bluuebunny/crossref_metadata_2025 huggingface dataset:
Middle Turbinate Headache Syndrome
Authors: Goldsmith Ari J. , Zahtz Gerald D. , Stegnjajic Arsen , Shikowitz Mark
Published: September 2007

Sinus headaches are attributed to inflammatory disease of the sinus mucosa or ostium. In 1948 H.G. Wolff first recognized that sinus headaches may occur in the absence of inflammatory sinusitis, and may be due to contact between strategic “trigger points” in the sinonasal passages. Since this time there have been sporadic reports of headaches and facial pain due to an enlarged middle turbinate contacting either the septum or lateral nasal wall. It is theorized that an enlarged middle turbinate, most commonly due to pneumatization (concha bullosa), can contact the septum or lateral nasal wall and give headaches referred to the ophthalmic division of the trigeminal nerve, the main sensory innervation of the anterior middle turbinate. Middle turbinate headache syndrome is reviewed, with attention to pathophysiology, clinical presentation, and treatment. Eight cases of middle turbinate headache will be presented in support of this clinical entity. We hope to alert the clinician to a relatively unknown source of recurrent headaches, that may be readily treated by otolaryngologists.
Paranasal Sinus Mucoceles in Cystic Fibrosis
Authors: Davis William E. , Barbero Giulio J. , LaMear William R. , Templer Jerry W. , Konig Peter
Published: September 2007

Six patients between the ages of 6 and 22 years old with cystic fibrosis were found to have mucoceles of the paranasal sinuses. Four were male and two were female. They experienced nasal obstruction, purulent rhinorrhea, and anosmia, but none had fever or pain. Nasal endoscopy and coronal computerized tomography scans revealed the lateral nasal wall to be displaced medially against the septum. Functional endoscopic sinus surgery revealed large cystic spaces filled with thick yellow-green mucus. Postoperatively most patients are able to smell and breathe through their noses. The mucocele probably begins as an obstructed anterior ethmoid cell, which then enlarges and obstructs the osteomeatal complex, which further impairs drainage of the other sinuses into this area.
The Effectiveness of Oral Azelastine in the Management of Perennial Allergic Rhinitis
Authors: Meltzer Eli O. , Halverson Philip C. , Banov Charles H. , Weiler John M. , Woehler Thomas R. , Hemsworth George R. , Freitag Jeffrey J.
Published: September 2007

Azelastine, a phthalazinone derivative, is a chemically novel antiallergy compound that inhibits inflammatory responses in the upper and lower airway. Previous clinical trials demonstrated the effectiveness of azelastine in the treatment of allergic rhinitis. The objective of this double-blind trial was to further evaluate the efficacy and safety of oral azelastine compared with placebo in patients with perennial allergic rhinitis. A total of 192 patients (between 13 and 60 years of age) who satisfied a minimum symptom score during a single-blind placebo evaluation period were randomized to receive one of three treatments: 2 mg of azelastine b.i.d., 1.34 mg of clemastine fumarate b.i.d., or placebo b.i.d. for a 4-week double-blind treatment period. In the primary efficacy analysis, rhinitis symptoms were analyzed as a Total Symptom Complex severity score (nose blows, runny nose, sneezes, stuffy nose, itchy nose, and itchy eyes/ears/throat). After 2 and 4 weeks of therapy, the azelastine group had greater mean percent improvements than the placebo group in the Total Symptom Complex severity scores. The overall and endpoint improvements for the azelastine group were statistically significant (P ≤ .026) versus placebo. Improvements in individual rhinitis symptoms for the azelastine group were superior to placebo for nose blows, runny nose, sneezes, itchy nose, and itchy eyes/ears/throat. Azelastine was well tolerated. Clemastine was also significantly more effective than placebo and was well tolerated. The results support oral azelastine's safety and effectiveness in the treatment of perennial allergic rhinitis.
Scarring in Endoscopic Ethmoidectomy
Authors: Gaskins Ralph E.
Published: September 2007

The formation of postoperative adhesions is perhaps the most frequent complication of endoscopic sinus surgery: These incidents may vary from trivial, small strands of scar to serious obstructive situations that mandate further surgery. This study is a retrospective analysis of 970 endoscopic ethmoidectomies performed in 535 patients over a 5-year period and followed by a single surgeon. Postoperative follow-up ranged from 6 to 70 months. The overall incidence of postoperative adhesions of all types was 10.5% and involving 102 cases. Of these, 40 cases (4.1%) of the total required subsequent revision surgery due to obstructive scarring. Further analysis is presented, showing the effects of various surgical techniques on the development of adhesions. The incidence of postsurgical lateral adhesion of the middle turbinate was reduced in this series in procedures that incorporated partial middle turbinate resection.
Nevoid Basal Cell Carcinoma Syndrome Presenting as Chronic Maxillary Sinusitis
Authors: Busch Richard F.
Published: September 2007

Nevoid basal cell carcinoma syndrome is a very rare condition consisting of nevoid basal cell epitheliomas, jaw cysts, and skeletal abnormalities. This article describes the first reported presentation of this syndrome as maxillary sinusitis. The multiple and varied features of this rare syndrome are discussed together with management and treatment modalities.
Conducting Outcomes Research in a Community-based Practice Setting
Authors: Hoffman Sanford R. , Mahoney Martin C. , Chmiel James F. , Stinziano Gerald D. , Hoffman Kevin N.
Published: September 2007

