bluuebunny/crossref_metadata_2025 huggingface dataset:
Catheter- and Antibiotic-Related Complications of Ambulatory Intravenous Antibiotic Therapy for Chronic Refractory Rhinosinusitis
Authors: Lin Jerry W. , Kacker Ashutosh , Anand Vijay K. , Levine Howard
Published: August 2018

Background

Chronic rhinosinusitis has several features of a prolonged bacterial infection including positive bacterial cultures and abnormal computed tomography findings such as mucosal thickening and hyperostotic bone. Recent studies have suggested that chronic rhinosinusitis may be treated successfully by outpatient parenteral antibiotic treatment (OPAT). In this setting, antibiotics are administered through a peripherally inserted central catheter (PICC). This study evaluates complications arising from OPAT for chronic rhinosinusitis.

Methods

A chart review was performed of 177 patients who underwent OPAT for chronic rhinosinusitis.

Results

PICC line–related infections (4/177, 2%)) included line thrombosis in three patients and septicemia in one patient. In the three patients with line thrombosis, the PICC lines were removed and replaced, allowing for completion of the antibiotic course. Antibiotic complications (29/177, 16%) included four patients with transient neutropenia and one patient with elevated liver function tests. Of the four patients with neutropenia, only one required a change in antibiotics. The patient with elevated liver function tests did not require a change in antibiotics. Minor complications from antimicrobial treatment such as rash, itchiness, flushing, and diarrhea were reported by 25 patients, 9 of these patients required a change in antibiotics. There were no permanent complications or deaths in this study.

Conclusion

Intravenous antimicrobial treatment administered through a PICC line in an outpatient setting is well-tolerated for chronic rhinosinusitis. Although PICC line and antibioticrelated complications are relatively infrequent, the physician should be aware of these complications and consider them in selecting patients for OPAT.
Lack of Significant Correlation between Rhinosinusitis Symptoms and Specific Regions of Sinus Computer Tomography Scans
Authors: Holbrook Eric H. , Brown Christopher L. , Lyden Elizabeth R. , Leopold Donald A.
Published: August 2018

Background

The sinonasal computer tomography (CT) scan is frequently used to help confirm the diagnosis of rhinosinusitis. However, little data exist correlating patient symptoms with CT findings.

Methods

Immediately preceding CT of the sinuses, 94 subjects without evidence of trauma, nasal tumors, or previous sinus surgery completed the Rhinosinusitis Outcome Measure 31 symptom questionnaire and were asked to locate areas of facial pain or pressure. CT scans were graded according to the Lund-MacKay system, and agger nasi and ethmoid bulla cells were measured. Data from CT scans and symptom/pain questionnaire responses were analyzed for significant correlations.

Results

No correlation was identified when comparing total Lund-MacKay scores, opacification of individual sinuses, and size of the agger nasi and ethmoid bulla cells with the Rhinosinusitis Outcome Measure 31 subset scores and areas of facial pain or pressure.

Conclusion

The sinus CT scan is a necessary tool for preoperative planning; however, it should not be used to predict symptoms or to localize areas responsible for facial pain or pressure.
Fluoroquinolone-Induced Arthralgia and Myalgia in the Treatment of Sinusitis
Authors: O-Lee Tsungju , Stewart Charles E. , Seery Loren , Church Christopher A.
Published: August 2018

Background

Because of their broad-spectrum coverage, fluoroquinolone antibiotics are widely used in the treatment of acute sinusitis and acute exacerbations of chronic sinusitis. Generally, they are well tolerated, and adverse effects are usually mild. In our experience with quinolones, patients have frequently complained of arthralgias and/or myalgias. Although tendon rupture has been described as one of the more severe side effects, there are few published reports of arthralgias and/or myalgias associated with these drugs.

Methods

A retrospective review of fluoroquinolone prescriptions in a tertiary rhinology clinic was completed. Patients treated with oral levofloxacin for sinusitis over a 12-month period were contacted by mail and asked to complete an anonymous survey regarding adverse effects. Of 81 patients identified, 36 responses were received.

Results

Among respondents, the incidence of arthralgias and/or myalgias was 25%, which was more than twice the incidence of any other adverse effect reported. Occurrence of arthralgias and/or myalgias did not appear to be influenced by respondent age, course length, concurrent use of oral steroids, or a history of arthritis. Among those reporting arthralgia or myalgia, symptoms began after an average of 3 days of therapy and resolved an average of 7.5 days after cessation of treatment. Fourteen percent of respondents were unable to complete their course of therapy because of arthralgias and/or myalgias.

Conclusion

Although effective and generally well tolerated in the treatment of sinusitis, fluoroquinolone antibiotics may produce adverse effects of arthralgia and/or myalgia.
Extraocular Muscle Damage Associated with Endoscopic Sinus Surgery: An Ophthalmology Perspective
Authors: Thacker Neepa M. , Velez Federico G. , Demer Joseph L. , Wang Marilene B. , Rosenbaum Arthur L.
Published: August 2018

Background

Orbital complications associated with endoscopic sinus surgery are well documented. Damage to the medial rectus muscle results in complicated strabismus and disturbing diplopia. The aim of this study was to characterize the types of extraocular muscle injury and the number of muscles involved that may complicate endoscopic sinus surgery and correlate its occurrence to factors in the surgical procedure itself.

