bluuebunny/crossref_metadata_2025 huggingface dataset:
Second Step of LTP: A New Technique for Stoma Closure
Authors: Trozzi Marilena , Revol Magdalena Roques , Bottero Sergio
Published: September 2011

Objective

To present our protocol and propose a new surgical technique for the closure of the tracheocutaneous fistula in patients admitted for laryngotracheal reconstruction.

Method

We present a modified surgical technique to close the tracheocutaneous fistula performed on patients around 6 months after laryngotracheoplasty and decannulation. The procedure involves the closure of the stoma of the tracheal anterior wall by placing the suture along the longitudinal axis and approaching the tracheal margins in craniocaudal direction.

Results

Eight closures were performed in accordance with this technique without complications in the short and long term. Max follow‐up was 3 years with no evidence of tracheal stenosis, tracheomalacia, tracheal pouch, or caliber irregularities on the site of the previous stoma. Although the modified closure technique slightly reduces the length of the trachea, it has proven to effectively enlarge the transverse diameter, reduce the risk of an extraluminal or intraluminal invagination of the flaps, and prevent secondary tracheal stenosis or pouch.

Conclusion

Based on our protocol for decannulation after LTP, we recommend postponing fistula treatment until the grafts have been well established, the stomal scar has reduced spontaneously, and the traumatic effect of intubation has been minimized. Our method for surgical closure has shown to reduce problems associated with these fragile tracheae.
Sharp Foreign Body Aspiration Patients: Are They Different?
Authors: AlRomaih Saud Romaih , Alrajhi Yaser , Nguyen Lily H. P.
Published: September 2011

Objective

Compare and contrast patients with sharp foreign body aspiration (FBA) in the airways to other non‐sharp FBA in terms of age, social background, presentation, and nature of foreign body.

Method

Case series of patients with FBA in airways and the upper digestive tract in multi‐centers, between Jan 2004 to Dec 2009.

Results

Around 10 percent of patients had sharp FBA in the airway. We noticed that they are overall older. They mostly have the same social background. Most of them gave clear history of sharp FBA. Imaging was useful in the majority of patients. Most sharp FBA happened with the same object.

Conclusion

Patients with sharp FBA are different in terms of age, social background, presentation, and nature of FBA when compared to other non‐sharp FBA.
The Effectiveness of Laryngotracheal Separation for Children
Authors: Hara Hirotaka , Nakamoto Tetsuya , Yamashita Hiroshi
Published: September 2011

Objective

1) Evaluate the effectiveness of laryngotracheal separation (LTS) for pediatric neurological impaired patients from a viewpoint of postoperative improvement of respiratory condition and swallowing function. 2) Evaluate the effectiveness of LTS from a viewpoint of postoperative improvement of the burden on the caregiver.

Method

Study design: prospective. From September 2004 to December 2010, nineteen children underwent LTS. The effectiveness of LTS and postoperative improvement of QOL on patients and caregivers were evaluated by the questionnaire for caregivers. The questionnaire included frequency of suction, frequency of aspiration pneumonia, methods of food intake, and postoperative complications.

Results

After the laryngotracheal separation, frequency of suction decreased significantly (Wilcoxon t‐test). The episodes of aspiration pneumonia and respiratory disorders were well controlled after operation. The burden on the caregiver was reduced. There were no significant complications of laryngotracheal separation. There were two episodes of laryngocutaneous fistules.

Conclusion

Laryngotracheal separation can prevent the neurologically impaired children from aspiration pneumonia and provide higher QOL. Also, laryngotracheal separation provides a higher QOL for the caregiver of the neurologically impaired child.
The Increased Risk of Post‐tonsillectomy Hemorrhage in Coagulopathic Children
Authors: Venkatesan Naren Natraj , Mukerji Shraddha S. , Rodman Regina E.
Published: September 2011

Objective

Tonsillectomy is a routine procedure performed in children with the main complication being postoperative hemorrhage. In coagulopathic patients, does their disease affect management of these children after a tonsillectomy? Whether these patients need more intricate management following a tonsillectomy is important to know to prevent and treat postoperative hemorrhage.

Method

This case series is done through a chart review searching for patients who have undergone a tonsillectomy and have a known coagulopathic disorder. This will include von Willebrand’s disease, Hemophilia A, Hemophilia B, and Factor 8 deficiency.

Results

The results show that these children do not suffer posttonsillectomy hemorrhage at an increased rate over non‐coagulopathic patients. These patients should be managed by correction of the Protime and INR to normal ranges prior to procedure. If this is done, these patients are not at an increased risk of postoperative hemorrhage.

Conclusion

While coagulopathic patients are at an increased risk for prolonged hemorrhage, their risk of postoperative hemorrhage is not increased. Correction of INR and Protime decreases their risk of hemorrhage. If a hemorrhage does occur, these patients will require both surgical intervention and specific correction of their coagulopathy.
The Relationship between Vitamin D, Otitis Media, and Weight
Authors: Weinreich Heather , Daly Kathleen
Published: September 2011

Objective

1) Assess vitamin D levels as a predictor of history of recurrent otitis media (ROM), tube treatment, and weight‐for‐length (WFL). 2) Explore the relationship of vitamin D as a confounder in the relationship between OM and overweight status.

Method

Data were analyzed from a prospective cohort of mothers/children recruited between 1995 and 2002 from local HMO. ROM and tube status were obtained through physical exam and medical records, while WFL data was gathered from well‐child checks. Vitamin D levels were assayed from cord blood. Chi‐square and logistic regression were performed.