Although there is both a need and a desire to critically evaluate data from community-based clinical practices, many clinicians are inadequately prepared for this undertaking. This paper illustrates the process of establishing a computerized research data base in a community-based medical practice by highlighting issues of design, data collection, enrollment, and data management. In addition, a practical illustration of implementing such a data base system to perform community-based outcomes research among patients with chronic sinusitis is presented. Data bases established for community-based outcomes research can serve as a means for a single medical practice to examine patient outcomes or can serve as a component of a collaborative multi-site research effort.
Complications of Sinusitis
Authors: Ognibene Roberto Z. , Voegels Richard L. , Bensadon Rogerio L. , Butugan Ossamu
Published: September 2007

From 1982 to 1992, 65 patients presented to our service with sinusitis complications. In this report we will analyze our clinical material with emphasis on the type of complications, clinical presentations, and radiologic findings. The most common complication was orbital (83.1%), followed by intracranial (18.5%) and bony (7.7%). There was a higher incidence of complications in the second decade of life (44.6%), and 83.2% of the cases occurred in the third decade of life. The main complaints were orbital swelling (63.1%), fever (33.8%), headache (32.3%), and rhinorrhea (21.5%). The predominant signs were eyelid swelling (73.8%) and rhinorrhea (64.6%). The most frequent radiologic findings (x-ray, CT, MRI) were pansinusitis (40%), maxilloethmoidal sinusitis (24.6%), and maxillary sinusitis (13.8%). All patients were treated with intravenous antibiotics, and surgery was performed in 50.8% of the patients. Almost all patients (98.5%) had a good outcome, and one patient died (cavernous sinus thrombosis). Complicated sinusitis can be a life-threatening condition. CT and MRI are a great aid in the diagnosis of these complications.
Neuropeptide Levels in the Nasal Secretion and Nasal Mucosa of Patients with Chronic Sinusitis and Nasal Polyposis
Authors: Perkins Jonathan A. , Moore Katherine H. , Canonico Domenic M. , Morris Michael R.
Published: September 2007

Neuropeptides are present within the nasal cavity and are thought to mediate inflammation in this region. The exact role these peptides might play in causing the inflammation present in chronic rhinosinusitis and nasal polyposis is not known. Calcitonin Gene Related Peptide (CGRP) was measured in the nasal secretion and nasal mucosa of 10 patients having chronic rhinosinusitis and 10 patients with nasal polyposis, using radioimmunoassay. These values were compared to ten controls without sinonasal disease. Additionally, each subject's history and baseline laboratory data were analyzed to establish the presence or absence of allergic disease. The results of these assays are discussed, as well as the potential pathophysiologic role that neuropeptides play in these disease states.
Sensation of Nasal Obstruction Compared to Rhinomanometry in Patients Referred for Septoplasty and in Patients with Chronic Rhinitis
Authors: Sipilä Jukka I. , Suonpää Jouko T. , Laippala Pekka T.
Published: September 2007

Correlation between active anterior rhinomanometry and subjective sensation of nasal obstruction was studied in three groups of patients. Group A included patients with marked septal deviation causing high nasal resistance. Group B represented cases where there was minor septal deviation, but normal resistance. Group C consisted of cases with chronic rhinitis causing nasal stuffiness, but normal septum and normal decongestion resistance. The patient's response as to the more obstructed side of the nose was correlated with the rhinomanometrically recorded less patent nostril. The results show that the correlation was good in Group A, but did not exist in the other groups. The reason for this is that, when the side difference of resistance between the two nasal cavities was less than 60–70%, it was very difficult for the patient to estimate the more obstructed side. This was especially the case in Group C, where mucosal swelling often changes sides. The conclusion is that patients’ capability to detect a minor side difference is poorer than rhinomanometry's. Furthermore, if rhinomanometry and subjective sensation do not agree, the reason may be that the patient's nasal complaint is dominated by the mucosal disease, rather than by a structural deformity and therefore, treatment other than surgery may be preferred.
Endoscopic Endonasal Treatment of Ostium of the Frontal Sinus and the Results of Endoscopic Surgery
Authors: Moriyama Hiroshi , Fukami Masaya , Yanagi Kiyoshi , Ohtori Nobuyoshi , Kaneta Kensaku
Published: September 2007

We discuss a procedure for opening the nasofrontal duct and the postoperative findings in endoscopic endonasal surgery. The route of the anterior ethmoidal artery was also studied. The subjects of this study were 57 patients (105 sides) who had frontal sinus disease. The patients all underwent surgery for chronic sinusitis between 1990 and 1992. Patients undergoing revision surgery were excluded. All patients were operated on by the same surgeon. In each patient, following anterior and posterior ethmoidectomy, the frontal sinus ostial region was opened using a 70 endoscope, while carefully monitoring the anterior ethmoidal artery. The agger nasi was left intact. The cells around the ostium were opened using a curved suction tip and upward bent forceps, and the lamellae were removed to achieve the greatest possible communication with the frontal sinus. In 77 sides (73.4%), the communication between the frontal and ethmoidal sinuses was well maintained. The ostium was patent with edematous mucosa in 18 sides (17.1%). The opened ostium could not be confirmed due to presence of polyp, etc., in 10 sides (9.5%). During surgery, the route of the anterior ethmoidal artery was confirmed in 70.8%; and of these cases, it was located anterior to the third ground lamella in about 50%.
Factors Associated with Septal Deviations in School-Aged Children
Authors: Haapaniemi Jorma J. , Suonpää Jouko T. , Tuominen Juhani
Published: September 2007