Methods

A retrospective chart review was performed of 14 patients with strabismus after endoscopic sinus surgery. Operative notes of the surgical procedure, pathology reports of the intraoperative specimens, postoperative pattern of strabismus, the extraocular muscle involved, and the type of muscle injury characterized by orbital imaging were reviewed in each patient.

Results

In our series, not only the medial rectus muscle but also the inferior rectus and the superior oblique muscles were damaged with multiple muscles being involved in one patient. Extraocular muscle injury varied from hematoma, entrapment of muscle in the fractured orbital wall, damage to the oculomotor nerve entry zone, muscle transection, and partial or complete muscle destruction with entrapment in scar tissue. Use of the microdebrider causes extensive irreparable muscle damage.

Conclusion

Extraocular muscle damage complicating endoscopic sinus surgery can produce therapeutically challenging complicated strabismus.
Osteoplastic Flap for Frontal Sinus Obliteration in the Era of Image-Guided Endoscopic Sinus Surgery
Authors: Anand Vijay K. , Hiltzik David H. , Kacker Ashutosh , Honrado Carlo
Published: August 2018

Background

This study evaluates the management of frontal sinus disease using osteoplastic flap surgery (OPFS) in the current era of image-guided endoscopic sinus surgery (IGESS). Study Design: A retrospective chart review was performed of patients who underwent OPFS and imaged-guided endoscopic frontal sinus surgery in the past 10 years at a tertiary care teaching hospital.

Methods

Chart reviews of clinic patients and inpatients who underwent OPFS were performed. Indications for surgery, prior sinus surgeries, time to OPFS, post-OPFS sinus surgeries, and associated comorbid factors were reviewed.

Results

In the period under review, 710 IGESS cases were performed. Thirty patients, who were candidates for OPFS, underwent IGESS for frontoethmoid disease. Fourteen patients from this group failed IGESS and underwent OPFS. The indications for OPFS included mucocele in 10 cases, tumors in 2 cases, and trauma in 2 cases. Four patients underwent revision OPFS. The patients who failed IGESS had prior trauma, tumor resection, radiation, or large septate frontal sinus with lateral extension in which the mucocele could not be drained endoscopically. The average time to OPFS was 6.2 years (0–27 years). Nine patients had prior sinus surgery (1–7 prior surgeries) and five patients had subsequent endoscopic surgical procedures.

Conclusion

In all patients with frontal mucocele, surgery should be attempted endoscopically using IGESS because of the low morbidity of the procedure. Patients with risk factors for failure should be considered for OPFS if IGESS proves to be unsuccessful.
Staged Endoscopic and Combined Open/Endoscopic Approach in the Management of Inverted Papilloma of the Frontal Sinus
Authors: Dubin Marc G. , Sonnenburg Robert E. , Melroy Christopher T. , Ebert Charles S. , Coffey Charles S. , Senior Brent A.
Published: August 2018

Background

The endoscopic management of inverted papilloma has gained increasing popularity over the last 10 years. Although early concerns over an increased risk of recurrence seem to have been allayed, the appropriate management of lesions involving the frontal sinus and frontal recess still has to be determined.

Methods

We performed a retrospective review of the results of all patients with inverted papilloma from 2000 to 2004.

Results

A total of 18 patients were treated between October 2000 and January 2004. Six patients had frontal sinus involvement at the time of initial evaluation. One of these patients had isolated frontal sinus involvement. These patients were managed with either initial endoscopic resection with determination for the need for an additional procedure at the time of endoscopic resection (n = 5) or open/endoscopic approach for isolated frontal sinus involvement (n = 1). Of the five patients who had their disease managed endoscopically, three patients were determined at the initial procedure to need an osteoplastic flap and, subsequently, were managed successfully with a combined approach. One other patient was initially successfully managed endoscopically but ultimately required an osteoplastic flap for definitive management. The fifth patient was managed entirely endoscopically with multiple procedures. All patients treated with this protocol remain disease free with an average follow-up of 13.3 months.

Conclusion

The limitations of endoscopic resection of inverted papilloma of the frontal recess can be managed with staged procedures. Initial endoscopic resection of ethmoid/maxillary disease with subsequent open treatment of the frontal sinus has been successful in our experience.
Endoscopic Management of Extensive Inverted Papilloma
Authors: Jameson Mark J. , Kountakis Stilianos E.
Published: August 2018

Background

Given the malignant potential and propensity for recurrence of inverted papilloma (IP) of the sinonasal cavity, complete excision is warranted. For disease extending to multiple sites, open surgical oncological procedures are associated with high morbidity and do not assure complete control of the tumor. The endoscopic approach provides excellent visualization, permits removal of diseased mucosa while preserving vital anatomic structures, and allows for excellent postoperative surveillance. Recurrences are identified early and endoscopic resection is repeated as necessary until there is no evidence of disease.

Methods

Data were prospectively collected and subsequently reviewed on 18 consecutive patients who underwent endoscopic management of extensive IP (present at more than one anatomic site) between 1999 and 2003.

