6410 Fannin St 1200
Houston TX 77030
Medical School: Other - 1998
Accepts Medicare: Yes
Participates In eRX: Yes
Participates In PQRS: Yes
Participates In EHR: Yes
License #: M1087
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Awards & Recognitions
Dr. Samer Fakhri is associated with these group practices
|HCPCS Code||Description||Average Price||Average Price
Allowed By Medicare
|HCPCS Code:31255||Description:Removal of ethmoid sinus||Average Price:$4,762.15||Average Price Allowed
|HCPCS Code:31267||Description:Endoscopy maxillary sinus||Average Price:$4,177.64||Average Price Allowed
|HCPCS Code:31276||Description:Sinus endoscopy surgical||Average Price:$3,829.50||Average Price Allowed
|HCPCS Code:31237||Description:Nasal/sinus endoscopy surg||Average Price:$2,572.38||Average Price Allowed
|HCPCS Code:61782||Description:Scan proc cranial extra||Average Price:$509.00||Average Price Allowed
|HCPCS Code:31231||Description:Nasal endoscopy dx||Average Price:$456.00||Average Price Allowed
|HCPCS Code:99203||Description:Office/outpatient visit new||Average Price:$208.00||Average Price Allowed
|HCPCS Code:99212||Description:Office/outpatient visit est||Average Price:$84.00||Average Price Allowed
HCPCS Code Definitions
- Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
- Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
- Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
- Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
- Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
- Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus
- Stereotactic computer-assisted (navigational) procedure; cranial, extradural (List separately in addition to code for primary procedure)
- Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus
Medical Malpractice Cases
Medical Board Sanctions
*These referrals represent the top 10 that Dr. Fakhri has made to other doctors
Airway surface mycosis in chronic TH2-associated airway disease. - The Journal of allergy and clinical immunology
Environmental fungi have been linked to TH2 cell-related airway inflammation and the TH2-associated chronic airway diseases asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown.To determine the frequency of fungus isolation and fungus-specific immunity in patients with TH2-associated and non-TH2-associated airway disease.Sinus lavage fluid and blood were collected from sinus surgery patients (n = 118) including patients with CRSwNP, patients with CRS without nasal polyps, patients with AFRS, and non-CRS/nonasthmatic control patients. Asthma status was determined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. PBMCs were restimulated with fungal antigens in an enzyme-linked immunocell spot assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared with fungus-specific IgE levels measured from plasma by ELISA.Filamentous fungi were significantly more commonly cultured in patients with TH2-associated airway disease (asthma, CRSwNP, or AFRS: n = 68) than in control patients with non-TH2-associated disease (n = 31): 74% vs 16%, respectively (P < .001). Both fungus-specific IL-4 enzyme-linked immunocell spot (n = 48) and specific IgE (n = 70) data correlated with TH2-associated diseases (sensitivity 73% and specificity 100% vs 50% and 77%, respectively).The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with TH2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients.Copyright Â© 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
The effect of intranasal fluticasone propionate irrigations on salivary cortisol, intraocular pressure, and posterior subcapsular cataracts in postsurgical chronic rhinosinusitis patients. - International forum of allergy & rhinology
Intranasal corticosteroid irrigations, especially budesonide, are used increasingly in the management of chronic rhinosinusitis. In post-endoscopic sinus surgery patients, irrigations may offer improved delivery at higher doses to the paranasal sinuses than intranasal spray preparations. Fluticasone propionate may have higher potency and lower systemic bioavailability than budesonide, but there is little data on its effects as an intranasal irrigation on the hypothalamic-pituitary-adrenal axis or on ocular findings.Adult patients who had previously undergone bilateral endoscopic sinus surgery and had not taken systemic corticosteroids in the last 6 months were prospectively enrolled. Subjects irrigated with 3 mg of fluticasone propionate in 240 mL saline solution twice daily. Salivary cortisol, intraocular pressure, and the presence of posterior subcapsular cataracts were measured before drug administration and after 6 weeks of continuous use.Twenty-three subjects completed the study. No subjects had salivary cortisol levels below the normal range before or after therapy, and there was no statistical difference in mean salivary cortisol levels pretreatment and posttreatment (0.294 vs 0.392 Î¼g/dL; p = 0.27). There was no clinical or statistical difference in mean intraocular pressure before or after therapy (13.3 vs 13.3 mmHg; p = 0.86). No subjects developed a posterior subcapsular cataract.Fluticasone propionate irrigations did not suppress salivary cortisol levels or result in ocular changes. Irrigation with fluticasone propionate 3 mg in 240 mL saline twice daily may be a safe alternative to other intranasal or systemic corticosteroid treatments for chronic rhinosinusitis patients.Â© 2013 ARS-AAOA, LLC.