A total of 687 school children between the ages of 6 and 15 years were examined for nasal septal deformities as part of a comprehensive epidemiological ENT study. Stepwise logistic regression analysis showed that the occurrence of clinically significant septum deviation was associated with age, sex, and dental malocclusion. The authors could not demonstrate any unambiguous correlation between respiratory symptoms or infections and nasal septal deformities, although there was a tendency for an increased frequency of infections in children with clinically significant septum deformity.
NIDCD Research in Human Communication
Authors: Snow James B.
Published: September 2007

The mission of the National Institute on Deafness and Other Communication Disorders (NIDCD) is to support and conduct biomedical and behavioral research and research training on normal mechanisms as well as diseases and disorders of hearing, balance, smell, taste, voice, speech, and language. The National Strategic Research Plan, developed in 1989, guides the research supported and conducted by the Institute in each of its seven areas of interest. Each year two sections of the plan are updated. The chemical senses section of the plan was updated in January 1993. Some of the research goals, opportunities, and priorities in olfaction recommended by the panel are presented. Several examples of NIDCD-supported olfactory research are also highlighted. Research opportunities for foreign scientists in the Institute's intramural laboratories are outlined along with opportunities for international collaborations through the NIDCD. NIDCD funding for chemosensory research is provided.
Chronic Sinusitis as a Manifestation of Primary Immunodeficiency in Adults
Authors: Manning Scott C. , Wasserman Richard L. , Leach Joseph , Truelson John
Published: September 2007

Twenty-three adult patients evaluated at a university medical center for severe refractory sinusitis were found to have a primary immunodeficiency on the basis of total immunoglobulin, IgG subclass, and vaccine response determinations. The most common finding was IgG3 deficiency with antibody hyporesponsiveness to pneumococcal vaccine. Treatment options included prophylactic antibiotics and aggressive management of associated allergies with intravenous immunoglobulin reserved for severely affected patients who failed more conservative therapy.
Clinical Evaluation of Maxillary Diffuse Polypoid Sinusitis after Functional Endoscopic Sinus Surgery
Authors: Liu Chia-Ming , Yeh Te-Huei , Hsu Mow-Ming
Published: September 2007

Functional endoscopic sinus surgery (FESS) for chronic sinusitis has become popular as a substitution for radical operations. We selected 24 patients with diffuse polypoid rhinosinopathy who had been admitted for FESS and followed up for at least 6 months. The recovery of 39 maxillary sinuses was inspected with endoscopy through the enlarged middle meatal antrostomies. We found that of 8 sinuses recovered, 19 still had diffuse polypoid change, and another 12 had focal polypoid sinuses. We conclude that for diffuse polypoid rhinosinopathy, management of maxillary polypoid mucosa is complicated, and recovery of polypoid mucosa is dependent not only on the patency of the sinus ostia, but also on other factors such as alterations of mucosal, glandular, and epithelial changes by chronic stimuli.
Effect of Chlorpheniramine on Airway Physiology and Symptoms during Natural Pollen Exposure
Authors: Skoner David P. , Asman Barry , Fireman Philip
Published: September 2007

Previous studies have documented the changes in airway physiology which accompany natural pollen exposure. This study was designed to determine the effect of chlorpheniramine (8 mg b.i.d.) on seasonal changes in airway physiology and symptoms. Pollen counts, eustachian tube (ET) function, nasal resistance, mucociliary transport, and nasal symptoms were assessed weekly before, during, and after ragweed pollen season in 15 chlorpheniramine-treated and 15 placebo-treated allergic rhinitis (AR) subjects in a double-blind protocol and in 10 untreated control (non-AR) subjects. In placebo-treated AR subjects, the degree of congestion, rhinorrhea, sneezing, ET dysfunction, and nasal obstruction closely tracked pollen counts. However, symptoms, ET obstruction, and nasal obstruction persisted well beyond the temporal peak in pollen counts. There were no changes in mucociliary transport or pulmonary function during pollen exposure. Compared to placebo, chlorpheniramine-treated subjects manifested significantly less (p < .05) seasonal sneezing and rhinorrhea, but similar degrees of nasal congestion, ET dysfunction, and nasal obstruction. Pollen-related changes in nasal physiology and symptoms were not detected in the non-AR subjects. These data document that chlorpheniramine significantly attenuated the seasonal increases in rhinorrhea and sneezing, but did not lessen the concommitant physiologic alterations or the increase in nasal congestion.
The Use of Nasal Endoscopes in the Diagnosis of Nasal and Paranasal Sinus Masses
Authors: Jeffrey Trimas Scott , Stringer Scott P.
Published: September 2007

The histopathologic diagnosis of nasal and paranasal sinus masses may be problematic. Traditionally, a biopsy through an external ethmoidectomy or Caldwell-Luc procedure has been required. The advent of nasal endoscopy provides an alternative method of obtaining tissue. The diagnostic evaluations of 57 cases of nasal or paranasal sinus masses, seen from 1985 through 1991, were reviewed. The use of nasal endoscopy in the diagnosis of nasal and paranasal sinus masses was associated with decreased morbidity as compared to more traditional approaches. Potential surgical approaches were not violated prior to definitive treatment. Representative cases will be presented illustrating changes in management by using nasal endoscopes.
Effects of Substance P and Methacholine on Mucosal Blood Flow in the Upper Airways
Authors: Runer Thomas , Lindberg Sven , Mercke Ulf , Olsson Peter
Published: September 2007