Results

Fourteen men and four women with a mean age of 54 years (range, 36–74 years) were followed for an average of 29 months (range, 6–46 months) after initial endoscopic resection. Seventy-eight percent (14 patients) complained of nasal airway obstruction for more than 6 months and 22% (4 patients) were incidentally noted to have a nasal mass on endoscopy or computed tomography. Eleven patients had undergone therapeutic procedures on initial evaluation. The most common sites affected were maxillary sinus, lamina papyracea, and ethmoid sinus. Patients required an average of 1.6 endoscopic surgeries (range, 1–3 surgeries) to achieve local control; 10 patients (56%) required only one. All patients were symptomatically improved and complications were limited to one cerebrospinal fluid leak, which was repaired intraoperatively.

Conclusion

Extensive IP can be controlled using minimally invasive endoscopic procedures as long as close follow-up is maintained. Operative risk and postoperative morbidity are significantly less than observed with open procedures.
Demonstration of Biofilm in Human Bacterial Chronic Rhinosinusitis
Authors: Ferguson Berrylin J. , Stolz Donna B.
Published: August 2018

Background

Bacterial biofilms may explain why some patients with bacterial chronic rhinosinusitis (CRS) improve while on antibiotics but relapse after completion of the antibiotic. In the human host, biofilms exist as a community of bacteria surrounded by a glycocalyx that is adherent to a foreign body or a mucosal surface with impaired host defense. Biofilms generate planktonic, nonadherent bacterial forms that may metastasize infection and generate systemic illness. These planktonic bacteria are susceptible to antibiotics, unlike the adherent biofilm.

Methods

We reviewed four cases of CRS using transmission electron microscopy (TEM) to assay for typical colony architecture of biofilms. Bacterial communities surrounded by a glycocalyx of inert cellular membrane materials consistent with a biofilm were shown in two patients.

Results

In the two patients without biofilm, a nonbacterial etiology was discovered (allergic fungal sinusitis) in one and in the other there was scant anaerobic growth on culture and the Gram stain was negative. Culture of the material from the biofilm grew Pseudomonas aeruginosa in both patients. Pseudomonas from the biofilm showed a glycocalyx, not present in Pseudomonas cultured for 72 hours on culture media. Both patients’ symptoms with bacterial biofilms were refractory to culture-directed antibiotics, topical steroids, and nasal lavages. Surgery resulted in cure or significant improvement.

Conclusion

Biofilms are refractory to antibiotics and often only cured by mechanical debridement. We believe this is the first TEM documentation of bacterial biofilms in CRS in humans.
Bacterial Location in Chronic Sinusitis
Authors: Ebenfelt Anders
Published: August 2018

Background

In chronic nonallergic sinusitis, it is often assumed that bacteria invade the sinus mucosa where the inflammatory condition begins and is maintained. However, the bacterial presence in a normal or moderately damaged epithelial layer has never been proved in biopsy studies.

Methods

In this study, mucosal samples from six consecutive patients with chronic sinusitis were examined. Transmission electron microscopy was used and the presence of bacterial invasion and formation of phagosomes containing bacteria as a marker of host response were studied.

Results

Phagocytosis of bacteria was observed in the sinus mucosa in samples from only one patient. In the other five patients, no signs of phagocytosis were seen.

Conclusion

Based on these results, we concluded that in chronic sinusitis, bacterial invasion in sinus mucosa is not an obligatory phenomenon.
Annexin A1 Expression in Nasopharyngeal Carcinoma Correlates with Squamous Differentiation
Authors: Rodrigo Juan Pablo , Garcia-Pedrero Juana Maria , Fernandez M. Pilar , Morgan Reginald O. , Suárez Carlos , Herrero Agustin
Published: August 2018

Background

Alterations of annexin A1 (ANXA1) expression have been reported in various cancers. However, no data are available about the expression of this protein in nasopharyngeal carcinomas (NPCs). The objective of this study was to investigate the expression of ANXA1 in these tumors.

Methods

We examined noncancerous nasopharyngeal mucosa (4 cases) and NPC (20 cases) for ANXA1 expression using immunohistochemistry.

Results

All tumor tissues showed markedly reduced ANXA1 expression compared with a strong positive signal observed in the corresponding normal epithelia. We found that ANXA1 expression is associated with the histological type in NPC. Only squamous cell carcinomas presented a positive ANXA1 signal in differentiated areas whereas all poorly differentiated tumors exhibited negative staining.

Conclusion

Our data show for the first time that ANXA1 expression is down-regulated in NPC and that its expression seems to be related with the squamous differentiation status of these tumors.
The Effect of the Total Intravenous Anesthesia Compared with Inhalational Anesthesia on the Surgical Field during Endoscopic Sinus Surgery
Authors: Wormald Peter J. , van Renen Graham , Perks Jonathon , Jones Janine A. , Langton-Hewer Claire D.
Published: August 2018

Background

Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed.

Methods

Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses offentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system.

Results

The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001).

Conclusion

In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.
Evidence Supporting Endoscopic Sinus Surgery in the Management of Adult Chronic Rhinosinusitis: A Systematic Review
Authors: Smith Timothy L. , Batra Pete S. , Seiden Allen M. , Hannley Maureen
Published: August 2018

Background

Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence on the use of endoscopic sinus surgery (ESS) in the management of adult chronic rhinosinusitis (CRS) examining the clinical question: “In adults with CRS who have failed medical management, does ESS improve symptoms and/or quality of life (QOL)?”