Results

A total of 47.9% of children had ROM, 13.2% received tubes. A total of 10.7% of children age 2 years had a WFL ≥ 95th percentile. A total of 56.7% of children had vitamin D levels below sufficient. Children with a sufficient vitamin D level were at greater risk of having a WFL ≥85th in multivariate analysis (OR 2.004, P =. 04); however, vitamin D status did not predict ROM or tube status. Children with history of tube treatment had a significantly increased risk of a WFL ≥95th percentile after controlling for family income, maternal prenatal smoking, maternal education, gender, birth season, breastfeeding status, daycare attendance, and vitamin D level (OR 3.69, P =. 01).

Conclusion

Vitamin D is not a predictor of ROM or tube status; however, children with a vitamin D status that is sufficient are more likely to be ≥85th WFL percentile. Vitamin D status is not a confounder in the relationship between a history of tube treatment and overweight status.
The Use of Intranasal Corticosteroids in Children
Authors: Marianowski Remi , Lacroix Candice , Mornet Emmanuel , Potard Gael , Valette Gerald
Published: September 2011

Objective

Investigate the use of intranasal corticosteroids (ICS) by otolaryngologists with a predominantly pediatric practice, a national inquiry has been conducted in a European country.

Method

Participants: 212 otolaryngologists, representing around 10% of the specialty, answered the survey (M/F ratio=179/33). The mean age of this population was 52 ± 8.4 years, with a mean time in practice of 20.7 ± 9 years.

Results

Disease treated by ICS were chronic rhinosinusitis in 39.2% for a mean duration of 30 days in 62.2% of the cases, aergic rhinitis in 69.2 %, nasal polyposis in 67.2%, and OME in 30.2%. Acute rhinosinusitis was considered for treatment by intranasal corticosteroids by only 8.5% of otolaryngologists. Adenoid hypertrophy was treated in 16% of cases by ICS. Symptoms considered for treatment by ICS were nasal obstruction (88.6%), rhinorrhea (67.6%), nasal itching (66.1%), ocular symptoms (41.2%), sneezing (63%), olfactory troubles (73.2%), dyspnea (76%), edema of nasal mucosa (76.2%). Fever was never an indication (75%).

Conclusion

According to this nationwide survey nasal polyposis and allergic rhinitis are the most frequent indications for ICS treatment in children.
The Use of Propranolol in Infantile Subglottic Hemangiomas
Authors: Hui‐Chi Ang Annette , Manuel Anura M. , Anicete Rosslyn , Tan Henry K.
Published: September 2011

Objective

The discovery of propanolol for treatment of hemangiomas is a breakthrough, as current modalities are hampered by unpredictable outcomes and complications. Currently, there is a lack of long‐term data. We aim to contribute with our series of 3 patients with subglottic hemangiomas causing airway compromise, treated successfully with propanolol.

Method

A detailed retrospective review of 3 patients who had received oral propanolol for the treatment of their subglottic hemangiomas was conducted based on the patients’ records. We documented their clinical history, degree of airway compromise, and duration of treatment and outcome with oral propanolol.

Results

Patient 1 was a 23‐day‐old girl who had a 1‐week history of stridor complicated by spontaneous rib fractures. Patient 2 was a 3‐month‐old girl who had a 1‐month history of stridor associated with a beard distribution of cutaneous hemangiomas. Patient 3 was a 2‐month‐old girl who had intermittent stridor from third week of birth. All children required intubation for relief of respiratory distress. Microlaryngobronchoscopy was performed for diagnosis and follow‐up at regular intervals. Cardiac echography was done prior to oral propanolol commencement at 1mg/kg/d, which was gradually escalated to 2mg/kg/d. All patients demonstrated significant clinical improvement at one week.

Conclusion

While the patients demonstrated remarkable clinical improvement at one week, radiological response (magnetic resonance imaging) was muted in contrast. This remarkable clinical response was not found to be sustained at 6 months interval. Propanolol may have to be combined with another modality of treatment to achieve a long‐term positive outcome.
Ultrasound Imaging to Identify Occult Submucous Cleft Palate
Authors: Meier Jeremy D. , Banks Caroline A. , White David R.
Published: September 2011

Objective

1) Determine the feasibility of transoral ultrasound imaging in evaluating palatal anatomy using a human cadaver model. 2) Describe ultrasound findings in patients with a submucous cleft palate.

Method

Ultrasound imaging of the soft palate in twenty fresh human cadaver specimens was performed using the Sono Site M Turbo system. In two specimens, the soft palate was imaged ex vivo to better evaluate the anatomy. Ultrasound imaging was then performed in three living patients with a submucous cleft palate.

Results

The uvularis and levator sling were identified by ultrasound in each cadaver specimen. In each of the three patients with a submucous cleft palate, absence of the central uvularis muscle and discontinuity of the levator sling was seen on ultrasound imaging. The abnormal anatomy was confirmed after surgical exploration during the palatoplasty.

Conclusion

Ultrasound imaging of normal velopharyngeal muscle is possible in human cadaver specimens. These results suggest that ultrasound imaging has potential in identifying patients with an occult submucous cleft palate. Ultrasound could help determine the appropriate surgery when formulating treatment for patients with velopharyngeal insufficiency without an obvious cleft palate.
Unilateral Vocal Cord Paralysis in Children: Our Experience
Authors: Rooney Megan , Sidman James D. , Grischkan Jonathan M. , Tibesar Robert J. , Lander Timothy
Published: September 2011

Objective

Review presentations, etiology, management, and outcomes of unilateral vocal cord paralysis (UVCP) managed at a single institution over a 10‐year period.