IL-33-responsive innate lymphoid cells are an important source of IL-13 in chronic rhinosinusitis with nasal polyps. - American journal of respiratory and critical care medicine
Chronic rhinosinusitis (CRS) without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP) are associated with Th1 and Th2 cytokine polarization, respectively; however, the pathophysiology of CRS remains unclear. The importance of innate lymphoid cells in Th2-mediated inflammatory disease has not been clearly defined.The objective of this study was to investigate the role of the epithelial cell-derived cytokine IL-33 and IL-33-responsive innate lymphoid cells in the pathophysiology of CRS.Relative gene expression was evaluated using quantitative real-time polymerase chain reaction. Innate lymphoid cells in inflamed ethmoid sinus mucosa from patients with CRSsNP and CRSwNP were characterized using flow cytometry. Cytokine production from lymphoid cells isolated from inflamed mucosa of patients with CRS was examined using ELISA and intracellular cytokine staining.Elevated expression of ST2, the ligand-binding chain of the IL-33 receptor, was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP and healthy control subjects. An increased percentage of innate lymphoid cells was observed in inflamed sinonasal mucosa from CRSwNP compared with CRSsNP. ST2(+) innate lymphoid cells are a consistent source of IL-13 in response to IL-33 stimulation. Significant induction of IL-33 was observed in epithelial cells derived from patients with CRSwNP compared with patients with CRSsNP in response to stimulation with Aspergillus fumigatus extract.These data suggest a role for sinonasal epithelial cell-derived IL-33 and an IL-33-responsive innate lymphoid cell population in the pathophysiology of CRSwNP demonstrating the functional importance of innate lymphoid cells in Th2-mediated inflammatory disease.
Optical rhinometry in nonallergic irritant rhinitis: a capsaicin challenge study. - International forum of allergy & rhinology
Patients with nonallergic irritant rhinitis (NAIR) have symptoms of nasal congestion, nasal irritation, rhinorrhea, and sneezing in response to nasal irritants. We currently have no reliable objective means to quantify these patients' subjective symptoms. In this study, we used the transient receptor potential vanilloid receptor (TRPV1) receptor agonist, capsaicin, as an intranasal challenge while comparing the changes in blood flow with optical rhinometry between subjects with NAIR and healthy controls (HCs).Six HCs and 6 NAIR subjects were challenged intranasally with saline solution followed by increasing concentrations of capsaicin (0.005 mM, 0.05 mM, and 0.5 mM) at 15-minute intervals. We recorded maximum optical density (OD) and numeric analog scores (NAS) for nasal congestion, nasal irritation, rhinorrhea, and sneezing for each subject after each challenge. Correlations between NAS and maximum OD were calculated.Maximum OD increased with increasing concentrations of intranasal capsaicin in NAIR subjects. There were significant differences in maximum OD obtained for 0.05 mM and 0.5 mM capsaicin between NAIR subjects and HCs. Significant differences were found in the NAS for nasal irritation at 0.005 mM, 0.05 mM, and 0.5 mM, and nasal congestion at 0.5 mM. Correlation between maximum OD and mean NAS was most significant for 0.05 mM capsaicin.Optical rhinometry with intranasal capsaicin challenge could prove a viable option in the diagnosis of NAIR. Further studies will investigate its use to monitor a patient's response to pharmacologic therapy and provide further information about the underlying mechanisms of NAIR.Â© 2013 ARS-AAOA, LLC.