Methods

The American Rhinologic Society and the American Academy of Otolaryngology–Head and Neck Surgery convened a steering committee composed of the authors. Primary research articles evaluated for this report were identified using appropriate search terms and a Medline search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines (level 1 = randomized trials; level 2 = prospective cohort studies with comparison group; level 3 = case-control studies; level 4 = retrospective case series; level 5 = expert opinion).

Results

We identified 886 abstracts to review, retrieved 75 articles for full review, and included 45 articles in our report. The vast majority of articles represented level 4 evidence (n = 42) and two articles represented level 5 evidence. One article was identified that qualified for level 2 evidence. All of these articles generally supported the finding that ESS improves symptoms and/or QOL in adult patients with CRS.

Conclusion

There is substantial level 4 evidence with supporting level 2 evidence that ESS is effective in improving symptoms and/or QOL in adult patients with CRS. Future research efforts should focus on prospective studies that include appropriate comparison groups in their design.
Bacterial Infection in Chronic Rhinosinusitis: A Controlled Paired Analysis
Authors: Bhattacharyya Neil
Published: August 2018

Background

The aim of this study was to determine if pathogenic bacteria are involved in the pathogenesis of chronic rhinosinusitis (CRS).

Methods

A consecutive series of adult patients with unilateral sinus disease determined by unilateral radiographic involvement or unilateral purulent secretions was microbiologically studied. Aerobic and anaerobic bacterial and fungal cultures were obtained during endoscopic sinus surgery from purulent secretions or tissue culture. Positive culture rates were compared between the diseased sinus and the contralateral nondiseased (control) sinus to determine if pathogenic bacteria were more commonly recovered from the diseased sinuses.

Results

Forty-nine adult patients completed the study with appropriate microbiological data. Coagulase-negative staphylococci were the most commonly recovered bacteria followed by Staphylococcus aureus from the diseased side of the sinuses with similar findings for the control sinus. Bacterial species were recovered from 87.8% of the diseased side of the sinuses versus 85.7% from the control sinuses (p = 0.50). Reanalysis with coagulase-negative staphylococci considered as non-pathogen showed a 46.9 and 49.0% positive bacterial culture rate in diseased and control groups, respectively (p = 0.50). No significant difference in positive anaerobic culture rates were identified between groups (59.1% diseased versus 55.1% control, respectively, p = 0.61). Antibiotic resistance rates were no different between bacteria cultured from diseased sinuses versus control (p = 0.115).

Conclusion

Both aerobic and anaerobic bacterial species may be recovered from both diseased and nondiseased sinuses in patients with CRS. These findings cast some doubt on the exact etiologic role of bacteria in CRS, suggesting other factors or other agents also may be responsible in CRS pathogenesis.
What is the Correlation between Ratings and Measures of Olfactory Function in Patients with Olfactory Loss?
Authors: Welge-Luessen Antje , Hummel Thomas , Stojan Tomislav , Wolfensberger Markus
Published: August 2018

Background

Major complaints of many patients with olfactory dysfunction relate to the impairment of quality of life. Nevertheless, it is unclear to what extent there is a correlation between ratings of olfactory abilities/impairment and olfactory function.

Methods

Patients with olfactory dysfunction (n = 152) were examined psychometrically using the “Sniffin’ Sticks” test battery. Ratings of olfactory function and ratings of impairment were recorded using visual analog scales.

Results

Following standardized olfactory testing, 78 of the 152 patients were categorized as functionally anosmic, 64 as hyposmic, and 10 as normosmic. Groups differed significantly with regard to ratings of olfactory function. Functionally anosmic patients rated impairment to be significantly higher compared with hyposmic and normosmic patients. Ratings of olfactory function correlated significantly with measured olfactory function (r = +0.57) and ratings of impairment (r = —0.30).

Conclusion

There was a moderate correlation between ratings and measures of olfactory function. On average, functionally anosmic patients recognized their olfactory loss, although, on an individual basis, there were striking differences between measures and ratings of olfactory function.
Montelukast Effectively Treats the Nighttime Impact of Seasonal Allergic Rhinitis
Authors: Meltzer Eli O. , Philip George , Weinstein Steven F. , LaForce Craig F. , Malice Marie-Pierre , Dass S. Balachandra , Santanello Nancy C. , Reiss Theodore F.
Published: August 2018

Background

Nighttime problems constitute a significant burden on the quality of life of patients with seasonal allergic rhinitis (SAR). The aim of this study was to evaluate the effectiveness of montelukast on nighttime AR symptoms.

Methods

In seven multicenter, double-blind, parallel-group trials, nighttime problems were assessed as the nighttime symptoms score (NSS), an average of three individual symptom scores: difficulty going to sleep, nighttime awakening, and nasal congestion on awakening (each rated 0 = none to 3 = severe). Patients (aged 15–82 years) were randomized to receive montelukast, 10 mg (n = 1751), placebo (n = 1557), or the positive control loratadine, 10 mg (n = 1616).