Method

Retrospective review at a tertiary care pediatric hospital. Forty‐two patients less than 18 years old presented with UVCP between 2002 and 2011. Interventions included injection laryngoplasty, ansa cervicalis to recurrent laryngeal nerve anastomosis (AC‐RLNA), and cordotomy. Outcomes measured were vocal cord motility and reports of feeding, aspiration, stridor, and voice.

Results

Etiology of UVCP in the 42 patients included: surgical injury (n = 23), birth trauma (n = 10), prolonged intubation (n = 3), neurological origin (n = 2), vincristine chemotherapy (n = 2), and idiopathic (n = 2). Sixteen of the 42 (38%) patients fully recovered vocal cord mobility after an average of 6.03 months. Nine patients underwent injection laryngoplasty with either Gelfoam or Radiesse Voice and saw improvement of symptoms for a median of 2 or 4 months respectively. Two patients underwent AC‐RLNA with symptom improvement or resolution beginning 6 months postoperatively. Fifteen patients did not recover motion but were asymptomatic and did not require intervention.

Conclusion

Children with UVCP face airway compromise, chronic aspiration, exercise intolerance, and voice abnormalities. This study favors conservative management in the majority of cases and waiting up to 1 year prior to intervention. When spontaneous recovery does not occur, injection laryngoplasty and AC‐RLNA can improve symptoms for pediatric patients.
Velopharyngeal Insufficiency Repair Outcomes in Patients with Velocardiofacial Syndrome
Authors: Hall Joseph E. , Muckala Jennifer , Sowder Derrick , Wooten Christopher , Goudy Steven L.
Published: September 2011

Objective

Analyze outcomes of operations for velopharyngeal insufficiency (VPI) in patients with velocardiofacial syndrome (VCFS). We hypothesize that patients with more severe phenotypic features of VCFS have greater VPI and are more likely to require revision VPI surgery.

Method

Retrospective chart review. Demographic data, VCFS characteristics, anatomical variations, perceptual speech investigation, nasal endoscopy, acoustic nasometry, and operative intervention data were collected for each patient with VCFS and VPI at Vanderbilt University Medical Center. Sixteen patients with VCFS were reviewed.

Results

Average age was 7.38 years, with 8 female patients. Surgery was necessary in 12 of 16 patients (75%). Eight patients (50%) underwent pharyngeal flap, 2 patients (12.5%) underwent Furlow palatoplasty, and 2 patients (12.5%) underwent sphincter pharyngoplasty. Six patients had heart anomalies (37.5%). Eight patients (50%) had hearing loss (average loss of 31 dB), and 3 patients had significant hypocalcemia (18.8%). Two patients had submucous clefts (12.5%), while 1 patient had cleft palate (6.3%). Two patients (12.5%) required revision operations. Both patients requiring revision had Tetralogy of Fallot, mild/moderate conductive hearing loss, and moderate to severe hypernasality preoperatively.

Conclusion

VPI is common in VCFS, and most patients require surgical intervention. VCFS patients presenting with a more severe phenotype as exhibited by increasing severity of heart disease, hearing loss, and hypernasality are more likely to require revision surgery to correct VPI.
A Case of Juvenile Angiofibroma Confined to the Vidian Canal and Sphenoid Sinus
Authors: Siva Thiru , Martinez‐Devesa Pablo , Paul Ciba A.
Published: September 2011

Objective

In this descriptive case we highlight the need for vigilance in investigating patients with typical demographic but without clinical signs of juvenile angiofibroma on nasendoscopy. We also examine the management of these cases where there is intimate relationship to the optic nerve and carotid artery.

Method

We use case records, correspondences, radiological investigations, radiographic images, and intraoperative images and videos to outline the disparity between clinical signs and pathology in this individual case.

Results

The CT imaging of this patient demonstrates intracanulicular juvenile angiofibroma within the vidian canal without an intranasal component. This was safely but incompletely removed via an endonasal approach with preoperative embolization. Surveillance imaging allowed detection of residual tumor, which may be removed via a mid‐facial degloving approach at a subsequent procedure.

Conclusion

Vigilance should be exercised when assessing and investigating patients with subtle signs and symptoms but typical demographic for intra‐nasal juvenile angiofibroma. Safe endoscopic removal after embolization can be performed with open surgery reserved for residual or recurrences noted on surveillance imaging.
A Novel Lid Crease Approach to Supraorbital Mucoceles
Authors: Desai Lajja , Chang Eugene H. , Allen Richard C.
Published: September 2011

Objective

1) Review various approaches to lateral frontal supraorbital mucoceles (endoscopic, open: bicoronal, hemicoronal with osteoplastic flap, subfrontal, and supraciliary approach). 2) Describe a hybrid lid crease approach that allows the direct excision of the mucocele lining and harvest of a pericranial flap through a minimally invasive well‐hidden blepharoplasty incision.

Method

1) Literature review of current endoscopic and open approaches for the removal of frontal/supraorbital mucoceles. 2) Description of surgical technique of the lid crease approach, harvest of pericranial flap, and a representative case with radiology, pathology, preoperative photos, intraoperative photos, postoperative photos, and follow‐up.