The aims of the present investigation were to examine the in vivo effects of substance P (SP) and methacholine on blood flow measured by laser Doppler technique in the maxillary sinus of the rabbit and in the human nasal mucosa. In the rabbit, the test substances were administered by intra-arterial catheter, and the laser Doppler probe was inserted into the maxillary sinus through a trepanation in the anterior wall. In the human nose, the laser Doppler probe was directed toward the nasal septum at the level of the anterior margin of the middle turbinate, and the test substances were administered as aerosols into the ipsilateral nostril. In the rabbit maxillary sinus, both SP and methacholine increased the blood flow, the maximum increases obtained being 13.5 ± 3.1% and 39.0 ± 5.6% after challenges with SP at 0.1 μg/kg and methacholine at 0.5 μg/kg, respectively. The rabbits displayed a decrease in blood flow after challenges at higher dosages of both SP and methacholine, accompanied by a simultaneous fall in systemic blood pressure. Atropine given IV five minutes before methacholine abolished the effects of this compound in the rabbit. The blood flow in the human nose was unaffected by saline controls, whereas it was increased both by SP and by methacholine, the increases being 34.9 ± 6.0% after challenges with SP 1.0 nmol and 119.2 ± 15.1% after challenges with methacholine 5.0 μmol. According to acoustic rhinometry, neither SP nor methacholine had, at the doses used, any effect on human nasal patency. Pretreatment with lidocaine hydrochloride spray into the human nose did not affect the increase in nasal blood flow induced by SP, but abolished the methacholine-evoked blood flow increase. Pretreatment with ipratropium bromide spray into the human nose abolished the increase in blood flow induced by methacholine. The results of the present study indicate that blood flow in the upper airways of humans and rabbits may increase due to release of SP or acetylcholine in vivo, an event that occurs after exposure to airway irritants. The vasodilation in the human nose produced by acetylcholine may be due to a neurogenic reflex, in contrast to the effect of SP.
Measurement of Pharyngeal Pressure in Patients using Nasal CPAP
Authors: Fürst Gudrun , Riechelmann Herbert , Mann Wolf J. , Amedee Ronald G.
Published: September 2007

In patients with obstructive sleep apnea syndrome (OSAS), nasal continuous positive airway pressure (nCPAP) prevents pharyngeal collapse by applying positive pressure transnasally. Currently there are not objective criteria to determine whether surgical improvement of nasal resistance is necessary in patients undergoing nCPAP treatment. In 16 patients with documented OSAS, inspiratory and expiratory pressures in the pharynx were measured during nCPAP with pressures ranging from 5 to 20 mbar. Identical studies were performed in 12 patients with severe nasal obstruction without OSAS and in eight normal patients. The results of each group were compared to the nasal resistance as measured by acoustic rhinometry. The pharyngeal pressures under nCPAP were found to be independent of nasal resistance and of the minimal cross-sectional area of the nose. Additionally, nCPAP was effective in individuals with severe nasal obstruction. Nasal obstruction has no influence on nasal pressure when using nCPAP. Perhaps other factors, such as collapsing of the pharynx or tone of the pharyngeal muscles, play a role in determining the nasal pressure of the nCPAP.
Psychometric and Clinimetric Validity of the 31-Item Rhinosinusitis Outcome Measure (RSOM-31)
Authors: Piccirillo Jay F. , Edwards Dorothy , Haiduk Andrea , Yonan Cynthia , Thawley Stanley E.
Published: September 2007

Descriptions of rhinosinusitis (RS) patients and evaluation of treatment effectiveness are currently hindered by the lack of a valid measure of health status and quality of life. The RSOM contains 31 RS-specific items (e.g., runny nose, cough, facial pain/pressure), grouped into 7 domains (nasal, eye, sleep, ear, and general symptoms; practical problems, and emotional consequences), and was created from discussions with RS patients. Two categorical rating scales were selected for patients to indicate the Magnitude and Importance of each item. The RSOM score is calculated as the sum of the Magnitude X Importance scores. The goal of this project was to validate the RSOM-31. In 142 patients who completed the RSOM, the average age was 45 and there were 86 women. The average total RSOM score was 5.8 (0.8—15.1 = good—bad). The domains most affected were sleep (7.7), general problems (6.4), nasal (6.3), and emotional (6.2). The RSOM score correlated significantly with an overall global quality of life question (r = 0.36); and the Vitality (r = 0.50), General Health (r = 0.47), Social Functioning (r = 0.46), and Role-Physical (r = 0.41) sub-scales of the Medical Outcomes Study Short-Form 36. The average total RSOM score decreased over time (indicating improvement) and was correlated with the patient's assessment of their response to treatment (F Value 6.49; P < 0.0001). This study demonstrates that the 31-item RSOM is a valid measure of RS health status and quality of life.
The Effect of Cetirizine on Nasal Allergic Response
Authors: Small P. , Barrett Doreen
Published: September 2007