Results

In a combined analysis, changes from baseline (mean ± SE) in NSS were -0.28 ± 0.01, -0.16 ± 0.01, and —0.24 ± 0.01 for the montelukast, placebo, and loratadine groups, respectively. Difference versus placebo in least-squares mean change from baseline were —0.11 (95% confidence interval, -0.14, -0.08; p ≤ 0.001) for montelukast and -0.09 (-0.12, -0.06; p ≤ 0.001) for loratadine. Strong baseline correlations (R > 0.70; p < 0.001) of NSS and two of its individual symptoms with the sleep domain of the validated Rhinoconjunctivitis Quality of Life Questionnaire support the validity and importance of measuring nighttime morbidity in SAR. Furthermore, a clinically important benefit of montelukast on the nighttime impact of SAR was shown using an analysis anchored on the Patient's Global Evaluation.

Conclusion

These data underscore the importance of nighttime problems in patients with SAR and the need to treat nighttime symptoms. In these studies, montelukast significantly improved the NSS, a clinically relevant and valid measure in patients with SAR.
Nasal Septal Suture Technique versus Nasal Packing after Septoplasty
Authors: Yildirim Altan , Yasar Mehmet , Bebek Ali Ihsan , Canbay Ercan , Kunt Tanfer
Published: August 2018

Background

The aim of this study was to compare eustachian function and blood gas changes with nasal packing (NP) and nasal septal suturing (NSS) after septoplasty.

Methods

Eighty patients who have nasal septal deviation and who otherwise are healthy were studied. Forty of these patients had finger glove NPs in their nasal cavities for 48 hours after septoplasty. Another 40 patients had NSS performed after septoplasty. Acoustic tympanometry and pH, PCO2, and PO2 analyses of arterial blood were performed preoperatively and 48 hours postoperatively.

Results

We observed a statistically significant increase in middle ear pressure (p < 0.001) and a significant reduction of PO2 (p < 0.001) and increase of PCO2 (p = 0.041) in the NP group but no difference in the NSS group, postoperatively.

Conclusion

NSS should be preferred as an alternative to intranasal packing.
Endoscopic Orbital Decompression for Graves’ Ophthalmopathy
Authors: Kasperbauer Jan L. , Hinkley Lucinda
Published: August 2018

Background

Graves’ ophthalmopathy generates a volume excess for the orbital cavity, which may produce proptosis, pain, exposure keratitis, diplopia, and optic neuropathy. Endoscopic orbital decompression expands the orbital cavity into the ethmoid cavity and medial maxillary sinus. This retrospective study documents the outcomes after endoscopic orbital decompression for patients with Graves’ ophthalmopathy.

Methods

Data collected included demographic information, symptom resolution, complications related to the surgery, reduction in proptosis, subsequent need for eye muscle surgery, and hospital length of stay. Between July 1989 and April 2003, 62 patients were referred for endoscopic orbital decompression (often unilateral).

Results

Three patients refused use of their medical records for research purposes. Seventy percent were women; the average age of the study group was 49 years. Preoperatively, 63% of the patients had diplopia and optic neuropathy was noted in 27%. Two patients had a cerebrospinal fluid leak identified and managed during the decompression. No postoperative leaks occurred. Twenty-five percent of patients did not require eye muscle surgery. Forty-eight percent of the patients underwent one procedure to manage diplopia. The average reduction in proptosis was 2.5 mm. Fifty-four percent were managed as an outpatient and 27% underwent a 23-hour observation period.

Conclusion

This data supports the safety, efficiency, and efficacy of endoscopic orbital decompression for unilateral and bilateral Graves’ ophthalmopathy. Eye muscle surgery frequently will be required to manage diplopia after decompression. (American Journal of Rhinology 19, 603–606, 2005)
Is Septoplasty Alone Adequate for the Treatment of Chronic Rhinosinusitis with Septal Deviation?
Authors: Bayiz Ünal , Dursun Engin , İslam Ahmet , Korkmaz Hakan , Arslan Necmi , Ceylan Kürşat , Samim Erdal
Published: August 2018

Background

The purpose of this study was to reveal the role of septoplasty in curing chronic rhinosinusitis (CRS) in patients with significant septal deviation.

Methods

This prospective study involved 26 patients with CRS and septal deviation. The patients were randomly divided into two groups according to the applied surgical procedures. In the first and second groups, septoplasty and septoplasty plus endoscopic sinus surgery were applied, respectively. Subjective (questionnaire) and objective (endoscopy and computerized tomography) success rates were used to analyze the results.

Results

Septoplasty alone and septoplasty plus endoscopic sinus surgery were applied in 57.7% (15/26) and 42.3% (11/ 26) of the patients, respectively. Success rates were 93.3% (14/15) and 81.8% (9/11), subjectively (p > 0.05), and 66.7% (10/15) and 54.5% (6/11), objectively (p > 0.05), respectively in each group.

Conclusion

We suggest that septoplasty alone can be adequate for the treatment of CRS with septal deviation.
Bipolar Radiofrequency Volumetric Tissue Reduction of Inferior Turbinate: Does the Number of Treatment Sessions Influence the Final Outcome?
Authors: Atef Ahmed , Mosleh Mohamed , El Bosraty Hossam , El Fatah Gamal Abd , Fathi Ahmed
Published: August 2018

Background

The aim of this study was to determine if the number of treatment sessions has an influence on the final intermediate term results of submucosal bipolar radiofrequency volumetric tissue reduction of the inferior turbinate.