Results

Open approaches to the frontal sinus are successful in the removal of lateral frontal/supraorbital mucoceles. However, disadvantages include large scars and increased operative and recovery time. Endoscopic approaches are also successful but can be limited in lateral frontal lesions. We describe a novel approach via a lid crease incision. This approach provides direct access to the frontal sinus with complete removal of the mucocele lining. In addition, a pericranial flap can be harvested to obliterate the frontal sinus. In our case, one month postoperative photos show a well‐hidden scar and 9‐month follow‐up does not show recurrence of disease.

Conclusion

The hybrid lid crease approach combines the advantages of direct removal of the mucocele lining in a well‐hidden blepharoplasty incision. Although long‐term follow‐up is required to validate this technique, our preliminary data suggests this technique combines the advantages of both open and endoscopic approaches.
Application of Transepithelial Brush Biopsy for Oral Mucosal Lesions
Authors: Seltzer Paul , Loewenstein Ronald K. , Carroll Deborah J. , Buechler R. Bruce
Published: September 2011

Objective

For cases with suspicious lesions in the oral cavity, this study presents an understanding and evaluation of the clinically relevant information that can be provided from oral mucosal brush biopsy in making treatment plan decisions.

Method

Between 2008 and 2010, patients with suspicious lesions were evaluated with an oral mucosal brush biopsy prior to making treatment plans. Decision tree analysis was performed, and clinical relevancy of the information was provided by the pathologist. Clinical interventions with the oral cytology findings were correlated.

Results

During the evaluation period, 38 patients used the test. The oral mucosal brush biopsy provided the following clinically relevant information: 31% contained dysplasia or abnormal cells, 2% fungal organisms, 33% inflammation, 33% no cellular abnormality, and 1% other findings. In cases where inflammation was identified in conjunction with absence of abnormal or dysplastic cells, patients were placed on an observation protocol. In cases where the brush biopsy showed abnormal cells, the patient was scheduled for a surgical biopsy. A decision tree will be presented.

Conclusion

An oral mucosal brush biopsy can provide clinically relevant information about lesions prior to treatment decisions. The information provided from brush biopsy can be used as one of the factors considered with other clinical information to assist doctors in making definitive selections in a clinical management plan.
Aesthetic Outcome of Rhinophyma Using Diode Laser
Authors: Natt Ravinder Singh , Tahery Jawed , Zakaria Rasheed
Published: September 2011

Objective

Determine if rhinophyma can be treated with the diode laser, a modality never used before in the United Kingdom for this condition.

Method

A 1470 nm‐wavelength diode laser with 220‐micron bare fiber was used. The fine diameter fiber allows energy to be delivered in a very small area. The probe is used “freehand” to sculpt the nasal contour to aesthetic requirements using a microscope, as it is not fixed to a rigid hand‐piece.

Results

Problems with hemostasis were not encountered, as there is no bleeding or break in the continuity of the skin. Patients were discharged with topical mupirocin ointment (Bactroban; GlaxoSmithKline, Uxbridge, UK) applied under a loose dressing. Patients were followed up on a weekly basis in the outpatient clinic for 6 weeks for inspection of the external nose, decrusting, and application of mupirocin ointment.

Conclusion

Diode laser therapy appears to be an effective method of treating rhinophyma, avoiding postoperative bleeding and associated complications that characterize surgical resection without sacrificing the cosmetic result.
Allergic Fungal Sinusitis Presenting with Bilateral Abducens Nerve Palsy
Authors: Gudis David , Palmer James
Published: September 2011

Objective

1) Report a very unusual presentation of allergic fungal sinusitis. 2) Alert the practicing clinician to consider allergic fungal sinusitis in the differential diagnosis of unilateral or bilateral cranial neuropathies.

Method

We report a case from 2010 of a 39‐year‐old man presenting initially with bilateral abducens nerve palsy and subsequently found to have allergic fungal sinusitis with skull base erosion. The patient underwent an endoscopic approach and resection of the lesion, which extended intracranially into the epidural space.

Results

An endoscopic image‐guided resection of the skull base lesion was successfully performed in the patient, with intraoperative findings consistent with allergic fungal sinusitis. Pathology and microbiology results revealed aspergillus fumigatus. Postoperatively the patient recovered well with complete resolution of his left abducens nerve function and no CSF leak. AFS, reportedly present in as many as 5%‐10% of patients with chronic rhinosinusitis, can present with local destruction and extensive involvement of adjacent critical structures in immunocompetent patients. This is the second known case of fungal sinusitis presenting with bilateral abducens nerve palsy, and the first in an otherwise asymptomatic healthy patient.

Conclusion

Allergic fungal sinusitis has repeatedly been demonstrated to cause aggressive local destruction, often out of proportion to patient symptomatology. This case contributes to the literature an exceedingly rare initial presentation of this pathology, alerting the clinician to consider AFS in the differential diagnosis of unilateral or bilateral cranial neuropathies.
Antrochoanal Polyp Originating from Inferior Turbinate
Authors: Anfuso Anthony J. , Ramadan Hassan H.
Published: September 2011

Objective

Present a case of an unusual presentation of an antral choanal polyp that originates from the left inferior turbinate and does not extend into the maxillary sinus. Literature review shows only 3 prior cases where an antrochoanal polyp originated from the inferior turbinate.

Method

This is a case presentation of an 81‐year‐old woman who presented with a left sided nasal mass. Her workup included CT scan and MRI of the sinuses. The nasal mass was removed endoscopically and was sent for review by our pathologists.