Sinonasal undifferentiated carcinoma (SNUC): morphoproteomic-guided treatment paradigm with clinical efficacy. - Annals of clinical and laboratory science
Sinonasal undifferentiated carcinoma (SNUC) is a rare and highly malignant tumor that occurs in the nasal cavity and/or paranasal sinuses. Prognosis is poor despite multimodality treatment. Currently, there is no optimal standard of treatment, partially due to a lack of research defining the biology of such tumors. This report discusses two SNUC cases where patients received a novel chemotherapeutic approach using cisplatin, etoposide, Adriamycin (doxorubicin), metformin, and adjuvant melatonin therapies based on morphoproteomic-guidance, followed by consolidation with chemoradiation therapy. This resulted in excellent and objective tomographic and magnetic resonance imaging and clinical responses including complete responses in the induction phase utilizing morphoproteomic-guided therapies. Later, endoscopic excision of the tumor bed failed to reveal any residual tumor. Morphoproteomics helped to define the biology of these SNUC tumors and provided targets for the agents employed, creating a new treatment paradigm for such tumors. This treatment regimen poses a new effective regimen to treat SNUC.
End-organ testing for allergic rhinitis with fungi is poorly correlated with fungal sensitivity. - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
To evaluate optical rhinometry (ORM) using nasal provocation testing (NPT) as an objective tool to diagnose fungal allergic rhinitis (AR).Prospective.Tertiary academic center.We prospectively enrolled healthy controls (HCs) and subjects with a clinical history of AR and positive skin prick test to Alternaria or Aspergillus antigens. Baseline measurements with an optical and acoustic rhinometer (AcR) were taken, and all subjects underwent NPT with increasing concentrations of Alternaria and then Aspergillus in each nasal cavity. Optical density (OD), nasal mean cross-sectional area (MCA), visual analog scale (VAS), and nasal allergen provocation scale (NAP) were measured after each provocation. A NAP score â‰¥ 3 was considered positive. Receiver operating characteristic (ROC) curve analysis was performed on measured parameters.Eleven HCs and 11 AR subjects were enrolled. Of the 8 AR patients with an Alternaria-positive skin test, 50% had a positive NAP score (4/8) vs 0% in HCs (0/11, P = .01). Although VAS could differentiate Alternaria-sensitive patients from controls, change in OD and MCA could not. Of the 7 skin test-positive Aspergillus patients, 43% had a positive NAP score (3/7) vs 0% in HCs (0/11, P = .02). The VAS and change in OD and MCA did not differentiate Aspergillus-sensitive patients from controls.In this study, fungal antigens caused irritation but did not elicit early phase changes in nasal patency or blood flow in fungal-sensitive AR patients. The poor correlation of skin testing and objective nasal response to fungi argues against a pure IgE-mediated immune response in the nasal cavity.
Pilot study comparing total intravenous anesthesia to inhalational anesthesia in endoscopic sinus surgery: novel approach of blood flow quantification. - The Annals of otology, rhinology, and laryngology
We compared anesthesia with sevoflurane-remifentanil hydrochloride (SR) to total intravenous anesthesia with propofol-remifentanil hydrochloride (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in terms of sinonasal mucosal blood flow, the surgical field visualization score, and blood loss.We performed a double-blinded prospective study at a tertiary care center in 23 adults scheduled to undergo endoscopic sinus surgery for chronic rhinosinusitis. The patients were randomized to receive SR or PR. The sinonasal mucosal blood flow was measured by optical rhinometry. The surgical field visualization score was based on the Boezaart scale.The groups had similar clinical characteristics. During the 60- to 90-minute and 90- to 120-minute operative time windows, the blood flow was significantly greater in the PR group than in the SR group (p = 0.04 and p = 0.03, respectively). The amounts of blood loss in the PR and SR groups were 152.9 +/- 161.3 mL and 355.9 +/- 393.4 mL, respectively (p = 0.12). The median ratios of the surgical field visualization score to the number of sinuses operated on in the PR and SR groups were 2.1 and 1.8, respectively (p = 0.52).The intraoperative blood flow, as determined by optical rhinometry, was significantly greater with anesthesia with PR than with anesthesia with SR, 1 hour into the procedure; however, this difference did not translate into differences in the amounts of operative blood loss or in the surgical field visualization scores.
