P128 Otolaryngology–Head and Neck Surgery 151(1S) Presentation schedule is subject to change. For the most up-to-date information, visit www.entnet.org/annual_meeting. Sinonasal Symptomatic Outcomes following Laser Treatment of Epistaxis Related to Hereditary Hemorrhagic Telangiectasias Edward C. Wu, MD (presenter); Kevin A. Peng, MD; Christopher F. Thompson, MD; Jeffrey D. Suh, MD; Marilene B. Wang, MD Objectives: (1) Characterize baseline sinonasal symptoms for hereditary hemorrhagic telangiectasia (HHT) patients. (2) Analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. Methods: Retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010, and December 31, 2013, in a tertiary academic medi- cal center with an HHT Foundation-approved Center of Excellence. All HHT patients who had undergone one or more laser surgical treatments by 1 of 2 otolaryngologists were included in the analysis. Preoperative and all subsequent post- operative SNOT-22 scores were compared using unpaired t tests. Subgroup analysis was performed for patients who underwent more than 1 laser surgery. Results: A total of 21 consecutive HHT patients underwent laser surgery for recurrent epistaxis. Compared with preopera- tive scores, patients reported significantly improved (P < .05) SNOT scores at 2 weeks postoperatively for dizziness, diffi- culty falling asleep, waking up at night, getting a good night’s sleep, waking up tired, reduced concentration, feeling of frus- tration, and sadness. The same cohort reported significantly worse nasal obstruction at 2 weeks postoperatively. Patients who underwent more than one surgery experienced overall symptomatic improvement after the second surgery. Conclusions: HHT patients experienced a short-term improve- ment in sinonasal symptoms, especially those producing social and emotional consequences, following laser surgery for HHT-related epistaxis. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT. Sinus Disease following Total Laryngectomy: A Radiographic Review Sarah M. Kidwai (presenter); Arjun K. Parasher, MD; Abib A. Agbetoba, MD; Alfred M. Iloreta, MD; Satish Govindaraj, MD; Brett A. Miles, MD Objectives: (1) Compare the incidence of radiographic sinus disease before and after laryngectomy by retrospective analy- sis of preoperative and postoperative computed tomography (CT) scans. (2) Analyze the change in pre-existing radio- graphic sinus disease via a subset analysis. Methods: A single-institution retrospective chart review was conducted. Patients who received a total laryngectomy or total laryngopharyngectomy between 2002 and 2012 with pre- operative and postoperative CT scans were included. The Lund-Mackay (LM) Scores for each sinus as well as the total LM score were recorded for both scans. The assessment of differences in these scores is based on McNemar’s statistic for each sinus and on a paired t-test for the total LM score. Results: Surgical removal of the larynx creates an anatomi- cal disconnect between the sinonasal cavity and distal respira- tory tract. Normal nasal airflow is disrupted, resulting in alterations to the nasal mucosa, mucociliary clearance, and nasal flora. While the incidence of sinonasal disease in patients undergoing total laryngectomy has been studied via subjective scoring methods, this study is the first to evaluate radiographic sinusitis via an objective measure by comparing Lund-Mackay scores before and after total laryngectomy. There were no sig- nificant differences in the LM scores between preoperative and postoperative scans within each sinus (P value >.05) or in the total LM score (t statistic >0.56). Conclusions: In patients undergoing total laryngectomy, dis- ruption in nasal airflow has been correlated with altered sino- nasal physiology and decreased subjective symptoms. However, our study shows no significant change in radio- graphic evidence of sinonasal disease after laryngectomy. Sinus Headaches: Otolaryngology Treatment or Neurology Referral: Analysis of Efficacy and Cost-Effectiveness of Migraine Treatment Pedram Daraei (presenter); Jennifer H. Gross; John M. Delgaudio, MD Objectives: Evaluate the efficacy and cost-effectiveness of empiric treatment of sinus headaches/migraines initiated by an otolaryngologist versus referral to a neurologist for treatment. Methods: Retrospective chart review from 1998 to 2013 of patients with ICD-9 codes for headache or atypical facial pain at an academic medical center. Comparison of cost of workup and treatment initiated by an otolaryngologist was compared with that of patients referred to neurology. Length of delay in treatment was also calculated for patients referred to neurology. Results: Of 797 patients reviewed, 57 patients were primar- ily treated by otolaryngology, and 104 patients were referred to neurology for treatment. Success of patients treated by oto- laryngology was 78.9% versus 81.8% for neurology-treated patients (P = .77). The average wait for an appointment with a neurologist specializing in headache was 57.9 days. Forty-two patients had a history of chronic rhinosinusitis, with 18 in the otolaryngology-treated group and 24 in the neurology referral group (P = .25). Cost analysis showed that there was a signifi- cant increase in health care costs when patients were referred to neurology for diagnosis and treatment, with the referred patients accruing higher health care costs in the form of office visits, medications, and imaging techniques. Conclusions: Recognition of sinus headaches as migraines by the otolaryngologist and initiation of treatment allows for earlier improvement of symptoms, improved quality of life, and decreased health care costs, with equal success rates to that of patients treated by neurology. RHINOL/ALLER at The University of Iowa Libraries on June 4, 2016 oto.sagepub.com Downloaded from at The University of Iowa Libraries on June 4, 2016 oto.sagepub.com Downloaded from at The University of Iowa Libraries on June 4, 2016 oto.sagepub.com Downloaded from at The University of Iowa Libraries on June 4, 2016 oto.sagepub.com Downloaded from at The University of Iowa Libraries on June 4, 2016 oto.sagepub.com Downloaded from