Results

In this elderly female, physical examination showed a dark nasal mass filling the entire nasal cavity. CT and MRI showed a left‐sided nasal soft tissue mass with lateral displacement of the medial wall of the left maxillary antrum. The preoperative diagnosis included inverted papilloma, benign nasal polyp, and squamous cell carcinoma. The patient was taken to the operating room where it was found that the mass originated from inferior turbinate and spanned its entire length. It was removed from this attachment and delivered nasally using endoscopic sinus instruments. Surprisingly, pathology revealed antrochoanal polyp.

Conclusion

Classically, an antrochoanal polyp originates within the maxillary antrum. We present this case to illustrate that the antrochoanal polyp can originate from the inferior turbinate and should be considered in a patient with a unilateral nasal mass distinct from the maxillary sinus.
Auto‐erosion of the Uncinate Process in Cystic Fibrosis
Authors: McClay John E. , Rihani Jordan J.
Published: September 2011

Objective

Report a phenomenon of auto‐erosion of the uncinate process and medial maxillary wall in children with cystic fibrosis.

Method

Retrospective chart review with IRB approval. Setting: Tertiary care children’s medical center. Patients: Children evaluated from 1995 to 2010 with cystic fibrosis and chronic sinusitis who were noted to have auto‐erosion of the uncinate process on endoscopic and radiographic evaluations.

Results

Six out of 62 (10%) children evaluated from 1995 to 2010 with cystic fibrosis and sinusitis without previous sinus surgery at a tertiary children’s hospital were noted to have auto‐erosion of the uncinate process and medial maxillary wall. Auto‐erosion appears to occur from expansion, pressure, and demineralization of the bones of the uncinate process and medial maxillary wall.

Conclusion

Auto‐erosion of the uncinate process is seen in children with sinusitis and cystic fibrosis. Auto‐erosion appears to be a non‐surgical self‐ventilating phenomenon associated with improvement of maxillary sinus disease on computed tomography.
Atypical Presentations of Pleomorphic Adenoma
Authors: Ballin Annelyse Cristine , Carvalho Bettina , Bettega Marcelo , Ballin Carlos‐Roberto , Bettega Silvio , Mocellin Marcos
Published: September 2011

Objective

Report 2 cases of pleomorphic adenoma with different clinical presentations and unusual locations—the uvula and inferior nasal turbinate (INT)—and discuss the variety of presentings in this type of tumor.

Method

Report of 2 cases of pleomorphic adenoma in unusual places.

Results

Case 1: For 20 years, the patient complained of frequent choking and progressive growth of lesions in the uvula, then underwent uvuloplasty with total excision of the lesion. Case 2: The patient complained of progressive nasal obstruction in the right nasal cavity and had septoplasty and turbinectomy performed. CT of the paranasal sinuses revealed an extensive mass of inferior nasal turbinate to the right choana. An endoscopic right turbinectomy procedure was conducted. The pathology suggested pleomorphic adenoma.

Conclusion

Pleomorphic adenoma located either in the uvula or the inferior nasal turbinate are rare. This neoplasm should always be considered in the differential diagnosis of head and neck injuries so that early surgical treatment might prevent its progression to malignancy.
Chronic Invasive Sinonasal Mucormycosis: A Case Series
Authors: Al Masaoudi Laila Musabah , Al Mujaini Abdulla , Balkhair Abdullah , Al Azri Faisal , Al Badaai Yahya Nasser
Published: September 2011

Objective

Mucormycosis infection of the paranasal sinuses is a rare disease that usually presents as an acute fulminant infection in immunocompromised patients. However, the chronic form of mucormycosis can be seen as well as an indolent and slowly progressive disease.

Method

Case series of four patients diagnosed with chronic sinonasal mucormycosis.

Results

A series of four consecutive patients treated at a tertiary care center with diagnosis of sinonasal mucormycosis based on histopathological and microbiological confirmation. The duration of symptoms before presentation varied from eight days to four months. Three patients were immunocompromised. Of these, two were rhino‐orbito‐cerebral form. Mucormycosis was successfully treated with endoscopic surgical debridement and antifungal therapy. Complete resolution reported in two patients and partial response in two patients.

Conclusion

Chronic invasive sinonasal mucormycosis is an increasingly diagnosed form of invasive fungal rhinosinusitis, which necessitates further study to understand the natural history of the disease.
Clinical Scores Evaluation for Brazilian CRS Patients
Authors: Tamashiro Edwin , Adelino Odair Aparecido , Valera Fabiana C. P. , Antunes Marcelo Barros , Anselmo‐Lima Wilma T.
Published: September 2011

Objective

Evaluate if the clinical measures SNOT‐22 and UPSIT are efficient in monitoring treatment in Brazilian patients with CRS.

Method

A total of 16 patients with CRS were treated with topical mometasone (200 microgram BID) for 2 months. SNOT‐22, sense of smell score in SNOT‐22, UPSIT, Lund‐Mackay (for CT) and Lund (for endoscopy) scores were evaluated before and after treatment. Multi‐variable correlation tests were used to compare the differences between scales.

Results

Improvement in UPSIT scores correlated negatively to the sense of smell score in SNOT‐22, (R2: 0.50; P =. 0367), demonstrating to be a good tool to quantify smell problems. On the contrary, UPSIT did not correlate with CT and endoscopy scores. Improvement in SNOT‐22 scores correlated significantly to improvement in endoscopy scores (R2: 0.49; P =. 0297), but not to CT and UPSIT scores.