Methods

One hundred two patients were enrolled in this study prospectively. The procedure was done using the Coblation (Arthrocare Corp., Sunnyvale, CA). The assessment was done using the 10-cm visual analog scale and acoustic rhinometry. Surgical procedures and preand postoperative assessments were done at the Faculty of Medicine, Cairo University.

Results

Eighty eight percent of our study population achieved final relief of their nasal obstruction, and at least three sessions were needed to maintain the favorable outcome at 1-year follow up.

Conclusion

Increasing the number of bipolar radiofrequency volumetric tissue reduction treatment sessions was associated with better intermediate-term outcome. This was confirmed using subjective and objective methodology.
Radiofrequency for Inferior Turbinate Hypertrophy: Could Its Long-Term Effect be Predicted with a Preoperative Topical Vasoconstrictor Drop Test?
Authors: Yilmaz Metin , Kemaloğlu Yusuf K. , Baysal Elif , Tutar Hakan
Published: August 2018

Background

Our purpose was to evaluate whether postoperative improvement by radiofrequency (RF) volumetric tissue reduction (RFVTR) correlated with a preoperative topical vasoconstrictor drop test (TVDT) in subjects with chronic nasal obstruction secondary to inferior turbinate hypertrophy (ITH).

Methods

This study was a prospective and unblinded clinical trial. We included 22 subjects suffering from chronic nasal obstruction secondary to ITH. TVDT was performed on all subjects before the operation, and RF energy was delivered to three different sites of each turbinate. Nasal obstruction was evaluated by visual analog score (VAS) preoperatively, after TVDT, and 1, 2, 4, 6, 8,12, and 24tweeks after surgery. Success rates of RFVTR and gain ratios of RFVTR and TVDT were calculated.

Results

Significant improvements were observed in success ratios by RFVTR between the 2nd and 12th weeks. Postoperative VAS values reached to VAS value achieved by TVDT at the 8th week. Correlation analysis revealed that postoperative VAS values found at the 2nd to 24th weeks correlated positively with VAS values achieved by TVDT (r = 0.47 and p < 0.03 at the 2nd week; r = 0.65 and p = 0.001 at the 24th week) but not with preoperative VAS values. Similar positive correlations also were found between gain ratios of TVDT and RFVTR from the 4th to 24th weeks.

Conclusion

This study showed that success by RFVTR in ITH could be predicted by preoperative TVDT. Improvement by RFVTR depends on how much the patient's turbinates respond to TVDT, but not how much he/she complains of nasal obstruction.
Effects of Septoplasty on the Nasal Flora
Authors: Eviatar Ephraim , Kessler Alexander , Segal Samuel , Vaiman Michael , Kalmovich Limor Muallem
Published: August 2018

Background

Disruption in the balance of the nasal flora influences infectious diseases of the nose. We characterized the changes in nasal flora of the middle meatus of patients with a symptomatic deviated nasal septum before and after septoplasty.

Methods

The study cohort included 33 patients with symptomatic deviated nasal septum who underwent septoplasty from 1998 to 2001. Cultures from the middle meatus were taken preoperatively and 1 month postoperatively.

Results

Fifty-two percent of the preoperative cultures and 76% of the postoperative cultures were positive. The preoperatively cultured bacteria were similar to those usually cultured from the nose of a healthy individual–-mainly Staphylococcus aureus and Corynebacterium. The postoperative cultures included bacteria not considered as being nasal flora and infrequently cultured from the nose: Pseudomonas, Haemophilus influenza, and Staphylococcus coagulase negative.

Conclusion

Symptomatic septal deviation does not influence nasal flora. The bacterial changes without clinical complaints that we found postseptoplasty might call for a more in-depth workup.
A New in Vitro Method of Decongestant Assay of Nasal Mucosa: A Preliminary Report
Authors: Wang Hsing-Won , Kao Chuan-Hsiang , Chu Yueng-Hsiang
Published: August 2018

Background

The calculation of cell planar surface area, successfully used for glomerular mesangial cell–-altered contractility, also is a reasonable methodology to assess nasal mucosal contractility. A simple technique that works particularly well with vasoconstriction-inducing agents has been introduced to test the effects of several drugs on patient turbinate nasal mucosa in vitro. This report will introduce this technique and present some of the initial findings.

Methods

We tested epinephrine, norepinephrine, pseudoephedrine HCl, and methoxamine, respectively, for effectiveness as a vasoconstricting drug. We also tested the effectiveness of verapamil as a vasodilating drug. A piece of nasal mucosa ∼3 × 4 mm in size was mounted with a 27-gauge needle and submersed in a 4-mL muscle bath in a Petri dish at room temperature. The bath consisted of 4 mL of Kreb's solution. We recorded the decrease of nasal mucosa planar surface area in response to the application of vasoconstricting agents, as measured using a digital microscope connected to a Pentium III with morphometric software, as the estimated degree of contraction. A photograph of the same mucosa was taken every 3 minutes for a total period of 18 minutes.