The effect of cetirizine on both early and late nasal allergic response was assessed in 15 ragweed sensitive patients. All patients were challenged before treatment and after 7 days of cetirizine 10 mg qd. Clinical assessments and measurements of mediators were performed at baseline, after positive challenge, 1 and 2 hours later, and repeated 7 and 8 hours later. There was a significant change (P < 0.0001) in the early response threshold to ragweed challenges after cetirizine. There were early phase elevations of prostaglandin D2, leukotriene C4, and eosinophil cationic protein both pre and post-treatment. Late phase changes were difficult to detect, but a statistically significant rise of both prostaglandin D2 and histamine was diminished after cetirizine treatment. Cetirizine clinically inhibited the early response to nasal allergen challenge, but early mediators were not affected. An effect on the late phase could not be clearly demonstrated.
T-Cell Receptor Vβ Gene Rearrangements of T Lymphocytes Infiltrating the Mucosa in Chronic Sinusitis
Authors: Chikamatsu Kazuaki , Eura Masao , Nakano Koji , Kanzaki Yuichi , Masuyama Keisuke , Ishikawa Takeru
Published: September 2007

Lymphocytic infiltration within the mucosa of patients with chronic sinusitis may reflect an in situ immune reaction. An analysis of the T-cell receptor (TCR) expressed by these lymphocytes may help to understand T-cell immunity in chronic sinusitis. We analyzed the TCR Vβ gene rearrangements in T cells that infiltrated the mucosa of the maxillary sinuses in 24 patients with chronic sinusitis using the reverse transcription polymerase chain reaction method. The analysis of the TCR Vβ repertoire revealed a significant limited usage (P < 0.01) of the Vβ gene families, compared with peripheral blood lymphocytes that expressed all of the gene families in all these patients. The limited gene usage of the T cells suggests that bacterial or viral infection of the sinus mucosa attracts T cells that specifically respond to the bacterial or virus-derived antigens.
Endoscopic Sinus Surgery: A Comparison of Preoperative and Postoperative Status
Authors: Downie David B. , Walster William
Published: September 2007

This article presents an analysis of 27 patients who had endoscopic sinus surgery in 1989 and were followed for 2 years postoperatively. To measure clinical improvement, two parameters were used: the frequency of physician visits for chronic sinusitis, and the number of courses of antibiotics. Data on both measures were collected for 1 year before and 2 years after endoscopic sinus surgery. This retrospective study demonstrates both a statistically significant and practically important decrease in physician visits and courses of antibiotics following endoscopic sinus surgery. Two years postoperatively 78% of the patients undergoing surgery had a greater than 50% reduction in physician visits for sinusitis, and 67% had a greater than 50% reduction in courses of antibiotics for sinusitis.
A Short-Acting Opioid, Alfentanil, before Closed Reduction of Nasal Fracture
Authors: Silvola Juha T. , Saarnivaara Laila
Published: September 2007

A short-acting opioid, alfentanil (20 μg/kg i.v.), was used before local anaesthetic procedure of the nose to alleviate pain caused by intranasal cocaine-epinephrine soaked cotton swabs and lidocaine-epinephrine infiltration into the infraorbital nerve region. The study was randomized and double blind and included 52 healthy young adults, 26 each in alfentanil and placebo groups. Pain was assessed with a visual analogue scale and by observation of pain-related behavioral changes. Alfentanil proved to be effective in relieving pain caused by local anesthetic procedure (P < 0.005 compared with the placebo group). No hemodynamic or respiratory problems were noticed. None of the patients suffered from nausea. We conclude that alfentanil alleviates pain caused by nasal local anesthetic procedures.
Nasal Resistance and Nasal Valve Area
Authors: Frenkiel Saul , Segal Bernard , Sinclair David
Published: September 2007

The nasal valve is considered to be the primary flow-limiting segment of the normal upper airway. We examined subjects with and without nasal pathology to determine whether nasal airway resistance, as determined by rhinomanometry, could be related to clinically measurable geometrical characteristics of the nasal valve. Data was obtained from 26 subjects, 22 with nasal airflow complaints due to valvular or septal abnormalities and four without. Nasal valve area was estimated by triangular approximation, and transnasal airflow resistance was measured using head-out whole-body plethysmography. When all subjects were considered, no clear relationship between nasal resistance and nasal valve area was apparent. However, when patients with severe septal deflection or with a prominent vasomotor response to nasal decongestion were not considered, nasal resistance was found to be significantly negatively correlated to nasal valve area. Further studies are required to relate more posterior pathology to nasal resistance.
Clinical Applications of the Island-Pedicled Nasolabial Musculocutaneous Flap
Authors: Dolan Robert , Arena Sebastian
Published: September 2007

The island-pedicled musculocutaneous nasolabial flap (MNLF) represents a new generation of nasolabial flaps that address the problems of a bulky and immobile pedicle. The intention of this report is to present our experience with the MNLF for reconstruction of large nasal defects involving the columella, septum, and nasal ala. The charts and clinical photographs of eight patients who underwent nasal reconstruction using the MNLF were reviewed. There were no flap failures or partial necroses. All patients were noted to have a symmetric facial appearance at rest and with expression postoperatively. Using the MNLF, it is possible to reconstruct the entire columella and more extensive defects that may also include the membranous and cartilaginous septum, in a single stage. Repair of these defects was previously beyond the capabilities of the nasolabial flap.
The Role of Mucosal Oedema in Nasal Obstruction in Patients with Septal Pathology
Authors: Suonpää Jouko T. , Sipilä Jukka I.
Published: September 2007