Conclusion

UPSIT is a valuable tool to measure smell changes and monitor the effect of clinical treatment in patients with CRS. SNOT‐22 correlated positively to intranasal polyp formation rather than sinusal opacity on CT scans.
Clinical Study of 1304 Patients with Epistaxis for Recent 5 Years
Authors: Yukitatsu Yoriko , Oka Hideki , Takebayashi Hironori , Tsuzuki Kenzo , Sakagami Masafumi
Published: September 2011

Objective

Epistaxis is one of the most common symptoms encountered in the ENT clinic. In this study, we reviewed our recent clinical experience of patients with epistaxis and discussed important lessons for the management of cases of epistaxis.

Method

Between 2005 and 2009, 1304 patients with epistaxis were treated at our department. There were 795 men and 509 women. Mean age was 57 years (range, 0‐99 years). Clinical features: situations at the first visit; pathogenesis; bleeding points; methods of treatments; and clinical courses were retrospectively investigated.

Results

The 700 patients (54%) first visited in the nighttime. The most common condition was hypertension in 388 patients (30%) followed by cardiovascular disease in 262 patients (20%). The 630 patients (48%) were on medication with hypotensors and/or antithrombotic drugs. Kiesselbach’s plexus was the mostly observed, as it was observed in 679 patients (52%). In 225 patients (17%), bleeding point was not confirmed. The 424 patients (33%) were primarily treated by anterior packing, followed by electrocauterization in 365 patients (28%). Re‐bleedings within 14 days after the primary treatments were found in 181 patients (14%). Hospitalized surgical treatments were required in 3% (6/181 patients).

Conclusion

Outpatient therapy is usually enough to arrest hemorrhage in major cases. However, we have encountered patients with repeating arterial pulsing bleedings who require emergent hospitalized surgical therapy. Risk of re‐bleeding within a day should be considered if patients had uncertain bleeding point and circulatory diseases.
Dacryocystorhinostomy Endoscopic Endonasal Surgery: Analysis of 17 Cases
Authors: Mosciaro Manuela Salvador , Teixeira Alex , Andreiuolo Fernando , Dias Priscilla Sequeira , Ferreira Terceiro Denivaldo R. , Barbosa Leite Jorge da Cunha , de Arajuo Melo Maria‐Helena
Published: September 2011

Objective

Nasolacrimal duct obstruction is a common change clinically manifested by the presence of epiphora and/or dacryocystitis. The objective is to analyze the technique and evaluate the success of endoscopic endonasal dacryocystorhinostomy to remove obstructions in the lacrimal ducts, using the same surgical technique for all cases.

Method

This is a retrospective study. All 17 surgeries were performed from May 2006 to January 2011. Variables of interest were age, gender, duration, clinical presentation, etiology, surgical technique, use of silicone tubes, complications, and postoperative success. Successful surgery: absence of symptoms and tear flow after 7 months of follow‐up.

Results

Although drug therapy may resolve the symptoms, the definitive approach consists of surgical procedure to restore patency of the lacrimal drainage system. We noticed that females were predominant (70.59%). There were 11 women, 1 girl, and 5 boys ages 3 to 71 years (average age range, 40.11 years) submitted to surgery performed by unciform process incision and posterior flap of lacrimal sac. The most involved side was the right (n = 11). Etiology was idiopathic, and the most predominant clinic was dacryocystitis. Silicone tube was used in 2 cases. We obtained a primary success of 94.11%. Complication: major bleeding in 1 case (anterior tamponade).

Conclusion

Primary success rate in most cases. Endoscopic surgery is a safe technique with excellent results for nasolacrimal duct obstruction. It is an excellent surgical option for otorhinolaryngology residents in university hospitals.
Effect on O‐Methylated Catechin for Allergic Rhinitis
Authors: Ishizaki Hisayoshi , Maeda‐Yamamoto Mari
Published: September 2011

Objective

Benihuuki is a kind of Japanese green tea with high O‐methylated catechin content. The purpose of this study is to demonstrate the effect of Benihuuki on allergic rhinitis induced by cedar pollen. We evaluate the effect of Benihuuki and Yabukita without O‐methylated catechin.

Method

Two kinds of Benihuuki and Yabukita green tea were prepared for allergic rhinitis induced by cedar pollen. The subjects were asked to drink tea 2 times a day, following tea making instruction. The effect of those green teas was evaluated with immunological examination, blood sample test, and rhinomanometry.

Results

Both Benihuuki and Yabukita were effective for the improvement of nasal obstruction. Benihuuki has more potential for improvement of nasal obstruction. Improvement of life disability caused by allergic rhinitis was more significantly demonstrated in Benihuuki.

Conclusion

Benihuuki was proven to have high potential for treatment of nasal obstruction due to allergic rhinitis caused by cedar pollen provocation. Benihuuki is one beneficial way to protect against allergic rhinitis induced by cedar pollen.
Endoscopic Removal of Massive Sinonasal and Skull Base Osteoblastoma
Authors: Patel Amit , Liu James , Eloy Jean , Friedel Mark E.
Published: September 2011

Objective

Osteoblastomas are uncommon bone neoplasms, accounting for 1% of all newly diagnosed primary bone tumors. Sinonasal and skull base osteoblastomas are exceedingly rare. We describe an endoscopic resection of a massive sinonasal/skullbase osteoblastoma, which was misdiagnosed as an ossifying fibroma. We discuss the histopathologic diagnosis of these sinonasal bony lesions.

