomes, future prospective longitudinal studies could evaluate individuals' olfaction across their lifespan to assess the full impact of HEMT on olfaction.

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Frequent coauthors

• Jennifer L. Taylor‐Cousar

  43 shared

• Timothy L. Smith

  Oregon Health & Science University

  43 shared

• Jeremiah A. Alt

  University of Utah

  34 shared

• Jess C. Mace

  Oregon Health & Science University

  28 shared

• Vijay R. Ramakrishnan

  Indiana University – Purdue University Indianapolis

  28 shared

• Zachary M. Soler

  Medical University of South Carolina

  26 shared

• Rodney J. Schlosser

  Oregon Health & Science University

  24 shared

• Peter H. Hwang

  Stanford University

  24 shared

Awards & honors

• Cottle Award, Runner up for Best Clinical Research Manuscrip…
• First Place Award for Best Clinical/Translational Research P…
• Top Reviewer, International Forum of Allergy and Rhinology,…
• First Prize Clinical Research Manuscript, American Rhinologi…
• Innovation in Otolaryngology Award, California Bay Area Resi…