The degree of mucosal edema was assessed using the decongestion effect achieved with vasoconstrictor spray in 102 patients referred for septoplasty. In preoperative rhinomanometry it was found that 62 patients had high postdecongestion nasal airway resistance (NAR) compared with control material, whereas in 40 cases, NAR was normal before operation. Our results show that the decongestion effect was higher, both pre- and postoperatively, in patients with high preoperative postdecongestion NAR. Although surgery succeeded in normalizing the mean decongestion values in these patients, there still remained considerable mucosal congestion compared to cases with low preoperative resistance. We conclude that a marked septal structural pathology causes not only high postdecongestion resistance, but that abnormal structures of the nasal airway also cause mucosal hypertrophy, mucosal irritation, and inflammation, which is measurable with rhinomanometry as elevated baseline resistance and higher decongestion effect.
Lacrimal Sac Mucocoele after Septorhinoplasty
Authors: Hehar Sukhminderjit S. , Jones Nicholas S. , Nunez Desmond A.
Published: September 2007

Lacrimal sac mucocoele formation after septorhinoplasty has not been previously described. We believe it occured secondary to the trauma of an external osteotomy. Through attention to detail, it should be avoidable.
Isolated Sphenoid Sinusitis: Problems in Diagnosis and Therapy
Authors: Seiden Allen M.
Published: September 2007

Isolated sphenoid sinusitis is relatively uncommon and may present with a variety of symptoms. Therefore, it is often misdiagnosed, or detected only when complications develop. As skull base surgery becomes more prevalent, an understanding of sphenoid disease and its manifestations becomes increasingly important. From September 1989 through January 1994, 10 patients were seen with isolated sphenoid sinus disease. All patients presented with atypical headaches. Six had bacterial infections, three had noninvasive fungal infections, and one patient had a sphenoid mucocele. No patient had any recognized risk factors predisposing to such infection. All patients required surgical drainage, which was done through an endoscopic transnasal approach in five, an endoscopic transethmoid approach in three, and a transseptal approach in two, with no surgical complications. The advantages and disadvantages of these approaches compared to more traditional surgical approaches to the sphenoid sinus are discussed.
Clinical Implications of the Uncinate Process in Paranasal Sinusitis: Radiologic Evaluation
Authors: Min Yang-Gi , Koh Tae-Yong , Rhee Chae-Seo , Han Moon-Hee
Published: September 2007

Ostiomeatal unit (OMU) plays an important role in the development of paranasal sinusitis. The ethmoidal infundibulum is bordered medially by the uncinate process, and the anatomic relationship between the ethmoidal infundibulum and the frontal recess may depend upon the types of attachment of the uncinate process. The aim of this study was to evaluate the types of attachment of the uncinate process and its implications in the development of sinus inflammation. The most frequently observed type of the uncinate process attachment on OMU computerized tomographic (CT) scans was the lamina papyracea (LP) attachment, followed by the skull base (SB) and the middle turbinate (MT) attachments. The order of frequency of both partial and total opacification in the anterior ethmoidal and frontal sinuses was LP, MT, and SB types. However, the maxillary sinus was most frequently involved in SB type. When only total opacification of the paranasal sinuses on CT scans was considered, it was less frequent in SB type than the other types. The results of this study suggest that ventilation and drainage of the paranasal sinus may be more favorable in SB type than in LP or MT type.
Nasal Function following Carbon Dioxide Laser Turbinate Surgery for Allergy
Authors: Kubota Ichiyo
Published: September 2007

A carbon dioxide laser (CO2 laser) was used to treat the hypertrophic inferior turbinates of 121 patients with nasal symptoms related to house dust allergy. Follow-up ranged from 6 to 48 months (mean follow-up period: 17.8 months). Treatment involved 10–14 watts of a defocused pulse beam of a CO2 laser fitted with special handpieces. Subjectively, 111 of the 121 patients (91.7%) reported a reduction in nasal stuffiness, 76 of the 112 patients (67.9%) had reduction in rhinorrhea, and 63 of the 96 patients (65.7%) had decrease in sneezing. Nasal airflow resistances were confirmed to have decreased in 82 patients using rhinomanometry. Nasal provocation reactions by a house dust disk, which were investigated in 10 patients, showed a tendency to reduce from 1 to 11 months after laser treatment. Nasal mucociliary transports, which were followed by the saccharin test in 50 patients, recovered 1–1.5 months after the laser surgery. To study mucosal structure after laser irradiation, the inferior turbinates of five patients were examined under a light microscope. The ciliated epithelium was shown to have recovered on light microscopic examination, whereas the number of goblet cells decreased. A net of new collagen fibers was observed in the superficial submucosa a few months after treatment. The quantity of submucosal glands was reduced in the treated portion. Such findings suggested that CO2 laser turbinate surgery may be effective in relieving the nasal symptoms associated with allergy.
The Anterior Sphenoid Wall: Relative Anatomy for Sphenoidotomy
Authors: Hosemann W. , Gross R. , Göde U. , Kühnel Th. , Röckelein G.
Published: September 2007

A total of 53 anatomical specimens of the posterior ethmoid and the adjacent anterior sphenoid sinus wall were examined in reference to the operative guidelines for endonasal sphenoidotomy. Six anatomical points of measurement were defined for clinical orientation, and both the absolute and the relative widths of each third (i.e. of each of three vertical sections) of the pars nasalis and the pars ethmoidalis of the anterior sphenoid sinus wall determined.