Method

Case report and current literature review.

Results

A 14‐year‐old female presented with progressive right‐sided proptosis and nasal obstruction. CT and MRI scanning demonstrated a massive sinonasal lesion with orbital and skull base involvement. An endoscopic biopsy performed by another otolaryngologist revealed a fibrous and highly vascular lesion. Histopathologic diagnosis was consistent with an ossifying fibroma. Endoscopic endonasal extended approach of this anterior skull base tumor was successfully performed with complete resection. Final histopathologic diagnosis revealed an osteoblastoma. The patient did well postoperatively without complication.

Conclusion

This case aims to increase awareness of this infrequently encountered disease of the nasal cavity and paranasal sinuses and offers insight into the diagnosis and treatment of this rare entity.
Endoscopic Sinus Surgery: Complications and Experience
Authors: Ribeiro Ricardo B. , Ribeiro  , Sousa Cecília , Reis Cláudia , Ferreira João P. , Castro Sandra S.
Published: September 2011

Objective

Determine the incidence of complications in endoscopic sinus surgery (ESS) in a surgical center with 20 years of experience, and whether or not the surgeon’s experience can be a predisposing factor for them to happen.

Method

The clinical data of the patients submitted to EES between 2006 and 2009 was reviewed, and the perioperative and postoperative complications were evaluated, with a minimum follow‐up period of 3 months. For each surgery, the surgeon’s experience and surgery particularities were correlated with the presence of complications.

Results

In the 677 surgeries, the incidence of complications was 7.39% (5.91% minor and 1.48% major). There was no correlation between surgery complications and the years of experience of the main surgeon. When comparing the complication rate between residents and specialists, there were no statistically significant differences between them. Extensive surgeries, revision surgeries, and the presence and grade of polyposis, were associated with a higher rate of complications.

Conclusion

When some rules are imposed, experience is not the key factor in what concerns the presence of complications during ESS. Patients who are submitted to surgery by residents are not at greater risk of complications than those operated on by specialists.
Endoscopic Transnasal Dacryocystorhinostomy: Technique and Results
Authors: Silva Maria L. S. , Santos Fabio P. , Balieiro Fernando O. , Pacoto Gabriela R. , Pignatari Shirley S. N. , Stamm Aldo E. C.
Published: September 2011

Objective

The complete or partial obstruction of the lacrimal system is a disorder that manifests clinically by epiphora and/or recurrent dacryocystitis. The recommended treatment for obstructions below the common canaliculus is external or endoscopic transnasal dacryocystorhinostomy (ETDCR). This study aims to evaluate ETDCR as surgical treatment for patients with lower lacrimal system obstruction.

Method

This was a retrospective study, performed at the Complexo Hospitalar Edmundo Vasconcelos in the period from 2000 to 2009, with 20 patients showing low obstruction of the lacrimal system unilaterally or bilaterally, which were submitted to ETDCR with a total of 27 queries.

Results

A total of 27 procedures were performed in 20 patients (10 male and 10 female, mean age of 1.6 to 81 years). The most common complaint was epiphora, and the most frequent causes were idiopathic (59.2%), followed by congenital (29.6%), iatrogenic (4.5%), and trauma after radiotherapy (3.7%). Two patients had a new blockage in the postoperative period, and only 3 patients remained with Crowcroft probe for a period of 3 months postoperatively. The success rate of ETDCR in our series was 92.5%.

Conclusion

ETDCR proved to be a safe technique as a surgical option to treat lower lacrimal system obstruction, with some advantages compared to the external technique, and it can still be accomplished without the use of a stent.
Epistaxis: Is Routine Hemoglobin Recheck Required after Admission?
Authors: Mahalingappa Yogesh , Rashid Mamun
Published: September 2011

Objective

Epistaxis is one of the most common reasons for hospital presentation. To our knowledge there is no prior study that addresses the need for routine hemoglobin recheck prior to discharge. This study assesses the hemoglobin change for patients admitted as inpatients in a ENT department at a busy UK hospital.

Method

We retrospectively analyzed records of all adult hospital admissions in a 6‐month period between January and June 2009. We included patients with whom at least 2 Hb values were available for comparison.

Results

A total of 42 patients fulfilled the inclusion criteria. Twenty patients were female, 22 male. The age range varied between 65 and 90 years. On average, we measured a Hb drop of 10.22 g/l.

Conclusion

Epistaxis clearly has the potential to affect hemoglobin levels, particularly when severe. Although initial Hb measurement is relevant to assess hemodynamic stability, our data suggest that there is no need for a routine recheck if not clinically indicated. Further prospective research in this area is recommended.
Evaluation of Clinical Features of Antrochoanal Polyps
Authors: Yamada Yuko , Asaka Daiya , Okushi Tetsushi , Moriyama Hiroshi , Otori Nobuyoshi , Nakayama Tsuguhisa , Matsuwaki Yoshinori
Published: September 2011

Objective

Antrochoanal polyps (ACPs) are benign polypoid lesions that arise from the maxillary sinus and extend into the choana. Current knowledge regarding the prevalence and clinical features of ACPs in Japan is very limited. Here, we performed a prospective study to evaluate the prevalence and clinical features of ACPs.

Method

Between April 2007 and March 2008, 728 patients undergoing endoscopic endonasal sinus surgery were prospectively enrolled in this study at the Department of Otorhinolaryngology, Jikei University School of Medicine.