Staphylococcus aureus prevalence in allergic fungal rhinosinusitis vs other subsets of chronic rhinosinusitis with nasal polyps. - International forum of allergy & rhinology
The pathogenesis of allergic fungal rhinosinusitis (AFRS) is thought to represent an immunological reaction to fungal antigens. Recent studies have implicated superantigens and non-immunoglobulin E (IgE)-mediated mechanisms in the development of AFRS. The objective of this study is to assess the prevalence of Staphylococcus aureus in AFRS vs other subsets of chronic rhinosinusitis with polyps (CRSwNP, also termed non-AFRS).A case series with retrospective review of 19 patients with AFRS and 21 patients with CRSwNP was performed at a tertiary referral center. The diagnosis of AFRS required the presence of defined criteria described by Bent and Kuhn. Bacterial cultures and fungal cultures were analyzed for each group.S. aureus was significantly more prevalent in the AFRS group compared with the non-AFRS group (63.2% vs 24.1%, p = 0.005).S. aureus has been implicated as a disease modifier in CRSwNP through superantigen-mediated mechanisms. This study demonstrates a higher prevalence of S. aureus in patients with AFRS vs patients with other subsets of CRSwNP (non-AFRS). These results support a potential role for S. aureus in the pathogenesis of AFRS.Â© 2013 ARS-AAOA, LLC.
Endoscopic trans(naso)orbital management of supraorbital mucoceles with biliary T-tube stenting. - The Laryngoscope
The objective of this article is to describe our surgical technique for accessing orbital and supraorbital ethmoid sinus mucoceles and the novel application of a biliary T-tube to stent and redirect mucociliary flow into the frontal recess. We describe in technical terms our surgical approach and the use of an 8-Fr pediatric biliary T-tube as a paranasal sinus stent with demonstrative case reports. Four patients have been successfully managed employing the endoscopic trans(naso)orbital approach to access and marsupialize supraorbital and superiorly located orbital mucoceles without egress to the frontal recess. Patency of drainage was maintained by utilizing a flexible, pediatric, biliary T-tube that is inserted via an above (trephination) and below (endoscopic) approach in three patients, and without the need for stenting in one patient (median follow-up, 14.5 months). The presented surgical strategy is safe and effective in accessing and maintaining long-term patency of problematic supraorbital and superiorly located intraorbital mucoceles without communication to the frontal recess.Copyright Â© 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Mometasone furoate gel: a novel in-office treatment of recalcitrant postoperative chronic rhinosinusitis. - Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
To assess the effect of in-office intranasal application of mometasone furoate (MF) gel in reducing sinonasal mucosal inflammation in patients who have undergone endoscopic sinus surgery (ESS) for chronic rhinosinusitis.Retrospective review.Symptomatic post-ESS patients were evaluated with nasal endoscopy. Sinus mucosa was graded as normal, edematous, polypoid, or with frank polyps (scored as 0, 1, 2, or 3, respectively), and the presence or absence of eosinophilic mucin was noted. MF gel was then applied under endoscopic visualization to sinus mucosa demonstrating signs of inflammation. Patients returned to the clinic for three follow-up visits for nasal endoscopy and mucosal evaluation and, if indicated, retreatment with MF gel.Sixteen patients were treated with hydrophilic MF gel. The volume and concentrations applied were 2 to 10 cc of 1200 Î¼g/5 cc MF gel (ASL Pharmacy, Camarillo, CA). At the initial visit, the average mucosal score was 2.19 Â± 0.16. At follow-up visits 1 and 2, the average mucosal score was 1.44 Â± 0.25 (p â€Š=â€Š .01) and 1.38 Â± 0.28 (p â€Š=â€Š .03), respectively. There was an observed overall decrease in systemic steroid use.In-office endoscopic sinonasal application of MF gel is a useful adjunct to treat mucosal inflammation in postoperative patients with chronic rhinosinusitis. It may help reduce the need for systemic as well as topical steroid therapy.
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6410 Fannin St 1200 Houston, TX 77030
6624 Fannin St Suite 2180
6620 Main St Ste 1325
6621 Fannin St Ste W6104
6410 Fannin St Suite 1200