Results

Nasal mucosa that was mounted in a muscle bath in a Petri dish and treated with a small dose of a nasal decongestant was observed to contract. Drug dosage determined the degree of nasal mucosa contraction. Nasal mucosa similarly prepared but treated with a vasodilating agent, such as verapamil, exhibited a relaxation response only when pretreated with a vasoconstricting agent, such as methoxamine. Both vasoconstricting and vasodilating drugs induce dose-related responses in planar surface calculation.

Conclusion

In this study, drug dosage determined the degree of nasal mucosa contraction. We also found that the rate of contraction and percent of contraction were dose dependent. We believe this new method will prove useful in studying the effects of drugs on nasal blood vessels.
A Comparison of Computer-Aided Surgery Registration Methods for Endoscopic Sinus Surgery
Authors: Hardy Stuart M. , Melroy Christopher , White David R. , Dubin Marc , Senior Brent
Published: August 2018

Background

Stereotactic computer-aided surgery has provided the surgeon with a means to navigate more safely through diseased or surgically altered sinus anatomy. Accurate registration is vital to successful image-guided surgery. This study compared the accuracy and performance of three registration methods: fiducial, anatomic landmarks, and surface registration.

Methods

Ten fixed cadaveric heads underwent endoscopic computed tomography scan followed by middle meatal antrostomy and sphenoidotomy. Each registration method was performed, and the time required and mean registration error were recorded. Five anatomic sites were then identified and compared with the preoperative computed tomography images. The true distances between the known anatomic sites and the crosshair locations on the images were measured.

Results

Statistically significant differences were noted for mean registration error and time for registration. The mean ± SEM time for registration for the fiducial, surface, and landmark methods were 5 minutes 24 seconds ± 27 seconds, 1 minute 1 second ± 5 seconds, and 11 minutes 46 seconds ± 45 seconds, respectively. The mean ± SEM registration error for the fiducial, surface, and landmark methods were 0.48 ± 0.21 mm, 1.05 ± 0.06 mm, and 3.1 ± 0.25 mm, respectively. When the true accuracy of the three registration methods were compared, no significant difference was found between fiducial and surface registration. However, fiducial registration was significantly more accurate than landmark registration at all points. When compared with landmark registration, surface registration was statistically more accurate at all anatomic sites except for the sella turcica and optic nerve.

Conclusion

When the true accuracies of these methods were compared infixed cadaveric specimens, fiducial and surface registration were statistically similar but were found to be significantly more accurate than landmark registration. Furthermore, when time of registration, accuracy, and ease of use were considered, surface registration was found superior.
Risk Factors for Wheezing in Primary School Children in Bursa, Turkey
Authors: Alper Züleyha , Sapan Nihat , Ercan İlker , Canıtez Yakup , Bilgel Nazan
Published: August 2018

Background

Wheezing is the most common symptom of childhood respiratory tract illnesses. It is important not only for its associated acute morbidity, but also for the fact that early childhood wheezing confers a high risk for asthma. Epidemiological studies from various countries show that 10–15% of children <1 year of age and 25% of children <5 years of age have wheezing-associated respiratory tract illness, and one-third of these children develop asthma later in life.

Methods

In this retrospective study, we evaluated the association between a history of wheezing and prenatal, postnatal, familial, and environmental risk factors in 858 7-year-old children, randomly selected from seven primary schools in Bursa, Turkey, by means of an easy-to-understand questionnaire form. Among these children, 12.4% had a history of early transient wheezing, 7.1% had persistent wheezing, and 7.7% had late onset wheezing; 72.8% had no wheezing symptoms and 33.3% of children who experienced wheezing during the first 3 years of life had physician-diagnosed asthma.

Results

Notable risk factors associated with wheezing were as follows: male gender, lower socioeconomic status, premature birth, maternal smoking during pregnancy, bottle-feeding before 2 months of age, dampness and mold at home, hospitalization due to any respiratory illness in infancy, history of croup between 6 months and 5 years of age, frequent upper respiratory infections during the first 3 years of life, allergic eczema in the child, and any allergic disease in the mother or siblings.

Conclusion

This study shows that the high rates of reported wheezing in the 858 primary school children in Bursa are clearly attributable to important risk factors that have long been recognized and discussed by researchers worldwide, and this suggests that all efforts at primary prevention may be insufficient.
Endoscopic Treatment of Benign Tumors of the Nose and Paranasal Sinuses: A Report of 33 Cases
Authors: Sciarretta Vittorio , Pasquini Ernesto , Frank Giorgio , Modugno Giovanni Carlo , Cantaroni Cosetta , Mazzatenta Diego , Farneti Giovanni
Published: August 2018

Background

The endoscopic approach can be used successfully for the treatment of benign tumors such as fibroosseous and vascular lesions, pleomorphic adenoma, glioma, meningioma, and schwannoma.

Methods

Thirty-three patients diagnosed with benign tumors of the nasal cavity and paranasal sinuses and treated using an endoscopic approach were reviewed retrospectively. The endoscopic approach was simple in 28 cases and associated with an external approach in 5 cases (because of an intracranial extension of the tumor in four patients and its location at the level of the anterior wall of the frontal sinus in the last case).