Results

Fifteen (2.1%) of those patients were diagnosed as having ACP(s). The symptom scores for nasal obstruction, rhinorrhea, and postnasal drip were each significantly reduced postoperatively. The distribution of the ACPs’ origin in the maxillary sinus was as follows: floor of the maxillary sinus to the posterior wall (40%), floor of the maxillary sinus (26.7%), and floor of the maxillary sinus to the internal wall (20%). The recurrence rate following endoscopic endonasal sinus surgery was 13.3%.

Conclusion

Endoscopic endonasal sinus surgery for ACPs was most effective when the origin of the polyp in the maxillary sinus was carefully determined and excised as completely as possible, followed by appropriate postoperative treatment.
Evaluation of Estrogenic Receptors in the Nasal Mucosa of Women Taking Oral Contraceptives
Authors: Millas Ieda , Liquidato Bianca , Barros Mirna Duarte
Published: September 2011

Objective

Evaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.

Method

Two groups of 32 women with regular menstrual cycles who had undergone nasal surgery were selected. One group of women was taking oral contraceptives, and the other wasn’t. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta estrogen receptors.

Results

The use of oral contraceptives induced a decrease of beta‐receptor in lamina propria cells. On the other locations there was no statistically significant difference. In both groups there was a predominance of beta‐receptor presence.

Conclusion

Women taking contraceptive pills had a decrease of beta‐receptor in lamina propria cells.
Evaluation of Peak Nasal Inspiratory Flow as an Objective Method of Measuring Nasal Airflow
Authors: Teixeira Rodrigo Ubiratan Franco , Zappelini Carlos Eduardo Monteiro , Costa Everardo Andrade , Alves Fábio
Published: September 2011

Objective

Evaluate the Peak Nasal Inspiratory Flow as a method of measuring nasal patency and compare the values between healthy and obstructive nasal symptoms of allergic rhinitis.

Method

A cohort with contemporary cross‐sectional study, nonrandomized in a sample of 78 subjects.

Results

In simple linear regression, the PNIF shows significant results for nasal obstruction, rhinorrhea, itching, sneezing, and watery eyes (P <. 0001). There was also a correlation between the presence of nasal septal deviation and PNIF (P =. 561). We found a positive correlation between PNIF and the Visual Analogue Scale ‐ VAS for nasal obstruction (P <. 001). Finally, in a multiple linear regression model, statistical significance was found between the values found in PNIF with allergic rhinitis and age (P =. 005 and P =. 023 respectively).

Conclusion

The PNIF proved to be a reliable method for detecting changes in nasal patency by both inflammatory and obstructive causes, with an acceptable level of statistical significance, simple, easy to handle, inexpensive, and reproducible.
Experiences of Sublingual Immunotherapy in Allergic Rhinitis
Authors: Lee Heung‐Man , Choi Hyuk , Park Il‐Ho , Kim Yong‐Dae
Published: September 2011

Objective

Sublingual immunotherapy (SLIT) is currently used worldwide as an allergic rhinitis management tool. The purpose of this study was to investigate the efficacy and safety of SLIT for Asian patients with allergic rhinitis to house dust mites.

Method

Ninety‐eight patients who had allergic rhinitis for dermatophagoides were included and started to receive SLIT. Symptom scores and quality of life were evaluated before and until 1 year by questionnaires. Medication score was assessed monthly by a diary medication card. Adverse effects and compliance were also investigated.

Results

All nasal and non‐nasal symptoms and quality of life were significantly improved after treatment except itchy palate (P <. 05). Total medication score was decreased after treatment significantly (P <. 05). Some minor adverse effects was reported, however there was no systemic reaction. The drop‐out rate was 19%.

Conclusion

SLIT for Korean patients with allergic rhinitis to house dust mites is an efficient and safe treatment tool.
Expression of Matrix Metalloproteinase‐2 and ‐9 in Recurrent Nasal Polyposis
Authors: Wang Ling‐Feng , Chien Chen‐Yu , Tai Chih‐Feng
Published: September 2011

Objective

Matrix metalloproteinase (MMP) is involved in the upper airway remodeling process. We hypothesized that MMP had an additive effect to the formation of recurrent nasal polyp. We also investigated the association of MMP’s functional promoter polymorphism and its labeling index in different tissues.

Method

Thirty‐two patients with recurrent nasal polyps and 30 patients without recurrence of nasal polyp (non‐recurrent) after surgery were collected. Inferior turbinate mucosa obtained from 31 patients without chronic rhinosinusitis were used as controls. Two promoter functional single nucleotide polymorphisms were selected. Tissue samples were frozen for immunohistohemistry.

Results

The expression of MMP‐9 was significantly enhanced in gland, but not in surface epithelium, for recurrent nasal polyp (P =. 016) and non‐recurrent nasal polyp (P =. 005) compared with the control. MMP‐2 positivity was significantly increased in surface epithelium, but not in gland, for recurrent nasal polyp (P =. 004), and a trend toward significance for non‐recurrent nasal polyp compared to the control. However, there was no statistically significant difference of MMP‐9 and ‐2 expressions between recurrent nasal polyp and non‐recurrent nasal polyp. The genetic polymorphism of MMP‐2 and ‐9 functional promoters was not associated with the intensity of immunohistochemical labeling index.

Conclusion

These results suggested up‐regulation of MMP‐9 in gland and MMP‐2 in surface epithelium were characteristic of both recurrent nasal polyp and non‐recurrent nasal polyp. The pathogenesis of recurrent nasal polyps may involve a mechanism other than MMP.