The choana proved to be the most valuable regional anatomic landmark. In 43 cases (41%), a pervading ethmoidal cell was found, extending superiorly and medically all the way up to the nasal septum. In contrast with certain guidelines reported in the literature, 18% of the specimen (sides) showed a wider pars nasalis in the vertical middle third of the anterior sphenoid sinus wall as compared to the adjacent pars ethmoidalis. The thickness of the bone in the anterior wall was similar in both areas. The present measurements support Wigand's recommendation (1990) that the anterior sphenoid sinus wall be perforated paramedially, 10 mm superiorly to the choana.
Meningioma of the Frontal Sinus
Authors: Sillers Michael J. , Peters Glenn E.
Published: September 2007

Meningioma of the frontal sinus is a rare entity. Only nine cases of primary frontal sinus meningioma are reported in the literature. Two cases of frontal sinus meningioma, one primary and one secondary, are herein described. Each patient presented with headache and a frontal mass. Neither patient had fever or signs of meningeal irritation. Computerized tomography (CT) of the paranasal sinuses demonstrated frontal sinus opacification, posterior table bone erosion, and inferolateral displacement of the orbital contents in both patients. One patient underwent preoperative magnetic resonance imaging (MRI) that was officially interpreted as a frontal sinus mucocele and a small epidural abscess. Patients underwent unsuccessful endoscopic decompression for presumed mucoceles. Subsequent MRI in the second patient showed a large intracranial mass with extension into the frontal sinus. Treatment included frontal sinus obliteration and frontal craniotomy for removal of tumor, respectively. Meningioma was confirmed histologically in each patient. Although meningioma of the frontal sinus is rare, thorough evaluation, including MRI, should be considered for frontal sinus opacification in association with posterior table bone erosion.
Otomicroscopic, Audiometric, and Impedance Findings Associated with Septal Deviations in School-Aged Children
Authors: Haapaniemi Jorma J. , Suonpää Jouko T. , Salmivalli Altti J. , Tuominen Juhani
Published: September 2007

The association of a conspicuous nasal septal deviation with otomicroscopic, audiometric, and impedance findings was studied in 687 school children, aged 6–15 years. Changes in color and structure of pars tensa and the retraction of pars flaccida were indirectly associated with clinically significant septal deviation as a result of an increased incidence of upper respiratory tract infections, but no association was found between hearing loss and pathological impedance findings and clinically significant septal deviation.
Dermabrasion and Nasal Reconstruction
Authors: Rossiter James L. , Maloney Brian P. , Rousso Daniel E. , McCollough E. Gaylon
Published: September 2007

Facial plastic surgeons perform various reconstructive procedures in the nasal region following trauma and ablative surgery. Occasionally these procedures lead to postoperative scarring and contour deformities. Although dermabrasion has been used extensively in the nasal area as a treatment for acne scarring, its role as an adjunct for the refinement of primary procedures in this prominent region is often overlooked. Dermabrasion is invaluable as an ancillary tool for the treatment of localized irregularities following nasal reconstruction. In a retrospective study of patients’ records from 1989 to 1992, 55 nasal reconstructive procedures were performed on 44 patients; 19 of these patients underwent postoperative dermabrasion. The most common procedure requiring dermabrasion was local flap reconstruction. Dermabrasion was also used as the primary reconstructive procedure for eight additional patients. A summary and discussion of the primary procedures, anatomical site, indications, timing, technique, postoperative course, and complications of dermabrasion following nasal reconstruction is included. In addition, the special anatomical and technical considerations and general indications for dermabrasion in the nasal region are addressed, as well as other available treatment options.
Periosteal Chondrosarcoma of the Maxilla
Authors: Kerner Marc M. , Wang Marilene B. , DiGregorio Frank , Zimmerman Marilyn
Published: September 2007

Primary chondrosarcomas of the head and neck region are exceedingly rare neoplasms. These lesions have clinical and histologic characteristics that make them difficult to discern from benign chondromas. Additionally, they may arise from the periosteum, making it even more difficult to distinguish them from osteosarcomas. We present a patient with a periosteal chondrosarcoma of the maxilla. Characteristic radiologic and histologic findings associated with this lesion are described. This is the first reported case of such a lesion in the maxilla, as previous reports of periosteal chondrosarcomas have involved long bones. The diagnostic dilemma posed by this extremely unusual lesion is discussed, as well as treatment options.
Sinusitis in the Bone Marrow Transplant Patient: Diagnosis and Management
Authors: Gussack Gerald S. , Burson James G. , Hudgins P. , Wingard John R. , Devine Steven M. , Grist William J.
Published: September 2007

This study was undertaken to examine the frequency, morbidity, and management of sinus infections in patients undergoing bone marrow transplantation (BMT). Fifteen patients from February 1992 through February 1993 required intensive therapy for the management of paranasal sinus disease in the post-BMT period. Presenting symptoms included fever of unknown origin, sepsis, purulent nasal discharge, and ocular gaze abnormalities. Diagnosis was confirmed by computed tomographic (CT) scanning. Five patients required bilateral endoscopic sinus surgery. Preoperative preparation secondary to ongoing pancytopenia requiring platelet and fresh frozen plasma transfusions was undertaken. Fungal species and gram-negative and gram-positive organisms were all recovered from operative cultures. An algorithm for treatment of sinus problems in patients undergoing BMT is presented.
Inflammatory Pseudotumor of the Maxillary Sinus: Case Reports and Review of the Literature
Authors: Reino Anthony J. , Lawson William , Som Peter
Published: September 2007

The term inflammatory pseudotumor (IPT) has been applied to a benign, reactive, non-neoplastic and inflammatory space occupying lesion that clinically and radiographically mimics a neoplasm. Histologically, IPT is composed of polymorphous inflammatory cell infiltrates and variable fibrous stroma containing thick walled blood vessels.