Results

The resection of the lesions was complete in 32 patients and subtotal in one case. The mean follow-up was 28 months and only two recurrences (6%) were observed in the juvenile angiofibroma group and in the case of the fibrous dysplasia associated to aneurysmal bone cyst, respectively, 20 and 24 months postoperatively.

Conclusion

In selected cases, endoscopic surgery can be considered an effective treatment for the resection of benign tumors involving the sinonasal tract.
Endoscopically Guided Aerobic Cultures in Postsurgical Patients with Chronic Rhinosinusitis
Authors: Coffey Charles S. , Sonnenburg Robert E. , Melroy Christopher T. , Dubin Marc G. , Senior Brent A.
Published: August 2018

Background

There is considerable amount of debate in the literature regarding the microbial flora of normal, acutely infected, and chronically infected paranasal sinuses. Few studies have specifically looked at the microbial flora of healthy and infected sinus cavities after functional endoscopic sinus surgery.

Methods

One hundred thirty-four cultures were studied. All cultures were obtained using a standard technique. The nasal cavities were decongested and anesthetized, and nasal endoscopy was performed. When purulent secretions were identified, specimens of purulent secretions were obtained for incubation. Sensitivities were tested according to microorganisms identified. Empiric therapy generally consisted of a fluoroquinolone, amoxicillin/clavulanate, or a later-generation cephalosporin, and adjustment in individual instances when appropriate.

Results

Twelve cultures showed no growth, 86 grew a single microorganism, and 35 grew two or more microorganisms for a total of 151 microorganisms identified. The most common microorganisms were Staphylococcus aureus, coagulase-negative staphylococci, and Pseudomonas aeruginosa. Other organisms that were cultured <5% of the time included Streptococcus pneumoniae, Haemophilus influenza, Moraxella catarrhalis, Serratia liquefaciens, Stenotrophomonas (Xanthomonas) maltophilia, alcaligenes, Fusobacterium, Escherichia coli, diphtheroids, Acinetobacter species, Klebsiella species, skin flora, and mixed Gram-negative and Gram-positives.

Conclusion

Endoscopically guided aerobic cultures in postsurgical patients with acute exacerbations of chronic rhinosinusitis most commonly grew S. aureus, coagulase-negative staphylococci, and pseudomonal species. These cultures altered antibiotic treatment management decisions in a significant number of cases regardless of patients’ clinical characteristics or history of previous culture.
Analysis of Methods to assess Frontal Sinus Extent in Osteoplastic Flap Surgery: Transillumination versus 6-ft Caldwell versus Image Guidance
Authors: Melroy Christopher T. , Dubin Marc G. , Hardy Stuart M. , Senior Brent A.
Published: August 2018

Background

The aim of this study was to compare three common methods (transillumination, plain radiographs, and computerized tomography [CT] image guidance) for estimating the position and extent of pneumatization of the frontal sinus in osteoplastic flap surgery.

Methods

Axial CT scans and 6-ft Caldwell radiographs were performed on 10 cadaver heads. For each head, soft tissue overlying the frontal bone was raised and the anticipated position and extent of the frontal sinus at four points was marked using three common methods. The silhouette of the frontal sinus from the Caldwell plain radiograph was excised and placed in position. Four points at the periphery also were made using information obtained from a passive optically guided image-guided surgery device, and transillumination via a frontal trephination also was used to estimate sinus extent. The true sinus size was measured at each point and compared with experimental values.

Results

The use of CT image guidance generated the least difference between measured and actual values (mean = 1.91 mm; SEM = 0.29); this method was found statistically superior to Caldwell (p = 0.040) and transillumination (p = 0.007). Image guidance did not overestimate the size of the sinus (0/36) and was quicker than the Caldwell approach (8.5 versus 11.5 minutes). There was no learning curve appreciated with image guidance.

Conclusion

Accurate and precise estimation of the position and extent of the frontal sinus is crucial when performing osteoplastic flap surgery. Use of CT image guidance was statistically superior to Caldwell and transillumination methods and proved to be safe, reproducible, economic, and easy to learn.
Low Temperature Decreased Tension in Isolated Hypertrophic Human Nasal Mucosa
Authors: Chu Yueng-Hsiang , Wu Chin-Chen , Kao Chuan-Hsiang , Wang Hsing-Won
Published: August 2018

Background

The purpose of this study was to evaluate the effect of low temperature on basal tension in isolated hypertrophic human nasal mucosa with or without α1-agonist stimulation.

Methods

A tissue bath for isolated nasal mucosa was used. Tension in strips of human turbinate mucosa that were untreated and treated with an α1-adrenoreceptor agonist, methoxamine (10 μM), was recorded continuously in a stepwise manner in temperatures that varied from 37 to 10°C.

Results

The changes of tension in the human nasal mucosa were found to be temperature-dependent in both untreated and treated tissues, with tension decreasing to 48.6% at 10°C in comparison with 100% at 37°C in the untreated group, the presence of methoxamine (10 μM) had minimal effect.

Conclusion

Low temperature induced a rapid and reproducible relaxation in isolated hypertrophic human nasal mucosa that was not affected by the presence of the α1-agonist methoxamine (10 μM).