Aggressive pseudotumors must be distinguished from malignancy to avoid unnecessary surgery or irradiation. Some cases can be differentiated from neoplasms by their dramatic response to oral steroid therapy. Because of the diverse cellular proliferation, diagnosis can be difficult, especially on frozen section study.

Primary pseudotumor of the maxillary sinus is an extremely rare entity. An extensive review of the literature has produced only four reported cases. We describe six cases of pseudotumor of the maxillary sinus that had clinical and radiographic findings suggesting neoplasia. The purpose of this paper is to report these new cases of maxillary sinus pseudotumor and to better define its natural history, criteria for diagnosis, and selection of treatment.
Intracranial Invasion of an Extramedullary Plasmacytoma in the Paranasal Sinus: A Case Report with a Reference to Magnetic Resonance Imaging
Authors: Katoh Taiji , Yamasaki Toshiki , Kataoka Shingo , Sano Keisuke , Kawauchi Hideyuki
Published: September 2007

A case of extramedullary plasmacytoma arising from the paranasal sinus with intracranial invasion at recurrence is reported. In this case, magnetic resonance imaging was first employed not only to delineate tumor extension into the cranial space, but also to evaluate the therapeutic response. Histological confirmation was made after a biopsy was performed. Despite widespread tumor involvement of orbit in the cavernous sinus and anterior skull base, radiotherapy and subsequent maintenance chemotherapy with cisplatin and etoposide induced a long-term, 42-month partial remission. The pertinent clinical characteristics are reviewed in the literature and the therapeutic problems and prognostic factors are discussed with an introduction of advantage of magnetic resonance imaging.
Loracarbef: Sinus Tissue Penetration after Single dose Administration
Authors: Edelstein David R. , Kimmelman Charles P.
Published: September 2007

The underlying basis of the antibiotic treatment of sinusitis is still unclear. Critical to the use of antibiotics in patients with sinusitis is the tissue penetration of the curative agent. However, there is scant information available regarding maxillary mucosal tissue levels in patients with this disease. We present the results of plasma and sinus tissue concentrations of loracarbef in six patients and one control. Levels were taken at 2 and 3 hours after the oral administration of the medication. The mean sinus tissue level was 2.5 mcg/gm and 2.7 mcg/gm at 2 and 3 hours after administration respectively. Although therapeutic efficacy cannot be predicted by the concentrations attained in a specific body fluid or tissue, we believe that these levels are excellent based on mean inhibitory concentrations. Additional studies are underway to document the penetration of this and comparable other drugs in multiple sinuses.
Multiple Submucosal Out-Fracture of the Inferior Turbinates: Evaluation of the Results by Acoustic Rhinometry
Authors: Márquez F. , Cenjor C. , Gutierrez R. , Sanabria J.
Published: September 2007

A multiple submucosal out-fracture of the inferior turbinates was made in 21 patients with nasal obstruction due to hypertrophy of the inferior turbinates. Before surgery, an endoscopic evaluation and an acoustic rhinometry was performed in all the cases. The operation was done under general anesthesia and bilaterally in all the patients. Three months after surgery, a postoperative acoustic rhinometry was done and an increase of the minimal cross-section area was achieved in all the cases. Acoustic rhinometry performed in 100 normal cases was used as a control group.
Subcellular Distribution and Pharmacological Identification of M1 Receptors in the Submucosal Nasal Gland Acinar Cells of Guinea Pigs
Authors: Nakabayashi Seiichiro , Ikeda Katsuhisa , Shimomura Akira , Wu DaZheng , Ueda Narihisa , Furukawa Masayuki , Takasaka Tomonori
Published: September 2007

A muscarinic receptor in the submucosal nasal gland acinar cells controls electrolyte and fluid secretion. We investigated the pharmacological identification and the subcellular distribution of Ml receptor using a selective antagonist, pirenzepine (PZ). Intracellular Ca2+ concentration ([Ca2+]i) in the isolated acinar cells was measured by a fura-2 method. Addition of PZ inhibited the increase of the [Ca2+]i induced by acetylcholine in a dose-dependent manner, indicating the presence of the Ml receptor. Both fixed section of the nasal septal mucosa and living isolated acinar cells were selectively stained by fluorescence-labeled PZ. Furthermore, confocal laser scanning microscopy revealed that PZ specifically labeled the plasma membrane in the isolated acinar cells. Thus, M1 receptor was proven to be located in the plasma membrane of the submucosal nasal gland acinar cell.
Functional Endoscopic Sinus Surgery, Symptomatic Relief: A Patient Perspective
Authors: Conte Louis J. , Holzberg Norman
Published: September 2007

Functional endoscopic sinus surgery (F.E.S.S.) is an efficient, safe treatment of chronic sinus disease. A retrospective individual review of 81 patients (41 males, 40 females) all having undergone F.E.S.S. at Saint Barnabas Medical Center in Livingston, New Jersey, reveals positive patient reactions. The senior author (N.H.) performed all surgery on an outpatient basis. Surgery has been classified by the Anand & Panje staging system. Each patient was sent a comprehensive questionnaire at least 6 months postoperatively. A critical assessment was completed of subjects ‘ preoperative and postoperative histories along with a patient survey of their personal perspectives on preoperative symptoms and postoperative symptomatic relief. This paper describes patient perspective outcomes of symptomatic relief in patients who underwent F.E.S.S. Ninety-four percent of the patients indicated overall improvement. Ninety-one % of the patients who responded were satisfied with results, and 86% of the patients stated they would undergo this procedure again if necessary.